Segurança do paciente na utilização de heparina sódica intravenosa: cuidados de enfermagem baseados na análise dos fatores de risco para eventos hemorrágicos

O objeto deste estudo são os eventos hemorrágicos em pacientes críticos que utilizam infusão contínua de heparina sódica. Tem como objetivo geral propor cuidados de enfermagem para pacientes que recebem infusão contínua de heparina, a fim de aumentar a segurança do paciente e reduzir a ocorrência de hemorragia, com base nos fatores de risco. Esta pesquisa procura contribuir com a farmacovigilância da heparina e com a qualidade da assistência de enfermagem. Trata-se de um estudo de coorte retrospectivo, com análise em prontuário, desenvolvido em unidade intensiva e semi-intensiva de um hospital público do Rio de Janeiro. Foram investigados 867 prontuários de 2010 a 2011, encontrando-se uma população de 79 pacientes que fizeram uso de heparina sódica em infusão contínua. As variáveis do estudo foram submetidas a tratamentos estatísticos não paramétricos e a medidas de associação. Os resultados apontam entre os pacientes três diagnósticos: fibrilação atrial, trombose venosa profunda e síndrome coronariana; percebe-se ainda predomínio do sexo feminino (58,23%) e de idosos (md=65 anos). A taxa de eventos hemorrágicos foi de 21,52% e se mostrou mais elevada quando comparada a outros estudos. Evidencia-se que pacientes com TTPa maior do que 100s tem um risco 9,29 vezes maior de apresentar eventos hemorrágicos. Todos os fatores de risco idade maior do que sessenta anos, hipertensão arterial sistêmica, TTPa maior do que 100s, uso prévio de anticoagulante e insuficiência renal apresentam associação positiva com a presença de evento hemorrágico. Entre os pacientes com eventos hemorrágicos, 94,16% apresentam um ou mais fatores de risco para sangramento. Os eventos hemorrágicos foram identificados na pele (47,37%), em sítio de punção, nas vias aéreas, no sistema geniturinário (15,79%) e no sistema gastrointestinal (10,53%). A maioria (55%) dos eventos hemorrágicos foi classificada com tipo 2 de BARC. Na associação entre o dispositivo invasivo utilizado e o tipo de sangramento, 100% dos pacientes com sangramento de via aérea ou do sistema gastrointestinal utilizavam sonda nasoentérica. Paciente com cateter vesical de demora (CVD) tem sete vezes mais risco de hematúria quando comparados com pacientes sem CVD; já pacientes com acesso venoso periférico tem menos risco de sangramento de sítio de punção quando comparados ao pacientes com acesso venoso central (RR= 0,74; 1,29). Essas associações norteiam a assistência de enfermagem e sugerem que o enfermeiro seja cauteloso ao realizar esses procedimentos nos pacientes com heparina sódica. Frente às variações no TTPa dosado, analisou-se o seguimento do protocolo e detectou-se que, nos pacientes com eventos hemorrágicos, a taxa de erro no ajuste da infusão foi maior (76,24%) quando comparada com os pacientes sem eventos hemorrágicos (39,05%). Ao se associar a taxa de erro da infusão com a presença de evento hemorrágico, evidencia-se que, quando a heparina não é ajustada segundo o protocolo, aumenta-se em 3,3 vezes o risco de evento hemorrágico. Portanto, para garantir o uso seguro na infusão de heparina, descrevem-se alguns cuidados específicos de enfermagem baseados nos fatores de risco e na indicação clínica de cada paciente.

Individual growth rates and movement of juvenile white shrimp (Litopenaeus setiferus) in a tidal marsh nursery

We measured growth and movements of individually marked free-ranging juvenile white shrimp (Litopenaeus setiferus) in tidal creek subsystems of the Duplin River, Sapelo Island, Georgia. Over a period of two years, 15,974 juvenile shrimp (40−80 mm TL) were marked internally with uniquely coded microwire tags and released in the shallow upper reaches of four salt marsh tidal creeks. Subsequent samples were taken every 3−6 days from channel segments arranged at 200-m intervals along transects extending from the upper to lower reach of each tidal creek. These collections included 201,384 juvenile shrimp, of which 184 were marked recaptures. Recaptured shrimp were at large an average of 3−4 weeks (range: 2−99 days) and were recovered a mean distance of <0.4 km from where they were initially marked. Mean residence times in the creek subsystems ranged from 15.2 to 25.5 days and were estimated from exponential decay functions describing the proportions of marked individuals recaptured with increasing days at large. Residence time was not significantly correlated with creek length (Pearson=−0.316, P=0.684 ), but there was suggestive evidence of positive associations with either intertidal (Pearson r=0.867, P=0.133) or subtidal (Pearson r=0.946, P=0.054) drainage area. Daily mean specific growth rates averaged 0.009 to 0.013 among creeks; mean absolute growth rates ranged from 0.56−0.84 mm/d, and were lower than those previously reported for juvenile penaeids in estuaries of the southeastern United States. Mean individual growth rates were not significantly different between years (t-test, P>0.30) but varied significantly during the season, tending to be greater in July than November. Growth rates were size-dependent, and temporal changes in size distributions rather than temporal variation in physical environmental factors may have accounted for seasonal differences in growth. Growth rates differed between creeks in 1999 (t-test, P<0.015), but not in 1998 (t-test, P>0.5). We suggest that spatial variation in landscape structure associated with access to intertidal resources may have accounted for this apparent interannual difference in growth response.

光系统II反应中心复合物组成性质与光仰制分子机理研究

由于光系统Ⅱ反应中心Dl/D2/Cyt b559色素蛋白复合物(PSII-RC)的红 区吸收光谱严重重叠，给其组成特性研究及光抑制分子机理研究造成 了困难，因此我们运用多种光谱分析技术配合计算机数据处理技术对 PSII-RC复合物的组成特性进行了研究，并用自己建立的方法对PSII-RC 的色素和多肽的化学计量进行了进一步确定，另外还重点研究了单线 态氧在PSII-RC光破坏中的作用，据此提出新的PSD[-RC光抑制分子机 理。主要结果如下： 1．用反相HPLC外标法测定我们制备的色谱纯PSR-RC样品的色素化 学计量结果为Chl:Pheo:Car= 6:2:2。我们发现，当PSII-RC中存在微量CP47 时，Chl: Pheo的比例与CP47的含量呈正相关关系，说明较高的Chl比例 可能表示样品中有CP47污染。结果还表明PSII-RC中Car: Pheo的比例也与 CP47含量有关，说明CP47可影响Car在PSII-RC上的结合，这暗示CP47可 能结合Car，或者CP47对PSII-RC上Car的结合位点有影响，这一推测对阐 明CP47的功能有一定启发作用。 2．建立了一种估算PSII-RC多肽化学计量的理论计算方法，即利用计 算机统计PSII-RC中各多肽组分的不同氨基酸残基数量，以确定不同多 肽化学计量时的理论氨基酸残基组成，并与PSlI-RC的实测氨基酸残基 组成进行比较，得到所用PSII-RC样品的多肽化学计量值为D1+D2:Cyt b559-o+邮：I=2:1:1. 3．对PSII-RC的红区吸收光谱进行了高斯解析，发现680 nm附近含有 峰高和半高宽明显不同的两个高斯组分，它们对光抑制处理的响应具 有明显差别，分别表现了P680和Pheo的特征。由此可知，在680nm处除了 有P680的信号外，PSII-RC中的Pheo在这个区域也有跃迁组分。这个结果 表明光抑制进程中PSII-RC红区吸收光谱信号的下降除了P680的破坏 外，还与Pheo的破坏有关。 4．用Ste)anov关系式分析了PSII-RC色素激发态分布的平衡状态，发现 经过暗适应的PSII-RC的激发态可达到充分的平衡，光抑制处理可导致 PSIL-RC激发态平衡受到破坏。 5．用荧光发射光谱观察到PSII-RC在光抑制进程中有弱光破坏和强光 破坏两个破坏过程，前者是与色素间能量传递的色素结合状态与 取向的破坏，后者与色素本身化学结构的破坏有关。通过研究不同激发波长下的发射光谱发现Car的弱光破坏过程比Chl快，暗示Car可能的保护作用，而Pheo的破坏程度比Chl小。从发射光谱组分的光破坏时间 进程推断强光破坏过程导致的色素破坏是多步反应，验证我们小组原 先报导的PSII-RC的多步反应特性。 6．首次将磁圆二色光谱( MCD)技术应用于PSII-RC研究，发现MCD明显表现出比吸收光谱要丰富得多的光谱精细结构，同时还具有较高的灵敏度和分辨率，不经过任何解析就可直接观察到680 nm组分及其它色素组分的变化，而且PSⅡ-RC中的Car没有明显MCD信号，使PSII-RC谱 图简化，便于进一步分析。用MCD技术还观察到光抑制初期Chl从PSII- RC复合物上脱离及Pheo的光破坏现象。 7．分别用HPLC法、吸收光谱高斯解析法、荧光发射光谱分析法和MCD法共四种方法证明了PSII-RC中Pheo的光破坏，充分证实我们小组关于Pheo光破坏的报导，同时还证明Pheo的光破坏是单线态氧作用的结果。 8．给出了单线态氧参与PSII-RC色素和蛋白光破坏的直接实验证 据，即发现光抑制过程中色素和蛋白的破坏受到单线态氧的特异性清除剂的保护，用化学方法在暗中产生的单线态氧同样造成与光抑制相 似的PSII-RC各组分的损伤，由此说明单线态氧是PSII-RC光抑制过程中 的直接破坏因子。 9．提出了PSII-RC中Hiis残基光破坏的一种新的分子机理。用组氨酸残基的特异性化学修饰剂证实以前我们实验室发现的PSI[-RC组氨酸残基的光破坏，根据比较蛋白变性前后的测定结果，初步证明PSIl-RC中 受光破坏的His残基位于P680附近。我们还观察到光抑制处理后，PSII- RC表现与组氨酸残基被修饰后的样品相似的紫外吸收特征，由此提出 PSII-RC中His残基光破坏的一种分子机理，即His残基的眯唑环上的两个氮原子与其它多肽上的游离氨基在单线态氧的作用下发生反应形成酰 胺键而导致PsII-RC多肽间的共价交联，推测PSII-RC中His残基的光破坏与其蛋白的光致交联和降解有直接的因果联系。

Heat transfer and aerodynamics of turbine blade tips in a linear cascade

Local measurements of the heat transfer coefficient and pressure coefficient were conducted on the tip and near tip region of a generic turbine blade in a five-blade linear cascade. Two tip clearance gaps were used: 1.6% and 2.8% chord. Data was obtained at a Reynolds number of 2.3 × 10 5 based on exit velocity and chord. Three different tip geometries were investigated: a flat (plain) tip, a suction-side squealer, and a cavity squealer. The experiments reveal that the flow through the plain gap is dominated by flow separation at the pressure-side edge and that the highest levels of heat transfer are located where the flow reattaches on the tip surface. High heat transfer is also measured at locations where the tip-leakage vortex has impinged onto the suction surface of the aerofoil. The experiments are supported by flow visualisation computed using the CFX CFD code which has provided insight into the fluid dynamics within the gap. The suction-side and cavity squealers are shown to reduce the heat transfer in the gap but high levels of heat transfer are associated with locations of impingement, identified using the flow visualisation and aerodynamic data. Film cooling is introduced on the plain tip at locations near the pressure-side edge within the separated region and a net heat flux reduction analysis is used to quantify the performance of the successful cooling design. copyright © 2005 by ASME.

莱州湾西南岸河口地貌演化及典型环境要素的遥感研究

河口和潮汐海湾是受陆海相互作用共同影响的一个复杂动力系统，是陆海相 互作用研究的理想区域。特别是大河影响下的邻近海域，其海岸带发育、动力地 貌、生态环境必将表现出复杂的特征，开展该区域的陆海相互作用研究是非常必 要的。本文采用遥感定量反演手段和泥沙模拟估算方法，结合多年潮汐数据、河 口段水文水质观测数据、近岸区遥感和历史图件等从研究莱州湾西南近岸物质组 成与输运特征，河口沙坝地貌演化及动力机制，河口拦门沙发育演变，水质状况 监测分析等方面探讨黄河影响下的风暴潮、水质污染灾害严重的莱州湾西南近岸 区域的陆海相互作用特征。 结果表明，近岸为典型粉砂淤泥质的莱州湾西南海岸，其泥沙主要来源于近 岸与外海再悬浮供沙、黄河来沙。海区内泥沙运移格局主要为外海泥沙有由河口 口门外向河道运移的趋势、莱州湾西部近岸海区存在一股黄河南向的沿岸泥沙 流，其主要在淄脉沟口以北区域沉积。在正常天气条件下，河口及附近海区泥沙 含量较低，风暴潮期间本海区的悬浮泥沙含量将增加4-5 倍，最高可达10 倍， 其泥沙运移范围主要在河口与近岸海域。 小清河河口属陆海双相缓混合型，其河口堆积地貌主要包括河口沙嘴、沙坝 和河道拦门沙体。径、潮流携带泥沙分别在河口区和口门以内落淤形成拦门沙体 和堆积沙坎。在NE 向波浪和NE-E 向的涨、落潮流作用下，局地再悬浮的泥沙 和沿岸流携带的部分输沙堆积在河口北侧，形成沿落潮流方向延伸的河口沙嘴； 河口段河道南移过程中存在沙嘴、沙坝相互转化的自调整过程，并认为1979-1982 年和1997-2000 年两个时间段为自调整过程的中期。 根据小清河河口沙坝的发育过程及其发育特征，本文提出了该沙坝地貌发育 演变的概念模式。

高频发射机帘栅开关电源装置

本实用新型涉及一种高频发射机帘栅开关电源装置。以高频发射机为主体，连接直流变换器、反激式逆变器、高频整流滤波电路、高频机帘栅开关电源连接；高频机帘栅开关电源又与取样电路、脉宽调制器、直流变换器连接，形成环路反馈调压系统，从而保证了帘栅电源的输出电压长期稳定在１×１０＃＋［－４］，满足了高频大动率发射机的特殊要求。

Embodied energy as an environmental impact indicator for basement wall construction

Attempts were made to quantify the environmental impacts of the basement walls of two commercial buildings in London. Four different retaining wall options were designed based on steel and concrete systems for each of the sites. It was considered that excavation would take place with the aid of a one or two anchors system. Evaluation of embodied energy (EE) and CO2 emissions for each of the wall designs and anchoring systems were compared. Results show that there are notable differences in EE between different wall designs. Using the averaged set of Embodied Energy Intensity (EEI) values, the use of recycled steel over virgin steel would reduce the EE of the wall significantly. The difference in anchor designs is relatively insignificant, and therefore the practicality of the design for the specific site should be the deciding factor for anchor types. Generally, the scale of environmental impacts due to constructions is large compared to other aspects in life as demonstrated with the comparisons to car emissions and household energy consumption. Copyright ASCE 2008.

Design-phase-specific selection of user research methods

For increasing the usability of a medical device the usability engineering standards IEC 60601-1-6 and IEC 62366 suggest incorporating user information in the design and development process. However, practice shows that integrating user information and the related investigation of users, called user research, is difficult in the field of medical devices. In particular, identifying the most appropriate user research methods is a difficult process. This difficulty results from the complexity of the medical device industry, especially with respect to regulations and standards, the characteristics of this market and the broad range of potential user research methods available from various research disciplines. Against this background, this study aimed at guiding designers and engineers in selecting effective user research methods according to their stage in the design process. Two approaches are described which reduce the complexity of method selection by summarizing the high number of methods into homogenous method classes. These approaches are closely connected to the medical device industry characteristic design phases and therefore provide the possibility of selecting design-phase- specific user research methods. In the first approach potential user research methods are classified after their characteristics in the design process. The second approach suggests a method summarization according to their similarity in the data collection techniques and provides an additional linkage to design phase characteristics. Both approaches have been tested in practice and the results show that both approaches facilitate user research method selection. © 2009 Springer-Verlag.

A novel family of antimicrobial peptides from the skin of Amolops loloensis

While conducting experiments to investigate antimicrobial peptides of amphibians living in the Yunnan-Sichuan region of southwest China, a new family of antimicrobial peptides was identified from skin secretions of the rufous-spotted torrent frog, Amolops loloensis. Members of the new peptide family named amolopins are composed of 18 amino acids with a unique sequence, for example, NILSSIVNGINRALSFFG. By BLAST search, amolopins did no show similarity to any known peptides. Among the tested microorganisms, native and synthetic peptides only showed antimicrobial activities against Staphylococcus aureus ATCC2592 and Bacillus pumilus, no effects on other microorganisms. The CD spectroscopy showed that it adopted a structure of random combined with beta-sheet in water, Tris-HCl or Tris-HCl-SDS. Several cDNAs encoding amolopins were cloned from the skin cDNA library of A. loloensis. The precursors of amolopin are composed of 62 amino acid residues including predicted signal peptides, acidic propieces, and mature antimicrobial peptides. The preproregion of amolopin precursor comprises a hydrophobic signal peptide of 22 residues followed by an 18 residue acidic propiece which terminates by a typical prohormone processing signal Lys-Arg. The preproregions of precursors are very similar to other amphibian antimicrobial peptide precursors but the mature amolopins are different from other antimicrobial peptide families. The remarkable similarity of preproregions of precursors that give rise to very different antimicrobial peptides in distantly related frog species suggests that the corresponding genes form a multigene family originating from a common ancestor. (C) 2008 Elsevier Masson SAS. All rights reserved.