Integrating risks of climate change into water management

The Working Group II contribution to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change critically reviewed and assessed tens of thousands of recent publications to inform about the assess current scientific knowledge on climate change impacts, vulnerability and adaptation. Chapter 3 of the report focuses on freshwater resources, but water issues are also prominent in other sectoral chapters and in the regional chapters of the Working Group II report as well as in various chapters of Working Group I. With this paper, the lead authors, a review editor and the chapter scientist of the freshwater chapter of the WGII AR5 wish to summarize their assessment of the most relevant risks of climate change related to freshwater systems and to show how assessment and reduction of those risks can be integrated into water management.

The urban cool island phenomenon in a high-rise high-density city and its mechanisms

The urban heat island (UHI) phenomenon has been studied extensively, but there are relatively fewer reports on the so-called urban cool island (UCI) phenomenon. We reveal here that the UCI phenomenon exists in Hong Kong during the day, and is associated with the UHI at night under all wind and cloud conditions. The possible mechanisms for the UCI phenomenon in such a high-rise compact city have been discovered using a lumped urban air temperature model. A new concept of urban cool island degree hours (UCIdh) to measure the UCI intensity and duration is proposed. Our analyses reveal that when anthropogenic heat is small or absent, a high-rise and high-density city experiences a significant daytime UCI effect. This is explained by an intensified heat storage capacity and the reduced solar radiation gain of urban surfaces. However, if anthropogenic heat in the urban area increases further, the UCI phenomenon still exists, yet UCIdh decrease dramatically in a high-rise compact city. In a low-rise, low-density city, the UCI phenomenon also occurs when there is no anthropogenic heat, but easily disappears when there is little anthropogenic heat, and the UHI phenomenon dominates. This probably explains why the UHI phenomenon is often observed, but the UCI phenomenon is rarely observed. The co-existence of urban heat/cool island phenomena implies reduction of the daily temperature range (DTR) in such cities, and its dependence on urban morphology also implies that urban morphology can be used to control the urban thermal environment.

Evolutionary model trees for handling continuous classes in machine learning

Model trees are a particular case of decision trees employed to solve regression problems. They have the advantage of presenting an interpretable output, helping the end-user to get more confidence in the prediction and providing the basis for the end-user to have new insight about the data, confirming or rejecting hypotheses previously formed. Moreover, model trees present an acceptable level of predictive performance in comparison to most techniques used for solving regression problems. Since generating the optimal model tree is an NP-Complete problem, traditional model tree induction algorithms make use of a greedy top-down divide-and-conquer strategy, which may not converge to the global optimal solution. In this paper, we propose a novel algorithm based on the use of the evolutionary algorithms paradigm as an alternate heuristic to generate model trees in order to improve the convergence to globally near-optimal solutions. We call our new approach evolutionary model tree induction (E-Motion). We test its predictive performance using public UCI data sets, and we compare the results to traditional greedy regression/model trees induction algorithms, as well as to other evolutionary approaches. Results show that our method presents a good trade-off between predictive performance and model comprehensibility, which may be crucial in many machine learning applications. (C) 2010 Elsevier Inc. All rights reserved.

Fenômeno vivido por familiares de pacientes internados em unidade de terapia intensiva

COMASSETTO, Isabel, ENDERS, Bertha Cruz. Fenômeno vivido por familiares de pacientes internados em Unidade de Terapia Intensiva. Revista Gaúcha de Enfermagem., Porto Alegre(RS), v.30,n., p.46-53. Mar. 2009. Disponivel em: < http://www.seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/search/results>.

Desigualdade regional da mortalidade neonatal no Brasil

In Brazil, despite the decline in infant mortality in recent decades it still has high rates going against recommended by WHO. Being the largest percentage of infant mortality rate composed of neonatal deaths. Objective: A study was conducted to analyze the spatial distribution of neonatal mortality and its correlation with the biological, socioeconomic and maternal and child health care in the Brazilian states in the period from 2006 to 2010. Method: The study made thematic maps and correlation (LISA) for verification of spatial dependence and multiple linear regression models. Results: Was found that there is no spatial autocorrelation for neonatal mortality in the Brazilian states (R = 0.002, p = 0.48). Most of variables were correlated (r> 0.3, p <0.05) with neonatal mortality, forming clusters in the North and Northeast, with the highest rates of teenage mothers, low household income per capita, lower prenatal appointments and beds of Neonatal Intensive Care Unit. The number of Neonatal UCI beds remained independent effect after regression analysis. Conclusion: The study concludes that regional inequalities in living conditions and especially the access to maternal and child health services contribute to the unequal distribution of neonatal mortality in Brazil

Bloqueio contínuo do plexo lombar via posterior bilateral com bomba de infusão descartável: relato de caso

JUSTIFICATIVA E OBJETIVOS: O número de artroplastia total de quadril (ATQ) bilateral tem aumentado a cada ano. Analgesia pós-operatória pela infusão contínua perineural com anestésico local tem se mostrado favorável quando comparada com analgesia sistêmica. O uso de bombas elastoméricas tem aumentado a satisfação do paciente quando em comparação com os modelos eletrônicos. O objetivo deste relato foi descrever um caso de analgesia contínua bilateral do plexo lombar via posterior, com infusão contínua através de bomba elastomérica, em paciente submetido à uma artroplastia bilateral de quadril. RELATO do CASO: Paciente feminina, 46 anos, 65 kg, 162 cm, com artrite reumatoide e hipertensão arterial, estado físico ASA II, escalada para ser submetida a ATQ bilateral em um único estágio. Uso de corticosteroide por 13 anos. Hemoglobina = 10,1 g.dL-1, hematócrito = 32,7%. Monitoração de rotina. Raquianestesia com 15 mg de bupivacaína 0,5% isobárica. Anestesia geral com propofol (PFS) e remifentanil e intubação sem bloqueadores neuromusculares. ATQ direita e no final, bloqueio plexo lombar com estimulador e conjunto agulha 150 mm e injeção de 20 mL bupivacaína 0,2% e passagem de cateter. ATQ esquerda e, no final, mesmo procedimento. Estudado dispersão do anestésico e contraste. Instalado bomba elastomérica com bupivacaína 0,1% (400 mL) em velocidade de 14 mL.h-1. Transferida para Unidade de Cuidados Intensivos (UCI). Vinte e quatro horas após, nova bomba com a mesma solução. Nenhum bolus durante 50 horas. Após remoção de cateter, dor controlada por via oral com cetoprofeno e dipirona. CONCLUSÕES: O bloqueio bilateral contínuo periférico com infusão de bupivacaína a 0,1% com bombas elastoméricas é um procedimento seguro e efetivo em adultos.

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dimensão pessoal do processo de trabalho para enfermeiras de Unidades de Terapia Intensiva

OBJETIVO: Compreender os aspectos da dimensão pessoal do processo de trabalho para enfermeiras que atuam em Unidades de Terapia Intensiva (UTI) de um hospital universitário do interior do Estado de São Paulo. MÉTODOS: Estudo de abordagem qualitativa utilizando o método fenomenológico. Foram entrevistadas 12 enfermeiras que trabalhavam nas UTI de adulto, pediátrica e coronariana dessa instituição hospitalar e para análise dos relatos, utilizou-se o referencial da estrutura do fenômeno situado. RESULTADOS: A análise dos relatos permitiu identificar a categoria: dimensão pessoal do trabalho na UTI, com os temas - trabalho gratificante, trabalho desgastante e (des) valorização do trabalho. CONCLUSÃO: Os resultados do estudo revelam que as enfermeiras das UTI selecionadas identificam-se com o trabalho, porém vivenciam situações desmotivadoras decorrentes da elevada carga de trabalho, que dificulta o desenvolvimento do processo de trabalho e compromete a qualidade do cuidado.

Revelando o processo de recriação do banho no leito no cenário da terapia intensiva: produto da sustentabilidade da enfermagem em incorporar o conhecimento êmico a sua práxis

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Estudo da associação entre urticária crônica idiopática e autoimunidade tireóidea: aspectos clínicos, positividade do teste do soro autólogo da pele e expressão gênica do receptor de TSH

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Família Enterobacteriaceae, Acinetobacter baumannii e Pseudomonados na microbiota bucal de pacientes mantidos em unidades de terapia intensiva

Enteric organisms, pseudomonads and other opportunistic microorganisms in the oral microbiota have been linked to serious infections in patients hospitalized in intensive care units (ICU). The present study evaluated the presence of family Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii in the mouth of patients in ICU, correlating it with oral and systemic conditions. Data on health, socioeconomic status, medication use, drug addiction, medical and family histories of patients held for more than 72 hours in the ICU with a diagnosis of severe infection or that developed this condition after entry in said unit were obtained. Fifty patients provided clinical samples of supragingival and subgingival biofilms, saliva and oral mucous membranes were collected, as well as respiratory secretions from patients with pneumonia, blood and urine for sepsis. The presence of target microorganisms was carried out by polymerase chain reaction (PCR) and by culture using selective media. The Chi-square and Mann-Whitney tests were used for statistical analysis, and the significance level was 5%. The intraoral clinical conditions of the patients were poor. The family Enterobacteriaceae was the most prevalent, affecting 39.5% of the supragingival biofilm samples of patients attended in ICU and 18.6% of patients in the control group, besides the rods were the only group found in extraoral samples.

Enterococcus spp. em espécimes clínicos de pacientes atendidos em unidades de terapia intensiva

The relationship between the occurrence of enterococci in the oral microbiota and serious infections in patients hospitalized in intensive care units (ICU) has been established. This study evaluated the presence of Enterococcus faecalis and other species of this genus in the mouths of patients on ICU, correlating it with oral and systemic conditions. Data on health and socioeconomic, medication use, medical and family history of patients maintained for 72 hours in the ICU, diagnosed with severe infection or who have developed this condition after the entry to the unit were obtained. Fifty patients provided intraoral and extraoral clinical samples for analysis (above and subgingival biofilm, saliva and buccal mucosa, followed by obtaining samples of respiratory secretions for patients with pneumonia, and blood and urine for sepsis). The presence of target microorganisms was performed by polymerase chain reaction (PCR) and culture using selective media. The chi-square and Mann-Whitney tests were used for statistical analysis, and the significance level was 5%. The intraoral clinical conditions of the patients showed poor. E. faecalis was significantly more frequent microorganism, followed by E. faecium. The use of broadspectrum antimicrobial action was associated with the presence of these opportunistic microorganisms. These bacteria were more frequent in patients with periodontitis or gingivitis. The results showed that enterococci associated with serious infectious processes may originate from resident microbiota of patients and its prevalence is not elevated in healthy individuals.

Experience of family members as a result of children's hospitalization at the Intensive Care Unit

Objective. To describe the experience of family members as a result of children’s hospitalization at the Intensive Care Unit (ICU). Methodology. Descriptive and cross-sectional study. A structured interview was held with 20 relatives of patients hospitalized at two clinics of the Botucatu Medical School at Universidade Estadual Paulista “Júlio de Mesquita Filho”. Information was collected between July and September 2010. Results. The main characteristics of the participating relatives were: 80% mothers of the children; 70% low education level and 70% married. Sixty percent of the children were hospitalized at the ICU for the first time. Eighty percent of the interviewees believe that the children’s behavior changes inside the unit and 85% consider that visiting hours are sufficient. The predominant negative feelings are fear (50%) and insecurity (20%), while the predominant positive feelings are hope (50%) and the expectation of discharge (25%). The professional who most supported the relatives was the nurse (35%). Conclusion. The family members’ experience as a result of the children’s hospitalization at the ICU involves positive and negative aspects, which also affect the child’s behavior at the unit.

O significado do processo de trabalho cuidar para o enfermeiro da UTI

The study has resulted from the desire to comprehend how intensive care unit (ICU) nurses understand the caregiving process. The ICU nurses must be able to promote effective changes in the care provided, to give attention to adversities and be able to act promptly to attend several demands. Aim: understanding the meaning to nurses of the caregiving process at the ICU. Methodology: it consists of a qualitative research with a phenomenological view that has three moments: description, reduction and comprehension. After approval by the Research Ethics Committee (211/08) in 02/06/2008, individual interviews were conducted by using the following guiding questions: What is the working process to ICU nurses? What is it to you, to be an ICU nurse? The study subjects were twelve nurses who worked at the ICUs. Results: the analysis showed the themes: nursing process, relationship with the ICU patient and family, and humanization. Conclusion: From the results it is concluded that nurses working in ICUs in the study report difficulties as well as satisfaction related to caregiving process, especially in the context of the anxieties of patients and families, revealing the difficulties in the processing of feelings. A nurse is recognized by the team as a leader agent and a multiplier of the caregiving actions.

Candidemia en el paciente crítico no neutropénico : epidemiología, factores de riesgo y predictores de mortalidad

Eliminadas las páginas en blanco