Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil

Objectives: Main Objective: to identify ethical problems in primary care according to nurses` and doctors` perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design: Synthesis to integrate and reinterpret primary results of qualitative studies. Setting: Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods: Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results: Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions: Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation. (C) 2009 Elsevier Espana, S.L. All rights reserved.

Magnetization studies of binary and ternary Co-rich phases of the Co-Si-B system

CoB, CO(2)B, CoSi, Co(2)Si and CO(5)Si(2)B phases can be formed during heat-treatment of amorphous co-Si-B soft magnetic materials. Thus, it is important to determine their magnetic behavior as a function of applied field and temperature. In this study, polycrystalline single-phase samples of the above phases were produced via arc melting and heat-treatment under argon. The single-phase nature of the samples was confirmed via X-ray diffraction experiments. AC and DC magnetization measurements showed that Co(2)Si and CO(5)Si(2)B phases are paramagnetic. Minor amounts of either Co(2)Si or CoSi(2) in the CoSi-phase sample suggested a paramagnetic behavior of the CoSi-phase, however, it should be diamagnetic as shown in the literature. The diamagnetic behavior of the CoB phase was also confirmed. The paramagnetic behavior of CO(5)Si(2)B is for the first time reported. The magnetization results of the phase CO(2)B have a ferromagnetic signature already verified on previous NMR studies. A detailed set of magnetization measurements of this phase showed a change of the easy magnetization axis starting at 70K, with a temperature interval of about 13K at a very small field of 1 mT. As the strength of the field is increased the temperature interval is enlarged. The strength of field at which the magnetization saturates increases almost linearly as the temperature is increased above 70K. The room temperature total magnetostriction of the CO(2)B phase was determined to be 8 ppm at a field of 1T. (C) 2010 Elsevier B.V. All rights reserved.

Adsorption kinetic, thermodynamic and desorption studies of phosphate onto hydrous niobium oxide prepared by reverse microemulsion method

A type of Nb(2)O(5)center dot 3H(2)O was synthesized and its phosphate removal potential was investigated in this study. The kinetic study, adsorption isotherm, pH effect, thermodynamic study and desorption were examined in batch experiments. The kinetic process was described by a pseudo-second-order rate model very well. The phosphate adsorption tended to increase with a decrease of pH. The adsorption data fitted well to the Langmuir model with which the maximum P adsorption capacity was estimated to be 18.36 mg-Pg(-1). The peak appearing at 1050 cm(-1) in IR spectra after adsorption was attributed to the bending vibration of adsorbed phosphate. The positive values of both Delta H degrees and Delta S degrees suggest an endothermic reaction and increase in randomness at the solid-liquid interface during the adsorption. Delta G degrees values obtained were negative indicating a spontaneous adsorption process. A phosphate desorbability of approximately 68% was observed with water at pH 12, which indicated a relatively strong bonding between the adsorbed phosphate and the sorptive sites on the surface of the adsorbent. The immobilization of phosphate probably occurs by the mechanisms of ion exchange and physicochemical attraction. Due to its high adsorption capacity, this type of hydrous niobium oxide has the potential for application to control phosphorus pollution.

Artificial Pinning Center Studies in BI2212 Tapes and Bulks With Zirconium Oxide Inclusion

Zirconium oxide inclusion in Bi2212 superconducting tapes and bulks was studied as possible artificial pinning centers (APC). In order to analyze the zirconium oxide APC addition in Bi2212 samples, magnetization measurements were performed in bulks and transport properties measurements were performed on tapes. In magnetization measurements, the critical current densities are proportional to the width of the magnetization loop at each applied magnetic field. Addition of ZrO(2) in Bi2212 superconductors broadened the magnetization loop and enhanced the critical current densities at 4.2 K in bulks, as a clear indication that ZrO(2) addition improved the pinning and acted as APCs. In contrast, the transport critical current densities decreased in tapes.

Identification and Validation of Brazilian Chronic Pain Descriptors

Appropriate pain assessment is very important for managing chronic pain. Given the cultural differences in verbally expressing pain and in psychosocial problems, specific tools are needed. The goal of this study was to identify and validate Brazilian pain descriptors. A purposive sample of health professionals and chronic pain patients was recruited. Four studies were conducted using direct and indirect psychophysical methods: category estimation, magnitude estimation, and magnitude estimation and tine-length. Results showed the descriptors which best describe chronic pain in Brazilian culture and demonstrated that there is not a significant correlation between patients and health professionals and that the psychophysical scale of judgment of pain descriptors is valid, stable, and consistent. Results reinforced that the translations of word descriptors and research tools into another language may be inappropriate, owing to differences in perception and communication and the inadequacy of exact translations to reflect the intended meaning. Given the complexity of the chronic pain, personal suffering involved, and the need for accurate assessment of chronic pain using descriptors stemming from Brazilian culture and language, it is essential to investigate the most adequate words to describe chronic pain. Although it requires more refinement, the Brazilian chronic pain descriptors can be used further to develop a multidimensional pain assessment tool that is culturally sensitive. (C) 2009 by the American Society for Pain Management Nursing

Impact of Childhood Cancer on Parents` Relationships: An Integrative Review

Purpose: The diagnosis of cancer and the treatment decisions associated with it may cause uncertainty, stress, and anxiety among parents. Emotional tensions can affect parents` relationships during the trajectory of the child`s cancer illness. We conducted an integrative review to examine the evidence related to the effects of childhood cancer on parents` relationships. Methods: An integrative literature search of studies published between 1997 and 2009 was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychology Information (PsycINFO), PubMed, Scopus, CUIDEN, and Latin American and Caribbean Health Science Literature (LILACS). The key words used were neoplasms, child, marriage, spouses, family relations, and nursing. Articles were reviewed if the (a) topic addressed parents` relationships during childhood cancer; (b) participants were mothers, fathers, or both; (c) design was either qualitative or quantitative; (d) language was English, Portuguese, or Spanish; (e) date of publication was between January 1997 and October 2009; and (f) abstract was available. Results: Fourteen articles met the search criteria and were reviewed using Cooper`s framework for integrative reviews. Four themes emerged: (a) changes in the parents` relationship during the trajectory of the child`s illness; (b) difficulty in communication between couples; (c) gender differences in parental stress and coping; and (d) role changes. Conclusions and Implications: Findings revealed positive and negative changes in parents` relationships, communication, stress, and roles. Nurses need to assess the impact of cancer diagnosis and treatments on parent relationships, offer support and encouragement, and allow expression of feelings. Future research is needed to develop and test interventions that increase parents` potentials and strengthen relationships during the challenging trajectory of their children`s cancer and treatment. Clinical Relevance: The multiple sources of stress and uncertainty associated with a child`s cancer diagnosis and treatment affect parents` relationships. Difficulties in communication appear frequently in parents` relationship. Our findings may guide healthcare professionals in identifying parents at risk for developing conflicts, communication problems, and lack of alignment between parents that could interfere with providing optimal care for their child with cancer. Healthcare professionals may promote dialogue and encourage parents to express their feelings, seek mutual support, and establish a partnership in dealing with the child`s illness.

A Cost-Benefit Analysis on Modulation Formats for 40-Gb/s Optical Communication Systems

This article discusses possible approaches for optical network capacity upgrade by considering the use of different modulation formats at 40 Gb/s. First, a performance evaluation is carried out regarding tolerance to three impairments: spectral narrowing due to filter cascading, chromatic dispersion, and self-phase modulation. Next, a cost-benefit analysis is conducted, considering the specific optoelectronic components required for the optical transmitter/receiver configuration of each format.

Studies of cases in power systems by Sensitivity Analysis oriented by OPF

This paper presents studies of cases in power systems by Sensitivity Analysis (SA) oriented by Optimal Power Flow (OPF) problems in different operation scenarios. The studies of cases start from a known optimal solution obtained by OPF. This optimal solution is called base case, and from this solution new operation points may be evaluated by SA when perturbations occur in the system. The SA is based on Fiacco`s Theorem and has the advantage of not be an iterative process. In order to show the good performance of the proposed technique tests were carried out on the IEEE 14, 118 and 300 buses systems. (C) 2010 Elsevier Ltd. All rights reserved.

Chaotic communication based on the particle-in-a-box electronic circuit

A secure communication system based on the error-feedback synchronization of the electronic model of the particle-in-a-box system is proposed. This circuit allows a robust and simple electronic emulation of the mechanical behavior of the collisions of a particle inside a box, exhibiting rich chaotic behavior. The required nonlinearity to emulate the box walls is implemented in a simple way when compared with other analog electronic chaotic circuits. A master/slave synchronization of two circuits exhibiting a rich chaotic behavior demonstrates the potentiality of this system to secure communication. In this system, binary data stream information modulates the bifurcation parameter of the particle-in-a-box electronic circuit in the transmitter. In the receiver circuit, this parameter is estimated using Pecora-Carroll synchronization and error-feedback synchronization. The performance of the demodulation process is verified through the eye pattern technique applied on the recovered bit stream. During the demodulation process, the error-feedback synchronization presented better performance compared with the Pecora-Carroll synchronization. The application of the particle-in-a-box electronic circuit in a secure communication system is demonstrated.

Remote control of CNC machines using the CyberOPC communication system over public networks

During the last few years, the evolution of fieldbus and computers networks allowed the integration of different communication systems involving both production single cells and production cells, as well as other systems for business intelligence, supervision and control. Several well-adopted communication technologies exist today for public and non-public networks. Since most of the industrial applications are time-critical, the requirements of communication systems for remote control differ from common applications for computer networks accessing the Internet, such as Web, e-mail and file transfer. The solution proposed and outlined in this work is called CyberOPC. It includes the study and the implementation of a new open communication system for remote control of industrial CNC machines, making the transmission delay for time-critical control data shorter than other OPC-based solutions, and fulfilling cyber security requirements.

A simple way to introduce fibers into FEM models

This communication proposes a simple way to introduce fibers into finite element modelling. This is a promising formulation to deal with fiber-reinforced composites by the finite element method (FEM), as it allows the consideration of short or long fibers placed arbitrarily inside a continuum domain (matrix). The most important feature of the formulation is that no additional degree of freedom is introduced into the pre-existent finite element numerical system to consider any distribution of fiber inclusions. In other words, the size of the system of equations used to solve a non-reinforced medium is the same as the one used to solve the reinforced counterpart. Another important characteristic is the reduced work required by the user to introduce fibers, avoiding `rebar` elements, node-by-node geometrical definitions or even complex mesh generation. An additional characteristic of the technique is the possibility of representing unbounded stresses at the end of fibers using a finite number of degrees of freedom. Further studies are required for non-linear applications in which localization may occur. Along the text the linear formulation is presented and the bounded connection between fibers and continuum is considered. Four examples are presented, including non-linear analysis, to validate and show the capabilities of the formulation. Copyright (c) 2007 John Wiley & Sons, Ltd.

Natural and human forcing in recent geomorphic change; case studies in the Rio de la Plata basin

An analysis of geomorphic system`s response to change in human and natural drivers in some areas within the Rio de la Plata basin is presented The aim is to determine whether an acceleration of geomorphic processes has taken place in recent years and, if so, to what extent it is due to natural (climate) or human (land-use) drivers Study areas of different size, socio-economic and geomorphic conditions have been selected: the Rio de la Plata estuary and three sub-basins within its watershed Sediment cores were extracted and dated ((210)Pb) to determine sedimentation rates since the end of the 19th century. Rates were compared with time series on rainfall as well as human drivers such as population, GDP, livestock load, crop area, energy consumption or cement consumption, all of them related to human capacity to disturb land surface Data on river discharge were also gathered Results obtained indicate that sedimentation rates during the last century have remained essentially constant in a remote Andean basin, whereas they show important increases in the other two, particularly one located by the Sao Paulo metropolitan area Rates in the estuary are somewhere in between It appears that there is an intensification of denudation/sedimentation processes within the basin. Rainfall remained stable or varied very slightly during the period analysed and does not seem to explain increases of sedimentation rates observed. Human drivers, particularly those more directly related to capacity to disturb land surface (GDP, energy or cement consumption) show variations that suggest human forcing is a more likely explanation for the observed change in geomorphic processes It appears that a marked increase in denudation, of a ""technological"" nature, is taking place in this basin and leading to an acceleration of sediment supply This is coherent with similar increases observed in other regions (C) 2010 Elsevier B V All rights reserved

Kinetic studies of urban solid residues and leachate from sanitary landfill

Urban solid residues are constituted of food remaining, grass leaves, fruit peelings, paper, cardboard, rubber, plastic, etc. The organic fraction formed represents about 50% during the decomposition yields biogas and leachate, which are sources of pollution. Residue samples were collected from the landfill in different and cells from several ages and the corresponding leachate, both after treatments, were submitted to thermal analysis. Kinetic parameters were determined using Flynn-Wall-Ozawa method. The linear relation between the two kinetic parameters (ln A and E) was verified for organic residue urban`s samples, but not for leachate`s sample. The occurred difference can be attributed to the constituents present in leachate.

Urban upgrading interventions and engaging residents in fuzzy management: Case studies from Novos Alagados, Salvador, Brazil

International theory and practice have promoted state-assisted upgrading of `informal` urban areas worldwide since the late 1970s, with various forms of monitoring and assessment of impact. Two independent studies of how residents perceive and evaluate such interventions have recently been undertaken for neighbouring parts of the upgraded area of Novos Alagados on the Itapagipe peninsula in the northwestern part of Salvador, Brazil`s third largest city. These studies start from different premises and have been implemented in very different ways, but both have the objective of permitting the `voice` of the residents to be heard concerning the upgrading process. Comparing them helps highlight the essential `fuzzy` nature of values concerning urban interventions of this nature and leaves us with thought-provoking questions concerning the role of local society in relation to the state in urban development, and the potential this has for on-going forms of urban management in cities which are emerging globally. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.

Toxicity-directed approach of polyester manufacturing industry wastewater provides useful information for conducting treatability studies

A broader characterization of industrial wastewaters, especially in respect to hazardous compounds and their potential toxicity, is often necessary in order to determine the best practical treatment (or pretreatment) technology available to reduce the discharge of harmful pollutants to the environment or publicly owned treatment works. Using a toxicity-directed approach, this paper sets the base for a rational treatability study of polyester resin manufacturing. Relevant physical and chemical characteristics were determined. Respirometry was used for toxicity reduction evaluation after physical and chemical effluent fractionation. Of all the procedures investigated, only air stripping was significantly effective in reducing wastewater toxicity. Air stripping in pH 7 reduced toxicity in 18.2%, while in pH 11 a toxicity reduction of 62.5% was observed. Results indicated that toxicants responsible for the most significant fraction of the effluent`s instantaneous toxic effect to unadapted activated sludge were organic compounds poorly or not volatilized in acid conditions. These results led to useful directions for conducting treatability studies which will be grounded on actual effluent properties rather than empirical or based on the rare specific data on this kind of industrial wastewater. (C) 2008 Elsevier B.V. All rights reserved.