Qualidade da água no município de Lençóis Paulista-SP e Comparação entre métodos de purificação de água

The purpose of a water treatment plant (WTP) is to provide quality water to the population in the municipality where it is operate, being directly linked to the health of the community. The efficiency of a water treatment is directly related to the quality and reliability of the methods used. The analytical results of any laboratory test or calibration is a critical process for any company today. A tool used to assist in a quality management system process is ISO/IEC 17025:2005. Given the above, the objective of this study was to evaluate the performance of an ETA located in Lençóis Paulista-SP, using the analytical results obtained by physical, chemical and microbiological determinations in the period 1-30 October 2015. Such determinations are grounded in compliance with current Ordinance 2914 the Ministry of Health and the Quality Management System, which is required for all laboratories carrying out laboratory tests for control and surveillance of water quality for human consumption

Caracterização química e legalidade em bebidas não alcoólicas de maçã

Apple is a fruit that offers promising prospect for industrialization as it has favorable characteristics for this purpose and can obtain products with good acceptance. In Brazil, approximately 15% of the production is processed into juice, and a portion is exported. Among the fresh fruit and juice, apple adds US$ 30 million annually to the Brazilian foreign exchange earnings. The aim of this study was to characterize, using chemical analysis, concentrated juices, commercial apple juice, nectar, and soft drink. In addition, to compare them with their respective Quality and Identity Standards (PIQ) published by the Ministry of Agriculture, Livestock and Food Supply (MAPA) and Codex Alimentarius. Concentrated juices and commercial beverages were analyzed in triplicate for soluble solids content (Brix), pH, total acidity (AT), and ratio. In concentrated juices, the Total Sugar Reducer (ART) was also assessed. The results obtained in the laboratory were compared with the PIQ and Codex Alimentarius to verify compliance with applicable regulations. Seven concentrate juices, five juices, six nectars, and three apple-flavoured soft drinks were analyzed. The Brix of pulpy and clarified concentrated juices were, respectively, 71.16±1.29 and 40.40±0.57°Brix. In all concentrated juices, the Brix was in accordance with Codex Alimentarius. The Brix and AT in sweetened clarified juices were 11.50±0.14°Brix and 0.18±0.04g of malic acid/100g sample. In pulpy whole juices the values ​​were 11.20±0.70°Brix and 0.30±0.06g of malic acid/100g sample. The values of Brix and AT in apple-flavoured soft drinks were 11.03±0.93°Brix and 0.18±0.04g of malic acid/100ml sample. Commercial juices and soft drinks also presented °Brix and AT in accord with the PIQ established by MAPA. The apple nectars could not be compared with the standards because they are not published by MAPA or Codex Alimentarius. The definition of the PIQ is an important tool for quality control of beverages manufacture in Brazil. Therefore, it is recommended for the control agencies to define the parameters that are not established.

Material educativo para familiares de recém-nascidos em terapia intensiva neonatal: percepção dos pais e equipe de saúde

Pós-graduação em Enfermagem - FMB

Análise de misturas solo-agregado reciclados de resíduos sólidos da construção civil, para fins de pavimentação de vias urbanas de baixo volume de tráfego

This work deals with the continuation of Scientific Initiation research initiated by Tamura (2012), which draws up a mixture of soil and recycled aggregate analysis for paving of low traffic volume roads using local materials from the Vale do Paraíba region. The main steps of the process were the soil and recycled aggregate characterization, along with grading tests and California Bearing Ratio (CBR) applied to the soil, the recycled aggregate and the mixture of soil and recycled aggregate; aiming their use as base and sub-base in paving urban roads. The results are discussed, emphasizing the mechanical behavior. The current results are compared with the results of IC Tamura research, taking decisions over this job to the final product best result. For a greater understanding of the work in general were described paving, its structure, its components and its physical behavior. It has been intended to emphasize the importance of the mixture of soil and recycled aggregate to meet the quality requirements and compliance with the specifications of current technical standards, in the context of durability, natural materials economy, decreases volume in landfills and cost reduction

RELATED LAWS ON EXOTIC AND NATIVE WILD ANIMALS

This paper is submitted in an effort to acquaint the personnel of allied State agencies with related laws which control the public and private possession of live exotic and native wild animals. The need for this common knowledge of related laws by agencies with law enforcement responsibility is readily apparent when the annual number and related problems from imported or resident wild animals in California are examined. In addition to resident wild animal populations, millions of fish and thousands of mammals, birds, and reptiles enter California each year through the utilization of most methods of transportation. Most of these imported animals are exotic species from foreign lands which cannot be readily identified and pose various degrees of potential and actual threat to native wild life, agriculture, and public health if they are introduced into the wilds of this State. For the purpose of this report, a general picture of imported exotic animals is presented in an introduction, and specific animals with related laws are treated individu-ally under the headings of current laws and future regulations.

Análise de misturas solo-agregado reciclados de resíduos sólidos da construção civil, para fins de pavimentação de vias urbanas de baixo volume de tráfego

This work deals with the continuation of Scientific Initiation research initiated by Tamura (2012), which draws up a mixture of soil and recycled aggregate analysis for paving of low traffic volume roads using local materials from the Vale do Paraíba region. The main steps of the process were the soil and recycled aggregate characterization, along with grading tests and California Bearing Ratio (CBR) applied to the soil, the recycled aggregate and the mixture of soil and recycled aggregate; aiming their use as base and sub-base in paving urban roads. The results are discussed, emphasizing the mechanical behavior. The current results are compared with the results of IC Tamura research, taking decisions over this job to the final product best result. For a greater understanding of the work in general were described paving, its structure, its components and its physical behavior. It has been intended to emphasize the importance of the mixture of soil and recycled aggregate to meet the quality requirements and compliance with the specifications of current technical standards, in the context of durability, natural materials economy, decreases volume in landfills and cost reduction

A general framework for multi-compartmental analysis of drug chemotherapy dynamics in human immunodeficiency virus type-1 infected individuals

An optimal control strategy for the highly active antiretroviral therapy associated to the acquired immunodeficiency syndrome should be designed regarding a comprehensive analysis of the drug chemotherapy behavior in the host tissues, from major viral replication sites to viral sanctuary compartments. Such approach is critical in order to efficiently explore synergistic, competitive and prohibitive relationships among drugs and, hence, therapy costs and side-effect minimization. In this paper, a novel mathematical model for HIV-1 drug chemotherapy dynamics in distinct host anatomic compartments is proposed and theoretically evaluated on fifteen conventional anti-retroviral drugs. Rather than interdependence between drug type and its concentration profile in a host tissue, simulated results suggest that such profile is importantly correlated with the host tissue under consideration. Furthermore, the drug accumulative dynamics are drastically affected by low patient compliance with pharmacotherapy, even when a single dose lacks. (C) 2012 Elsevier Inc. All rights reserved.

Applying validated quality indicators to surgical antibiotic prophylaxis in a Brazilian hospital: Learning what should be learned

Background: Compliance with the best surgical antibiotic prophylaxis practice is usually low despite many published guidelines. Objective: This study investigated compliance with the Hospital Infection Control Committee guideline for antibiotic prophylaxis in a Brazilian hospital using quality indicators. Methods: A retrospective study was carried out from November 2009 to March 2010. Medical records from adult inpatients undergoing cardiac, neurologic, and orthopedic clean surgeries were included. The full compliance index was considered 100% when the antibiotic prophylaxis showed adequacy in all evaluated attributes. Analyses were conducted with 5% significance. Results: Medical records from 101 cardiac, 128 neurologic, and 519 orthopedic surgical patients were evaluated. The compliance index was 4.9%, and the compliance index according to specialty was 5.8%, 3.1%, and 3.0%, respectively, for orthopedic, neurologic, and cardiac surgeries. The attribute route of administration produced the best outcomes, whereas the attribute duration of antibiotic prophylaxis produced the worst. No association was identified between compliance to the attributes and patient characteristics. Conclusion: This study showed a low level of adherence to Hospital Infection Control Committee guidelines for antibiotic prophylaxis. This suggests that different strategies should be implemented to promote the best possible practice in the field of antibiotic prophylaxis with greater surgeon engagement. Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere can enhance function of the paretic hand in patients with mild motor impairment. Effects of low-frequency rTMS to the contralesional motor cortex at an early stage of mild to severe hemiparesis after stroke are unknown. In this pilot, randomized, double-blind clinical trial we compared the effects of low-frequency rTMS or sham rTMS as add-on therapies to outpatient customary rehabilitation, in 30 patients within 5-45 days after ischemic stroke, and mild to severe hand paresis. The primary feasibility outcome was compliance with the interventions. The primary safety outcome was the proportion of intervention-related adverse events. Performance of the paretic hand in the Jebsen-Taylor test and pinch strength were secondary outcomes. Outcomes were assessed at baseline, after ten sessions of treatment administered over 2 weeks and at 1 month after end of treatment. Baseline clinical features were comparable across groups. For the primary feasibility outcome, compliance with treatment was 100% in the active group and 94% in the sham group. There were no serious intervention-related adverse events. There were significant improvements in performance in the Jebsen-Taylor test (mean, 12.3% 1 month after treatment) and pinch force (mean, 0.5 Newtons) in the active group, but not in the sham group. Low-frequency rTMS to the contralesional motor cortex early after stroke is feasible, safe and potentially effective to improve function of the paretic hand, in patients with mild to severe hemiparesis. These promising results will be valuable to design larger randomized clinical trials.

Nursing Workload as a Risk Factor for Healthcare Associated Infections in ICU: A Prospective Study

Introduction: Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS). Methods: This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. Results: 195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI. Conclusions: Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Influence of Roux-en-Y Gastric Bypass Surgery on Vitamin C, Myeloperoxidase, and Oral Clinical Manifestations: A 2-Year Follow-Up Study

Background: Bariatric surgery influences the intake and absorption of nutrients. The serum concentrations of vitamin C, myeloperoxidase (MPO) and oral clinical manifestations were examined in patients two years after Roux-en-Y gastric bypass (RYGB). Methods: Clinical prospective-study with control-group (CG; n = 26), assessed only once, and the bariatric-group (BG; n = 26), assessed in the basal period and at 12 and 24 months after surgery. The mean ages in the CG and BG were 37.8 +/- 1.51 and 39.6 +/- 1.93 years, respectively, and their body mass indices were 22.07 +/- 0.29 and 45.62 +/- 1.46 kg/m2, respectively. Results: At 12 months after surgery, increased episodes of vomiting (P < .001) and dental hypersensitivity (P=.012) were observed, with a reduction in the saliva buffering capacity of 21.3 2.9% (P=.004). At 24 months after RYGB, we detected a significant reduction in serum vitamin C (32.9 +/- 5.3%, P < .001) and MPO values were higher than in the basal period (P = .032). With regard to oral hygiene habits, 92.3% of patients reported frequent tooth brushing and 96.1% used fluoride, which were similar across the two years. However, dental hypersensitivity (P = .048) was significantly increased than baseline. Conclusions: The results demonstrated that vitamin C deficiency and increased vomiting after RYGB for morbid obesity may contribute to increased periodontal disease. The fact it is impossible to determine which factors (diet, poor compliance with supplementation, vomiting, poor oral hygiene) contributed to the dental problems in these patients is a shortcoming of the report. (Nutr Clin Pract. 2012; 27: 114-121)

Gauging food and nutritional care quality in hospitals

Background: Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods: Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results: Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Conclusions: Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

Prevalência de infecção pelo T. cruzi em doadores de sangue nos hemocentros coordenadores do Brasil em 2007

Objetivo: conhecer a prevalência de Trypanosoma cruzi entre os doadores de sangue, analisar a organização da rede de hemoterapia e as normas de segurança do sangue para transfusão no Brasil no ano de 2007. Métodos: estudo descritivo utilizando-se os Regulamentos Técnicos para hemoterapia definidos pela Agência Nacional de Vigilância Sanitária (Anvisa) e o questionário aplicado aos Hemocentros Coordenadores (HC) do Brasil. Resultados: responderam 84% dos hemocentros, onde doaram sangue 3.251.361 indivíduos, sendo 1.192 (0,04%) excluídos na triagem clínica por risco presumido para doença de Chagas; foram realizadas 2.726.668 sorologias; 5.432 (0,20%) foram reagentes para Trypanosoma cruzi e 3.065 (0,11%) inconclusivas. Conclusão: a falta de resposta dos Estados de Pernambuco, Bahia, Paraíba, Goiás e Rondônia constituiu limitação ao estudo; entretanto, os resultados obtidos sugerem baixa prevalência de Trypanosoma cruzi entre os doadores de sangue e indicam o cumprimento dos procedimentos para a segurança do sangue definidos pela Anvisa.

Desconsideração e consideração da pessoa jurídica no Direito Penal Ambiental: convergindo antíteses aparentes para a tutela penal do meio ambiente humano

A discussão da desconsideração da pessoa jurídica no âmbito do Direito Penal, em consonância à Lei n. 9.605/98, Lei dos Crimes Ambientais, pressupõe discutir, também, a própria consideração para efeitos penais.