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.

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.

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.

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.

Nursing workload and occurrence of adverse events in intensive care: a systematic review.

OBJECTIVE: To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). METHOD: A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. RESULTS: Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU. CONCLUSION: The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care. OBJETIVO: Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI). MÉTODO: Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos. RESULTADOS: Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP. CONCLUSÃO: A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.

Analysis of intensive care unit admissions for older adults with femoral fractures: a retrospective cohort.

OBJECTIVES: To describe the historical series of admissions to the Intensive Care Unit of older adults with femoral fractures, and verify the association between age and injury characteristics and treatment, nursing workload, severity, and clinical evolution in the unit. METHOD: Retrospective cohort of 295 older adults (age ≥60 years) admitted to the Intensive Care Unit of a hospital in São Paulo, between 2013 and 2019, and who presented with a femur fracture as the main cause of hospitalization. Variables regarding demographic characteristics, cause, and type of fracture, treatment provided, severity, nursing workload, and medical outcome of patients were analyzed. The Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis tests and Pearson correlation were applied. RESULTS: There was an increase in older adults admission to the Intensive Care Unit from 2017 on. Female patients with distal femur fractures who died in the Intensive Care Unit had significantly (p < 0.05) higher median age than men, patients with shaft or proximal femur fractures, and survivors. CONCLUSION: The study findings highlight essential information for structuring care for older adults with femoral fractures who require intensive care.

Screening and early detection of post-extubation oropharyngeal dysphagia: a best practice implementation project.

INTRODUCTION: Patients undergoing intubation and mechanical ventilation in an intensive care unit risk developing post-extubation oropharyngeal dysphagia (PED). PED can lead to aspiration complications, aspiration pneumonia, and prolonged hospitalization, as well as increased repeat intubation and in-hospital morbidity and mortality. OBJECTIVE: This evidence implementation project aimed to promote evidence-based screening and early detection of PED in an adult intensive care unit in a secondary public hospital in Brazil. METHOD: The project followed the seven-phase JBI Evidence Implementation Framework to promote changes at the study site. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) approach were also used. The project was developed considering the main barriers to best practices, which were identified through a baseline audit. An educational program was designed to address the identified barriers. Two follow-up audits were then conducted to assess the changes in compliance with the evidence-based practices. RESULTS: The baseline audit showed deficits in current practices. The first follow-up audit indicated improved compliance with best practices, with five of the seven audit criteria showing 100% compliance. The second follow-up audit indicated that compliance remained at 100% for those five criteria and increased for the other two after an additional intervention to address poor results in nursing care documentation. CONCLUSION: The first follow-up audit showed good adherence to the educational program for the screening and detection of PED by nurses. The second follow-up audit, in line with the new strategies, showed improvement in nursing documentation. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A241.

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.

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.

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.

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.

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.

Analysis of intensive care unit admissions for older adults with femoral fractures: a retrospective cohort / Análisis de los ingresos de ancianos con fracturas de fémur a unidades de cuidados intensivos: cohorte retrospectiva / Análise das internações na unidade de terapia intensiva de idosos com fratura de fêmur: coorte retrospectivo

ABSTRACT Objectives: To describe the historical series of admissions to the Intensive Care Unit of older adults with femoral fractures, and verify the association between age and injury characteristics and treatment, nursing workload, severity, and clinical evolution in the unit. Method: Retrospective cohort of 295 older adults (age ≥60 years) admitted to the Intensive Care Unit of a hospital in São Paulo, between 2013 and 2019, and who presented with a femur fracture as the main cause of hospitalization. Variables regarding demographic characteristics, cause, and type of fracture, treatment provided, severity, nursing workload, and medical outcome of patients were analyzed. The Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis tests and Pearson correlation were applied. Results: There was an increase in older adults admission to the Intensive Care Unit from 2017 on. Female patients with distal femur fractures who died in the Intensive Care Unit had significantly (p < 0.05) higher median age than men, patients with shaft or proximal femur fractures, and survivors. Conclusion: The study findings highlight essential information for structuring care for older adults with femoral fractures who require intensive care.

RESUMEN Objetivo: Describir la serie histórica de internaciones, en la Unidad de Cuidados Intensivos, de ancianos con fractura de fémur, y verificar la asociación entre la edad y las características y tratamiento de la lesión, carga de trabajo de enfermería, gravedad y evolución clínica en la unidad. Método: Cohorte retrospectiva de 295 ancianos (edad ≥60 años) ingresados en la Unidad de Cuidados Intensivos de un hospital de São Paulo, entre 2013 y 2019, y que presentaron fractura de fémur como principal causa de hospitalización. Se analizaron variables relativas a características demográficas, causa y tipo de fractura, tratamiento realizado, gravedad, carga de trabajo de enfermería y evolución clínica de los pacientes. Se aplicaron las pruebas de Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis y correlación de Pearson. Resultados: Hubo aumento de hospitalizaciones de ancianos en Unidad de Cuidados Intensivos desde 2017. Las pacientes del sexo femenino con fracturas de fémur distal que murieron en la Unidad de Cuidados Intensivos tuvieron mediana de edad significativamente (p < 0,05) más alta que los hombres, los pacientes con fracturas de diáfisis o de fémur proximal y los supervivientes. Conclusión: Los hallazgos del estudio resaltan información esencial para estructurar la atención de los ancianos con fracturas femorales que requieren tratamiento intensivo.

RESUMO Objetivos: Descrever a série histórica das internações, na Unidade de Terapia Intensiva, de idosos com fratura de fêmur, e verificar a associação entre idade e as características e tratamento da lesão, carga de trabalho de enfermagem, gravidade e evolução clínica na unidade. Método: Coorte retrospectiva de 295 idosos (idade ≥60 anos) admitidos na Unidade de Terapia Intensiva de hospital em São Paulo, entre 2013 e 2019, e que apresentaram fratura de fêmur como causa principal da internação. Variáveis sobre características demográficas, causa e tipo da fratura, tratamento realizado, gravidade, carga de trabalho de enfermagem e desfecho clínico dos pacientes foram analisadas. Os testes de Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis e correlação de Pearson foram aplicados. Resultados: Houve aumento das internações de idosos na Unidade de Terapia Intensiva a partir de 2017. Pacientes do sexo feminino, com fratura distal de fêmur e que morreram na Unidade de Terapia Intensiva apresentaram significativamente (p < 0,05) maior mediana de idade do que homens, pacientes com fratura de diáfise ou proximal do fêmur e sobreviventes. Conclusão: Os achados do estudo evidenciam informações essenciais para estruturação dos cuidados ao idoso com fratura de fêmur que necessita de tratamento intensivo.

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.

[The need for nursing care in intensive care units: daily patient assessment according to the nursing activities score (NAS)]. / Necessidades de cuidados de enfermagem em terapia intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS).

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in São Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66.5% (+/- 9.1) with a score higher than 50.0% during their stay in the ICU.

[Therapeutic interventions in intensive care units: analysis according to therapeutic intervention scoring system-28 (TISS-28)]. / Intervenções terapêuticas em unidade de terapia intensiva: análise segundo o therapeutic intervention scoring system-28 (TISS-28).

The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided to the clients, as they contribute to the human resources estimative and materials in the ICU as well.

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.

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

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.