Comparación entre la gravedad del paciente y la carga de trabajo de la enfermería antes y después de la ocurrencia de eventos adversos en ancianos con cuidados críticos

Indexación: Scopus.Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences. © 2018, Universidade Federal de Santa Catarina. All rights reserved.Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.Objetivo: comparar la gravedad del paciente y la carga de trabajo en enfermería antes y después de ocurrir un evento adverso moderado y grave en ancianos internados en unidades de terapia intensiva. Método: estudio comparativo realizado en nueve unidades de terapia intensiva de un Hospital Universitario de São Paulo. Los eventos fueron obtenidos a través de los prontuarios de los pacientes y clasificados en moderados y graves según la Organización Mundial de la Salud. El análisis sobre la gravedad fue realizado de acuerdo al Symplified Acute Physiologic Score II y la carga de trabajo se hizo conforme al Nursing Activities Score, 24 horas antes y después del evento moderado y grave. El test t, con una significancia del 5%, fue utilizado para la comparación de los promedios de la gravedad clínica y de la carga de trabajo antes y después del evento. Resultados: la muestra incluyó 315 ancianos, siendo que 94 (29,8%) sufrieron eventos moderados y graves en las unidades. De los 94 eventos, predominó el tipo de proceso clínico y el procedimiento (40,0%). La instalación y mantenimiento de artefactos terapéuticos y catéteres fueron las intervenciones prevalentes que resultaron en daños fisiopatológicos (66,0%) y de grado moderado (76,5%). El promedio de puntuación de la carga de trabajo (75,19%) disminuyó 24 horas después de ocurrido el evento (71,97%, p=0,008) y la gravedad, representada por la probabilidad de muerte, aumentó de 22,0% para 29,0% después del evento (p=0,045). Conclusion: en el contexto de seguridad del paciente, la identificación de las alteraciones en las condiciones clínicas y en la carga de trabajo de enfermería en los ancianos que sufren eventos subsidia la prevención de tales ocurrencias.http://ref.scielo.org/wcg6x

H 2 And H ∞ Filtering Design Subject To Implementation Uncertainty

This paper presents new filtering design procedures for discrete-time linear systems. It provides a solution to the problem of linear filtering design, assuming that the filter is subject to parametric uncertainty. The problem is relevant, since the proposed filter design incorporates real world implementation constraints that are always present in practice. The transfer function and the state space realization of the filter are simultaneously computed. The design procedure can also handle plant parametric uncertainty. In this case, the plant parameters are assumed not to be exactly known but belonging to a given convex and closed polyhedron. Robust performance is measured by the H 2 and H ∞ norms of the transfer function from the noisy input to the filtering error. The results are based on the determination of an upper bound on the performance objectives. All optimization problems are linear with constraint sets given in the form of LMI (linear matrix inequalities). Global optimal solutions to these problems can be readily computed. Numerical examples illustrate the theory. © 2005 Society for Industrial and Applied Mathematics.442515530Gevers, M., Li, G., (1993) Parametrizations in Control, Estimation and Filtering Problems, , Springer-Verlag, LondonWilliamson, D., Finite wordlength design of digital Kalman filters for state estimation (1985) IEEE Trans. Automat. Control, 30, pp. 930-939Williamson, D., Kadiman, K., Optimal finite wordlength linear quadratic regulators (1989) IEEE Trans. Automat. Control, 34, pp. 1218-1228Liu, K., Skelton, R.E., Grigoriadis, K., Optimal controllers for finite wordlength implementation (1992) IEEE Trans. Automat. Control, 37, pp. 1294-1304Hwang, S.Y., Minimum uncorrelated unit noise in state-space digital filtering (1977) IEEE Trans. Acoustics Speech Signal Process, 25, pp. 273-281Amit, G., Shaked, U., Minimization of roundoff errors in digital realizations of Kalman filters (1989) IEEE Trans. Acoustics Speech Signal Process, 37, pp. 1980-1982De Oliveira, M.C., Skelton, R.E., Synthesis of controllers with finite precision considerations (2001) Digital Controller Implementation and Fragility: A Modern Perspective, pp. 229-251. , R. S. H. Istepanian and J. F. Whidborne eds., Springer-Verlag, New YorkKeel, L.H., Bhattacharyya, S.P., Robust, fragile or optimal (1997) IEEE Trans. Automat. Control, 42, pp. 1098-1105Keel, L.H., Bhattacharyya, S.P., Authors' reply to: "Comments on 'Robust, fragile or optimal' " by P. M. Mäkilä (1998) IEEE Trans. Automat. Control, 43, p. 1268Dorato, P., Non-fragile controller design: An overview (1998) Proceedings of the 1998 American Control Conference, 5, pp. 2829-2831. , Philadelphia, IEEE, Piscataway, NJFamularo, D., Dorato, P., Abdallah, C.T., Haddad, W.H., Jadbabaie, A., Robust non-fragile LQ controllers: The static state feedback case (2000) Internat. J. Control, 73, pp. 159-165Yang, G.H., Wang, J.L., Robust nonfragile Kalman filtering for uncertain linear systems with estimator gain uncertainty (2001) IEEE Trans. Automat. Control, 46, pp. 343-348Haddad, W.M., Corrado, J.R., Robust resilient dynamic controllers for systems with parametric uncertainty and controller gain variations (2000) Internat. J. Control, 73, pp. 1405-1423Keel, L.H., Bhattacharyya, S.P., Stability margins and digital implementation of controllers (1998) Proceedings of the 1998 American Control Conference, 5, pp. 2852-2856. , (Philadelphia), IEEE, Piscataway, NJGeromel, J.C., Optimal linear filtering under parameter uncertainty (1999) IEEE Trans. Signal Process, 47, pp. 168-175Nesterov, Y., Nemirovskii, A., (1994) Interior-Point Polynomial Algorithms in Convex Programming, , SIAM, PhiladelphiaGeromel, J.C., Bernussou, J., Garcia, G., De Oliveira, M.C., H 2 and H ∞ robust filtering for discrete-time linear systems (2000) SIAM J. Control Optim., 38, pp. 1353-1368Geromel, J.C., De Oliveira, M.C., Bernussou, J., Robust filtering of discrete-time linear systems with parameter dependent Lyapunov functions (2002) SIAM J. Control Optim., 41, pp. 700-711De Oliveira, M.C., Bernussou, J., Geromel, J.C., A new discrete-time robust stability condition (1999) Systems Control Lett., 37, pp. 261-265Sayed, A.H., A framework for state-space estimation with uncertain models (2001) IEEE Trans. Automat. Control, 46, pp. 998-1013Balakrishnan, V., Huang, Y., Packard, A., Doyle, J.C., Linear matrix inequalities in analysis with multipliers (1994) Proceedings of the 1994 American Control Conference, 2, pp. 1228-1232. , Baltimore, MD, IEEE, Piscataway, NJGeromel, J.C., Peres, P.L.D., Bernussou, J., On a convex parameter space method for linear control design of uncertain systems (1991) SIAM J. Control Optim., 29, pp. 381-40

Gravitational Collapse in Higher Dimensional Husain Space-Time

We investigate exact solution in higher dimensional Husain model for a null fluid source with pressure $p$ and density $\rho$ are related by the following relations (i) $p=k\rho$, (ii) $p=k\rho-\frac{B(v)}{\rho^{\alpha}}$ (variable modified Chaplygin) and (iii) $p=k\rho^{\alpha}$ (polytropic). We have studied the nature of singularity in gravitational collapse for the above equations of state and also for different choices of the of the parameters $k$ and $B$ namely, (i) $k=0$, $B=$ constant (generalized Chaplygin), (ii) $B=$ constant (modified Chaplygin). It is found that the nature of singularity is independent of these choices of different equation of state except for variable Chaplygin model. Choices of various parameters are shown in tabular form. Finally, matching of Szekeres model with exterior Husain space-time is done.Comment: 12 latex pages, No figure, RevTex styl

Nonclassicality and information exchange in deterministic entanglement formation

We discuss the role of nonclassicality of quantum states as a necessary resource in deterministic generation of multipartite entangled states. In particular for three bilinearly coupled modes of the electromagnetic field, tuning of the coupling constants between the parties allows the total system to evolve into both Bell and GHZ states only when one of the parties is initially prepared in a nonclassical state. A superposition resource is then converted into an entanglement resource.Comment: Replaced by the accepted version. Two optical implementations of the quantum resource conversion protocol are now proposed. To appear in Phys. Lett. A. 7 pages, 1 figur

Chemoenzymatic Synthesis of Luliconazole Mediated by Lipases

A straightforward chemoenzymatic synthesis of luli- conazole has been developed. The key step involved the preparation of the enantiomerically pure beta-halohydrin (1S)-2-chloro- 1-(2,4-dichlorophenyl)-1-ethanol through kinetic resolution of the corresponding racemic acetate. This was achieved by a hydrolytic approach, mediated by the lipase from Thermomyces lanuginosus or Novozym 435\uae. The latter enzyme proved to be a robust biocatalyst for the kinetic resolution, and the halohydrin was obtained with high selectivity (ee > 99%, E > 200) after just 15 min, at 45 \ub0C. It could be reused five times with maintenance of high values of both conversion and enantioselectivity. Subsequently, the (S)-beta-halohydrin was sub- jected to a mesylation reaction; the mesylated derivative re- acted with 1-cyanomethylimidazole in the presence of CS2 to give luliconazole in 43 % yield with >99 % ee

Diretorio nacional de pesquisadores de soja na alimentacao humana.

bitstream/item/23327/1/Doc44.pd

In Vitro Activity Of Artemisia Annua L (asteraceae) Extracts Against Rhipicephalus (boophilus) Microplus [atividade In Vitro De Extratos De Artemisia Annua L (asteraceae) Sobre Rhipicephalus (boophilus) Microplus]

The activity of plant extracts on parasites may indicate groups of substances that are potentially useful for controlling Rhipicephalus (Boophilus) microplus. The aim of the present study was to investigate the in vitro action of Artemisia annua extracts on this tick. The concentrations of the sesquiterpene lactones artemisinin and deoxyartemisinin present in plant extracts were quantified via high-performance liquid chromatography. Four extracts produced from the concentrated crude extract (CCE) were evaluated on larvae using the impregnated paper method, with readings after 24 hours of incubation. The engorged females were immersed in the CCE and in its four derived extracts for five minutes, with incubation for subsequent analysis of biological parameters. The extracts were not effective on the larvae at the concentrations tested (3.1 to 50 mg.mL-1). The CCE showed greater efficacy on engorged females (EC50 of 130.6 mg.mL-1 and EC90 of 302.9 mg.mL-1) than did the derived extracts. These results tend to confirm that the action of artemisinin on engorged females of R. (B.) microplus is conditional to their blood intake. In this case, in vitro methods would be inadequate for effective evaluation of the action of A. annua on R. (B.) microplus.2013135Amaral, N.K., Guidelines for the evaluation of ixodicides against the cattle tick Boophilus microplus (Canestrini, 1887) (Acari: Ixodidae) (1993) Revista Brasileira De Parasitologia Veterinária, 2 (2), pp. 144-151(2009) Anuário Da Pecuária Brasileira, p. 360. , ANUALPEC, Sao Paulo: Angra FNP PesquisasBorges, L.M.F., Acao do extrato hexanico de frutos maduros de Melia azedarach (Meliaceae) sobre Boophilus microplus (Acari: Ixodidae) em bezerros infestados artificialmente (2005) Revista De Patologia Tropical, 34 (1), pp. 53-59Cala, A.C., (2010) Avaliação Da Atividade De Artemisia Annua L., Melia Azedarach L. E Trichilia Claussenii C. Sobre Nematódeos Gastrintestinais De Ovinos, p. 64. , Dissertacao (Mestrado)- Universidade Estadual Paulista, Faculdade de Ciencias Agrarias e Veterinarias, JaboticabalCeleghini, R.M.S., Desenvolvimento e validacao de metodologia analitica por CLAE-IR para determinacao de artemisinina em Artemisia annua L (2009) Química Nova, 32 (4), pp. 875-878Chagas, A.C.S., Efeito acaricida de oleos essenciais e concentrados emulsionaveis de Eucalyptus em Boophilus microplus (2002) Brazilian Journal of Veterinary Research and Animal Science, 39 (5), pp. 247-253Chagas, A.C.S., Sensibilidade do carrapato Boophilus microplus a solventes (2003) Ciência Rural, 33 (1), pp. 109-114Creek, D.J., Kinetics of ironmediated artemisinin degradation:Effect of solvent composition and iron salt (2005) Journal of Pharmaceutical Sciences, 94 (8), pp. 1820-1829Drummond, R.O., Boophilus annulatus and B. Microplus: Laboratory tests of insecticides (1973) Journal of Economic Entomology, 66 (1), pp. 130-133Ekanem, A.P., Brisibe, E.A., Effects of ethanol extract of Artemisia annua L. Against monogenean parasites of Heterobranchus longifilis (2010) Parasitology Research, 106 (5), pp. 1135-1139Fernandes, F.F., Freitas, E.P.S., Acaricidal activity of an oleoresinous extract from Copaifera reticulata (Leguminosae: Caesalpinioideae against larvae of the southern cattle tick, Riphicephalus (Boophilus) microplus (Acari:Ixodidae) (2007) Veterinary Parasitology, 147 (1-2), pp. 150-154Ferreira, J.F.S., Agrotechnological aspects of the anti-malarial plant Artemisia annua and its potential use in animal health in Appalachia (2006) International Symposium on Perfume, Aromatic and Medicinal Plants, (2-4), pp. 797-804. , Revue de Regions Arides - Numero special - Actes du seminaire international les Plants a Parfum, Aromatiques et Medicinales (English version: International Center for Agricultural Research in Dry AreasFerreira, J.F.S., Nutrient Deficiency in the Production of Artemisinin, Dihydroartemisinic Acid, and Artemisinic Acid in Artemisia annua L (2007) Journal of Agricultural and Food Chemistry, 55 (5), pp. 1686-1694Ferreira, J.F.S., Gonzalez, J.M., Chemical and biological stability of artemisinin in bovine rumen fluid and its kinetics in goats (Capra hircus) (2008) Revista Brasileira De Parasitologia Veterinária, 17 (SUPPL. 1), pp. 103-109Furlong, J., O carrapato dos bovinos e a resistencia: Temos o que comemorar? (2007) A Hora Veterinária, 159, pp. 26-32Grisi, L., Impacto economico das principais ectoparasitoses em bovinos no Brasil (2002) A Hora Veterinária, 21 (125), pp. 8-10Heimerdinger, A., Extrato alcoolico de Capim-cidreira (Cymbopogon citratus) no controle do Boophilus microplus em bovinos (2006) Revista Brasileira De Parasitologia Veterinária, 15 (1), pp. 37-39Idris, U.A., Adam, S.E., Tartour, G., The anthelmintic efficacy of Artemisia herba-alba against Haemonchus contortus infection in goats (1982) Animal Health Quarterly, 22 (3), pp. 138-143Iqbal, Z., Anthelmintic activity of Artemisia brevifolia in sheep (2004) Journal of Ethnopharmacology, 93 (2), pp. 265-268Keiser, J., Artesunate and artemether are effective fasciolicides in the rat model and in vitro (2006) Journal of Antimicrobial Chemotherapy, 57 (6), pp. 1139-1145Keiser, J., Efficacy and safety of artemether against a natural Fasciola hepatica infection in sheep (2008) Parasitology Research, 103 (3), pp. 517-522Keiser, J., Utzinger, J., Food-borne trematodiasis: Current chemotherapy and advances with artemisinins and synthetic trioxolanes (2007) Trends In Parasitology, 23 (11), pp. 555-562Klayman, D.L., Qinghaosu (Artemisinin): Na antimalarial drug from China (1985) Science, 228 (4703), pp. 1049-1055La-Scalea, M.A., Silva, H.S.R.C., Ferreira, E., Reducao voltametrica de artemisinina e sua interacao com grupo heme (hemina) (2007) Brazilian Journal of Pharmaceutical Sciences, 43 (3), pp. 371-383Martins, R.M., Estudio in vitro de la accion acaricida del aceite esencial de la graminea Citronela de Java (Cymbopogon winterianus Jowitt) en la garrapata Boophilus microplus (2006) Revista Brasileira De Plantas Medicinais De Botucatu, 8 (2), pp. 71-78Meshnick, S.R., Second-generation antimamalarial endoperoxides (1996) Parasitology Today, 12 (2), pp. 79-82Ribeiro, V.L.S., Acaricidal properties of extracts from the aerial parts of Hypericum polyanthemum on the cattle tick Boophilus microplus (2007) Veterinary Parasitology, 147 (1-2), pp. 199-203Rodrigues, R.A.F., Otimizacao do processo de extracao e isolamento do antimalarico artemisinina a partir de Artemisia annua L (2006) Química Nova, 29 (2), pp. 368-372Silva, H.S.R.C., (2006) Antimaláricos Potenciais: Pró-fármacos Poliméricos E Formas De Liberação Controlada De Artemisinina, p. 209. , Tese (Doutorado)-Universidade de Sao Paulo, Sao PauloSimoes, C.M., (2004) Farmacognosia: Da Planta Ao Medicamento, p. 1102. , 5. ed. Porto Alegre: Editora da UFRGSFlorianopolis: Editora da UFSCTaranto, A.G., Estudo sobre o mecanismo de acao da artemisinina e dos endoperoxidos, a mais nova classe de agents antimalaricos (2006) Sitientibus, 34, pp. 47-58Tariq, K.A., Anthelmintic activity of extracts of Artemisia absinthium against ovine nematodes (2009) Veterinary Parasitology, 160 (1-2), pp. 83-8

Idosos institucionalizados no concelho de Viseu: Hábitos alimentares

O envelhecimento da população, bem como a alteração da dinâmica da família, têm contribuído diretamente para o aumento do número de idosos institucionalizados. A incidência da desnutrição alcança níveis elevados nestes idosos, sendo essencial o seu diagnóstico precoce para a melhoria da sua qualidade de vida. Constitui objetivo primordial do estudo a avaliação do estado nutricional de idosos institucionalizados no concelho de Viseu, Portugal. A amostra (n=120) é constituída por idosos de ambos os sexos, institucionalizados, com idade igual ou superior a 65 anos, com capacidade para se colocar de pé, sem demência e que não sejam portadores de patologia passível de afetar a digestão, absorção ou utilização dos nutrientes. A avaliação do estado nutricional é determinada tendo em conta parâmetros antropométricos e dietéticos, através da avaliação da ingestão alimentar (registo de 3 dias) e Mini Nutricional Assessment (MNA). Os questionários aplicados estão validados para a população portuguesa idosa e foram aplicados após consentimento informado. Considerou-se um nível de confiança de 95%. A amostra estudada é maioritariamente feminina (70,0%), com uma idade média de 82,4±6,4 anos. A determinação do IMC mostrou que 12,5% dos idosos avaliados têm baixo peso (IMC 17,7±1,3); 46,7% são eutróficos (IMC 19,9±0,5); 11,7% apresentam excesso de peso (IMC 22,1±0,7), sendo 29,1% classificados como obesos (IMC 28,8±4,2). O MNA mostra que 65% dos idosos apresenta estado nutricional normal, estando sob risco de desnutrição 33,3%, verificando-se, este risco de desnutrição ser superior nos idosos ≥ 75 anos e na população feminina (3:1). A ingestão energética média por dia é significativamente inferior à recomendada (p≤0,05), sendo a ingesta de proteína e hidratos de carbono superior aos valores recomendados para a população (p≤0,05). O consumo lipídico é maioritariamente normolipídico (54,1%), devendo-se a um consumo reduzido de ácidos gordos monosaturados vs. polinsaturados.info:eu-repo/semantics/publishedVersio

Controlling quantum entanglement through photocounts

We present a protocol to generate and control quantum entanglement between the states of two subsystems (the system ${\cal S}$) by making measurements on a third subsystem (the monitor ${\cal M}$), interacting with ${\cal S}$. For the sake of comparison we consider first an ideal, or instantaneous projective measurement, as postulated by von Neumann. Then we compare it with the more realistic or generalized measurement procedure based on photocounting on ${\cal M}$. Further we consider that the interaction term (between ${\cal S}$ and ${\cal M}$) contains a quantum nondemolition variable of ${\cal S}$ and discuss the possibility and limitations for reconstructing the initial state of ${\cal S}$ from information acquired by photocounting on ${\cal M}$.Comment: 12 pages, 3 figures, accepted for publication in Phys. Rev

Continuous Monitoring of Dynamical Systems and Master Equations

We illustrate the equivalence between the non-unitary evolution of an open quantum system governed by a Markovian master equation and a process of continuous measurements involving this system. We investigate a system of two coupled modes, only one of them interacting with external degrees of freedom, represented, in the first case, by a finite number of harmonic oscillators, and, in the second, by a sequence of atoms where each one interacts with a single mode during a limited time. Two distinct regimes appear, one of them corresponding to a Zeno-like behavior in the limit of large dissipation