Cuidados paliativos na insuficiência cardíaca: o conforto como desfecho do cuidar em enfermagem

O objetivo geral deste estudo foi: Verificar se a introdução dos princípios da teoria do conforto de Katherine Kolcaba na consulta de enfermagem para pacientes com IC sob cuidados paliativos a partir da sistematização da assistência utilizando as taxonominas NANDA-NOC-NIC promove maior conforto. Trata-se de um ensaio clínico aberto, tipo antes e depois, realizado em hospital federal localizado no Rio de Janeiro com amostra de 20 pacientes. Para avaliação do conforto, utilizou-se o questionário End of life comfort questionnaire patient e o resultado de enfermagem (NOC - Estado de Conforto). As avaliações do questionário ocorreram nas primeira, terceira e sexta consultas de enfermagem e o NOC em todas as consultas. A coleta de dados foi realizada entre os meses de novembro de 2012 e maio de 2013. Utilizou-se o programa SPSS 19.0 para análise dos dados. Foram utilizados os Testes Qui-Quadrado, Exato de Fisher e Mann-Whitney para verificar a associação dos diagnósticos e intervenções de enfermagem com o conforto aferido pelo questionário nos três tempos aplicados. Foi utilizado o Teste ANOVA (análise de variância) para avaliar a melhora na condição de conforto dos sujeitos através do questionário já descrito e também pela NOC Estado de Conforto verificada nas seis consultas. Como resultado encontrou-se três diagnósticos de enfermagem e duas intervenções de enfermagem relacionadas à maior conforto dos pacientes (p <0,05). Já associados ao menor conforto foram encontrados 08 diagnósticos e 12 intervenções. O conforto verificado pelo questionário e o resultado de enfermagem aumentaram significativamente (p <0,001) durante os 06 meses de acompanhamento. A aceitação da hipótese alternativa (a introdução dos princípios da teoria de Katherine Kolcaba na consulta de enfermagem está associada ao maior conforto dos pacientes com insuficiência cardíaca sob cuidados paliativos), se confirmou. O estudo contribuiu para reafirmar que quando se utiliza uma teoria de enfermagem para sustentar a prática/pesquisa da profissão, o desenvolvimento da sistematização da assistência se torna mais claro. A implementação da teoria faz com que o desfecho do cuidar em enfermagem se torne visível a outras profissões e à sociedade em geral.

Optimisation of CNTs and ZnO nanostructures for electron sources

The aim of this paper is to review our recent results on the growth and optimization of carbon nanotubes (CNTs) and CNT/Zinc Oxide nanostructures and present and discuss their suitability for various applications such as cold cathode electron sources for use in x-ray sources and lighting. ©2010 IEEE.

Characterization of the U.S. Gulf of Mexico and South Atlantic penaeid and rock shrimp fisheries based on observer data

In July 2007, a mandatory Federal observer program was implemented to characterize the U.S. Gulf of Mexico penaeid shrimp (Farfantepenaeus aztecus, F. duorarum, and Litopenaeus setiferus) fishery. In June 2008, the program expanded to include the South Atlantic penaeid and rock shrimp, Sicyonia spp., fisheries. Data collected from 10,206 tows during 5,197 sea days of observations were analyzed by geographical area and target species. The majority of tows (~70%) sampled were off the coasts of Texas and Louisiana. Based on total hours towed, the highest concentrated effort occurred off South Texas and southwestern Florida. Gear information, such as net characteristics, bycatch reduction devices, and turtle excluder devices were fairly consistent among areas and target species. By species categories, finfish comprised the majority (≥57%) of the catch composition in the Gulf of Mexico and South Atlantic penaeid shrimp fisheries, while in the South Atlantic rock shrimp fishery the largest component (41%) was rock shrimp. Bycatch to shrimp ratios were lower than reported in previous studies for the Gulf of Mexico penaeid shrimp fishery. These decreased ratios may be attributed to several factors, notably decreased shrimp effort and higher shrimp catch per unit of effort (CPUE) in recent years. CPUE density surface plots for several species of interest illustrated spatial differences in distribution. Hot Spot Analyses for shrimp (penaeid and rock) and bycatch species identified areas with significant clustering of high or low CPUE values. Spatial and temporal distribution of protected species interactions were documented.

A guide to monitoring reef fish in the National Park Service's South Florida/Caribbean Network

Reef fishes are conspicuous and essential components of coral reef ecosystems and economies of southern Florida and the United States Virgin Islands (USVI). Throughout Florida and the USVI, reef fish are under threat from a variety of anthropogenic and natural stressors including overfishing, habitat loss, and environmental changes. The South Florida/Caribbean Network (SFCN), a unit of the National Park Service (NPS), is charged with monitoring reef fishes, among other natural and cultural resources, within six parks in the South Florida - Caribbean region (Biscayne National Park, BISC; Buck Island Reef National Monument, BUIS; Dry Tortugas National Park, DRTO; Everglades National Park, EVER; Salt River Bay National Historic Park and Ecological Preserve, SARI; Virgin Islands National Park, VIIS). Monitoring data is intended for park managers who are and will continue to be asked to make decisions to balance environmental protection, fishery sustainability and park use by visitors. The range and complexity of the issues outlined above, and the need for NPS to invest in a strategy of monitoring, modeling, and management to ensure the sustainability of its precious assets, will require strategic investment in long-term, high-precision, multispecies reef fish data that increases inherent system knowledge and reduces uncertainty. The goal of this guide is to provide the framework for park managers and researchers to create or enhance a reef fish monitoring program within areas monitored by the SFCN. The framework is expected to be applicable to other areas as well, including the Florida Keys National Marine Sanctuary and Virgin Islands Coral Reef National Monument. The favored approach is characterized by an iterative process of data collection, dataset integration, sampling design analysis, and population and community assessment that evaluates resource risks associated with management policies. Using this model, a monitoring program can adapt its survey methods to increase accuracy and precision of survey estimates as new information becomes available, and adapt to the evolving needs and broadening responsibilities of park management.

National Centers for Coastal Ocean Science Coastal Ecosystem Assessment Program: a manual of methods

Environmental managers strive to preserve natural resources for future generations but have limited decision-making tools to define ecosystem health. Many programs offer relevant broad-scale, environmental policy information on regional ecosystem health. These programs provide evidence of environmental condition and change, but lack connections between local impacts and direct effects on living resources. To address this need, the National Oceanic and Atmospheric Administration/National Ocean Service (NOAA/NOS) Cooperative Oxford Laboratory (COL), in cooperation with federal, state, and academic partners, implemented an integrated biotic ecosystem assessment on a sub-watershed 14-digit Hydrologic Unit Code (HUD) scale in Chesapeake Bay. The goals of this effort were to 1) establish a suite of bioindicators that are sensitive to ecosystem change, 2) establish the effects of varying land-use patterns on water quality and the subsequent health of living resources, 3) communicate these findings to local decision-makers, and 4) evaluate the success of management decisions in these systems. To establish indicators, three sub-watersheds were chosen based on statistical analysis of land-use patterns to represent a gradient from developed to agricultural. The Magothy (developed), Corsica (agricultural), and Rhode (reference) Rivers were identified. A random stratified design was developed based on depth (2m contour) and river mile. Sampling approaches were coordinated within this structure to allow for robust system comparisons. The sampling approach was hierarchal, with metrics chosen to represent a range from community to cellular level responses across multiple organisms. This approach allowed for the identification of sub-lethal stressors, and assessment of their impact on the organism and subsequently the population. Fish, crabs, clams, oysters, benthic organisms, and bacteria were targeted, as each occupies a separate ecological niche and may respond dissimilarly to environmental stressors. Particular attention was focused on the use of pathobiology as a tool for assessing environmental condition. By integrating the biotic component with water quality, sediment indices, and land- use information, this holistic evaluation of ecosystem health will provide management entities with information needed to inform local decision-making processes and establish benchmarks for future restoration efforts.

Fish movement patterns in Virgin Islands National Park, Virgin Islands Coral Reef National Monument and adjacent waters

NOAA’s National Centers for Coastal Ocean Science (NCCOS)-Center for Coastal Monitoring and Assessment’s (CCMA) Biogeography Branch, National Park Service (NPS), US Geological Survey, and the University of Hawaii used acoustic telemetry to quantify spatial patterns and habitat affinities of reef fishes around the island of St. John, US Virgin Islands. The objective of the study was to define the movements of reef fishes among habitats within and between the Virgin Islands Coral Reef National Monument (VICRNM), the Virgin Islands National Park (VIIS), and Territorial waters surrounding St. John. In order to better understand species’ habitat utilization patterns among management regimes, we deployed an array of hydroacoustic receivers and acoustically tagged reef fishes. Thirty six receivers were deployed in shallow near-shore bays and across the shelf to depths of approximately 30 m. One hundred eighty four individual fishes were tagged representing 19 species from 10 different families with VEMCO V9-2L-R64K transmitters. The array provides fish movement information at fine (e.g., day-night and 100s meters within a bay) to broad spatial and temporal scales (multiple years and 1000s meters across the shelf). The long term multi-year tracking project provides direct evidence of connectivity across habitat types in the seascape and among management units. An important finding for management was that a number of individuals moved among management units (VICRNM, VINP, Territorial waters) and several snapper moved from near-shore protected areas to offshore shelf-edge spawning aggregations. However, most individuals spent the majority of their time with VIIS and VICRNM, with only a few wide-ranging species moving outside the management units. Five species of snappers (Lutjanidae) accounted for 31% of all individuals tagged, followed by three species of grunts (Haemulidae) accounting for an additional 23% of the total. No other family had more than a single species represented in the study. Bluestripe grunt (Haemulon sciurus) comprised 22% of all individuals tagged, followed by lane snappers (Lutjanus synagris) at 21%, bar jack (Carangoides ruber) at 11%, and saucereye porgy (Calamus calamus) at 10%. The largest individual tagged was a 70 cm TL nurse shark (Ginglymostoma cirratum), followed by a 65 cm mutton snapper (Lutjanus analis), a 47 cm bar jack, and a 41 cm dog snapper (Lutjanus jocu). The smallest individuals tagged were a 19 cm blue tang (Acanthurus coeruleus) and a 19.2 cm doctorfish (Acanthurus chirurgus). Of the 40 bluestriped grunt acoustically tagged, 73% were detected on the receiver array. The average days at large (DAL) was 249 (just over 8 months), with one individual detected for 930 days (over two and a half years). Lane snapper were the next most abundant species tagged (N = 38) with 89% detected on the array. The average days at large (DAL) was 221 with one individual detected for 351 days. Seventy-one percent of the bar jacks (N = 21) were detected on the array with the average DALs at 47 days. All of the mutton snapper (N = 12) were detected on the array with an average DAL of 273 and the longest at 784. The average maximum distance travelled (MDT) was ca. 2 km with large variations among species. Grunts, snappers, jacks, and porgies showed the greatest movements. Among all individuals across species, there was a positive and significant correlation between size of individuals and MDT and between DAL and MDT.

MDNR-NOAA trawl standardization study

Long-term living resource monitoring programs are commonly conducted globally to evaluate trends and impacts of environmental change and management actions. For example, the Woods Hole bottom trawl survey has been conducted since 1963 providing critical information on the biology and distribution of finfish and shellfish in the North Atlantic (Despres-Patango et al. 1988). Similarly in the Chesapeake Bay, the Maryland Department of Natural Resources (MDNR) Summer Blue Crab Trawl survey has been conducted continuously since 1977 providing management-relevant information on the abundance of this important commercial and recreational species. A key component of monitoring program design is standardization of methods over time to allow for a continuous, unbiased data set. However, complete standardization is not always possible where multiple vessels, captains, and crews are required to cover large geographic areas (Tyson et al. 2006). Of equal issue is technological advancement of gear which serves to increase capture efficiency or ease of use. Thus, to maintain consistency and facilitate interpretation of reported data in long-term datasets, it is imperative to understand and quantify the impacts of changes in gear and vessels on catch per unit of effort (CPUE). While vessel changes are inevitable due to ageing fleets and other factors, gear changes often reflect a decision to exploit technological advances. A prime example of this is the otter trawl, a common tool for fisheries monitoring and research worldwide. Historically, trawl nets were constructed of natural materials such as cotton and linen. However modern net construction consists of synthetic materials such as polyamide, polyester, polyethylene, and polypropylene (Nielson et. al. 1983). Over the past several decades, polyamide materials which will be referred to as nylon, has been a standard material used in otter trawl construction. These trawls are typically dipped into a latex coating for increased abrasion resistance, a process that is referred to as “green dipped.” More recently, polyethylene netting has become popular among living resource monitoring agencies. Polyethylene netting, commonly known as sapphire netting, consists of braided filaments that form a very durable material more resistant to abrasion than nylon. Additionally, sapphire netting allows for stronger knot strength during construction of the net further increasing the net’s durability and longevity. Also, sapphire absorbs less water with a specific gravity near 0.91 allowing the material to float as compared to nylon with specific gravity of 1.14 (Nielson et. al. 1983). This same property results in a light weight net which is more efficient in deployment, retrieval and fishing of the net, particularly when towing from small vessels. While there are many advantages to the sapphire netting, no comparative efficiency data is available for these two trawl net types. Traditional nylon netting has been used consistently for decades by the MDDNR to generate long term living resource data sets of great value. However, there is much interest in switching to the advanced materials. In addition, recent collaborative efforts between MDNR and NOAA’s Cooperative Oxford Laboratory (NOAA-COL) require using different vessels for trawling in support of joint projects. In order to continue collaborative programs, or change to more innovative netting materials, the influence of these changes must be demonstrated to be negligible or correction factors determined. Thus, the objective of this study was to examine the influence of trawl net type, vessel type, and their interaction on capture efficiency.

Predicting the distribution of Vibrio vulnificus in Chesapeake Bay

Vibrio vulnificus is a gram-negative pathogenic bacterium endemic to coastal waters worldwide, and a leading cause of seafood related mortality. Because of human health concerns, understanding the ecology of the species and potentially predicting its distribution is of great importance. We evaluated and applied a previously published qPCR assay to water samples (n = 235) collected from the main-stem of the Chesapeake Bay (2007 – 2008) by Maryland and Virginia State water quality monitoring programs. Results confirmed strong relationships between the likelihood of Vibrio vulnificus presence and both temperature and salinity that were used to develop a logistic regression model. The habitat model demonstrated a high degree of concordance (93%), and robustness as subsequent bootstrapping (n=1000) did not change model output (P > 0.05). We forced this empirical habitat model with temperature and salinity predictions generated by a regional hydrodynamic modeling system to demonstrate its utility in future pathogen forecasting efforts in the Chesapeake Bay.

Biogeographic characterization of essential fish habitats affected by human activities in the coastal zone of Puerto Rico

The overall purpose of this project was to collect available information on the characteristics of essential fish habitats in protected and non-protected marine areas around the islands of Puerto Rico. Specifically, this project compiled historical information on benthic habitats and the status of marine resources into a Geographic Information System (GIS) by digitizing paper copies of existing marine geologic maps that were developed for the Caribbean Fishery Management Council (CFMC) for areas around the Commonwealth of Puerto Rico. In addition, information on benthic habitat types, Essential Fish Habitat (EFH) requirements, and fishing and non-fishing impacts to marine resources were compiled for two priority areas: La Parguera and Vieques. The information obtained will help to characterize and select habitats for future monitoring of impacts of fishing and non-fishing activities and to develop management recommendations for conservation of important marine habitats. The project focused specifically on areas identified as priorities for conservation by the Puerto Rico Department of Natural and Environmental Resources (DNER) and the Local Action Strategy Overfishing Group.

Reproduction of blacknose shark (Carcharhinus acronotus) in coastal waters off northeastern Brazil

The blacknose shark, Carcharhinus acronotus, is a relatively small carcharinid, typically inhabiting continental shelf areas in the western Atlantic Ocean, from North Carolina throughout the Gulf of Mexico (Bigelow and Schroeder, 1948) and along the South American coast to Rio de Janeiro (Compagno, 1984). The abundance of this shark in nearshore areas throughout its distribution makes it accessible to commercial fishing, mainly from inshore hook-and-line and gill-net fisheries (Trent et al., 1997; Mattos and Hazin1).