The Mining Industry's Role in Enhanced Weathering and Mineralization for CO2 Removal.

Enhanced weathering and mineralization (EWM) aim to remove carbon dioxide (CO2) from the atmosphere by accelerating the reaction of this greenhouse gas with alkaline minerals. This suite of geochemical negative emissions technologies has the potential to achieve CO2 removal rates of >1 gigatonne per year, yet will require gigatonnes of suitable rock. As a supplier of rock powder, the mining industry will be at the epicenter of the global implementation of EWM. Certain alkaline mine wastes sequester CO2 under conventional mining conditions, which should be quantified across the industry. Furthermore, mines are ideal locations for testing acceleration strategies since tailings impoundments are contained and highly monitored. While some environmentally benign mine wastes may be repurposed for off-site use─reducing costs and risks associated with their storage─numerous new mines will be needed to supply rock powders to reach the gigatonne scale. Large-scale EWM pilots with mining companies are required to progress technology readiness, including carbon verification approaches. With its knowledge of geological formations and ore processing, the mining industry can play an essential role in extracting the most reactive rocks with the greatest CO2 removal capacities, creating supply chains, and participating in life-cycle assessments. The motivations for mining companies to develop EWM include reputational benefits and carbon offsets needed to achieve carbon neutrality.

Microscopic Raman study of fungal pigment using the genetically amenable rock inhabitant Knufia petricola as a model organism.

Fungal pigments such as melanin and carotenoids are distinctive markers of animal and plant pathogenic fungi as well as their environmental relatives. These complex pigments play important roles in pathogenicity and stress tolerance while also being useful as biomarkers. Accordingly, it is important to be able to identify in situ the pigments in black fungi, a group of clinical and environmental importance. In this study, wild-type and genetically modified strains of Knufia petricola A95 and wild fungal cells attached to ancient rock were investigated for their spectroscopic and microscopic Raman features and morphological appearance. Knockout mutants of melanin synthesis genes pks1 (polyketide synthase), sdh1 (scytalone dehydratase), and both pks1 and the carotenoid synthesis gene phd1 (phytoene desaturase) were studied We applied two different Raman microscopes using two lasers, with 633 nm and 488 nm wavelengths. We analyzed and compared Raman spectra between the measured reference substances and the mutant and wild-type strains. In the wild strain WT:A95, the peaks close to melanin peals were found at 1353 cm-1 and 1611 cm-1. There are no characteristic melanin peaks at 1580-1600 cm-1 and around 1350 cm-1 at the spectrum of the Δpks1/Δphd1 mutant and the Δsdh1 mutant. The Δpks1 mutant spectrum has the peaks at the beta-carotene v2 C-C in-plane stretch at 1155 cm-1 and v3 C-CH3 deformation at 1005 cm-1. The peaks of carotenoids and melanin were found in all mutants and the wild strain, except the Δpks1/Δphd1 mutant. Raman spectra allow for discrimination between the various pigments. Hence, interactions between natural fungal melanin, as well as other protective pigments, and complex environmental matrices can be characterized on a range of spatial and temporal scales.

Environmental and Mineralogical Controls on Biosignature Preservation in Magnesium Carbonate Systems Analogous to Jezero Crater, Mars.

Jezero Crater on Mars is a paleolacustrine environment where Mg-carbonates may host evidence of ancient life. To elucidate the environmental and mineralogical controls on biosignature preservation, we examined samples from five terrestrial analogs: Lake Salda (Turkey), Lake Alchichica (Mexico), Qinghai-Tibetan Plateau (China), Mg-carbonate playas (British Columbia, Canada), and a mine with fine-grained ultramafic tailings (Yukon, Canada). The mineralogical compositions of the samples varied, yet were often dominated by either aragonite (CaCO3) or hydromagnesite [Mg5(CO3)4(OH)2·4H2O]. Aragonite-rich samples from Alchichica, Mg-carbonate playas, and the ultramafic mine contained an abundance of entombed microbial biomass, including organic structures that resembled cells, whereas hydromagnesite-rich samples were devoid of microfossils. Aragonite often precipitates subaqueously where microbes thrive, thereby increasing the likelihood of biomass entombment, while hydrated Mg-carbonates typically form by evaporation in subaerial settings where biofilms are less prolific. Magnesite (MgCO3), the most stable Mg-carbonate, forms extremely slowly, which may limit the capture of biosignatures. Hydrated Mg-carbonates are prone to transformation via coupled dissolution-precipitation reactions that may expose biosignatures to degradation. Although less abundant, aragonite is commonly found in Mg-carbonate environments and is a better medium for biosignature preservation due to its fast precipitation rates and relative stability, as well as its tendency to form subaqueously and lithify. Consequently, we propose that aragonite be considered a valuable exploration target on Mars.

Carbonation, Cementation, and Stabilization of Ultramafic Mine Tailings.

Tailings dam failures can cause devastation to the environment, loss of human life, and require expensive remediation. A promising approach for de-risking brucite-bearing ultramafic tailings is in situ cementation via carbon dioxide (CO2) mineralization, which also sequesters this greenhouse gas within carbonate minerals. In cylindrical test experiments, brucite [Mg(OH)2] carbonation was accelerated by coupling organic and inorganic carbon cycling. Waste organics generated CO2 concentrations similar to that of flue gas (up to 19%). The abundance of brucite (2-10 wt %) had the greatest influence on tailings cementation as evidenced by the increase in total inorganic carbon (TIC; +0.17-0.84%). Brucite consumption ranged from 64-84% of its initial abundance and was mainly influenced by water availability. Higher moisture contents (e.g., 80% saturation) and finer grain sizes (e.g., clay-silt) that allowed for a better distribution of water resulted in greater brucite carbonation. Furthermore, pore clogging and surface passivation by Mg-carbonates may have slowed brucite carbonation over the 10 weeks. Unconfined compressive strengths ranged from 0.4-6.9 MPa and would be sufficient in most scenarios to adequately stabilize tailings. Our study demonstrates the potential for stabilizing brucite-bearing mine tailings through in situ cementation while sequestering CO2.

Aspectos epidemiológicos da tuberculose e dos serviços de atendimento à pessoa com tuberculose no Município de Chimoio, Moçambique, 2018-2019 / Epidemiological aspects of tuberculosis and care services for the person with tuberculosis in the Municipality of Chimoio, Mozambique, 2018-2019

Introdução: A tuberculose é uma doença milenar e infectocontagiosa causada pelo Mycobacterium tuberculosis. Trata-se de uma doença prevenível e com histórico de cura desde meados do século XX, mesmo assim, ainda é considerada um dos maiores problemas de saúde pública global do século XXI, sendo as regiões mais afetadas, o Sudeste Asiático e a África Subsaariana, onde Moçambique faz parte. Objetivo: O estudo buscou descrever os aspectos epidemiológicos da tuberculose e dos serviços de atendimento à pessoa com tuberculose (SAPTB) no Município de Chimoio no período 2018-2019. Método: Trata-se de um estudo transversal com abordagem quantitativa no qual foram usados dados primários e secundários. Os dados primários foram referentes aos aspectos da estrutura organizacional e funcional dos SAPTB obtidos a partir da aplicação de um questionário aos gestores dos SAPTB dos Centros de Saúde (C.S). Os dados secundários foram relativos aos aspectos sociodemográficos e clínico-epidemiológicos dos casos de tuberculose notificados no período 2018-2019 confirmados pelos métodos laboratoriais de baciloscopia e GeneXpert®MTB/RIF. Para o estudo de fatores associados, foi utilizado o modelo de regressão logística não ajustado entre as variáveis independentes (sociodemográficos e clínico-epidemiológicas) e dependente (desfecho desfavorável do tratamento da doença: óbito, perda de seguimento hospitalar e/ou abandono e falência terapêutica). As variáveis que apresentaram p≤0,20 foram consideradas candidatas para a inclusão nos modelos de regressão logística múltiplo ajustado pelo sexo e faixa etária. Na sequência, a força de associação (Odds Ratio-OR) entre as variáveis e os respectivos intervalos de 95% confiança (IC95%) foram calculados. Teste de Hosmer e Lemeshow (HL) foi aplicado para a avaliação da qualidade da bondade do ajuste do modelo de regressão logística múltiplo final. Resultados: Todos os C.S tinham SAPTB e equipe técnica estabelecida, porém, diferentes na composição e no tempo de resposta laboratorial. Foram no total, 1.078 casos identificados, sendo, 1.030 novos, 48 reingressados e 555 coinfectados TB-HIV. Destes, 642 (59,6%) eram do sexo masculino, 455 (42,2%) tinham idades na faixa etária de 30 a 44 anos, 901 (83,6%) residentes de zona suburbana e 858 (79,6%) desempregados. Muitos casos não tinham registro sobre estado civil e nível de escolaridade, destacando-se dos poucos casos com essa informação, 65 (6,0) com companheiro e 258 (23,9%) com nível de escolaridade entre 8 e 12 anos respectivamente. Foram envolvidos 1.009 casos no estudo de fatores associados, dos quais, 904 foram declarados curados, 53 óbitos, 49 perdas de seguimento e/ou abandonos do seguimento hospitalar e 3 com falência terapêutica, tendo sido identificado a TB-DR como fator associado (OR=134,3; IC 95%: 47,5-380,1) ao desfecho desfavorável do tratamento observado entre os casos estudados. Conclusão: Esses dados descrevem a estrutura organizacional dos SAPTB nos C.S dos Serviços Distritais da Saúde Mulher e Ação Social de Chimoio e ressaltam seus desafios no enfrentamento do quadro epidemiológico da tuberculose e o possível fator associado, sendo importante para instituir novas estratégias de monitoria e avaliação do Programa de Controle à Tuberculose local.

Introduction: Tuberculosis is an ancient infectious disease caused by Mycobacterium tuberculosis. It is a preventable disease with history of cure since the mid-twentieth century, yet it is still considered one of the greatest global public problems of the 21st century, with the most affected regions being Southeast Asia and Sub-Saharan Africa where Mozambique is part. Objectives: The study aimed to describe the epidemiological aspects of tuberculosis and the services for the care of person with tuberculosis (SAPTB) in the Municipality of Chimoio in the period 2018-2019. Method: This is a cross-sectional study with a quantitative approach in which were used primary and secondary data. Primary data were related to aspects of the organizational and functional structure of the SAPTB obtained from the application of a questionnaire to the managers of the SAPTB of the Health Centers (H.C). Secondary data were related to socio-demographic and clinical-epidemiological aspects of tuberculosis cases notified in the period 2018-2019 confirmed by the laboratory methods of bacilloscopy and GeneXpert®MTB/RIF. For the study of associated factors, the logistic regression model was used not adjusted between the independent variables (socio-demographic and clinical-epidemiological) and dependent (unfavourable outcome of the treatment of the disease: death, loss to follow-up and/or abandonment and therapeutic failure) variables. The variables that presented p≤0.20 were considered candidates for inclusion in the multiple logistic regression models adjusted for gender and age group. Subsequently, the strength of association (Odds Ratio-OR) between the variables was determined and the respective 95% confidence intervals (95% IC). Hosmer and Lemeshow test were applied to assess the quality of goodness of fit of the final multiple logistic regression model. Results: All the H.C had SAPTB and established technical team, however, different in composition and laboratory response time. 1,078 cases were identified, of which, 1,030 were new, 48 were re-infected and 555 were co-infected TB-HIV. Of these, 642 (59.6%) were male, 455 (42.2%) were aged between 30 and 44 years, 901 (83.6%) were living in suburban areas and 858 (79.6%) were unemployed. Many cases had no record on marital status and level of schooling, standing out from the few cases with this information, 65 (6.0) with a partner and 258 (23.9%) with a level of schooling between 8 and 12 years respectively. A total of 1009 cases were involved in the study of association factors, of which, 904 were declared cured, 53 deaths, 49 losses to follow-up and/or abandonment of hospital follow-up and 3 with treatment failure, and TB-DR was identified as factors associated (OR=134.3; IC 95%: 147.5-380.1) with the unfavourable treatment outcome observed among the cases studied. Conclusions: These data describe the organizational structure of SAPTB in the H.C of the District Health, Women and Social Services of Chimoio and highlight their challenges in addressing the epidemiological picture of tuberculosis and possible associated factors, being important to institute new strategies for monitoring and evaluating the local TB Control Program.

Incidência de lesão por pressão e tempo de assistência de enfermagem em terapia intensiva / Incidence of pressure injury and nursing care time in intensive care

Objectives: To correlate the incidence of pressure injury (PI) with the average time of nursing care in an intensive care unit (ICU). Method: Epidemiological, observational, retrospective study, carried out in the ICU of a university hospital. Data were collected by consulting the PI incidence and the average nursing care time from ICU databases between 2010 and 2014. Measures of central tendency and variability, and Pearson's correlation coefficient were used for data analysis. Results: The average incidence of PI between 2010 and 2014 was 10.83% (SD = 2.87) and the average time spent in nursing care for patients admitted to the ICU was 15 hours (SD = 0.94). There was no statistically significant correlation between the incidence of PI and the nursing care time (r = -0.17; p = 0.199), however, the results suggested an overload on the nursing team. Conclusion: This study confirms the importance of implementing and reassessing the effectiveness of preventive care protocols for PI, in addition to warning about the work overload of nursing in assisting critically ill patients.

Impact of acute pain and analgesic adequacy in hospitalized patients / Impacto da dor aguda e adequação analgésica em pacientes hospitalizados

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is a frequent symptom in the hospital environment. The study aimed to identify the impact of acute pain on activities of daily living and to analyze analgesic adequacy. METHODS: Cross-sectional study carried out in six units of a University Hospital. Patients were assessed for the presence and intensity of pain and impact on activities of daily living. Analgesic adequacy was assessed by the Pain Management Index. The association between pain and sociodemographic and clinical characteristics was investigated using the Chi-square test. A logistic regression model was applied to assess the impact of pain intensity on activities. RESULTS: 134 patients, mean age 53 years, were evaluated. At the moment of the interview 37 (27.6%) participants reported pain and 58 (45.7%) reported pain in the 24 hours before the interview. The average pain intensity was 6.6±2.4 and the pain was more frequent in patients in the Emergency Department, Intensive Care Unit and Internal Medicine. There was an association between pain and the female sex and there was no association with hospitalization unit, diagnosis, and specialty. Pain affected the ability to eat (p=0.036) and sleep (p=0.008). Most prescriptions (68%) were unsuitable for pain intensity. CONCLUSION: Frequency of pain was high, was more prevalent in women, and significantly impaired the ability to eat and sleep. Inadequacy of the analgesic regimen regarding intensity of pain was found in more than half of the patients, indicating that it's necessary to improve pain control in the hospital environment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é um sintoma frequente no ambiente hospitalar. O estudo objetivou identificar o impacto da dor aguda sobre as atividades de vida diária e analisar a adequação analgésica. MÉTODOS: Estudo transversal desenvolvido em seis unidades de um Hospital Universitário. Os pacientes foram avaliados quanto à presença e intensidade da dor e prejuízos às atividades de vida diária. A adequação analgésica foi avaliada pelo Índice de Manejo da Dor. A associação entre a dor e as características sociodemográficas e clínicas foi investigada por meio do teste Qui-quadrado. Um modelo de regressão logística foi aplicado para avaliar o impacto da intensidade da dor nas atividades. RESULTADOS: Foram avaliados 134 pacientes, com média de idade de 53 anos. No momento da entrevista 37 (27,6%) participantes referiram dor e 58 (45,7%) relataram dor nas 24h que antecederam a entrevista. A intensidade média da dor foi 6,6±2,4 e a dor foi mais frequente em pacientes do Pronto Atendimento, Unidade de Terapia Intensiva e Clínica Médica. Houve associação entre dor e sexo feminino e não foi encontrada associação com unidade de internação, diagnóstico e especialidade. A dor afetou a capacidade de comer (p=0,036) e dormir (p=0,008). A maior parte das prescrições (68%) estava inadequada à intensidade da dor. CONCLUSÃO: A frequência de dor foi alta e a incidência maior no sexo feminino, afetando de modo significativo a capacidade de comer e dormir. A prescrição de fármacos era inadequada à intensidade da dor em mais da metade dos pacientes, indicando a necessidade de aprimorar os protocolos de controle da dor.

Large-scale environmental policy change: analysis of the Brazilian reality / Cambio de gran escala en la política ambiental: análisis de la realidad brasileña / Mudança de larga escala na política ambiental: análise da realidade brasileira

Abstract The Brazilian presidential elections of 2018 brought large-scale changes in the Brazilian environmental policy subsystem. The purpose of this article is to analyze these changes through the lenses of the Advocacy Coalition Framework - ACF. First, we introduced some of the main characteristics of this subsystem, then we presented a hemerographic analysis to describe and analyze the effects of four recent shocks in this subsystem. Two of these shocks were external: (i) the election of a new political elite in power that brought a clear discourse of denial of the relevance of environmental policy and (ii) calamitous environmental events that occurred in Brazil in 2019. The other two shocks were internal: (i) the capture of key positions and resources by dominant coalition members and (ii) the rise of conflict and polarization among the coalitions in the subsystem. The results showed: (i) the rise of a hyper-adversarial environmental policy subsystem; (ii) a realignment between non-dominant coalitions in a cooperative direction; (iii) the imposition of clear barriers to negotiation; (iv) changes in the use of scientific information by more politicized discourses with a high degree of bias. The article contributes to the understanding of the processes of institutional change in environmental policy, especially in contexts of large-scale change generated by increasing electoral polarization and fierce political disputes. It also contributes to the analysis of the limits and possibilities of the ACF in the Brazilian environmental agenda.

Resumen Las elecciones presidenciales brasileñas de 2018 introdujeron cambios de gran escala en el subsistema de política ambiental del país. El propósito de este documento es analizar estos cambios a través de las lentes del Advocacy Coalition Framework - ACF. Para ello, exponemos algunas de las características principales de este subsistema y, luego, presentamos un análisis hemerográfico para describir y analizar los efectos de cuatro shocks recientes en este subsistema. Dos de estos shocks fueron externos: (i) el ascenso de una nueva élite política al poder, la cual ha traído un claro discurso de negación de la relevancia de la política ambiental y (ii) catastróficos eventos ambientales que ocurrieron en Brasil durante 2019. Otros dos shocks fueron internos: (i) la captura de posiciones y recursos claves por los miembros de la coalición dominante y (ii) el surgimiento de conflictos y polarizaciones entre las coaliciones del subsistema. Los resultados mostraron: (i) el ascenso de un subsistema de política ambiental hipercontradictorio; (ii) el realineamiento de las coaliciones no dominantes en una dirección cooperativa; (iii) la imposición de claras barreras en los procesos de negociación; y (iv) cambios en el uso de información científica por discursos más politizados con un alto grado de sesgo. Este artículo contribuye a la comprensión de los procesos de cambio institucional en la política ambiental, especialmente en contextos de cambios de gran escala generados por un aumento en la polarización electoral e intensas disputas políticas. También contribuye al análisis de los límites y posibilidades del ACF en la agenda ambiental brasileña.

Resumo As eleições presidenciais brasileiras de 2018 trouxeram mudanças em larga escala no subsistema de política ambiental do país. O objetivo deste artigo é analisar essas mudanças através do Advocacy Coalition Framework - ACF. Para isso, introduzimos algumas das principais características do subsistema de política ambiental e, a seguir, apresentamos uma análise hemerográfica para descrever e analisar os efeitos de quatro choques recentes no subsistema em análise. Dois desses choques foram externos: (i) a ascensão ao poder de uma nova elite política que trouxe um discurso claro de negação da relevância da política ambiental e (ii) eventos ambientais calamitosos que ocorreram no Brasil em 2019. Dois outros choques foram internos: (i) a captura de posições e recursos importantes pelos membros da coalizão dominante e (ii) o surgimento de conflitos e polarizações entre as coalizões no subsistema. Os resultados mostraram: (i) a ascensão de um subsistema hiper-contraditório; (ii) o realinhamento entre coalizões não dominantes em direção à cooperação; (iii) a imposição de barreiras claras à negociação; e (iv) mudanças no uso da informação científica por discursos mais politizados com alto grau de viés. O artigo contribui para a compreensão dos processos de mudança institucional na política ambiental, especialmente em contextos de mudança em larga escala gerados pelo aumento da polarização eleitoral e intensas disputas políticas. Contribui também para a análise dos limites e possibilidades do ACF na agenda ambiental brasileira.

Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017. / Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017.

OBJECTIVE: To analyze the correlation between municipalities adhering to the Health Fitness Center Program, noncommunicable chronic disease (NCD) hospitalizations and socioeconomic levels from 2011 to 2017. METHODS: This was an ecological study; HFCP adherence indicators for 2,837 municipalities were calculated, as were NCD hospitalization indicators, according to funding categories and the Firjan Socioeconomic Development Index. RESULTS: The HFCP adherence indicator was higher for municipalities that received Congress funding (1.18), had moderate to high Firjan Socioeconomic Development Indices (0.94) and high NCD hospitalization indicators (1.03) (p<0.001). There were positive correlations (p<0.05) between the two indicators in municipalities receiving Ministry of Health funding (r=0.14) and those receiving both Congress and Ministry of Health funding (r=0.12); whereas correlation was negative in municipalities with moderate to low Firjan Socioeconomic Development Indices (r=-0.09; p=0.013). CONCLUSION: The main form of adherence to the HFCP, according to population size, was through Congress funding. Municipalities with poorer socioeconomic and NCD indicators had lower adherence to the HFCP.

Programa Academia da Saúde: um olhar quantitativo das adesões entre 2011 a 2017 / The Health Academy Program in Brazil: a quantitative view of adhesions between 2011 to 2017

O objetivo foi analisar a distribuição das adesões municipais ao Programa Academia da Saúde (PAS) no território nacional e o impacto da alteração do tipo de financiamento das obras no quantitativo de adesões. Foram utilizados dados secundários disponibilizados pelo Ministério da Saúde (MS) referentes às adesões ocorridas de 2011 a 2017 para compor as variáveis do estudo. Foram realizadas análises descritiva e inferencial, empregando-se o teste t pareado de Student para verificar diferenças entre adesões em diferentes anos e modalidades de financiamento (emenda parlamentar ­ EP e MS). Os resultados mostram que a maioria das macrorregiões apresentou mais de 50% de municípios participantes (municípios-PAS). As regiões Nordeste e Sudeste tiveram mais adesões, mas a região Norte destacou-se com o maior quantitativo de municípios-PAS proporcionalmente ao total de municípios. O período de maior expansão foi de 2011 a 2013. O número de adesões e municípios-PAS nos cinco anos de financiamento exclusivo por EP não superou o quantitativo aprovado de 2011 a 2012. Nos primeiros anos de financiamento por EP, ocorreu concentração das adesões nos mesmos municípios. Todas as macrorregiões apresentaram mais de 60% de obras concluídas, entretanto foi baixo o percentual de academias com custeio federal dentre as adesões aptas ao recebimento. Concluímos que o PAS está bem distribuído em todo o país, com diferentes situações de implantação. O período de maior expansão do programa foi em 2011 e 2012, quando as obras eram financiadas com recurso do MS. De 2013 a 2017, com financiamento exclusivo por EP, o quantitativo de adesões não superou o observado nos dois primeiros anos

This study aimed to analyze the adhesions of the Health Academy Program (HAP) in the country and the impact of the funding type alteration for the facilities building. Secondary data provided by the Minis-try of Health regarding the adhesions from 2011 to 2017 were used to compose the variables. Descriptive and inferential analyses were conducted, using the Student's paired t-test to verify differences between the number of adhesions to the HAP in different years and funding types. Most regions had more than 50% of participating municipalities. Northeast and Southeast presented greater adhesions numbers concerning the other regions, but the North was highlighted with the largest quantity proportional to the number of municipalities. The greatest expansion was from 2011 to 2013. The number of facilities and municipalities enrolled in the HAP during the years of exclusive funding by parliamentary amendments did not exceed the amount approved from 2011 to 2012. There was a concentration of adhesions in the same municipalities in 2012 and 2013 when the parliamentary amendments were included. In all regions, the rate of facility building completion was above 60%, however the percentage of facilities with the maintenance funding among those able to receive it is low. In conclusion, the HAP has been largely implemented in the country, with a variety of implementation status. From 2011 to 2012 occurred the greatest expansion of the HAP, period that the facilities where financed with funds from the Ministry of Health. In the others hand, from 2013 to 2017, with exclusive funding by EP, the number of facilities did not exceed that observed in the first two years

Health Academy Program: correlation between hospitalizations due to noncommunicable chronical diseases and adherence to the program in Brazilian municipalities, 2011-2017 / Programa Academia de la Salud: correlación entre las hospitalizaciones por enfermedades crónicas no transmisibles en la adherencia en los municipios brasileños, 2011-2017 / Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017

Objective. To analyze the relationship between municipalities adherence to the Health Academy Program (HAP) and the noncommunicable chronical diseases (NCDs) and socioeconomic levels from 2011 to 2017. Methods. Were analyzed the adherence indicator (ADH-indicator) to HAP in 2,837 municipalities and hospitalizations due to NCDs (NCDs-indicator) according to the funding types and the Firjan Socioeconomic Development Index (FSDI) from 2011 to 2017. Results. ADH-indicator presented higher values for municipalities that received congress funding (1.18), moderate to high FSDI (0.94) and high NCDs-indicator (1.03) (p<0.001). There were positive correlations (p<0.05) between the indicators in municipalities funded by the Ministry of Health´s budget (r=0.14) and mixed (r=0.12) and negative correlation for municipalities with moderate to low FSDI (r=-0.09; p=0.013). Conclusion. Congress funding was the main type of cities adherence to the HAP, adjusted by population. In the municipalities with critical socioeconomic and NCD indicators, there was less adherence to the HAP.

Objetivo: Analisar a correlação entre adesão dos municípios ao Programa Academia da Saúde (PAS), internações por doenças crônicas não transmissíveis (DCNT) e níveis socioeconômicos, 2011-2017. Métodos. Estudo ecológico; foram calculados indicadores de adesão (IND-ADE) de 2.837 municípios brasileiros ao PAS, e de internações por DCNT (IND-DCNT), segundo categorias de financiamento e o Índice Firjan de Desenvolvimento Socioeconômico (IFDM). Resultados. O IND-ADE foi maior nos municípios financiados por emendas parlamentares (1,18), com IFDM moderado a alto (0,94) e IND-DCNT alto (1,03) (p<0,001). Houve correlação positiva (p<0,05) entre IND-ADE e IND-DCNT em municípios contemplados com recursos do Ministério da Saúde (r = 0,14) e de ambos tipos, emendas parlamentares e programa ministerial (r=0,12); e correlação negativa em municípios com IFDM moderado a baixo (r=-0,09; p=0,013). Conclusão. A principal forma de adesão ao PAS, referenciada pelo porte populacional, foi emenda parlamentar. Municípios com piores indicadores socioeconômicos e de DCNT apresentaram menor adesão.

Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017 / Programa Academia de la Salud: correlación entre las hospitalizaciones por enfermedades crónicas no transmisibles y adhesión en los municipios brasileños, 2011-2017 / Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017

Objetivo: Analisar a correlação entre adesão dos municípios ao Programa Academia da Saúde, internações por doenças crônicas não transmissíveis (DCNT) e níveis socioeconômicos, no período 2011-2017. Métodos: Estudo ecológico; foram calculados indicadores de adesão (IND-ADE) de 2.837 municípios brasileiros ao PAS, e de internações por DCNT (IND-DCNT), segundo categorias de financiamento e o Índice Firjan de Desenvolvimento Socioeconômico (IFDM). Resultados: O IND-ADE foi maior nos municípios financiados por emendas parlamentares (1,18), com IFDM moderado a alto (0,94) e IND-DCNT alto (1,03) (p<0,001). Houve correlação positiva (p<0,05) entre IND-ADE e IND-DCNT em municípios contemplados com recursos do Ministério da Saúde (r = 0,14) e de ambos os tipos, emendas parlamentares e programa ministerial (r=0,12); e correlação negativa em municípios com IFDM moderado a baixo (r=-0,09; p=0,013). Conclusão: A principal forma de adesão ao PAS, referenciada pelo porte populacional, foi emenda parlamentar. Municípios com piores indicadores socioeconômicos e de DCNT apresentaram menor adesão.

Objetivo: Analizar la relación entre adhesión de los municipios al Programa Federal Academia de la Salud y las hospitalizaciones por enfermedades crónicas no trasmisibles (ECNT) y niveles socioeconómicos entre 2011 y 2017. Métodos: Estudio ecológico; se calcularon los indicadores de adhesión (IND-ADH) de 2.837 municípios brasileños al PAS y de hospitalizaciones por enfermedades crónicas no transmisibles (IND-ECNT) según las categorías de financiación y el Índice Firjan de Desarrollo Socioeconómico (IFDM). Resultados: El IND-ADH fue alto en municipios financiados mediante enmiendas parlamentarias (1,18), el IFDM moderado a alto (0,94) y el indicador ECNT alto (1,03) (p<0,001). Hubo correlaciones significativas (p<0,05) entre los indicadores IND-ADH e IND-DCNT en municipios con financiamiento del Ministerio de Salud (r = 0,14) y mixtos (r=0,12); hubo correlación negativa para municipios con IFDM moderado a bajo (r=-0,09; p=0,013). Conclusión: La enmienda parlamentaria fue la forma principal de adhesión al PAS de los municipios, cuando ajustada por la población. Los municipios con los peores indicadores socioeconómicos y de ENT tuvieron un IND-ADH más bajo.

Objective: To analyze the correlation between municipalities adhering to the Health Fitness Center Program, noncommunicable chronic disease (NCD) hospitalizations and socioeconomic levels from 2011 to 2017. Methods: This was an ecological study; HFCP adherence indicators for 2,837 municipalities were calculated, as were NCD hospitalization indicators, according to funding categories and the Firjan Socioeconomic Development Index. Results: The HFCP adherence indicator was higher for municipalities that received Congress funding (1.18), had moderate to high Firjan Socioeconomic Development Indices (0.94) and high NCD hospitalization indicators (1.03) (p<0.001). There were positive correlations (p<0.05) between the two indicators in municipalities receiving Ministry of Health funding (r=0.14) and those receiving both Congress and Ministry of Health funding (r=0.12); whereas correlation was negative in municipalities with moderate to low Firjan Socioeconomic Development Indices (r=-0.09; p=0.013). Conclusion: The main form of adherence to the HFCP, according to population size, was through Congress funding. Municipalities with poorer socioeconomic and NCD indicators had lower adherence to the HFCP.

Medical device development, from technical design to integrated product development.

The development process of medical devices (MDs) implies the integration of knowledge and skills from the fields of medicine and engineering. Such an integration is difficult because of lack of communication, mismatch of priorities and work-style differences among those fields. Besides, MD development has particularities that make the product development process (PDP) even more complex such as high level of regulations, concurrent technologies application as well as different end users requirements. In addition, these MDs are classified according to the level of risk they offer to users - low, medium and high - what makes their development project very complex in practice depending on the risk associated. For the specific case of SMEs in the broad mechanical and electronic area that develop physical MD with low and medium-risk levels, PDP models in place have proved to be not well fit to the reality they face. This research objective is to synthesise a PDP model for SMEs in the specific medical sector, by incorporating the best practices of the engineering area and particularities of the medical area. The methodology used was an extensive bibliographic analysis and field research conducted towards SMEs in the MD industry.

The role of chitin-rich skeletal organic matrix on the crystallization of calcium carbonate in the crustose coralline alga Leptophytum foecundum.

The organic matrix (OM) contained in marine calcifiers has a key role in the regulation of crystal deposition, such as crystalline structure, initiation of mineralization, inhibition, and biological/environmental control. However, the functional properties of the chitin-rich skeletal organic matrix on the biological aspect of crystallization in crustose coralline algae have not yet been investigated. Hence, the characterization of organic matrices in the biomineralization process of this species was studied to understand the functions of these key components for structural formation and mineralization of calcium carbonate crystals. We purified skeletal organic matrix proteins from this species and explored how these components are involved in the mineralization of calcium carbonate crystals and environmental control. Intriguingly, the analytical investigation of the skeletal OM revealed the presence of chitin in the crustose coralline alga Leptophytum foecundum. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis of the OM revealed a high molecular mass protein as 300-kDa. Analysis of glycosylation activity exposed two strong glycoproteins as 300-kDa and 240-kDa. Our study of the biominerals of live collected specimens found that in addition to Mg-calcite up to 30% aragonite were present in the skeleton. Our experiment demonstrated that the chitin-rich skeletal OM of coralline algae plays a key role in the biocalcification process by enabling the formation of Mg-calcite. In addition, this OM did not inhibit the formation of aragonite suggesting there is an as yet unidentified process in the living coralline that prevents the formation of aragonite in the living skeletal cell walls.

Type of admission and nursing workload of critical patients: a cross-sectional study.

BACKGROUND: According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory. AIMS AND OBJECTIVES: To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU. DESIGN: This was a quantitative cross-sectional study comprised of a retrospective analysis of clinical records of critical patients. METHODS: Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level. RESULTS: In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay. CONCLUSIONS: The type of admission was not a predictive factor of the nursing workload required by critical patients. RELEVANCE TO CLINICAL PRACTICE: Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU.

Care time and quality indicators in Intensive Care Units.

OBJECTIVE: To verify the correlation between nursing care time and care quality indicators. METHOD: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. RESULTS: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. CONCLUSION: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

Care time and quality indicators in Intensive Care Units / Tiempo de atención e indicadores de calidad en Unidades de Terapia Intensiva / Tempo de assistência e indicadores de qualidade em Unidades de Terapia Intensiva

ABSTRACT Objective: To verify the correlation between nursing care time and care quality indicators. Method: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. Results: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. Conclusion: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

RESUMEN Objetivo: Verificar la correlación entre tiempo de atención de enfermería e indicadores de calidad asistencial. Método: Estudio observacional, correlacional, desarrollado en 11 Unidades de Terapia Intensiva. La población comprendió registros del cuantitativo de los profesionales de enfermería, del número de portadores de, al menos, uno de los dispositivos terapéuticos Sonda Oro/Nasogastroenteral (SONGE), Cánula Endotraqueal (COT) y Cateter Venoso Central (CVC) y de las ocurrencias relativas a las pérdidas de estos artefactos. Resultados: El tiempo correspondió a 18,86 horas (Hospital A), 21 horas (Hospital B) y 19,50 horas (Hospital C); el indicador Incidencia de Salida No Planeada de SONGE presentó una media de 2,19/100 pacientes/día; Incidencia de Extubación no planificada de COT, 0,42/100 pacientes/día; e Incidencia de Pérdida CVC, 0,22/100 pacientes/día. No hubo correlación estadísticamente significativa entre el tiempo y los indicadores analizados. Conclusión: Esta investigación puede apoyar decisiones metodológicas para investigaciones futuras que buscan el impacto de los recursos humanos en la calidad asistencial y seguridad de los pacientes.

RESUMO Objetivo: Verificar a correlação entre tempo de assistência de enfermagem e indicadores de qualidade assistencial. Método: Estudo observacional, correlacional, desenvolvido em 11 Unidades de Terapia Intensiva. A população compreendeu registros do quantitativo dos profissionais de enfermagem, do número dos portadores de, ao menos, um dos dispositivos terapêuticos Sonda Oro/Nasogastroenteral (SONGE), Cânula Endotraqueal (COT) e Cateter Venoso Central (CVC) e das ocorrências relativas às perdas desses artefatos. Resultados: O tempo correspondeu a 18,86 horas (Hospital A), 21 horas (Hospital B) e 19,50 horas (Hospital C); o indicador Incidência de Saída Não Planejada de SONGE apresentou média de 2,19/100 pacientes/dia; Incidência de Extubação não Planejada de COT, 0,42/100 pacientes/dia; e Incidência de Perda CVC, 0,22/100 pacientes/dia. Não houve correlação estatisticamente significante entre o tempo e os indicadores analisados. Conclusão: Esta pesquisa pode apoiar decisões metodológicas para investigações futuras que buscam o impacto dos recursos humanos na qualidade assistencial e segurança dos pacientes.

The influence of delayed admission to intensive care unit on mortality and nursing workload: a cohort study.

BACKGROUND: The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload. AIMS AND OBJECTIVES: To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients. DESIGN: This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED. METHODS: The data were collected between 2014 and 2016 in a hospital located in São Paulo, Brazil. Nursing workload was measured by the Nursing Activities Score. Multiple linear and logistic regressions were applied, with a significance level of 5%. RESULTS: Of the 534 patients analysed, the majority were men (57·49%); the mean age was 55·37 ± 19·64 years. Length of stay in the ED was not associated with nursing workload at the time of admission of patients to the ICU or during their stay in the unit. For mortality, this variable was a risk factor along with cause of admission, length of stay in the ICU and the Simplified Acute Physiology Score 3 score. For every additional hour that patients remained in the ED, their chance of dying in the ICU increased by 1%. CONCLUSION: Length of stay of patients in the ED was a risk factor for mortality in the ICU; however, this variable did not have any influence on nursing workload. RELEVANCE TO CLINICAL PRACTICE: Strategies need to be implemented to optimize the availability of ICU beds and reduce the length of stay of critical patients in the ED as delays in admitting such patients to the ICU have an impact on mortality.

Critérios de admissão do paciente oncológico em Unidades de Terapia Intensiva de hospitais gerais / Oncology patient admission criteria in Intensive Care Units of general care hospitals

A função da Unidade de Terapia Intensiva é de suporte terapêutico ao paciente. O paciente com câncer muitas vezes necessita de suporte intensivo. Nesse contexto, a gravidade das disfunções orgânicas, o comprometimento da capacidade funcional, o estadiamento do câncer e a aplicação de índices prognósticos são considerados na discussão para admissão na Unidade de Terapia Intensiva. Este artigo tem como objetivo identificar os critérios para admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais, através de uma revisão integrativa, com estudos de 2007 a 2017 disponíveis em versão completa e gratuita nas bases de dados digitais: Biblioteca Virtual em Saúde, Scientific Electronic Library Online e no portal PubMed. Foram encontradas 58 publicações potenciais. Após análise preliminar dos títulos e resumos e aplicação dos critérios de inclusão e exclusão, 23 artigos seguiram para leitura na íntegra, sendo que 10 compuseram a amostra final. Sete estudos (70%) citaram o escore prognóstico APACHE II, quatro (40%) utilizaram Simplified Acute Physiology Score, dois (20%) o Sequential Organ Failure Assessment e seis (60%) utilizaram mais de um instrumento. O câncer é uma doença grave, entretanto a decisão de indicação para tratamento intensivo não deve ser baseada em apenas uma morbidade. Pacientes oncológicos podem ter benefícios ao receberem suporte intensivo. Estudos que determinam critérios objetivos para admissão e avaliam o benefício da admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais devem ser incentivados a fim de melhor definir a utilização adequada dos recursos.

The role of the Intensive Care Unit is to provide therapeutic support for the patient. The cancer patient often needs intensive support. In this context, the severity of organ dysfunctions, the impairment of functional capacity, the stage of cancer and the application of prognostic indexes are factors considered in the discussion for the patient's admission into the Intensive Care Unit. The aim of this study is to identify the criteria for admission of cancer patients into the Intensive Care Unit of general care hospitals, through an integrative review, with studies performed between 2007 and 2017, which are fully available and free for downloading in the following digital databases: Virtual Library on Health, Scientific Electronic Library Online and PubMed. Fifty-eight potential studies were found. After a preliminary analysis of the titles and abstracts and application of the inclusion and exclusion criteria, 23 articles were analyzed, of which 10 composed the final sample. Seven studies (70%) cited the APACHE II prognostic score, four (40%) used the Simplified Acute Physiology Score, two (20%) the Sequential Organ Failure Assessment and six (60%) used more than one instrument. Cancer is a serious disease, but the indication for intensive care should not be based on just one morbidity. Oncology patients may benefit from receiving intensive treatment. Studies that establish objective criteria for admission and evaluate the benefit of admission of cancer patients into Intensive Care Unit of general care hospitals should be encouraged in order to better define the appropriate use of resources.

Central line bundle maintenance among adults in a university hospital intensive care unit in São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice. INTRODUCTION: Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream. METHODS: This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital. RESULTS: The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing. CONCLUSIONS: Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.