Aspectos técnicos e ambientais da incineração de resíduos sólidos urbanos: considerações sobre a proposta para São Paulo

A tecnologia de incineração no gerenciamento de resíduos sólidos urbanos é empregada de maneira intensa em diversos países do mundo. No Brasil, além da sua utilização eventual em resíduos de serviços de saúde, há uma proposta para implantação de duas usinas de grande porte visando ao tratamento térmico de resíduos sólidos domiciliares na cidade de São Paulo. Através de uma revisão bibliográfica sobre o tema, são apresentados os principais parâmetros técnicos e ambientais desta tecnologia, entre eles os mecanismos de combustão e de formação de poluentes, os tipos de equipamentos empregados, as formas de manejo e disposição de cinzas e escórias e os métodos de controle e redução de emissões atmosféricas como gases ácidos, material particulado e metais pesados. Também é feita uma revisão do atual conhecimento técnico-científico sobre dioxinas e furanos relativamente à incineração de resíduos sólidos urbanos. A partir desta base teórica pesquisada e da análise dos Estudos de Impacto Ambiental e dos Relatórios de Impacto Ambiental das usinas de incineração de Santo Amaro e Sapopemba, conclui-se que tais incineradores, na forma como são propostos, não apresentam o nível tecnológico necessário para atender às normas de operação e emissão de poluentes vigentes em países onde há legislação regulando esta atividade.

Perceções dos enfermeiros sobre os erros de medicação no pré-hospitalar

Quase metade da totalidade de eventos adversos evitáveis é consequência de erros de medicação (EM), contudo, não sendo possível evitá-los completamente, estes podem ser minorados. Esta problemática em contexto pré-hospitalar (PH) tem sido pouco estudada a nível internacional e nunca foi abordada em Portugal. O objetivo deste estudo é relacionar as variáveis sociodemográficas, socioprofissionais, formação, conhecimentos e experiências com EM com a perceção dos enfermeiros que exercem no PH relativamente à frequência da ocorrência dos tipos e causas de EM, dos obstáculos ao relato de EM, dos fatores facilitadores do relato de EM e com o grau de concordância sobre divulgação de EM. Métodos: Trata-se de um estudo analítico, descritivo, transversal e correlacional. A amostra é composta por 107 enfermeiros do PH (método snowball), dos quais 56.1% são do sexo masculino. Foi aplicado um questionário eletrónico constituído por uma componente sociodemográfica, escala de conhecimentos, perceções e experiência com erros de medicação (Raimundo, 2011; Maurer, 2010; Bohomol & Ramos, 2006; Mayo & Duncan, 2004; Osborne, Blais & Hayes, 1999; Gladstone, 1995). Resultados: Dos inquiridos 60.7% apresentam fracos a razoáveis conhecimentos sobre EM; mais de 54% perceciona a sua formação académica/contínua sobre EM como sendo inexistente/insuficiente e 52.3% não recebe formação sobre farmacologia há pelo menos 6 anos; 45.8% diz ter experienciado no PH um ou mais EM sem dano para o doente e apenas 14.9% relatou um ou mais EM sem dano para o doente. Os tipos e as causas de EM identificadas ocorrem com uma frequência elevada para mais de 39% dos inquiridos. A maioria dos inquiridos (47.7%) considera que no PH existem grandes obstáculos ao relato de EM e os fatores facilitadores do relato de EM apresentados são considerados por 49.5% dos enfermeiros como altamente prováveis de facilitar o relato. 52,3% dos enfermeiros do PH discordam de uma forma global com a divulgação de EM. O sexo feminino apresenta uma perceção mais elevada da ocorrência das causas primárias de EM (MF=2.68, Dp= 0.60 vs MM=2.36, Dp=0.66) e uma perceção mais elevada dos fatores facilitadores ao relato dos EM (MF=4.40, Dp= 0.64 vs MM=4.12, Dp=0.74). Os enfermeiros que exercem exclusivamente no PH possuem uma melhor perceção da frequência de ocorrência das causas primárias de EM. Quanto maior o conhecimento dos enfermeiros sobre EM, maior é a perceção destes relativamente aos tipos de erros e maior o grau de concordância com a divulgação dos EM. Existe evidência estatisticamente significativa (p<0.05) de que os enfermeiros que experienciaram a ocorrência de pelo menos 1 erro com dano para o doente possuem melhor perceção dos tipos, causas primárias e obstáculos ao relato dos EM, assim como apresenta um maior grau de concordância com a divulgação de EM. Conclusão: A perceção dos enfermeiros sobre a frequência dos tipos e das causas de EM, assim como dos obstáculos e dos fatores facilitadores do relato de EM por parte dos enfermeiros no PH não tem, de uma forma geral, relação com as características sociodemográficas e socioprofissionais, o que demonstra a transversalidade desta problemática. Tão ou mais importante do que avaliar a dimensão e caracterizar a tipologia, causas, obstáculos e fatores facilitadores ao relato dos EM será, com base no conhecimento obtido, definir e implementar ações de gestão de risco que permitam a sua redução ou mesmo a sua supressão. PALAVRAS-CHAVE: Erros de Medicação, Perceção dos Enfermeiros, Pré- Hospitalar.

The Contribution of the Activation Entropy to the Gas-Phase Stability of Modified Nucleic Acid Duplexes

Tricyclo-DNA (tcDNA) is a sugar-modified analogue of DNA currently tested for the treatment of Duchenne muscular dystrophy in an antisense approach. Tandem mass spectrometry plays a key role in modern medical diagnostics and has become a widespread technique for the structure elucidation and quantification of antisense oligonucleotides. Herein, mechanistic aspects of the fragmentation of tcDNA are discussed, which lay the basis for reliable sequencing and quantification of the antisense oligonucleotide. Excellent selectivity of tcDNA for complementary RNA is demonstrated in direct competition experiments. Moreover, the kinetic stability and fragmentation pattern of matched and mismatched tcDNA heteroduplexes were investigated and compared with non-modified DNA and RNA duplexes. Although the separation of the constituting strands is the entropy-favored fragmentation pathway of all nucleic acid duplexes, it was found to be only a minor pathway of tcDNA duplexes. The modified hybrid duplexes preferentially undergo neutral base loss and backbone cleavage. This difference is due to the low activation entropy for the strand dissociation of modified duplexes that arises from the conformational constraint of the tc-sugar-moiety. The low activation entropy results in a relatively high free activation enthalpy for the dissociation comparable to the free activation enthalpy of the alternative reaction pathway, the release of a nucleobase. The gas-phase behavior of tcDNA duplexes illustrates the impact of the activation entropy on the fragmentation kinetics and suggests that tandem mass spectrometric experiments are not suited to determine the relative stability of different types of nucleic acid duplexes.

Alcohol and drug abuse in medical education /

"Proceedings of the National Conference on Medical Education in Alcohol and Drug Abuse, jointly sponsored by the Association for Medical Education and Research in Substance Abuse and the Career Teacher Program in Alcohol and Drug Abuse (ADAMHA) November 5-6, 1977, Washington, D.C.": p. 75-131.

Classified list of medical colleges in the United States /

"Reprinted from the Journal of the American Medical Association January 18, 1913."

Medical data management /

Thesis (M.S.)--University of Illinois at Urbana-Champaign.

Numerical systems on a minicomputer /

Thesis (M. S.)--University of Illinois at Urbana-Champaign.

On the generation of parsers for BNF grammars: an algorithm,

"Supported in part by the Dept. of Computer Science, University of Illinois ... and in part by the Advanced Research Projects Agency ... under Contract no. U.S. AF 30(602)4144."

Report on maternal morbidity and mortality in Scotland,

At head of title: Department of health for Scotland. Scientific advisory committee: Clinical subcommittee.

The life and public services of the Hon. James Knox Polk, with a compendium of his speeches on various public measures. Also, a sketch of the life of the Hon. George Mifflin Dallas.

"George M. Dallas and the United States Bank": on inside covers.

Social security. Hearings before the Committee on Finance United States Senate Eighty-ninth Congress, first session on H.R. 6675

"H.R. 6675, an act to provide a hospital insurance program for the aged under the Social security act, with a supplementary health benefits program and an expanded program on medical assistance, to increase benefits under the old-age, survivors, and disability insurance system, to improve the Federal-State public assistance programs, and for other purposes."

Medical care and health services for rural people; a study prepared as a result of a conference held at Chicago, Illinois, April 11-13, 1944,

Mode of access: Internet.

Focusing in on structural genomics: The University of Queensland structural biology pipeline

The flood of new genomic sequence information together with technological innovations in protein structure determination have led to worldwide structural genomics (SG) initiatives. The goals of SG initiatives are to accelerate the process of protein structure determination, to fill in protein fold space and to provide information about the function of uncharacterized proteins. In the long-term, these outcomes are likely to impact on medical biotechnology and drug discovery, leading to a better understanding of disease as well as the development of new therapeutics. Here we describe the high throughput pipeline established at the University of Queensland in Australia. In this focused pipeline, the targets for structure determination are proteins that are expressed in mouse macrophage cells and that are inferred to have a role in innate immunity. The aim is to characterize the molecular structure and the biochemical and cellular function of these targets by using a parallel processing pipeline. The pipeline is designed to work with tens to hundreds of target gene products and comprises target selection, cloning, expression, purification, crystallization and structure determination. The structures from this pipeline will provide insights into the function of previously uncharacterized macrophage proteins and could lead to the validation of new drug targets for chronic obstructive pulmonary disease and arthritis. (c) 2006 Elsevier B.V. All rights reserved.

Computer-aided-design of saturated magnetic lenses for electron microscopes

In the last few years, there has been considerable interest in using saturated magnetic objective lenses in high resolution electron microscopes. Such lenses, in present commercial electron microscopes, are energized either by conventional or superconducting coils. Very little work, however, has been reported on the use of conventional coils in saturated magnetic electron lenses. The present investigation has been concerned with the design of high flux density saturated objective lenses of both single and double polepiece types which may be energized by conventional coils and in some cases by superconducting coils. Such coils have the advantage of being small and capable of carrying high current densities. The present work has been carried out with the aid of several computer programs based on the finite element method. The effect of the shape and position of the energizing coil on the electron optical parameter has been investigated. Electron optical properties such as chromatic and spherical aberration have been studies in detail for saturated single and double polepiece lenses. Several high flux density coils of different shapes have been investigated. The choice of the most favourable coil shape and position subject to the operational requirements, has been studied in some detail. The focal properties of such optimised lenses have been computed and compared.

Medicines non-use in primary care

This study expands the current knowledge base on the nature, causes and fate of unused medicines in primary care. Three methodologies were used and participants for each element were sampled from the population of Eastern Birmingham PCT. A detailed assessment was made of medicines returned to pharmacies and GP surgeries for destruction and a postal questionnaire covering medicines use and disposal was used to patients randomly selected from the electoral roll. The content of this questionnaire was informed by qualitative data from a group interview on the subject. By use of these three methods it was possible to triangulate the data, providing a comprehensive assessment of unused medicines. Unused medicines were found to be ubiquitous in primary care and cardiovascular, diabetic and respiratory medicines are unused in substantial quantities, accounting for a considerable proportion of the total financial value of all unused medicines. Additionally, analgesic and psychoactive medicines were highlighted as being unused in sufficient quantities for concern. Anti-infective medicines also appear to be present and unused in a substantial proportion of patients’ homes. Changes to prescribed therapy and non-compliance were identified as important factors leading to the generation of unused medicines. However, a wide array of other elements influence the quantities and types of medicines that are unused including the concordancy of GP consultations and medication reviews and patient factors such as age, sex or ethnicity. Medicines were appropriately discarded by 1 in 3 patients through return to a medical or pharmaceutical establishment. Inappropriate disposal was by placing in household refuse or through grey and black water with the possibility of hoarding or diversion also being identified. No correlations wre found between the weight of unused medicines and any clinical or financial factor. The study has highlighted unused medicines to be an issue of some concern and one that requires further study.