Work environment and quality of nursing care in primary health care: a scoping review

Abstract in proceedings of the Fourth International Congress of CiiEM: Health, Well-Being and Ageing in the 21st Century, held at Egas Moniz’ University Campus in Monte de Caparica, Almada, from 3–5 June 2019.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.info:eu-repo/semantics/publishedVersio

Analyse comparative de la modélisation numérique d'un élément de structure en béton armé : approches 2D et 3D

Dans le cadre du projet National CEOS.fr, destiné à mieux appréhender le développement de la fissuration dans les structures et éléments de structure en béton armé, plusieurs simulations numériques d'une poutre de grande taille en béton armé chargée en flexion ont été effectuées et comparées avec les données expérimentales. L'objectif était d'examiner les effets du type de calcul (2D ou 3D) de la modélisation du béton et des conditions aux limites sur la précision des résultats quantitatifs et qualitatifs, en particulier les ouvertures et espacements des fissures, et l'évolution de la force et des déformations en fonction du déplacement. Les cartographies d'endommagement obtenues montrent des différences qualitatives selon le modèle de béton et le type de modélisation considérés alors que la différence quantitative est beaucoup moins marquée

An educated guess: how coral reef fish make decisions under uncertainty

For many animals, making informed decisions is crucial to survival. A critical problem is how to make optimal decisions in the face of incomplete, unreliable or conflicting information. In many aquatic environments, fish use visual information to guide key behaviours, but the environment itself can alter or mask the very signals they rely on. Here, we asked how a highly visual species, Rhinecanthus aculeatus, responds to a learned discrimination task as signal reliability decreases, and whether probabilistic information gained during previous experience can be incorporated into their decision strategy. Fish were first trained to select a target (dark grey circle) from three distractors (light grey circles). In the first experiment, the target was more likely to appear in one of four possible stimulus positions. In the second experiment, the target appeared in all positions equally. In a series of trials, the difference in brightness between the target and distractors was reduced until all four stimuli were identical. We found that target selection accuracy decreased with decreasing target and distractor disparity. In experiment 1 where the target was more likely to be in one position, fish increasingly selected stimuli in the biased position as target selection accuracy decreased, but not in experiment 2. These results demonstrate (1) that fish learned more than a simple select/avoid rule based on stimulus brightness; they also integrated information (stimulus position), which could be considered ancillary to the primary task. (2) Fish can learn probability distributions and apply this knowledge as uncertainty increases, ultimately increasing the overall frequency of correct choices. Our results reveal that probabilistic decision rules can be used by fish when visual information is unreliable, indicating a possible mechanism for decision making given the inherent noise in incoming sensory information

Experimental study of corrosion-induced degradation of reinforced concrete elements

Corrosion of steel reinforcement is the main cause of damage for reinforced concrete structures. Iron oxides produced during the corrosion process can induce concrete cracking, loss of adhesion at the steel-concrete interface, loss of reinforcing bar cross-section and even spalling of the concrete cover. In the presented research, the durability problems related to the corrosion of the reinforcement are investigated by combining experimental and numerical studies. However, this paper particularly focuses on the experimental methodology used for the time evolution of damages (steel corrosion products formation and crack patterns) induced by the accelerated corrosion test. The accelerated corrosion tests were carried out by applying a constant current between reinforcement used as an anode and a counter electrode. To control the corrosion process, electrochemical parameters (such as free corrosion potential, polarization resistance, electrical concrete resistance) were measured. The purpose of this paper is to determine the width and length of the cracks and their orientation according to the current density and time

MEDIÇÕES ESPECTROFOTOMÉTRICAS DA OXIDAÇÃO NO DOSÍMETRO QUÍMICO FRICKE XYLENOL GEL (FXG): AVALIAÇÃO DAS DISPOSIÇÕES DAS AMOSTRAS PÓS-IRRADIAÇÕES

O método espectrofotométrico foi usado para determinação da oxidação em gel dosimétrico químico. Este baseia-se sobre a reação de Fe2+ para Fe3+ o qual a leitura aumenta de acordo com o sinal de absorbância em 585 nm. O dosímetro químico foi irradiação e mantido sobre as posições horizontais e verticais com e sem tampa para analises de oxidação devido à radiação ou contato com oxigênio. O método foi aplicado com sucesso para a determinação de oxidação em Fricke Xylenol Gel (FXG), e os resultados estão de acordo com a posição melhor acomodação deste dosímetro gel química

O USO DE IMAGENS SRTM E ASTER GDEM PARA ANÁLISE DE PARÂMETROS GEOMORFOLÓGICOS DA SUB-BACIA HIDROGRÁFICA DO RIO JACURUTU, SANTA QUITÉRIA – CE

O presente trabalho apresenta uma análise de parâmetros geomorfológicos da sub-baciahidrográfica do rio Jacurutu por meio de mapas de relevo sombreado e declividade. A área de estudo está localizada na porção central da Bacia Hidrográfica do Acaraú, na região noroeste do Estado do Ceará. Os produtos foram elaborados com base em imagens de radar dos projetos SRTM (Shuttle Radar TopographicMission), e ASTER GDEM (AdvancedSpaceborneThermalEmissionandReflectionRadiometerGlobal Digital ElevationMapAnnouncement) sendo processados por meio de um Sistema de Informações Geográficas (SIG), o software QGIS. A análise destes mapas permitiu a identificação de feições por meio do sombreamento gerado pela inclinação da fonte de luz em seu azimute e adelimitação de seis classes de declividade. Os resultados obtidos visam contribuir para o desenvolvimento de um banco de dados digitais georreferenciados da área de estudo, de forma integrada com outras fontes, de modo a possibilitaruma compartimentação fisiográfica detalhada da região

Does the residual effect of n-fertilization applied on corn phase maintain forage production of the following pasture phase in an integrated crop-livestock system?

Nutrient cycling represents an important nutrient source in the Integrated Crop-Livestock Systems (ICLS). In general, only the crop phase of the ICLS is fertilized, however little is known about this residual effect of nitrogen fertilization from summer crop to succeeding winter pasture. This research aimed to evaluate the forage growth dynamic and botanical composition of a mixed pasture of black oat (Avena strigosa Schreb) and ryegrass (Lolium multiflorum Lam.) affected by two canopy height managements (high and low) and nitrogen fertilization applied to either the summer crop (corn) or winter pasture phase of an ICLS. The experiment was established in 2012 in southern Brazil. Black oat and ryegrass were growing during winter season and corn (Zea mays L.) during summer season, being this paper related to the 2014 pasture period. Treatments were composed by two canopy heights (25 and 10 cm) and two N-Fertilization Times (N-Pasture or N-Corn) of 200 kg of N ha-1. Canopy height was regulated by beef steers grazing through continuous stocking with a variable stocking rate. Forage mass was lower in the 10 cm canopy height on average, however this forage mass was composed by greater proportion of ryegrass leaves and lower proportion of dead material in relation to the treatment with 25 cm canopy height. The N-fertilization applied directly on pasture phase (N-Pasture) increased forage mass, tiller population density, participation of ryegrass and ryegrass leaf proportion in the forage mass. Furthermore, when pasture was fertilized with N, the forage accumulation rate increased about 69%, highlighting that the corn N-fertilization did not present significant effect on forage productivity. The residual effect of corn N-fertilization was not enough to maintain high forage accumulation. Thus, the pasture N-fertilization is fundamental to keep high-productive crop-livestock system

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Optimization of measurement points for damage detection

Dynamical assessment is often employed to evaluate structures in civil engineering. This non-destructive surveillance technique became an attractive approach in order to show the existence of damages and to predict its location. The modal parameters of the structure are determined by modal identification methods without any prior knowledge of the nature of the excitation. The application of damage detection and localization techniques is performed by comparing the variation of the modal parameters between the states before and after damage. To do so, various methods can be used. In this paper, only the mode shape curvature and strain energy methods are considered because of the computation of the curvature in theirs algorithms. A discretization of the structure is needed on account of the location of the sensors and their number which generates a drawback. Commonly, the finest the discretization the better the approximate solution will be sufficiently accurate. However, several experimental analyses have shown this fact cannot be established in the damage detection domain. Indeed, this computation leads us to truncation errors including the effects of measurement noise, which leads to a loss of accuracy at the time of damage detection and localization. This paper aims to show the possibility to improve the accuracy of both proposed methods. The idea consists in minimizing the effect of noise and truncation errors by finding an optimal discretization interval. The values of this interval depend on several parameters, boundary conditions, bending mode, noise level. Numerical tests are carried out considering the presence of noise and damage simulations are performed on the tested beam. Furthermore, using the SysIdent-LCPC toolbox, several experimental tests are presented for the Merlebach’s beam in order to test the quality and the efficiency of the selected discretizations. The results are encouraging in order to go forwards the investigations in this direction