Nursing Activities Score e demanda de trabalho de enfermagem em terapia intensiva

OBJETIVO: Medir e caracterizar a carga de trabalho de enfermagem em Unidade de Terapia Intensiva (UTI) por meio da aplicação do Nursing Activities Score (NAS). MÉTODOS: Estudo descritivo quantitativo, retrospectivo, realizado em uma das UTIs de um Hospital Filantrópico de Teresina- PI, de setembro a outubro de 2010, com amostra de 66 pacientes. Foram realizadas 285 medidas do escore NAS. RESULTADOS: Quanto à carga de trabalho de enfermagem, foi verificada uma média do escore total do NAS de 68,1% (51,5% e 108,3%), correspondendo à porcentagem de tempo gasto pelo profissional de enfermagem na assistência direta ao paciente nas 24 horas. Houve correlação estatística entre NAS e desfecho clínico (p= 0,001). Já entre NAS e tempo de internação (p= 0,073) e NAS e idade (p=0,952), não houve significância estatística. CONCLUSÃO: Os resultados mostraram que os pacientes apresentaram elevada necessidade de cuidados, refletida pela média elevada do NAS.

Nursing intervention in insulin administration: telephone follow-up

OBJECTIVE: To analyze the competency of people with diabetes mellitus to perform the insulin administration process, before and after telephone monitoring. METHODS: A quantitative, observational, longitudinal, comparative study. Participants were 26 people enrolled in the at-home capillary glycemia self-monitoring program. Data collection occurred in three phases, in January and February of 2010, for a period of 30 days for each person, by means of interview guided by a data collection instrument and an intervention manual. RESULTS: Of the 38 (100%) questions referring to the insulin administration process, telephone monitoring was demonstrated to be efficient in 30 (78.9%), but in 19 (50%) the intervention was statistically significant (p<0.05), in 11 (28.9%) there were no errors in responses to the final competency evaluation, and seven (18.4%) were not amenable to intervention. CONCLUSION: Telephone mornitoring was effective, as a nursing intervention strategy for the insulin administration process in the home.

Rainwater major and trace element contents in Southeastern Brazil: an assessment of a sugar cane region in dry and wet period

The purpose of this study was to assess the composition of the rainwater in Araraquara City, Brazil, a region strongly influenced by pre-harvest burning of sugar cane crops. Chemical and mineralogical variables were measured in rainwater collected during the harvest, dry period of 2009 and the non-harvest, wet period of 2010. Ca2+ and NH4+ were responsible for 55% of cations and NO3- for 45% of anions in rainwater. Al and Fe along with K were the most abundant among trace elements in both soluble and insoluble fractions. High volume weighted mean concentration (VWM) for most of the analyzed species were observed in the harvest, dry period, mainly due to agricultural activities and meteorological conditions. The chemistry of the Araraquara rainwater and principal component analysis (PCA) quantification clearly indicate the concurrence of a diversity of sources from natural to anthropogenic especially related to agricultural activities.

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution Nº 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

From "wet biology" to statistical analysis of structural features with bioinformatics tools

Many new Escherichia coli outer membrane proteins have recently been identified by proteomics techniques. However, poorly expressed proteins and proteins expressed only under certain conditions may escape detection when wild-type cells are grown under standard conditions. Here, we have taken a complementary approach where candidate outer membrane proteins have been identified by bioinformatics prediction, cloned and overexpressed, and finally localized by cell fractionation experiments. Out of eight predicted outer membrane proteins, we have confirmed the outer membrane localization for five—YftM, YaiO, YfaZ, CsgF, and YliI—and also provide preliminary data indicating that a sixth—YfaL—may be an outer membrane autotransporter.

Atmospheric corrosion of quaternary bronzes (Cu-Sn-Zn-Pb): laboratory tests (accelerated ageing in wet & dry conditions)and field studies (the Bottego monument in Parma, Italy).

The interactions between outdoor bronzes and the environment, which lead to bronze corrosion, require a better understanding in order to design effective conservation strategies in the Cultural Heritage field. In the present work, investigations on real patinas of the outdoor monument to Vittorio Bottego (Parma, Italy) and laboratory studies on accelerated corrosion testing of inhibited (by silane-based films, with and without ceria nanoparticles) and non-inhibited quaternary bronzes are reported and discussed. In particular, a wet&dry ageing method was used both for testing the efficiency of the inhibitor and for patinating bronze coupons before applying the inhibitor. A wide range of spectroscopic techniques has been used, for characterizing the core metal (SEM+EDS, XRF, AAS), the corroded surfaces (SEM+EDS, portable XRF, micro-Raman, ATR-IR, Py-GC-MS) and the ageing solutions (AAS). The main conclusions were: 1. The investigations on the Bottego monument confirmed the differentiation of the corrosion products as a function of the exposure geometry, already observed in previous works, further highlighting the need to take into account the different surface features when selecting conservation procedures such as the application of inhibitors (i.e. the relative Sn enrichment in unsheltered areas requires inhibitors which effectively interact not only with Cu but also with Sn). 2. The ageing (pre-patination) cycle on coupons was able to reproduce the relative Sn enrichment that actually happens in real patinated surfaces, making the bronze specimens representative of the real support for bronze inhibitors. 3. The non-toxic silane-based inhibitors display a good protective efficiency towards pre-patinated surfaces, differently from other widely used inhibitors such as benzotriazole (BTA) and its derivatives. 4. The 3-mercapto-propyl-trimethoxy-silane (PropS-SH) additivated with CeO2 nanoparticles generally offered a better corrosion protection than PropS-SH.

Enteric coated mucoadhesive micropellets in rotary agglomeration process for wet spheronization

In this work a generally applicable method for the preparation of mucoadhesive micropellets of 250 to 600µm diameter is presented using rotor processing without the use of electrolytes. The mucoadhesive micropellets were developed to combine the advantages of mucoadhesion and microparticles. It was possible to produce mucoadhesive micropellets based on different mucoadhesive polymers Na-CMC, Na-alginate and chitosan. These micropellets are characterized by a lower friability (6 to 17%) when compared to industrial produced cellulose pellets (Cellets®) (41.5%). They show great tapped density and can be manufactured at high yields. The most influencing variables of the process are the water content at the of the end spraying period, determined by the liquid binder amount, the spraying rate, the inlet air temperature, the airflow and the humidity of the inlet air and the addition of the liquid binder, determined by the spraying rate, the rotor speed and the type of rotor disc. In a subsequent step a fluidized bed coating process was developed. It was possible to manifest a stable process in the Hüttlin Mycrolab® in contrast to the Mini-Glatt® apparatus. To reach enteric resistance, a 70% coating for Na-CMC micropellets, an 85% for chitosan micropellets and a 140% for Na-alginate micropellets, based on the amount of the starting micropellets, was necessary. Comparative dissolution experiments of the mucoadhesive micropellets were performed using the paddle apparatus with and without a sieve inlay, the basket apparatus, the reciprocating cylinder and flow-through cell. The paddle apparatus and the modified flow-through cell method turned out to be successful methods for the dissolution of mucoadhesive micropellets. All dissolution profiles showed an initial burst release followed by a slow release due to diffusion control. Depending on the method, the dissolution profiles changed from immediate release to slow release. The dissolution rate in the paddle apparatus was mainly influenced by the agitation rate whereas the flow-through cell pattern was mainly influenced by the particle size. Also, the logP and the HLB values of different emulsifiers were correlated to transfer HLB values of excipients into logP values and logP values of API´s into HLB values. These experiments did not show promising results. Finally, it was shown that manufacture of mucoadhesive micropellets is successful resulting in product being characterized by enteric resistency combined with high yields and convincing morphology.

Wet chemistry synthesis towards nanostructures of thermoelectric antimonides

Die vorliegende Arbeit befasst sich mit der Synthese von nanostrukturierten Antimoniden, wobei die folgenden beiden Themen bearbeitet wurden: rnAus chemischer Sicht wurden neue Synthesewege entwickelt, um Nanopartikel der Verbindungen in den binären Systemen Zn-Sb und Fe-Sb herzustellen (Zn4Sb3, ZnSb, FeSb2, Fe1+xSb). Anders als in konventionellen Festkörperreaktionen, die auf die Synthese von Bulk-Materialien oder Einkristallen zielen, muss die Synthese von Nanopartikeln Agglomerate und Ostwald-Wachstum vermeiden. Daher benötigen annehmbare Reaktionszeiten und vergleichsweise tiefe Reaktionstemperaturen kurze Diffusionswege und tiefe Aktivierungsbarrieren. Demzufolge bedient sich die Synthese der Reaktion von Antimon-Nanopartikeln und geeigneten molekularen oder nanopartikulären Edukten der entsprechenden Übergangsmetalle. Zusätzlich wurden anisotrope ZnSb Strukturen synthetisiert, indem eine Templat-Synthese mit Hilfe von anodisierten Aluminiumoxid- oder Polycarbonat-Membranen angewandt wurde. rnDie erhaltenen Produkte wurden hauptsächlich durch Röntgen-Diffraktion und Elektronenmikroskopie untersucht. Die Auswertung der Pulver Röntgendiffraktions-Daten stellte eine Herausforderung dar, da die Nanostrukturierung und die Anwesenheit von mehreren Phasen zu verbreiterten und überlagernden Reflexen führen. Zusätzliche Fe-Mößbauer Messungen wurden im Falle der Fe-Sb Produkte vorgenommen, um detailliertere Informationen über die genaue Zusammensetzung zu erhalten. Die erstmals hergestellte Phase Zn1+xSb wurde einer detaillierten Kristallstrukturanalyse unterzogen, die mit Hilfe einer neuen Diffraktionsmethode, der automatisierten Elektronen Diffraktions Tomographie, durchgeführt wurde.rnrnAus physikalischer Sicht sind Zn4Sb3, ZnSb und FeSb2 interessante thermoelektrische Materialien, die aufgrund ihrer Fähigkeit thermische in elektrische Energie umzuwandeln, großes Interesse geweckt haben. Nanostrukturierte thermoelektrische Materialien zeigen dabei eine höhere Umwandlungseffizienz zu erhöhen, da deren thermische Leitfähigkeit herabgesetzt ist. Da thermoelektrische Bauteile aus dichten Bulk-Materialien gefertigt werden, spielte die Verfestigung der synthetisierten nanopartikulären Pulver eine große Rolle. Die als „Spark Plasma Sintering“ bezeichnete Methode wurde eingesetzt, um die Proben zu pressen. Dies ermöglicht schnelles Heizen und Abkühlen der Probe und kann so das bei klassischen Heißpress-Methoden unvermeidliche Kristallitwachstum verringern. Die optimalen Bedingungen für das Spark Plasma Sintern zu finden, ist Inhalt von bestehender und weiterführender Forschung. rnEin Problem stellt die Stabilität der Proben während des Sinterns dar. Trotz des schnellen Pressens wurde eine teilweise Zersetzung im Falle des Zn1+xSb beobachtet, wie mit Hilfe von Synchrotrondiffraktionsuntersuchungen aufgedeckt wurde. Morphologie und Dichte der verschiedenen verfestigten Materialien wurden mittels Rasterelektronenmikroskopie und Lasermikroskopie bestimmt. Die Gitterdynamik wurde mit Hilfe von Wärmekapazitätsmessungen- und inelastischer Kern-Streuung untersucht. Die Wärmeleitfähigkeit der nanostrukturierten Materialien ist im Vergleich zu den Festkörpern ist drastisch reduziert - im Falle des FeSb2 um mehr als zwei Größenordnungen. Abhängig von der Zusammensetzung und mechanischen Härte wurden für einen Teil der verfestigten Nanomaterialien die thermoelektrische Eigenschaften, wie Seebeck Koeffizient, elektrische und Wärmeleitfähigkeit, gemessen.rn

Wet and dry model granulates under mechanical load : a confocal microscopy study

Granular matter, also known as bulk solids, consists of discrete particles with sizes between micrometers and meters. They are present in many industrial applications as well as daily life, like in food processing, pharmaceutics or in the oil and mining industry. When handling granular matter the bulk solids are stored, mixed, conveyed or filtered. These techniques are based on observations in macroscopic experiments, i.e. rheological examinations of the bulk properties. Despite the amply investigations of bulk mechanics, the relation between single particle motion and macroscopic behavior is still not well understood. For exploring the microscopic properties on a single particle level, 3D imaging techniques are required.rnThe objective of this work was the investigation of single particle motions in a bulk system in 3D under an external mechanical load, i.e. compression and shear. During the mechanical load the structural and dynamical properties of these systems were examined with confocal microscopy. Therefor new granular model systems in the wet and dry state were designed and prepared. As the particles are solid bodies, their motion is described by six degrees of freedom. To explore their entire motion with all degrees of freedom, a technique to visualize the rotation of spherical micrometer sized particles in 3D was developed. rnOne of the foci during this dissertation was a model system for dry cohesive granular matter. In such systems the particle motion during a compression of the granular matter was investigated. In general the rotation of single particles was the more sensitive parameter compared to the translation. In regions with large structural changes the rotation had an earlier onset than the translation. In granular systems under shear, shear dilatation and shear zone formation were observed. Globally the granular sediments showed a shear behavior, which was known already from classical shear experiments, for example with Jenike cells. Locally the shear zone formation was enhanced, when near the applied load a pre-diluted region existed. In regions with constant volume fraction a mixing between the different particle layers occurred. In particular an exchange of particles between the current flowing region and the non-flowing region was observed. rnThe second focus was on model systems for wet granular matter, where an additional binding liquid is added to the particle suspension. To examine the 3D structure of the binding liquid on the micrometer scale independently from the particles, a second illumination and detection beam path was implemented. In shear and compression experiments of wet clusters and bulk systems completely different dynamics compared to dry cohesive models systems occured. In a Pickering emulsion-like system large structural changes predominantly occurred in the local environment of binding liquid droplets. These large local structural changes were due to an energy interplay between the energy stored in the binding droplet during its deformation and the binding energy of particles at the droplet interface. rnConfocal microscopy in combination with nanoindentation gave new insights into the single particle motions and dynamics of granular systems under a mechanical load. These novel experimental results can help to improve the understanding of the relationship between bulk properties of granular matter, such as volume fraction or yield stress and the dynamics on a single particle level.rnrn

Wet bioadhesion in tree frogs

Viele Tiere wie etwa Geckos oder Laubfrösche können mittels ihrer Haftscheiben an Oberflächen kleben. Diese Haftscheiben ermöglichen es den Tieren, sich während ihrerrnFortbewegung an Oberflächen anzuheften und wieder zu lösen unabhängig von denrnvorherrschenden Umweltbedingungen. Frösche besitzen mikro- und nanostrukturierternsowie charakteristisch geformte Haftscheiben an Finger- und Zehenenden. Ihre besonderernevolutionäre Errungenschaft, sich stark und zugleich reversibel in sowohl trockenen alsrnauch feuchten Umgebungen anzuhaften, hat die Wissenschaft zur Nachahmung und Untersuchungrndieser Strukturen inspiriert. Zum besseren Verständnis der Mechanismen vonrnAnhaftung und Loslösung bei Laubfröschen wurden weiche, elastische und mikrostrukturierternOberflächen hergestellt, indem PDMS (Polydimethylsiloxan) auf einer Siliziummaskernmit Hexagonstruktur aufgetragen und vernetzt wurde. Dadurch wurden Anordnungenrnvon hexagonalen Mikrosäulen mit spezifischen geometrischen Eigenschaften undrnunterschiedlichen Kontaktgeometrien (normale, flache Form, T-Form und konkave Formrnder Säulenenden) erhalten. Um den Einfluss der van-der-Waals, hydrodynamischen,rnKapillar-und Adhäsionskräfte zu verstehen, wurden verschiedene experimentelle Ansätzernverfolgt: Die auf eine einzelne Säule wirkenden Adhäsionskräfte wurden mittelsrnRasterkraftmikroskopie gemessen. Dazu wurden speziell hergestellte kolloidale Sensorenrnverwendet. Diese Experimente wurden sowohl mit als auch ohne Flüssigkeitsfilm auf derrnSäule durchgeführt. Die Ergebnisse zeigten den Beitrag von Kapillarkraft und direktenrnKontaktkräften zur Adhäsionskraft bei Vorliegen eines Flüssigkeitsfilms. Die Adhäsionrnfiel umso größer aus, je weniger Flüssigkeit zwischen Sensor und Säule vorhanden war.rnIm Falle einer trockenen Adhäsion zeigte die Säule mit T-Form die höchste Adhäsion. Darndie Haftscheiben der Laubfrösche weich sind, können sie dynamisch ihre Form ändern,rnwas zu einer Änderung der hydrodynamischen Kraft zwischen Scheibe und Oberflächernführt. Der Einfluss der Oberflächenverformbarkeit auf die hydrodynamische Kraft wurderndaher am Modellsystem einer Kugel untersucht, welche sich einer weichen und ebenenrnOberfläche annähert. Dieses System wurde sowohl theoretisch über die Simulation finiterrnElemente als auch experimentell über die Messung mit kolloidalen Sonden untersucht.rnSowohl experimentelle Ergebnisse als auch die Simulationen ergaben eine Abnahme derrnhydrodynamischen Kraft bei Annäherung des kolloidalen Sensors an eine weiche undrnelastische Oberfläche. Beim Entfernen der Sensors von der Oberfläche verstärkte sichrndie hydrodynamische Anziehungskraft. Die Kraft, die zur Trennung eines Partikels von einer Oberfläche in Flüssigkeit notwendig ist, ist für weiche und elastischen Oberflächenrngrößer als für harte Oberflächen. In Bezug zur Bioadhäsion bei Laubfröschen konnternfestgestellt somit festgestellt werden, dass sich der hydrodynamische Anteil zur feuchtenrnBioadhäsion aufgrund der weichen Oberfläche erhöht. Weiterhin wurde der Einflussrndes Aspektverhältnisses der Säulen auf die Reibungskraft mittels eines kolloidalen Sensorsrnuntersucht. Gestreckte Säulen zeigten dabei eine höhere Reibung im Vergleich zu.rnSäulen mit einem gestreckten Hexagon als Querschnitt.

Reduction of inappropriate medications among older nursing-home residents: a nurse-led, pre/post-design, intervention study

Background: Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults. Objective: To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting. Study Design: The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up. Setting: 204-bed inpatient NH in Bern, Switzerland. Participants: NH residents aged ≥60 years. Intervention: The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training. Main Outcome Measure: IM prescription at study start, after the 4-month intervention period and at 1-year follow-up. Results: The mean±SD resident age was 80.3±8.8 years. Residents were prescribed a mean±SD 7.8±4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1). Conclusions: This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.