Simulações para avaliação dos impactos de economia de água nos centros de reservação de Curitiba

Orientador: Prof. Dr. Daniel Costa dos SantosMonografia (graduação) - Universidade Federal do Paraná. Setor de Tecnologia. Curso de Graduação em Engenharia AmbientalInclui referênciasResumo : O objetivo deste trabalho é estimular a economia de água e sensibilizar o usuário a utilizar formas eficientes para promover a diminuição do consumo exacerbado. Incentivar o uso consciente, reforçando a educação ambiental e estimular o investimento em dispositivos de economia de água. Com uma análise detalhada do Sistema de Abastecimento de Água de Curitiba e Região Metropolitana – SAIC, foram realizadas simulações nos centros de reservação do Cajuru e do Corte Branco. A partir dessas simulações, foi realizada a redistribuição do volume total de água economizado para as regiões onde o consumo médio é inferior ao consumo mínimo de conforto. A análise também foi realizada referente ao impacto que essa economia gerará no rodízio que está sendo realizado na cidade de Curitiba desde março de 2020. Finalmente, foi avaliada a motivação para a distribuição do rodízio e a influência do poder aquisitivo no seu relaxamento. A partir de toda essa análise, o resultado obtido foi que com as ações propostas, para diminuição dos desperdícios, seria possível atingir de forma positiva uma grande parcela da população.Abstract : The objective of this study is to stimulate water savings and sensitize the user to use efficient ways to promote a reduction in exacerbated consumption. Encourage conscientious use, reinforcing environmental education and encouraging investment in water-saving devices. With a detailed analysis of the Water Supply System of Curitiba and Metropolitan Region - SAIC, carrying out simulations in the reserve centers of Cajuru and Corte Branco. Based on these simulations, the total volume of water saved will be redistributed to regions where the average consumption is lower than the minimum consumption for comfort. The analysis will also be made regarding the impact that this economy will generate in the rotation that has been carried out in the city of Curitiba since March 2020. Finally, the motivation for the rotation distribution and the influence of purchasing power on its relaxation will be evaluated. From all this analysis, the result obtained was with the proposed actions, to reduce waste, it would be possible to positively reach a large portion of the population

DOR ONCOLÓGICA: manejo clínico realizado por enfermeiros

De todos os sintomas descritos pelos pacientes oncológicos, a dor é o mais temido, constituindo o fator mais determinante de sofrimento relacionado à doença mesmo quando comparado à expectativa de morte. O objetivo desse trabalho foi investigar o manejo clínico da dor oncológica realizado por enfermeiros. Pesquisa exploratória com abordagem qualitativa, realizada com 18 enfermeiros de um hospital filantrópico de Campina Grande–PB no período de novembro a dezembro de 2014, por meio de entrevistas, norteadas por um roteiro semiestruturado, analisadas à luz da técnica de Análise Temática. Os enfermeiros não realizam a avaliação da dor utilizando métodos sistemáticos, no entanto conhecem as modalidades terapêuticas (farmacológicas, não farmacológicas, cirúrgicas e paliativas) executam as intervenções, de acordo com suas habilidades e competências técnicas, a fim de controlar esse sintoma, minimizando, assim, o sofrimento e proporcionando conforto. É imprescindível que o enfermeiro realize a consulta de enfermagem, utilizando métodos sistemáticos para avaliação da dor, elabore e execute um plano de cuidados, com vistas a proporcionar alívio efetivo da dor oncológica. Descritores: Manejo da dor. Oncologia. Tratamento. Enfermeiros. Cuidados de enfermagem.

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

Simulações para avaliação dos impactos de economia de água nos centros de reservação de Curitiba

Orientador: Prof. Dr. Daniel Costa dos SantosMonografia (graduação) - Universidade Federal do Paraná. Setor de Tecnologia. Curso de Graduação em Engenharia AmbientalInclui referênciasResumo : O objetivo deste trabalho é estimular a economia de água e sensibilizar o usuário a utilizar formas eficientes para promover a diminuição do consumo exacerbado. Incentivar o uso consciente, reforçando a educação ambiental e estimular o investimento em dispositivos de economia de água. Com uma análise detalhada do Sistema de Abastecimento de Água de Curitiba e Região Metropolitana – SAIC, foram realizadas simulações nos centros de reservação do Cajuru e do Corte Branco. A partir dessas simulações, foi realizada a redistribuição do volume total de água economizado para as regiões onde o consumo médio é inferior ao consumo mínimo de conforto. A análise também foi realizada referente ao impacto que essa economia gerará no rodízio que está sendo realizado na cidade de Curitiba desde março de 2020. Finalmente, foi avaliada a motivação para a distribuição do rodízio e a influência do poder aquisitivo no seu relaxamento. A partir de toda essa análise, o resultado obtido foi que com as ações propostas, para diminuição dos desperdícios, seria possível atingir de forma positiva uma grande parcela da população.Abstract : The objective of this study is to stimulate water savings and sensitize the user to use efficient ways to promote a reduction in exacerbated consumption. Encourage conscientious use, reinforcing environmental education and encouraging investment in water-saving devices. With a detailed analysis of the Water Supply System of Curitiba and Metropolitan Region - SAIC, carrying out simulations in the reserve centers of Cajuru and Corte Branco. Based on these simulations, the total volume of water saved will be redistributed to regions where the average consumption is lower than the minimum consumption for comfort. The analysis will also be made regarding the impact that this economy will generate in the rotation that has been carried out in the city of Curitiba since March 2020. Finally, the motivation for the rotation distribution and the influence of purchasing power on its relaxation will be evaluated. From all this analysis, the result obtained was with the proposed actions, to reduce waste, it would be possible to positively reach a large portion of the population

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil : a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-totreat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, po0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, po0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts