Influência da temperatura de calcinação do fosfogesso no desempenho de cimentos supersulfatados

The supersulfated cement (CSS) basically consist of up to 90% blast furnace slag, 10-20% of a source of calcium sulfate and a small amount of alkali activator, covered by European standard EN 15743/2010. Because of this SSC are considered "green cement" low environmental impact. The source of calcium sulfate used in the preparation of CSS can be obtained from natural sources, such as gypsum or from alternative sources (industrial products), such as phosphogypsum. The phosphogypsum is a by-product of the fertilizer industry, used in the production of phosphoric acid. In this process the phosphate rock is treated with sulfuric acid to give as the major product phosphoric acid (H3PO4), gypsum and a small amount of hydrofluoric acid. The chemical composition of gypsum is basically calcium sulfate dihydrate (CaSO4.2H2O), similar to gypsum, because it can be used in this type of cement. To become anhydrous, the calcination of gypsum is necessary. The availability of the source of calcium sulfate to react with the slag is dependent on its solubility that is directly related to its calcination temperature. The solubility of the anhydrous gypsum decreases with increasing calcination temperature. This study investigated the influence of temperature of calcination of phosphogypsum on the performance of CSS. Samples were prepared with 10 and 20% of phosphogypsum calcinated at 350 to 650 ° C using KOH as an alkaline activator at three different concentrations (0.2, 0.5 and 0.8%). The results showed that all mortars presented the minimum values required by EN 15743/2010 for 7 and 28 days of hydration. In general CSS containing 10% phosphogypsum showed slightly better compressive strength results using a lower calcination temperature (350 °C) and curing all ages. The CSS containing 20% of calcined gypsum at 650 °C exhibit satisfactory compressive strenght at 28 days of hydration, but at later ages (56 to 90 days) it strongly reduced. This indicates that the calcination temperature of phosphogypsum has a strong influence on the performance of the CSS.

Ultrasonic wave reflection measurements on self-compacting pastes and concretes

The objective of this study was to extend the use of combined longitudinal (P-wave) and shear (S-wave) ultrasonic wave reflection (UWR) to monitor the setting and stiffening of self-compacting pastes and concretes. An additional objective was to interpret the UWR responses of various modified cement pastes. A polymeric buffer with acoustic impedance close to that of cement paste, high impact polystyrene, was chosen to obtain sensitive results from the early hydration period. Criteria for initial and final set developed by our group in a prior study were used to compute setting times by UWR. UWR results were compared with standard penetration measurements. Stiffening behavior and setting times for normal cement pastes, pastes modified with mineral and chemical admixtures, self-compacting pastes, and concretes were explored using penetration resistance, S-wave and P-wave reflection. All three methods showed that set times of pastes varied linearly with w/c, that superplasticizer and fly ash delayed the set times of pastes, and that differences in w/cm, sp/cm, and fa/cm could be detected. Final set times determined from UWR correlated well with those from penetration resistance. Initial set times from S-wave reflection did not correlate very well with those from penetration resistance. Final set times from P-wave and S-wave reflection were roughly the same. Pastes with different chemical admixtures were tested, and the effects of these admixtures on stiffening were determined using UWR. Self-compacting concretes were studied using UWR, and their response and setting times were largely similar to that of corresponding self-compacting pastes. The P-wave reflection response was explored in detail, and the phenomenon of partial debonding and the factors affecting it were explained. Partial debonding is probably caused by autogenous shrinkage at final set, and was controlled and limited by water. The extent of partial debonding was higher with the transducers placed on the side as opposed to the bottom, and the S-wave transducer seemed to promote debonding in the P-wave reflection, whereas the P-wave transducer seemed to reduce debonding in the S-wave reflection. Simultaneous formwork pressure testing and UWR were performed; however, no clear correlation was seen between the two properties.

Prevenção de úlceras por pressão segundo a perspectiva do enfermeiro intensivista

Analisar a atuação dos enfermeiros de unidade de terapia intensiva na prevenção da úlcera por pressão. Método: trata-se de estudo descritivo desenvolvido com 13 enfermeiros da unidade de terapia intensiva do Hospital Universitário Onofre Lopes (HUOL), em Natal-RN. Foi aplicado um questionário, submetido à análise de conteúdo temática. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Norte (UFRN), sob o CAAE n. 0240.0.051.000-10. Resultados: os enfermeiros reportaram a realização da mudança de decúbito, a avaliação de risco, a discussão com os colegas sobre as medidas adotadas, a higiene e hidratação da pele do paciente através de uso de ácidos graxos essenciais e hidratante corporal, o cuidado com a disposição dos lençóis, de forma a evitar dobras, a utilização de colchão de ar e a aplicação de placas de hidrocoloide nas proeminências ósseas. Conclusão: a prática da prevenção das úlceras por pressão aplicada pelos enfermeiros da unidade de terapia intensiva ocorre sem padronização dos cuidados

Produção e extração da enzima anidrase carbônica e de ficobiliproteínas a partir de microalgas

Muito interesse tem sido focado no potencial biotecnológico das microalgas, principalmente devido à identificação de diversas substâncias sintetizadas por estes organismos, dentre elas a anidrase carbônica e as ficobiliproteínas. A anidrase carbônica é uma metaloenzima que catalisa a hidratação reversível do CO2 em bicarbonato com alta eficiência, sendo utilizada para captação de CO2 através de sistemas biológicos. A C-ficocianina e a aloficocianina, corantes naturais, são os dois principais componentes das ficobiliproteínas em cianobactérias e apresentam diversas aplicações dentro da indústria alimentícia, cosmética e farmacêutica. O objetivo principal desta tese foi avaliar a produção e a extração da anidrase carbônica e das ficobiliproteínas a partir de diferentes microalgas. Para isso, primeiramente foi realizado uma investigação da produção da anidrase carbônica pela microalga Dunaliella tertiolecta, onde foi estudada a extração da enzima e sua aplicação em sistemas de captura enzimática de CO2. Posteriormente foi avaliada a produção da enzima ao longo do cultivo de diferentes microalgas marinhas e dulcícolas (Dunaliella tertiolecta, Tetraselmis sueccica, Phaeodactylum tricornutum, Nannochloropsis oculata, Isochysis galbana, Chlorella vulgaris e Scenedesmus obliquus). A produção da enzima e de ficobiliproteínas, também, foi estudada para as cianobactérias Spirulina platensis LEB 52, Spirulina sp. LEB 18 e Synechococcus nidulans. Todos os cultivos foram acompanhados em termos de biomassa e pH. Por último, foi realizado um estudo de extração da enzima de P. tricornutum e extração conjunta da anidrase carbônica e de ficobiliproteínas da cianobactéria S. sp. LEB 18. Os cultivos foram realizados em frascos erlenmeyer contendo os meios Conway (marinhas), BG-11 (dulcícolas) e Zarrouk 20% (cianobactérias). Na avaliação da ruptura celular foram testadas as técnicas de maceração em gral e pistilo, agitação em vórtex com pérolas de vidro, sonicação com pérolas de vidro, homogeneizador ultrassônico, secagem, congelamento e descongelamento e a combinação de tratamentos. Maiores rendimentos de extração da enzima a partir da microalga D. tertiolecta foram obtidos utilizando tratamento ultrassônico, juntamente com baixas concentrações de biomassa úmida (0,1 e 0,2 g/L), e a mesma apresentou potencial para aplicação em processos de captação enzimática do CO2. Durante os cultivos, a microalga C. vulgaris se destacou como maior produtora da enzima anidrase carbônica, atingindo valores de atividade enzimática de 44,0 U/L. As cianobactérias apresentaram valores de atividade entre 41,6 e 45,9 U/L, sendo que a S. sp. LEB 18 foi a que apresentou maiores produções de C-ficocianina e aloficocianina no ponto de máxima atividade volumétrica, 65,9 e 82,2 µg/mL, respectivamente. A enzima extraída da biomassa de S. platensis LEB 52 catalisou a hidratação do CO2 que precipitou na forma de CaCO3. Maiores rendimentos de extração da enzima a partir das microalgas P. tricornutum e S. sp. LEB 18 foram obtidos utilizando homogeneizador ultrassônico, que foram 31,3 U/g e 25,5 U/g, respectivamente. A biomassa de S. sp. LEB 18, também apresentou potencial para a extração de ficobiliproteínas, obtendo- se altas concentrações de C-ficocianina (100,5 mg/g) e aloficocianina (69,9 mg/g). Através dos resultados obtidos, pode-se verificar a potencialidade das microalgas e das cianobactérias para produção da enzima anidrase carbônica e das ficobiliproteínas, biomoléculas de alto valor industrial. Este trabalho apresenta processos eficientes para a extração da enzima e de ficobiliproteínas tanto para escala laboratorial como industrial.

Material para construção civil a partir de lodo de estação de tratamento de água, lama de polimento de mármore e resíduo de produção de cal

The rapid population growth is the great motivator for the development of the construction industry and the increased demand for drinking water, resulting in a gradual increase in the generation of solid waste. Thus, this work was carried out in order to recycle industrial and municipal wastes incorporating them into materials for civil construction. The composite produced from water treatment sludge and marble polishing mud, applying lime production waste as a binder, was evaluated for its mechanical performance and its morphological structure. The raw materials were characterized for their chemical composition, mineralogy, morphology, particle size and also the moisture content. With the featured materials nine compositions have been developed varying the content of the water treatment sludge between 25 to 50%, marble polishing mud between 35 to 50% and the lime production waste between 10 to 30%. The composites were subjected to mechanical strength tests, water absorption, chemical and mineralogical composition and morphology. The developed materials presented, on the 3rd day of hydration, maximum strength value of 4.65 MPa, the 7th day 6.36 MPa, on the 14th day 6.74 MPa, the 28th day 5.98 MPa, on the 60th day 8.52 MPa at 90th day 11.75 MPa and 180th day 12.06 MPa. The water absorption values after 28 days of hydration ranged from 16.27% to 26.32% and after 90 days, from 13.57% to 23.56%.

Adesão a recomendações de ingestão de água, em idosos: preditores psicossociais e efeitos da comunicação de informação com uso de âncoras de referência

Sendo os idosos um grupo de risco face a desidratação, torna-se particularmente relevante desenvolver estratégias eficazes de comunicação em saúde para o incremento da adesão a recomendações médicas para ingestão de água. Com este objetivo procurámos avaliar os efeitos da comunicação de uma recomendação, com recurso a uma referência familiar (e.g. garrafa de 1.5 Litros) na qual os idosos pudessem “ancorar” o seu julgamento e decisão de adesão à recomendação, com base numa mais eficaz compreensão de informação de quantidade. Dos 70 idosos que participaram no estudo, apenas 56 foram considerados na análise, por cumprirem os critérios de inclusão na amostra. Esta amostra incluiu idosos autónomos, não institucionalizados, responsáveis pelas suas escolhas alimentares e com indicadores de hidratação aceitáveis. Os resultados mostraram que numa condição com âncora familiar (mas não na condição sem), a adesão associada ao próprio nível de consumo existente, do idoso aumentou após a recomendação. Análises adicionais identificaram as crenças face à água e as suas várias funções, como um preditor psicossocial positivo da adesão, o mesmo não acontecendo com atitudes face à água, evitamento de informação alimentar negativa e numeracia; Abstract: Being the elderly a risk group with regard to dehydration it is necessary to develop effective health communication strategies to increase adherence to health recommendations concerning water intake. Accordingly, we aimed to assess the effects of communicating a recommendation with the addition of a familiar reference (e.g. bottle of 1.5 Liters) in which the elderly could anchor their judgment and decision making to adhere to the recommendation, based on a better comprehension of the quantified information presented. From the 70 older adults that have participated in the study, only 56 were considered in the analysis, for fulfilling the sample inclusion criteria. This sample included older adults considered to be autonomous, non-institutionalized, responsible for their good choices and with acceptable hydration levels. Results showed that in a condition with a familiar anchor (but not in a condition without) the adherence in line with the elderly own current consumption level, increased after the recommendation. Additional analysis identified beliefs concerning water and its various functions as a positive psychosocial predictor of adherence, the same not happening for attitudes towards water, avoidance of negative food information and numeracy.

Desenvolvimento de nanosistemas farmacêuticos para terapia gênica

Gene therapy is one of the major challenges of the post-genomic research and it is based on the transfer of genetic material into a cell, tissue or organ in order to cure or improve the patient s clinical status. In general, gene therapy consists in the insertion of functional genes aiming substitute, complement or inhibit defective genes. The achievement of a foreigner DNA expression into a population of cells requires its transfer to the target. Therefore, a key issue is to create systems, vectors, able to transfer and protect the DNA until it reaches the target. The disadvantages related to the use of viral vectors have encouraged efforts to develop emulsions as non-viral vectors. In fact, they are easy to produce, present suitable stability and enable transfection. The aim of this work was to evaluate two different non-viral vectors, cationic liposomes and nanoemulsions, and the possibility of their use in gene therapy. For the two systems, cationic lipids and helper lipids were used. Nanoemulsions were prepared using sonication method and were composed of Captex® 355; Tween® 80; Spam® 80; cationic lipid, Stearylamine (SA) or 1,2-dioleoyl-3-trimethylammoniumpropane (DOTAP) and water (Milli-Q®). These systems were characterized by average droplet size, Polidispersion Index (PI) and Zeta Potential. The stability of the systems; as well as the DNA compaction capacity; their cytotoxicity and the cytotoxicity of the isolated components; and their transfection capacity; were also evaluated. Liposomes were made by hydration film method and were composed of DOTAP; 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE), containing or not Rhodaminephosphatidylethanolamine (PE- Rhodamine) and the conjugate Hyaluronic Acid DOPE (HA-DOPE). These systems were also characterized as nanoemulsions. Stability of the systems and the influence of time, size of plasmid and presence or absence of endotoxin in the formation of lipoplexes were also analyzed. Besides, the ophthalmic biodistribution of PE-Rhodamine containing liposomes was studied after intravitreal injection. The obtained results show that these systems are promising non-viral vector for further utilization in gene therapy and that this field seems to be very important in the clinical practice in this century. However, from the possibility to the practice, there is still a long way

Efecto del ejercicio de tiro y arrastre sobre el eje renina-angiotensina-aldosterona y cociente testosterona/cortisol en caballos euhidratados y deshidratados

Introducción. El estado hídrico previo al inicio de un ejercicio (hiperhidratación-deshidratación o hipohidratación y euhidratación) modifica la respuesta neurohumoral. En personas, la deshidratación origina una liberación incrementada de las hormonas implicadas en el mantenimiento de la volemia y del estado hidroelectrolítico, tales como la renina (REN), angiotensina (ANG) y aldosterona (ALD). La testosterona (T) es una hormona anabólica, mientras que el cortisol (C) es una hormona de estrés, con funciones catabólicas. El cociente T/C es un reflejo de la intensidad anabólica/catabólica de un ejercicio y en atletas humanos, se ve afectada por el estado hídrico. Objetivos. 1) Describir las variaciones en las concentraciones de REN, ANG, ALD, T, C y ratio T/C en caballos durante un ejercicio de tiro y arrastre, en relación con otros marcadores de equilibrio hidroelectrolítico y en función de la carga arrastrada; 2) Analizar si la respuesta de estas hormonas al ejercicio difiere entre animales con deshidratación hipertónica y euhidratados; Hipótesis: 1) Que las concentraciones de REN, ANG, ALD, T, C serán más elevadas en los caballos deshidratados que en los euhidratados; 2) Que el ejercicio de tiro y arrastre, particularmente en los animales de mayor peso corporal, inducirá una mayor activación del eje REN, ANG, ALD y una liberación superior de T; 3) Que los animales deshidratados experimentarán un incremento más intenso de estas hormonas en respuesta al ejercicio. Material y métodos. Se han llevado a cabo dos estudios simultáneos. En el estudio I, se han analizado los siguientes parámetros: valor hematócrito (HTO), albúmina (ALB), sodio (Na), potasio (K), cloro (Cl), lactato (LA) y concentraciones séricas de REN, ANG y ALD y en el estudio II, se han determinado las concentraciones de ALB, T, C y ratio T/C. En el estudio I, se han incluido 64 caballos machos, enteros y castrados, divididos en dos grupos según su estado hídrico: grupo control o euhidratado (CTR, n=11) y grupo deshidratado (DH; n=53), con deshidratación hipertónica inducida por restricción de agua y comida. Además, según su peso corporal, los animales se han dividido en 3 categorías de peso: I (<350 kg; n=3 para grupo CTR; n=23 para DH), II (351-450 kg; n=3 para CTR; n=18 para DH) y III (>451 kg; n=5 para CTR; n=12 para DH). En el estudio II, se han incluido los mismos animales, con excepción de la categoría de peso III para el grupo CTR, que solo está constituida por 3 animales, en lugar de 5, al descartar a los machos castrados, debido a la medición de T. Todos los animales, realizaron un ejercicio consistente en recorrer una pista de arena de playa de 60 m de longitud, tirando de un carruaje, con 2, 2,25 y 2,5 veces su peso corporal para las tres categorías de peso. La pista de arena se dividió en cuatro áreas de 15 m, en cada una de las cuales, el animal hizo una parada obligatoria, de duración decidida por el acompañante, y que se incluyó como tiempo de carrera. Los animales eran eliminados si se superan los 5 min de duración. En los dos estudios, se tomaron muestras de sangre en los siguientes tiempos: en reposo, antes del ejercicio (R), dentro del primer minuto tras finalizar el ejercicio (E) y a los 5, 10, 15 y 30 minutos de una recuperación pasiva (5REC, 10REC, 15REC y 30REC). Resultados. Estudio I. La diferencia de peso de los caballos tuvo una influencia mínima en los valores basales y en la respuesta al ejercicio. En reposo, los caballos DH tuvieron valores superiores de HTO, ALB, LA, Na, K y ANG en comparación con los CTR. El ejercicio condicionó una elevación de HTO, ALB, LA y Na, tanto en los caballos CTR como en los DH. Se encontró un incremento de ANG en los caballos DH y de ALD en los caballos CTR. La elevación con el ejercicio experimentada por los parámetros analizados fue de magnitud similar en los grupos CTR y DH, con excepción del LA (incrementó más en DH) y ALD (aumentó más en CTR). Estudio II. El ejercicio dio lugar a un aumento de T en las categorías I y III de los grupos CTR y DH, así como un descenso en la categoría II del grupo CTR. El C mostró un aumento progresivo en las tres categorías y en los dos grupos de estado hídrico, con los valores máximos en el tiempo 30REC. El ratio T/C aumentó en la categoría III del grupo DH, descendió en la categoría II del grupo CTR y no varió en los otros casos. Los animales DH, independientemente de la categoría de peso, tuvieron valores superiores de T y C, en la mayoría de los tiempos de extracción de muestras. Sin embargo, si se consideran los cambios experimentados por estas hormonas durante el ejercicio o en la recuperación, en relación a los valores basales, el aumento del C fue más marcado en el grupo CTR que en el DH, para las tres categorías de peso. Las variaciones de la concentración de T fueron superiores en las categorías de peso I y III del grupo CTR que en el grupo DH. El ratio T/C fue estadísticamente igual entre caballos CTR y DH en las categorías I y III, mientras que en la categoría II, los caballos DH presentaron cocientes T/C mayores. Conclusiones. La deshidratación hipertónica altera la concentración de las hormonas implicadas en la regulación del equilibrio hidro-electrolítico, de la presión sanguínea y del metabolismo. Sin embargo, el estado hídrico previo al ejercicio tiene una acción mínima sobre la magnitud de estos cambios en respuesta a un ejercicio de tiro y arrastre de corta duración (inferior a 5 min). Relevancia. Se ha demostrado que la respuesta neurohumoral, determinada en base a las concentraciones circulantes de las hormonas REN, ANG, ALD, T y C, se ve afectada por el ejercicio cuando el animal empieza el mismo en estado de euhidratación o de deshidratación.

Estudo da adição de polímero superabsorvente e de nano partículas de sílica para melhorar propriedades de concretos de alta resistência

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Civil e Ambiental, 2016.

Partial molar volumes of l-serine and l-threonine in aqueous ammonium sulfate solutions at (278.15, 288.15, 298.15, and 308.15) K

In this study, the partial molar volumes of L-serine and L-threonine in aqueous solutions of ammonium sulfate at (0.0, 0.1, 0.3, 0.7, and 1.0) mol.kg(-1) are reported between 278.15 and 308.15 K. Transfer volumes and hydration numbers were obtained, which are larger in L-serine than in L-threonine. Dehydration of the amino acids is observed, rising with the temperature and salt molality. The data suggest that interactions between ions and charged/hydrophilic groups are predominant, and by applying the McMillan and Mayer formalism, it was concluded that they are mainly pair wise. The combination of the data presented in this study with solubility and molecular dynamics data suggests a stronger interaction of the ammonium cation with the zwitterionic centers of the amino acids when compared to the interactions of those centers with the sulfate anion.

Partial molar volumes of glycine and dl-alanine in aqueous ammonium sulfate solutions at 278.15, 288.15, 298.15 and 308.15 K

In this work, the partial molar volumes of glycine and DL-alanine in aqueous solutions of ammonium sulfate at 0.0, 0.1, 0.3, 0.7, and 1.0 mol.kg(-1) are determined between 278.15 and 308.15 K. Transfer volumes were obtained, which are larger for glycine than DL-alanine. On the contrary, the hydration numbers are higher for DL-alanine than glycine, and dehydration of the amino acids is observed with increasing temperature or salt molality. The data suggest that interactions between ion and charged/hydrophilic groups are predominant and, by applying the methodology proposed by Friedman and Krishnan, it was concluded that they are mainly pairwise. A group-contribution scheme has been successfully applied to the pairwise volumetric interaction coefficient. Finally, the dehydration effect on glycine, alanine and serine in the presence of different electrolytes has been rationalized in terms of the charge density and a parameter accounting for the cation's hydration.

The use of mo and cu monochromatic radiations for quantitative phase analysis: study of the accuracy

Cement hydration is a very complex process in which crystalline phases are dissolving in water and after supersaturation hydrated crystalline and amorphous phases precipitate. Great efforts are being made to develop analytical tools to accurately quantify these processes and X-ray Powder Diffraction (XRPD) combined with Rietveld methodology is a suitable tool to quantify these complex mixtures and their time evolutions. However, some problems/drawbacks should be overcome to fully apply it to cement pastes characterization in order to get accurate phase analyses. In order to tackle this issue, a comparison of the Rietveld quantitative phase analyses (RQPA) obtained using Cu-Kα1, Mo-Kα1, and synchrotron strictly monochromatic radiations of three set of mixtures with increasing amounts of a given phase (spiking-method) is presented. The main aim is to test a simple hypothesis: high energy Mo-radiation, combined with high resolution laboratory X-ray powder diffraction optics, could yield more accurate RQPA, for challenging samples, than well-established Cu-radiation procedure(s). Firstly, a series of crystalline inorganic phase mixtures with increasing amounts of an analyte was studied in order to determine if Mo-Kα1 methodology is as robust as the well-established Cu-Kα1 one. Secondly, a series of crystalline organic phase mixtures with increasing amounts of an organic compound was analyzed. This type of mixture can result in transparency problems in reflection and inhomogeneous loading in narrow capillaries for transmission studies. Finally, a third series with variable amorphous content was studied. Limit of detection in Cu-patterns, ~0.2 wt%, are slightly lower than those derived from Mo-patterns, ~0.3 wt%, for similar recording times and limit of quantification for a well crystallized inorganic phase using laboratory powder diffraction was established ~0.10 wt%. From the obtained results it is inferred that RQPA from Mo-Kα1 radiation have slightly better accuracies than those obtained from Cu-Kα1. The results obtained in the previous comparison have been taken into account to obtain accurate RQPA, including the amorphous component with internal standard methodology, of hydrating cement pastes. The final goal of this second study was understanding the early-stage hydration mechanisms of a variety of cementing systems (Ordinary Portland Cement or Belite Alite Ye’elimite cement) as a function of water content, superplasticizer additives and type and content of sulfate source. In order to do so, X-ray powder diffraction data were taken in-situ with the humidity chamber coupled to the Mo-Kα1 powder diffractometer. Some results of this ongoing investigation will be reported and discussed.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

Volumetric interactions of a series of α-amino acids in aqueous magnesium chloride solutions at 278.15, 288.15, 298.15, and 308.15 K

In this work, the partial molar volumes of glycine, l-alanine, l-valine, l-serine, and l-threonine in aqueous solutions of magnesium chloride at 0.0, 0.1, 0.3, 0.7, and 1.0 molal are addressed between 278.15 and 308.15 K. Volumes of transfer were obtained, following the rank serine > glycine a parts per thousand threonine > alanine > valine. Differently, the hydration numbers follow the sequence serine > valine > alanine > threonine > glycine, and dehydration of the amino acids is observed, rising the temperature or salt molality. The data suggest that interactions are mainly pairwise, between the ions and charged/hydrophilic groups of the amino acids. Within the Friedman and Krishnan formalism, a group-contribution scheme has been successfully applied to the pairwise volumetric interaction coefficient. Finally, the dehydration effect of MgCl2 on glycine, alanine, and serine has been predicted applying empirical correlations developed before, showing satisfactory results.