O acolhimento de usuários no centro cirúrgico e a humanização das práticas cotidianas do cuidado de enfermagem

Falar da humanização é retomar a tradição do ocidente de pensar o lugar que o ser humano ocupa no mundo, nas inter-relações com seus semelhantes, na esfera social e também de saúde, em uma ética e solidariedade. Para uma prática de cuidados humanizada, o início destes cuidados deve ocorrer com o acolhimento do usuário em todos os setores, entre eles o Centro Cirúrgico. Este estudo tem como objetivo geral: compreender o processo de acolhimento no cotidiano da assistência de enfermagem no Centro Cirúrgico a partir da diretriz: acolhimento, ambiência e clínica ampliada da Política Nacional de Humanização. E como objetivos específicos: descrever o acolhimento do usuário durante as práticas cotidianas do cuidado de enfermagem no Centro Cirúrgico; analisar as experiências de acolhimento na perspectiva dos usuários no Centro Cirúrgico durante as práticas cotidianas do cuidado de enfermagem e identificar as estratégias utilizadas durante o cuidado de enfermagem no Centro Cirúrgico que concretizam a viabilização da diretriz: acolhimento, ambiência e clínica ampliada. Para dar conta do estudo selecionamos a abordagem etnometodológica, caráter exploratório. O cenário do estudo foi um hospital da rede estadual do Rio de Janeiro e os dados foram coletados por meio de entrevista semiestruturada realizada com 18 usuários em pós-operatório e observação participante no Centro Cirúrgico. Em seguida submetidos à análise de conteúdo de Bardin, emergindo três categorias: A recepção do usuário no Centro Cirúrgico; caracterização da realização do acolhimento na recepção do Centro Cirúrgico na perspectiva do usuário e estratégias de cuidado direcionadas para ambiência, acolhimento e clínica ampliada. Conclui-se que compreender o processo de acolhimento no cotidiano da assistência de enfermagem somente foi possível pelo compartilhamento de experiências de usuários que utilizaram os serviços da unidade. O cuidado de enfermagem neste ambiente foi identificado a partir de duas práxis: na recepção do paciente para cirurgia eletiva e diferentemente para cirurgia de emergência. O ambiente do Centro Cirúrgico gera no usuário uma gama de sentimentos e há um imaginário em torno do evento cirúrgico e deste espaço. No que se refere à diretriz, o cuidado de enfermagem neste setor atende parcialmente ao que esta estabelecido. Um caminho para a viabilização da PNH e da diretriz: acolhimento, ambiência e clínica ampliada é a educação continuada em serviço que deve não somente dispor da política em sua teoria, mas desenvolver métodos para que a torne concreta e palpável promovendo melhoria no cuidado de enfermagem.

Dose terapêutica de radiação ionizante induz um fenótipo migratório em células de carcinoma de colon humano (caco-2): vias de sinalização envolvidas

O câncer colo-retal é a terceira neoplasia mais frequente em todo o mundo e a recorrência local e neoplasia refratária são desafios no tratamento do câncer colo-retal após a cirurgia convencional. Com o intuito de controlar a recorrência e aumentar a média de sobrevida dos pacientes, uma estratégia multidisciplinar que combina a radioterapia (RT) e a quimioterapia com o processo cirúrgico tem sido protocolo clínico de escolha. Embora esta combinação seja capaz de otimizar o tratamento, nem todos os pacientes são beneficiados com o protocolo quimio-rádio combinado, uma vez que existem os insucessos terapêuticos relacionados com a incidência de neoplasias secundárias tardias em pacientes que foram submetidos à RT para tratamento de neoplasias anteriores. Além da doença refratária, outro agravante da RT são os efeitos colaterais produzidos pela radiação ionizante (IR), em especial àqueles do trato gastrointestinal. Estes efeitos estão relacionados com alterações da homeostase do epitélio intestinal, através da desorganização dos complexos juncionais. Porém, os mecanismos que medeiam estes efeitos ainda não estão elucidados. Este estudo avaliou as vias de sinalização que medeiam os efeitos da IR em células Caco-2. Foi observado que a IR causa uma desorganização da junção aderente via Src, EGFR e MAPK, sendo estas alterações acompanhadas por desorganização do citoesqueleto de actina em todo o volume celular. Src, EGFR e MAPK participam de maneira diferenciada na modulação destes efeitos. Observamos também que a radiação aumenta a motilidade dessas células via Src e MAPK e não induz alteração na proliferação celular até 48 horas após o tratamento. Este é o primeiro trabalho que correlaciona vias de sobrevivência celular como Src, EGFR e MAPK com alterações nas proteínas de junção aderente, alterações do citoesqueleto e migração celular. Estes eventos são relacionados aos efeitos colaterais primários e tardios induzidos pela IR, e podem favorecer à aquisição de um fenótipo maligno herdável durante o fracionamento de doses na RT, favorecendo a progressão tumoral do câncer colo-retal. Logo, além da correlação das vias de sinalização envolvidas nos eventos induzidos pela IR mostrados neste estudo, os resultados também corroboram para um melhor entendimento da atividade farmacológica dos inibidores químicos utilizados, uma vez que muitos deles encontram-se em fase de ensaios pré-clínicos e clínicos.

Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study.

AIMS: To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone. MATERIALS AND METHODS: Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard. RESULTS: The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements CONCLUSIONS: Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.

Plans for laser spectroscopy of trapped cold hydrogen-like HCI

Laser spectroscopy studies are being prepared to measure the 1s ground state hyperfine splitting in trapped cold highly charged ions. The purpose of such experiments is to test quantum electrodynamics in the strong electric field regime. These experiments form part of the HITRAP project at GSI. A brief review of the planned experiments is presented. © 2005 Elsevier B.V. All rights reserved.

A microbeam RBS analysis of low temperature direct-write inkjet deposited copper

Quantitative microbeam Rutherford backscattering (RBS) analysis with a 1.5 MeV 4He+ beam has determined limits on the purity of copper deposited on glass with a novel inkjet process. A tetravinyl silane tetrakisCu(I) 1,1,1,5,5,5-hexafluoroacetylacetonate (TVST[Cu]hfac) complex was heated to 70 °C and jetted onto the glass substrate through a piezoelectric ceramic print head in droplets about 0.5 mm diameter. The substrate temperature was 150 °C. Solid well-formed deposits resulted which have a copper content greater than about 90% by weight. The RBS spectra were analysed objectively using the DataFurnace code, with the assumption that the deposit was CuOx, and the validity of different assumed values of x being tested. The assumptions and the errors of the analysis are critically evaluated. © 2002 Elsevier Science B.V. All rights reserved.

Accelerator-induced transients in Accelerator Driven Subcritical Reactors

Achieving higher particles energies and beam powers have long been the main focus of research in accelerator technology. Since Accelerator Driven Subcritical Reactors (ADSRs) have become the subject of increasing interest, accelerator reliability and modes of operation have become important matters that require further research and development in order to accommodate the engineering and economic needs of ADSRs. This paper focuses on neutronic and thermo-mechanical analyses of accelerator-induced transients in an ADSR. Such transients fall into three main categories: beam interruptions (trips), pulsed-beam operation, and beam overpower. The concept of a multiple-target ADSR is shown to increase system reliability and to mitigate the negative effects of beam interruptions, such as thermal cyclic fatigue in the fuel cladding and the huge financial cost of total power loss. This work also demonstrates the effectiveness of the temperature-to-reactivity feedback mechanisms in ADSRs. A comparison of shutdown mechanisms using control rods and beam cut-off highlights the intrinsic safety features of ADSRs. It is evident that the presence of control rods is crucial in an industrial-scale ADSR. This paper also proposes a method to monitor core reactivity online using the repetitive pattern of beam current fluctuations in a pulsed-beam operation mode. Results were produced using PTS-ADS, a computer code developed specifically to study the dynamic neutronic and thermal responses to beam transients in subcritical reactor systems. © 2012 Elsevier B.V.

Ultra-thin 242mAm fuel elements in nuclear reactors

There is a growing interest in using 242mAm as a nuclear fuel. The advantages of 242mAm as a nuclear fuel derive from the fact that 242mAm has the highest thermal fission cross section. The thermal capture cross section is relatively low and the number of neutrons per thermal fission is high. These nuclear properties make it possible to obtain nuclear criticality with ultra-thin fuel elements. The possibility of having ultra-thin fuel elements enables the use of these fission products directly, without the necessity of converting their energy to heat, as is done in conventional reactors. There are three options of using such highly energetic and highly ionized fission products. 1. Using the fission products themselves for ionic propulsion. 2. Using the fission products in an MHD generator, in order to obtain electricity directly. 3. Using the fission products to heat a gas up to a high temperature for propulsion purposes. In this work, we are not dealing with a specific reactor design, but only calculating the minimal fuel elements' thickness and the energy of the fission products emerging from these fuel elements. It was found that it is possible to design a nuclear reactor with a fuel element of less than 1 μm of 242mAm. In such a fuel element, 90% of the fission products' energy can escape.

Stable mode-locking in an Yb:YAG laser with a fast SESAM

Stable mode-locking in a diode-pumped Yb:YAG laser was obtained with a very fast semiconductor saturable absorber mirror (SESAM). The pulse width was measured to be 4 ps at the central wavelength of 1047 nm. The average power was 200 mW and the repetition rate was 200 MHz.

An outlook of heavy ion driven plasma research at IMP-Lanzhou

Since the successful completion of the cooling storage ring (CSR) project in China at the end of 2007, high qualitative heavy ion beams with energy ranging from keV to GeV/u have been available at the Heavy Ion Research Facility at Lanzhou (HIRFL). More than 1091 GeV/u C6+particles or 108235 MeV/u Xe particles can be stored in the CSR main-ring and extracted within hundred nano-seconds during the test running,the beam parameters will be improved in the coming years so that high energy density (HED) conditions could be achieved and investigated there. Recent scientific results from the experiments relevant to plasma research on HIRFL are summarized. Dense plasma research with intense heavy ion beams of CSR is proposed here.

potential mechanisms involved in resistant phenotype of MCF-7breast carcinoma cells to ionizing radiation induced apoptosis

In the present study, we investigated the mechanisms of apoptosis resistance and the roles of the phosphorylation of BRCA1, p21, the Bax/Bcl-2 protein ratio and cell cycle arrest in IR-induced apoptosis in MCF-7 cells. X-irradiation, in particular at low dose (1 Gy), but not carbon ion irradiation, had a significant antiproliferative effect on the growth of MCF-7 cells. 1 Gy X-irradiation resulted in G1 and G2 phase arrest, but 4 Gy induced a significant G1 block. In contrast, carbon ion irradiation resulted in a significant accumulation in the G2 phase. Concomitant with the phosphorylation of H2AX induced by DNA damage,carbon ion irradiation resulted in an approximately 1.9–2.8-fold increase in the phosphorylation of BRCA1 on serine residue 1524, significantly greater than that detected for X-irradiation. Carbon ion irradiation caused a dramatic increase in p21 expression and drastic decrease in Bax expression compared with X-irradiation. The data implicated that phosphorylation of BRCA1 on serine residue 1524 might,at least partially, induce p21 expression but repress Bax expression. Together, our results suggested that the phosphorylation of BRCA1 at Ser-1524 might contribute to the G2 phase arrest and might be an upstream signal involved in preventing apoptosis signal via upregulation of p21 and downregulation of the Bax/Bcl-2 ratio.

The preparation of 238U targets on 2mm Al foils

Preparation of 238U on 2μm Al foils by molecular plating technique is described. In order to obtain optimum conditions for deposition, several parameters influencing the quality of layers such as current density, distance between the anode and cathode and the deposition time were investigated. The target thickness was determined by spectrophotometry. The uniformity and morphology of the target surface were studied by means of scanning electron microscopy, energy dispersive X-ray spectrometry and Infrared spectra. The results show that uranium is deposited in its oxide or hydroxide form uniformly and adherently onto the foil.