656 resultados para Acessos vasculares


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Currently, the diagnostic ultrasound is inserted in various areas of medical action and carried out by many medical professionals, from which militate directly in the image area, such as radiologists and sonographers, but also by gynecologists, pediatricians, neurologists, general practitioners, endocrinologists, angiologists, orthopedists, rheumatologists, urologists, general and vascular surgeons. It is well known that the medical professional, for the exercise of its mission, requires a broad set of skills, competencies and attitudes developed and exercised during their training period. Living with medical students over nearly 20 years in hospital environment, I noticed gaps in the learning process by the students about what is diagnostic ultrasound and its applications, demonstrating failures as understanding the basic acoustic ultrasound, difficulties in identifying of anatomical structures in ultrasound images and inability in requests examinations and interpretations of images and reports. Based on these findings, it was developed in this Professional Masters a multimedia digital book that exposes what the ultrasound as a diagnostic modality imaging, dealing with its historiography and its physical/acoustic concepts, relating the process of formation of the ultrasound image, discussing about the features of sonographic equipments and their embedded technologies and highlighting its diagnostic applications , the latter presented through videos which will be described aspects of captured ultrasound images. This book will be available for access in digital format, serving as a teaching tool in medical education since the beginning of the course, so that can be used in conjunction with the discipline of Gross Anatomy, offered in the basic cycle of the Medicine Undergraduate Course of the Federal University of Rio Grande do Norte (UFRN).

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This work has as object the elaboration of social environmental indicator of disaster risk that are present in precarious areas of human occupation, related to intense environmental dynamic from the perspective of the studies about the subject in Geography. The District of Mãe Luiza in Natal, capital city of Rio Grande do Norte, was defined as the study area. The place was chosen because it presents –historically- several vulnerability conditions and exposure to disaster risk. After a local social environmental description, two indexes were elaborated: the Social Vulnerability Index (SVI or IVS in Portuguese), based on 17 (seventeen) variables arranged on a questionnaire addressed to the population nucleus of the district, on regular grid (systematic sampling), classified into 5 (five) levels of SV from the weighted average; and the Physical and Natural Exposure to the Mass Movements Index (EMMI or IEMM in Portuguese) which had 16 (sixteen) variables that feature conditions of exposure to the mass movements in the district with classified levels from the weighted average of 1 (one) to 5 (five). The relationship between these two results, specialized in the district map, produced the Social Environmental Vulnerability Index (SEVI or IVSA in Portuguese) of Mãe Luiza, also classified into 5 (five) levels, following the Boolean logic correlation for cartographic overlay with use of computer software ArcGIS v.9.3, being named as: Very Low; low; average; high; and Very High Environmental Vulnerability in District. The study is based on the methodology proposed by Guerra et al (2009) for EMMI and by Almeida (2010) for SVI. They were modified and adapted according to the local reality, producing a new methodology in this study area. It was concluded that the neighborhood has most of its area with High and Very High Socio-environmental vulnerability to disasters, defined seven (7) critical areas, with Very High IVSA, and hazards associated with mass movements or flooding. In the end, the main issues that were found, such as generating elements for proposing mitigation measures and/or the proposed interventions were enumerated, related to structural order of vulnerability factors: how low constructive pattern of households; poor urban drainage; Real Estate forsaken in landslide routes; infrastructure ready access roads and slope containment. And social: as a lack of education about environmental risk; income and education of residents; presence of persons with limited mobility and/or those with special needs. This reality highlights the need for urgent action applied to the resolution and/or reduction of these problems, which is focusing the end of this work.

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OBJECTIVE: To dev elop and evaluate the use of a body adjustable device for training of peripheral venous catheterization for healthcare undergraduate students . METHODS: This study involved two phases: I) development of the innovative simulator and II) a controlled trial co mparing the performance of the body adjustable device in relation to the commercial simulator for the training of venipuncture skills. A total of 79 first - year medical students participated in the intervention phase, which consisted of pretest assessment, lecture on peripheral venous access, randomization into two groups according to the simulator used for training (Commercial Simulator and Experimental Simulator), real venipuncture procedure, post - test assessment and evaluation of satisfaction. RESULTS: Gr oups were homogeneous in age, sex, pre - test and post - test scores, attitudinal assessment and performance in performing the real venipuncture. Students from the Experimental Simulator group performed better on the filling of simulated records. At the end of the study, cognitive gain significantly increased in both groups. The degree of realism perceived by students was equivalent for two groups. A total of 85.7% of students rated the Experimental Simulator as good or excellent. CONCLUSIONS: Experimental simu lator proved to be a low cost alternative for the training of venipuncture skills in upper limb. The cognitive procedural and attitudinal performances of students who used the experimental simulator were similar to those observed in the group trained with commercial simulator.

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The study discusses the changes in public management and their impacts on the educational field from the adoption of the flexible model production. It is based on the assumption that the changes incontemporary societies were influenced by the need to reorganize the capital that, in crisis, tried to overcome the Taylor/Ford production model, by implementing a more agile, more flexible one to meet the current demands of the market. For the implementation of the new public management, the Latin American countries started to use strategies based on the business model and the criteria of efficiency, effectiveness and productivity. This new management paradigm advocated replacing the bureaucratic model of management by a decentralized model, with focus on customer service. These guidelines have a broad impact on the educational management and were disseminated by international organizations. Studies show that the management model has been unable to overcome the bureaucratic model of management that existed within the school, which is found in the transformation of a bureaucratic flexibility, consistent with the new model of production.

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Natal, como outras cidades metropolitanas brasileiras, sofreu nas últimas décadas uma forte transformação impulsionada pelo mercado imobiliário e pela indústria da construção civil. A produção de apartamentos em condomínios fechados vem crescendo e tornando cada vez mais comum, no cenário urbano, a presença de torres residenciais (com extensos muros e grades, fachadas cegas e guaritas) que favorecem o “desurbanismo”. Por outro lado, este tipo de empreendimento, o edifício multifamiliar, apresenta plantas baixas padronizadas as quais frequentemente são incoerentes com a diversidade de perfis dos usuários. A consequência disso são reformas e adequações nos apartamentos após a entrega da obra. Diante deste contexto, elaborei uma proposta arquitetônica, que é apresentada nesta dissertação, como alternativa a essa modalidade de produção que está se tornando dominante no Brasil e em outros países. Dois conceitos nortearam esta proposta: a) o conceito de urbanidade cujo objetivo no projeto arquitetônico é favorecer a percepção do outro (por copresença e/ou cociência) através da permeabilidade, acessos e passagens entre o edifício e o entorno. A maneira como os cheios (barreiras) se estruturam com os vazios foi trabalhada de modo que definissem propriedades espaciais cuja intenção é facilitar o encontro e a diversidade entre moradores e entre estes e os de fora, no entanto sem desconsiderar o problema da violência urbana e, consequentemente a importância da promoção de segurança para os usuários. b) o conceito de flexibilidade a fim de possibilitar ao consumidor final o desmembramento da unidade habitacional em duas e, em especial, a participação e ou escolha na concepção do arranjo interno e da definição dos acabamentos do seu apartamento. Tudo isto durante a construção do empreendimento e ao longo da sua vida útil, favorecendo assim o potencial de diversidade (grupos sociais), adaptabilidade a fases distintas da vida e durabilidade do edifício.

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A sociedade digital nos abraça em todos os aspectos do cotidiano e uma parte significativa da população vive conectada em multiplataformas. Com a instantaneidade dos fluxos de comunicação, vivemos uma rotina onde muitos acessos estão a um “clique” ou toque. A televisão como mídia preponderante durante várias décadas, na sua transição digital comporta uma função além da TV que conhecíamos, como display interativo que se conecta e absorve conteúdos provenientes de várias fontes. Os consagrados modelos mundiais de distribuição de audiovisual, especialmente pelo Broadcast, sofrem as consequências da mudança do comportamento do seu público pelas novas oportunidades de acesso aos conteúdos, agora interativos e sob demanda. Neste contexto, os modelos das SmartTVs (TVs conectadas) em Broadband (Banda Larga) apresentam opções diferenciadas e requerem um espaço cada vez maior na conexão com todos os outros displays. Com este cenário, o presente estudo busca descrever e analisar as novas ofertas de conteúdos, aplicativos, possibilidades e tendências do hibridismo das fontes para a futura TV.

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El Síndrome Metabólico (SM) es un conjunto de factores de riesgo asociados con el incremento del riesgo de enfermedad cardiovascular y diabetes mellitus de tipo 2 (DM2). Dichos factores son obesidad (OB), resistencia a la Insulina (RI), hiperglucemia, dislipidemia e hipertensión (HTA) e interactúan entre sí sobre las anomalías vasculares, el estrés oxidativo, la grasa visceral, la inflamación y el cortisol en un entorno de OB y RI y bajo la influencia de las predisposiciones genéticas y condiciones ambientales, tales como hábitos de alimentación y actividad física. Según una hipótesis, la RI y la OB son los factores que más contribuyen en la manifestación de anormalidades metabólicas y las manifestaciones más tempranas del desarrollo de SM en niños. Mientras el páncreas compensa adecuadamente la RI mediante una mayor secreción de insulina, las concentraciones de glucosa en sangre se mantienen normales. Sin embargo, en algunos pacientes la capacidad de las células β del páncreas disminuye con el tiempo, lo que conduce al desarrollo de DM2. Otro factor a tener en cuenta en el diagnóstico del SM es la dislipidemia, caracterizada por el aumento de los triglicéridos (TG) y del VLDL‐colesterol, bajas cifras de HDL‐colesterol, así como por la presencia de partículas de LDL‐colesterol más pequeñas y densas de lo normal. Otro factor de riesgo de padecimiento de SM es la presión arterial elevada, que suele aparecer ligada a la presencia de OB, ya que el aumento de algunas adipoquinas que en esta se produce, entre las que se encuentran el AGE, PAI‐1, IL‐6, TNF‐α y leptina, pueden llevar a disfunción endotelial a través de la ruta del óxido nítrico. Debido a que el sobrepeso y el incremento de los valores de insulina plasmática son componentes clave del SM, es importante tener en cuenta los hábitos alimentarios y otros estilos de vida que influyen en los mismos...

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As a result of a floristic survey carried out in riparian habitats of northern Spain, new chorological data are provided for 9 alien and 6 native plant species. Some species are reported for the first time at regional scale, such as Carex strigosa, Helianthus x laetiflorus and Persicaria pensylvanica in Cantabria. Also noteworthy is the finding of naturalised populations of the North American grass Muhlenbergia schreberi at the Urumea river basin, which represents the second reference for the Iberian Peninsula.

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Embora tenha sido proposto que a vasculatura retínica apresenta estrutura fractal, nenhuma padronização do método de segmentação ou do método de cálculo das dimensões fractais foi realizada. Este estudo objetivou determinar se a estimação das dimensões fractais da vasculatura retínica é dependente dos métodos de segmentação vascular e dos métodos de cálculo de dimensão. Métodos: Dez imagens retinográficas foram segmentadas para extrair suas árvores vasculares por quatro métodos computacionais (“multithreshold”, “scale-space”, “pixel classification” e “ridge based detection”). Suas dimensões fractais de “informação”, de “massa-raio” e “por contagem de caixas” foram então calculadas e comparadas com as dimensões das mesmas árvores vasculares, quando obtidas pela segmentação manual (padrão áureo). Resultados: As médias das dimensões fractais variaram através dos grupos de diferentes métodos de segmentação, de 1,39 a 1,47 para a dimensão por contagem de caixas, de 1,47 a 1,52 para a dimensão de informação e de 1,48 a 1,57 para a dimensão de massa-raio. A utilização de diferentes métodos computacionais de segmentação vascular, bem como de diferentes métodos de cálculo de dimensão, introduziu diferença estatisticamente significativa nos valores das dimensões fractais das árvores vasculares. Conclusão: A estimação das dimensões fractais da vasculatura retínica foi dependente tanto dos métodos de segmentação vascular, quanto dos métodos de cálculo de dimensão utilizados

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Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. Método: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. Resultados: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (p<0,05). A VPD da artéria carótida interna diminuiu em ambos os lados (p<0,05). A VPS e a VPD da artéria vertebral direita também aumentaram (p<0,05). Achados assimétricos foram observados, de modo que artérias do lado direito foram as mais freqüentemente afetadas. Conclusões: Alterações hemodinâmicas foram observadas nas artérias vertebral e carótida após simpaticotomia para tratamento de HP. VPS foi o parâmetro mais freqüentemente alterado, principalmente nas artérias do lado direito, representando alterações assimétricas significantes nas artérias carótida e vertebral. Entretanto, são necessárias pesquisas subseqüentes para verificar se essas alterações são definitivas ou temporárias, uma vez que as inferências clínicas somente terão validação se as alterações forem permanentes

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In the social-historical moment we live in, it is each time more evident the necessity of the people to learn to deal with the environment in conscientious way, taking care of themselves properly through it. In this direction, considering the school as a place where children, young and adolescents spend great part of their time, this work had as objective to examine the perception of school environment for students, professors and employees of two schools in João Pessoa city - Centro Estadual Experimental de Ensino-Aprendizagem Sesquicentenário and Escola Estadual de Ensino Fundamental e Médio Presidente Emílio Garrastazu Médici (Experimental State Center of Learning-teaching Sesquicentenário and Basic and High State School Education Emilio Garrastazu Médici President). From the presupposed that the environments in which and with which people live reflect their daily practices, the field work searched to identify the social-environmental practices that characterize the relation of these users with the school and, from this understanding, to infer some of their concerns regarding the environment as a whole. To analyze the use of the available physical space in the two institutions it was opted the use of the After-Occupation Evaluation, one of the approaches that feed the process of building production or built set, rescuing aspects related to its use, operation and maintenance. Besides analyzing diverse school environments (such as classroom circulations/accesses, library, pedagogical and sportive spaces) in relation to the environmental comfort and the perceptions of the main users of the schools (pupils, professors and employees), the dissertation tried to inquire the care (ambient education) of these users with the school space. In general, it was verified that the two schools have evaluations and perceptions really different for four reasons: (i) management of the schools; (ii) the users perception; (III) localization of schools and (IV) feeling of place, territoriality and appropriation

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This paper studies modern houses built in the neighborhoods of Cabo Branco, Tambaú and Manaíra by the seafront in Joao Pessoa, built between 1960 and 1974. We start from the already widespread notion that Brazilian Modern Architecture was inspired by foreign ways, mainly European but also American here recast, adapted, often innovating repertoire and ideas received (Y. BRUAND, 2005; H. SEGAWA, 2002; C. E. COMAS, 2002; C. E. COMAS, 2002; M. M. ACAYABA e S. FICHER, 1982; M. B. C. ARANHA, 2008; F. C. L. LARA, 2001; R. V. ZEIN, 2005; L. E. AMORIM, 1999, C. V. STINCO, 2010). With this look, after a field study, we collected 61 specimens in the collection of the Central Archive of João Pessoa City Hall, in order to identify which reformulations, adaptations or innovations would exist in modern houses built along the coast in João Pessoa. As we try to analyze the houses by what the bibliography had suggested (G. C. ARGAN, 1992; L. CORBUSIER, 2002; C.E.D. e M. ADRIÀ, 2007; K. FRAMPTON, 1997; H. H. HITCHCOCK, 1976; L. BENEVOLO, 2004; R. DE FUSCO, 1992, N . PEVSNER, 2002; M. RAGON, 1986; B. RISEBERO, 1982; E. ROBBINS, 1997; W. J. R. CURTIS, 1982; V. SCULLY, 2003; B. ZEVI, 1984; D. DUNST, 1999; A. COLQUHOUN, 2002; R. WESTON, 2005; A. IÑAKI, 2006; J. PETER, 1994) the starting idea seemed to us not sufficiently developed. So we decided, first, to undertake a literature review comparing speech and image of modern houses most often cited by international and national literature, following a script freely inspired the Vitruvian triad: the functional and spatial (sectorization, guidance, spatiality, movement); constructive aspects (structural elements, modulation, deck, sealing), and aesthetic aspects (composition, apertures, ornaments) (Cap.1), then cast a look under this same route in 61 specimens obtained initially, trying to verify any specificities they would have (Cap.2). Failing to deepen the analysis of all these examples, we chose 10 projects which were redesigned and described in more detail to which we supplement with the aspects of place - location / lot location, access, axiality. (E. C. MAHFUZ, 2002; J. C. MIGUEL, 2000; E. C. CHEREGATI, 2007; M. COTRIM, 2007). (Cap. 3). The documentation and description resulting allowed us to approach some related questions about the canonical transcripts hybridizing, adoptions and any vernacular innovations of modern houses along the coast, We conclude that the appellants and anachronistic elements isolates found in each of the studied bind to the Brazilian Modern Architecture

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The peaches and nectarines are highly appreciated by consumer, but it is climacteric fruits, with availability in the market in small time. It is necessary to invest to obtain genotypes with fruit quality and small perishability or that it presente less physiological disorders after storage. The aims of this work were i) to evaluate the genetic divergence among 40 peach and nectarine trees genotypes based on postharvest quality and select posible parents; ii) to evaluate the susceptibility to chilling injury in peaches and nectarines after cold storage; iii) to evaluate divergence of peaches and nectarines on the basis in the susceptibility for chiling injury and select superior genotypes; iv) evaluate the correlations between quality and susceptibility to chilling injury of peaches and nectarines v) select parents with the combination of lower susceptibility to chilling injury and higher quality fruit. The study was carried out in EEAD-CSIC, Zaragoza - Spain, during the production cycle 2013/2014. A total of 40 peaches and nectarines genotypes from germplasm collection were evaluated. The quality characteristics as flesh firmness, total soluble solids, titratable acidity, pH, rippining index and flesh color parameters were evaluated. The fruits were submitted to cold storage at 0 °C and 5 °C, with 95% average relative humidity. The evaluations were after 14 and 28 days, it being observed the presence of symptoms, such as wooliness through mealiness, flesh grainy, leatheriness and flesh color changes, through browning, bleeding and off flavor. As a selection parameter was adopted 20% of genotypes that had a higher frequency of superiority for quality characteristics, susceptibility to chilling injury and the combining of both. For quality characteristic presented greater divergence the ‘Queen Giant’, ‘Sudanel Blanco’ and ‘Borracho de Jarque’. Based on the quality the eight genotypes were selected, ‘Andross’, ‘San Jaime’, ‘San Lorenzo’, ‘Borracho de Jarque’, ‘Sudanell 1’, ‘Carson’, ‘Baby Gold 6’ and ‘Stanford’. All genotypes studied exhibited susceptibility to one or more symptoms caused by cold storage during 28 days, independent of temperature. For 14 days, the ‘Baby Gold 6’, ‘Flavortop’ and ‘Queen Giant’ genotypes did not show any physiological disorder caused by cold. In general, the temperature of 0 °C favored fruit postharvest conservation, it have a lower incidence and severity of symptoms caused by cold storage. The storage for 14 days contributed for the lower incidence of damage in the genotypes fruits studied. For 14 days, with both temperatures, it was observed divergence for ‘Queen Giant’, ‘Sudanell Blanco’, ‘Baby Gold 6’ ‘GF3’, ‘Baby Gold 8’, ‘Campiel’ and ‘Campiel Rojo’ genotypes. For 28 days, in the 5 °C condition, ‘Queen Giant’, ‘Big Top’, ‘Flavortop’ and ‘Redhaven’ genotypes were divergents. Based on susceptibility to chilling injury at 0 °C, the eight genotypes were selected, it being these, ‘Queen Giant’, ‘Keimoes’, ‘Flavortop’, ‘Big Top’, 'Redhaven', 'Sudanell 3', 'Bonet I' and ‘Carson’. The quality parameters as rippining index, soluble solids, firmness and titratable acidity presented correlation among them. These, also it had correlation with woolines and bowning, what it indicate that fruits with more ripening can have this symptoms more easily. The browning, mealiness, flesh grainy and off flavor variables were correlationed with the time period and temperartures, what it confirm that these symptoms are the main disorders caused by cold storage. The quality characteristics together susceptibility to chilling injury allowed selected ‘Baby Gold 6’, ‘Sarell’, ‘Keimoes’, ‘GF3’ ‘San Jaime’, ‘Big Top’, ‘Sudanell 1’, ‘Carson’, ‘Baby Gold 8’, and ‘San Lorenzo’ genotypes.

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Embora tenha sido proposto que a vasculatura retínica apresenta estrutura fractal, nenhuma padronização do método de segmentação ou do método de cálculo das dimensões fractais foi realizada. Este estudo objetivou determinar se a estimação das dimensões fractais da vasculatura retínica é dependente dos métodos de segmentação vascular e dos métodos de cálculo de dimensão. Métodos: Dez imagens retinográficas foram segmentadas para extrair suas árvores vasculares por quatro métodos computacionais (“multithreshold”, “scale-space”, “pixel classification” e “ridge based detection”). Suas dimensões fractais de “informação”, de “massa-raio” e “por contagem de caixas” foram então calculadas e comparadas com as dimensões das mesmas árvores vasculares, quando obtidas pela segmentação manual (padrão áureo). Resultados: As médias das dimensões fractais variaram através dos grupos de diferentes métodos de segmentação, de 1,39 a 1,47 para a dimensão por contagem de caixas, de 1,47 a 1,52 para a dimensão de informação e de 1,48 a 1,57 para a dimensão de massa-raio. A utilização de diferentes métodos computacionais de segmentação vascular, bem como de diferentes métodos de cálculo de dimensão, introduziu diferença estatisticamente significativa nos valores das dimensões fractais das árvores vasculares. Conclusão: A estimação das dimensões fractais da vasculatura retínica foi dependente tanto dos métodos de segmentação vascular, quanto dos métodos de cálculo de dimensão utilizados

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Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. Método: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. Resultados: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (p<0,05). A VPD da artéria carótida interna diminuiu em ambos os lados (p<0,05). A VPS e a VPD da artéria vertebral direita também aumentaram (p<0,05). Achados assimétricos foram observados, de modo que artérias do lado direito foram as mais freqüentemente afetadas. Conclusões: Alterações hemodinâmicas foram observadas nas artérias vertebral e carótida após simpaticotomia para tratamento de HP. VPS foi o parâmetro mais freqüentemente alterado, principalmente nas artérias do lado direito, representando alterações assimétricas significantes nas artérias carótida e vertebral. Entretanto, são necessárias pesquisas subseqüentes para verificar se essas alterações são definitivas ou temporárias, uma vez que as inferências clínicas somente terão validação se as alterações forem permanentes