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.

Modeling surface-atmosphere exchange of trace gases and energy within and above the Amazon rain forest

Die vorliegende Dissertation untersucht die biogeochemischen Vorgänge in der Vegetationsschicht (Bestand) und die Rückkopplungen zwischen physiologischen und physikalischen Umweltprozessen, die das Klima und die Chemie der unteren Atmosphäre beeinflussen. Ein besondere Schwerpunkt ist die Verwendung theoretischer Ansätze zur Quantifizierung des vertikalen Austauschs von Energie und Spurengasen (Vertikalfluss) unter besonderer Berücksichtigung der Wechselwirkungen der beteiligten Prozesse. Es wird ein differenziertes Mehrschicht-Modell der Vegetation hergeleitet, implementiert, für den amazonischen Regenwald parametrisiert und auf einen Standort in Rondonia (Südwest Amazonien) angewendet, welches die gekoppelten Gleichungen zur Energiebilanz der Oberfläche und CO2-Assimilation auf der Blattskala mit einer Lagrange-Beschreibung des Vertikaltransports auf der Bestandesskala kombiniert. Die hergeleiteten Parametrisierungen beinhalten die vertikale Dichteverteilung der Blattfläche, ein normalisiertes Profil der horizontalen Windgeschwindigkeit, die Lichtakklimatisierung der Photosynthesekapazität und den Austausch von CO2 und Wärme an der Bodenoberfläche. Desweiteren werden die Berechnungen zur Photosynthese, stomatären Leitfähigkeit und der Strahlungsabschwächung im Bestand mithilfe von Feldmessungen evaluiert. Das Teilmodell zum Vertikaltransport wird im Detail unter Verwendung von 222-Radon-Messungen evaluiert. Die ``Vorwärtslösung'' und der ``inverse Ansatz'' des Lagrangeschen Dispersionsmodells werden durch den Vergleich von beobachteten und vorhergesagten Konzentrationsprofilen bzw. Bodenflüssen bewertet. Ein neuer Ansatz wird hergeleitet, um die Unsicherheiten des inversen Ansatzes aus denjenigen des Eingabekonzentrationsprofils zu quantifizieren. Für nächtliche Bedingungen wird eine modifizierte Parametrisierung der Turbulenz vorgeschlagen, welche die freie Konvektion während der Nacht im unteren Bestand berücksichtigt und im Vergleich zu früheren Abschätzungen zu deutlich kürzeren Aufenthaltszeiten im Bestand führt. Die vorhergesagte Stratifizierung des Bestandes am Tage und in der Nacht steht im Einklang mit Beobachtungen in dichter Vegetation. Die Tagesgänge der vorhergesagten Flüsse und skalaren Profile von Temperatur, H2O, CO2, Isopren und O3 während der späten Regen- und Trockenzeit am Rondonia-Standort stimmen gut mit Beobachtungen überein. Die Ergebnisse weisen auf saisonale physiologische Änderungen hin, die sich durch höhere stomatäre Leitfähigkeiten bzw. niedrigere Photosyntheseraten während der Regen- und Trockenzeit manifestieren. Die beobachteten Depositionsgeschwindigkeiten für Ozon während der Regenzeit überschreiten diejenigen der Trockenzeit um 150-250%. Dies kann nicht durch realistische physiologische Änderungen erklärt werden, jedoch durch einen zusätzlichen cuticulären Aufnahmemechanismus, möglicherweise an feuchten Oberflächen. Der Vergleich von beobachteten und vorhergesagten Isoprenkonzentrationen im Bestand weist auf eine reduzierte Isoprenemissionskapazität schattenadaptierter Blätter und zusätzlich auf eine Isoprenaufnahme des Bodens hin, wodurch sich die globale Schätzung für den tropischen Regenwald um 30% reduzieren würde. In einer detaillierten Sensitivitätsstudie wird die VOC Emission von amazonischen Baumarten unter Verwendung eines neuronalen Ansatzes in Beziehung zu physiologischen und abiotischen Faktoren gesetzt. Die Güte einzelner Parameterkombinationen bezüglich der Vorhersage der VOC Emission wird mit den Vorhersagen eines Modells verglichen, das quasi als Standardemissionsalgorithmus für Isopren dient und Licht sowie Temperatur als Eingabeparameter verwendet. Der Standardalgorithmus und das neuronale Netz unter Verwendung von Licht und Temperatur als Eingabeparameter schneiden sehr gut bei einzelnen Datensätzen ab, scheitern jedoch bei der Vorhersage beobachteter VOC Emissionen, wenn Datensätze von verschiedenen Perioden (Regen/Trockenzeit), Blattentwicklungsstadien, oder gar unterschiedlichen Spezies zusammengeführt werden. Wenn dem Netzwerk Informationen über die Temperatur-Historie hinzugefügt werden, reduziert sich die nicht erklärte Varianz teilweise. Eine noch bessere Leistung wird jedoch mit physiologischen Parameterkombinationen erzielt. Dies verdeutlicht die starke Kopplung zwischen VOC Emission und Blattphysiologie.

Sensitivity of atmospheric CO2 and climate to explosive volcanic eruptions

Impacts of low-latitude, explosive volcanic eruptions on climate and the carbon cycle are quantified by forcing a comprehensive, fully coupled carbon cycle-climate model with pulse-like stratospheric aerosol optical depth changes. The model represents the radiative and dynamical response of the climate system to volcanic eruptions and simulates a decrease of global and regional atmospheric surface temperature, regionally distinct changes in precipitation, a positive phase of the North Atlantic Oscillation, and a decrease in atmospheric CO2 after volcanic eruptions. The volcanic-induced cooling reduces overturning rates in tropical soils, which dominates over reduced litter input due to soil moisture decrease, resulting in higher land carbon inventories for several decades. The perturbation in the ocean carbon inventory changes sign from an initial weak carbon sink to a carbon source. Positive carbon and negative temperature anomalies in subsurface waters last up to several decades. The multi-decadal decrease in atmospheric CO2 yields a small additional radiative forcing that amplifies the cooling and perturbs the Earth System on longer time scales than the atmospheric residence time of volcanic aerosols. In addition, century-scale global warming simulations with and without volcanic eruptions over the historical period show that the ocean integrates volcanic radiative cooling and responds for different physical and biogeochemical parameters such as steric sea level or dissolved oxygen. Results from a suite of sensitivity simulations with different magnitudes of stratospheric aerosol optical depth changes and from global warming simulations show that the carbon cycle-climate sensitivity γ, expressed as change in atmospheric CO2 per unit change in global mean surface temperature, depends on the magnitude and temporal evolution of the perturbation, and time scale of interest. On decadal time scales, modeled γ is several times larger for a Pinatubo-like eruption than for the industrial period and for a high emission, 21st century scenario.

Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy

The purposes of the study reported here were to evaluate the signalment and clinical presentation in 50 dogs with degenerative myelopathy, to evaluate whether mean survival time was significantly affected by various means of physiotherapy performed in 22 dogs, and to determine whether neurologic status, anatomic localization, or age at onset had an influence on survival time in dogs that received physiotherapy. We found a significant (P < .05) breed predisposition for the German Shepherd Dog, Kuvasz, Hovawart, and Bernese Mountain Dog. Mean age at diagnosis was 9.1 years, and both sexes were affected equally. The anatomic localization of the lesion was spinal cord segment T3-L3 in 56% (n = 28) and L3-S3 in 44% (n = 22) of the dogs. Animals that received intensive (n = 9) physiotherapy had longer (P < .05) survival time (mean 255 days), compared with that for animals with moderate (n = 6; mean 130 days) or no (n = 7; mean 55 days) physiotherapy. In addition, our results indicate that affected dogs which received physiotherapy remained ambulatory longer than did animals that did not receive physical treatment.

A shift from oral to intravenous iron supplementation therapy is observed over time in a large swiss cohort of patients with inflammatory bowel disease

BACKGROUND In 2007, leading international experts in the field of inflammatory bowel disease (IBD) recommended intravenous (IV) iron supplements over oral (PO) ones because of superior effectiveness and better tolerance. We aimed to determine the percentage of patients with IBD undergoing iron therapy and to assess the dynamics of iron prescription habits (IV versus PO). METHODS We analyzed anonymized data on patients with Crohn's disease and ulcerative colitis extracted from the Helsana database. Helsana is a Swiss health insurance company providing coverage for 18% of the Swiss population (1.2 million individuals). RESULTS In total, 629 patients with Crohn's disease (61% female) and 398 patients with ulcerative colitis (57% female) were identified; mean observation time was 31.8 months for Crohn's disease and 31.0 months for ulcerative colitis patients. Of all patients with IBD, 27.1% were prescribed iron (21.1% in males; 31.1% in females). Patients treated with steroids, immunomodulators, and/or anti-tumor necrosis factor drugs were more frequently treated with iron supplements when compared with those not treated with any medications (35.0% versus 20.9%, odds ratio, 1.94; P < 0.001). The frequency of IV iron prescriptions increased significantly from 2006 to 2009 for both genders (males: from 2.6% to 10.1%, odds ratio = 3.84, P < 0.001; females: from 5.3% to 12.1%, odds ratio = 2.26, P = 0.002), whereas the percentage of PO iron prescriptions did not change. CONCLUSIONS Twenty-seven percent of patients with IBD were treated with iron supplements. Iron supplements administered IV were prescribed more frequently over time. These prescription habits are consistent with the implementation of guidelines on the management of iron deficiency in IBD.

Dating groundwater in the Bohemian Cretaceous Basin: Understanding tracer variations in the subsurface

The northern section of the Bohemian Cretaceous Basin has been the site of intensive U exploitation with harmful impacts on groundwater quality. The understanding of groundwater flow and age distribution is crucial for the prediction of the future dispersion and impact of the contamination. State of the art tracer methods (3H, 3He, 4He, 85Kr, 39Ar and 14C) were, therefore, used to obtain insights to ageing and mixing processes of groundwater along a north–south flow line in the centre of the two most important aquifers of Cenomanian and middle Turonian age. Dating of groundwater is particularly complex in this area as: (i) groundwater in the Cenomanian aquifer is locally affected by fluxes of geogenic and biogenic gases (e.g. CO2, CH4, He) and by fossil brines in basement rocks rich in Cl and SO4; (ii) a thick unsaturated zone overlays the Turonian aquifer; (iii) a periglacial climate and permafrost conditions prevailed during the Last Glacial Maximum (LGM), and iv) the wells are mostly screened over large depth intervals. Large disagreements in 85Kr and 3H/3He ages indicate that processes other than ageing have affected the tracer data in the Turonian aquifer. Mixing with older waters (>50 a) was confirmed by 39Ar activities. An inverse modelling approach, which included time lags for tracer transport throughout the unsaturated zone and degassing of 3He, was used to estimate the age of groundwater. Best fits between model and field results were obtained for mean residence times varying from modern up to a few hundred years. The presence of modern water in this aquifer is correlated with the occurrence of elevated pollution (e.g. nitrates). An increase of reactive geochemical indicators (e.g. Na) and radiogenic 4He, and a decrease in 14C along the flow direction confirmed groundwater ageing in the deeper confined Cenomanian aquifer. Radiocarbon ages varied from a few hundred years to more than 20 ka. Initial 14C activity for radiocarbon dating was calibrated by means of 39Ar measurements. The 14C age of a sample recharged during the LGM was further confirmed by depleted stable isotope signatures and near freezing point noble gas temperature. Radiogenic 4He accumulated in groundwater with concentrations increasing linearly with 14C ages. This enabled the use of 4He to validate the dating range of 14C and extend it to other parts of this aquifer. In the proximity of faults, 39Ar in excess of modern concentrations and 14C dead CO2 sources, elevated 3He/4He ratios and volcanic activity in Oligocene to Quaternary demonstrate the influence of gas of deeper origin and impeded the application of 4He, 39Ar and 14C for groundwater dating.

Triple isotope (δD, δ17O, δ18O) study on precipitation, drip water and speleothem fluid inclusions for a Western Central European cave (NW Switzerland)

Deuterium (δD) and oxygen (δ18O) isotopes are powerful tracers of the hydrological cycle and have been extensively used for paleoclimate reconstructions as they can provide information on past precipitation, temperature and atmospheric circulation. More recently, the use of δ17O excess derived from precise measurement of δ17O and δ18O gives new and additional insights in tracing the hydrological cycle whereas uncertainties surround this proxy. However, 17O excess could provide additional information on the atmospheric conditions at the moisture source as well as about fractionations associated with transport and site processes. In this paper we trace water stable isotopes (δD,δ17O and δ18O) along their path from precipitation to cave drip water and finally to speleothem fluid inclusions for Milandre cave in northwestern Switzerland. A two year-long daily resolved precipitation isotope record close to the cave site is compared to collected cave drip water (3 months average resolution) and fluid inclusions of modern and Holocene stalagmites. Amount weighted mean δD,δ18O and δ17O are -71.0‰, -9.9‰, -5.2‰ for precipitation, -60.3‰, -8.7‰, -4.6‰ for cave drip water and -61.3‰, -8.3‰, -4.7‰ for recent fluid inclusions respectively. Second order parameters have also been derived in precipitation and drip water and present similar values with 18 per meg for 17O excess whereas d-excess is 1.5‰ more negative in drip water. Furthermore, the atmospheric signal is shifted towards enriched values in the drip water and fluid inclusions (Δ of ~ + 10‰ for δD). The isotopic composition of cave drip water exhibits a weak seasonal signal which is shifted by around 8 - 10 months (groundwater residence time) when compared to the precipitation. Moreover, we carried out the first δ17O measurement in speleothem fluid inclusions, as well as the first comparison of the δ17 O behaviour from the meteoric water to the fluid inclusions entrapment in speleothems. This study on precipitation, drip water and fluid inclusions will be used as a speleothem proxy calibration for Milandre cave in order to reconstruct paleotemperatures and moisture source variations for Western Central Europe.

Radiocarbon ages and plateau definitions of sediments from the abyssal ocean

Ice core records demonstrate a glacial-interglacial atmospheric CO2 increase by ~100 ppm, while 14C calibration efforts document a strong decrease in atmospheric 14C concentration during this period. A calculated transfer of ~530 Gt of 14C depleted carbon is required to produce the deglacial coeval rise of carbon in the atmosphere and terrestrial biosphere. This amount is usually ascribed to oceanic carbon release, although the actual mechanisms remained elusive, since an adequately old and carbon-enriched deep-ocean reservoir seemed unlikely. Here we present a new, though still fragmentary, ocean-wide d14C dataset showing that during the Last Glacial Maximum (LGM) and Heinrich Stadial 1 (HS-1) the maximum 14C age difference between ocean deep waters and the atmosphere exceeded the modern values by up to 1500 14C yr, in the extreme reaching 5100 14C yr. Below 2000 m depth the 14C ventilation age of modern ocean waters is directly linked to the concentration of dissolved inorganic carbon (DIC). We propose as working hypothesis that the modern regression of DIC vs d14C also applies for LGM times, which implies that a mean LGM aging by ~600 14C yr corresponded to a global rise of ~85-115 µmol DIC/kg in the deep ocean. Thus, the prolonged residence time of ocean deep waters may indeed have made it possible to absorb an additional ~730-980 Gt DIC, one third of which possibly originated from intermediate waters. We also infer that LGM deep-water O2 dropped to suboxic values of <10µmol/kg in the Atlantic sector of the Southern Ocean, possibly also in the subpolar North Pacific. The outlined deglacial transfer of the extra aged, deep-ocean carbon to the atmosphere via the dynamic ocean-atmosphere carbon exchange would be sufficient to account for two trends observed, (1) for the increase in atmospheric CO2 and (2) for the 190-permil drop in atmospheric d14C during the so-called HS-1 'Mystery Interval', when atmospheric 14C production rates were largely constant.

Phosphorus partition and acumulation rates in sediments of ODP Legs 130 and 138

Understanding phosphorus (P) geochemistry and burial in oceanic sediments is important because of the role of P for modulating oceanic productivity on long timescales. We investigated P geochemistry in seven equatorial Pacific sites over the last 53 Ma, using a sequential extraction technique to elucidate sedimentary P composition and P diagenesis within the sediments. The dominant P-bearing component in these sediments is authigenic P (61-86% of total P), followed in order of relative dominance by iron-bound P (7-17%), organic P (3-12%), adsorbed P (2-9%), and detrital P (0-1%). Clear temporal trends in P component composition exist. Organic P decreases rapidly in younger sediments in the eastern Pacific (the only sites with high sample resolution in the younger intervals), from a mean concentration of 2.3 µmol P/g sediment in the 0-1 Ma interval to 0.4 µmol/g in the 5- 6 Ma interval. Over this same time interval, decreases are also observed for iron-bound P (from 2.1 to 1.1 µmol P/g) and adsorbed P (from 1.5 to 0.7 µmol P/g). These decreases are in contrast to increases in authigenic P (from 6.0-9.6 µmol P/g) and no significant changes in detrital P (0.1 µmol P/g) and total P (12 µmol P/g). These temporal trends in P geochemistry suggest that (1) organic matter, the principal shuttle of P to the seafloor, is regenerated in sediments and releases associated P to interstitial waters, (2) P associated with iron-rich oxyhydroxides is released to interstitial waters upon microbial iron reduction, (3) the decrease in adsorbed P with age and depth probably indicates a similar decrease in interstitial water P concentrations, and (4) carbonate fluorapatite (CFA), or another authigenic P-bearing phase, precipitates due to the release of P from organic matter and iron oxyhydroxides and becomes an increasingly significant P sink with age and depth. The reorganization of P between various sedimentary pools, and its eventual incorporation in CFA, has been recognized in a variety of continental margin environments, but this is the first time these processes have been revealed in deep-sea sediments. Phosphorus accumulation rate data from this study and others indicates that the global pre-anthropogenic input rate of P to the ocean (20x10**10 mol P/yr) is about a factor of four times higher than previously thought, supporting recent suggestions that the residence time of P in the oceans may be as short as 10000-20000 years.