Planar wire-array Z-pinch implosion dynamics and X-ray scaling at multiple-MA drive currents for a compact multisource hohlraum configuration.

An indirect drive configuration is proposed wherein multiple compact Z-pinch x-ray sources surround a secondary hohlraum. Planar compact wire arrays allow reduced primary hohlraum surface area compared to cylindrical loads. Implosions of planar arrays are studied at up to 15 TW x-ray power on Saturn with radiated yields exceeding the calculated kinetic energy, suggesting other heating paths. X-ray power and yield scaling studied from 1-6 MA motivates viewfactor modeling of four 6-MA planar arrays producing 90 eV radiation temperature in a secondary hohlraum.

Stable C isotope data of southern mixed-grass prairie vegetation from Oklahoma, United States.

Stable carbon isotopic data (δ13C) of 41 individual plant species was collected from long-term grazed and ungrazed pastures in Oklahoma, USA. These data can serve as a library of stable carbon isotope values for Southern mixed-grass prairie species. Seventeen warm-season (C4) and twenty-four cool-season (C3) plants were identified and collected from the United States Department of Agriculture (USDA) Southern Plains Experimental Range (SPER). Plant samples were dried at 55°C, and ground finely. The δ13C isotopic compositions were determined using a Europa Scientific automated nitrogen carbon analyzer (ANCA/NT) with a Solid/Liquid Preparation Module (Dumas combustion sample preparation system) coupled to a Europa 20-20 Stable isotope analyzer continuous flow isotope ratio mass spectrometer (Sercon Ltd, formerly Europa Scientific Ltd., Crewe, England). These data can be used as end members in isotopic mixing models or in paleoecology to correlate soil ages with plant species composition. Data from plant species provides information about soil organic carbon sequestration and possible long-term climate change.

Natural flavonoids inhibit the plasma membrane Ca2+-ATPase.

Research on flavonoids from plant sources has recently sparked increasing interest because of their beneficial health properties. Different studies have shown that flavonoids change the intracellular Ca2+ homeostasis linked to alterations in the function of mitochondria, Ca2+ channels and Ca2+ pumps. These findings hint at plasma membrane Ca2+-ATPase (PMCA) involvement, as it transports Ca2+ actively to the extracellular medium coupled to ATP hydrolysis, thus maintaining ion cellular homeostasis. The present study aims to investigate the effect of several natural flavonoids on PMCA both in isolated protein systems and in living cells, and to establish the relationship between flavonoid structure and inhibitory activity on PMCA. Our results show that natural flavonoids inhibited purified and membranous PMCA with different effectiveness: quercetin and gossypin were the most potent and their inhibition mechanisms seem to be different, as quercetin does not prevent ATP binding whereas gossypin does. Moreover, PMCA activity was inhibited in human embryonic kidney cells which transiently overexpress PMCA, suggesting that the effects observed on isolated systems could occur in a complex structure like a living cell. In conclusion, this work reveals a novel molecular mechanism through which flavonoids inhibit PMCA, which leads to Ca2+ homeostasis and signaling alterations in the cell.

[Prescription errors after the implementation of an electronic prescribing system]. / Errores de prescripción tras la implantación de un sistema de prescripción electrónica asistida.

OBJECTIVE: This study sets out to identify, compare and evaluate the medication errors of a manual prescribing system and an electronic prescribing system during the prescription and transcription phases. METHOD: A prospective study of two clinical in-patient units (pneumology and infectious diseases) in one general hospital. Two phases were studied; before and after an electronic prescribing system was implemented. Each phase lasted one month. A comparative analysis was carried out of the medication errors in the medical prescription process, the transcription process and the administration recording process carried out by nursing staff as well as the pharmacist s transcriptions/validations. RESULTS: A total of 3,908 patient treatment errors and 129 patient identification errors were detected during both of the periods studied. The rate of errors in patient identification or treatment orders using the manual prescribing system was 14.4 against 1.3% after the electronic system was implemented. The relative risk reduction for infectious diseases and pneumology was 100 and 85.44%, respectively (statistically significant). In general, relative risk reduction was achieved in both units, oscillating between 78.91 and 100%. The absolute risk reduction oscillated between 5.09 and 30.45% for errors in drug data, doses, frequency/time and route of administration. These results were statistically significant. CONCLUSIONS: The electronic prescribing system has reduced errors in the identification, prescription and transcription of pharmacological treatment and has consequently helped to improve the quality and safety of drug treatment received by patients.

Clinical pathway for hip arthroplasty six years after introduction.

PURPOSE: This paper seeks to analyse clinical pathways (CP) as a useful tool for the improvement of all aspects of quality in medical assistance - in this case, hip arthroplasty. DESIGN/METHODOLOGY/APPROACH: The study was carried out on patients who had undergone scheduled hip arthroplasty included in CP during the years 1999 to 2004. Data on demographics, lengths of stay, complications, process and result variables were gathered, coverage was calculated and the evolution of the indicators was compared. FINDINGS: A total of 487 patients were enrolled, with five leaving the pathway and with unequal coverage, leading to a maximum peak of 77 per cent in 1999. A statistically significant decrease exists in the consumption of overall stays and in the pre-surgical stay, which dropped from a mean of 19.41 days in the pre-pathway situation to 10.12 days in 2004 and 4.5 days pre-surgery to 1.08 days. As a process indicator, the performance should be highlighted of post-operation check-up radiographies, which have been gaining high levels of compliance (p < 0.05) since 2001. The rate of complications has remained stable over the years. ORIGINALITY/VALUE: Implementing the CP has meant a sustained saving of resources over the years and an improvement in the organization of work.

Nitrogen mineralization from organic residues: research opportunities.

Research on nitrogen (N) mineralization from organic residues is important to understand N cycling in soils. Here we review research on factors controlling net N mineralization as well as research on laboratory and field modeling efforts, with the objective of highlighting areas with opportunities for additional research. Among the factors controlling net N mineralization are organic composition of the residue, soil temperature and water content, drying and rewetting events, and soil characteristics. Because C to N ratio of the residue cannot explain all the variability observed in N mineralization among residues, considerable effort has been dedicated to the identification of specific compounds that play critical roles in N mineralization. Spectroscopic techniques are promising tools to further identify these compounds. Many studies have evaluated the effect of temperature and soil water content on N mineralization, but most have concentrated on mineralization from soil organic matter, not from organic residues. Additional work should be conducted with different organic residues, paying particular attention to the interaction between soil temperature and water content. One- and two-pool exponential models have been used to model N mineralization under laboratory conditions, but some drawbacks make it difficult to identify definite pools of mineralizable N. Fixing rate constants has been used as a way to eliminate some of these drawbacks when modeling N mineralization from soil organic matter, and may be useful for modeling N mineralization from organic residues. Additional work with more complex simulation models is needed to simulate both gross N mineralization and immobilization to better estimate net N mineralized from organic residues.

DMFT and treatment needs in adult population of Oviedo, Spain.

An epidemiological survey was carried out in 1992 researching dental caries and treatment needs in an adult population in Oviedo, Spain. A representative sample of 261 subjects, randomly obtained and stratified by age, was examined. Results show a dental decay prevalence of 99.6%; 12.5 DMFT index with 2.9, 7.5 and 2.1 mean values for D, M and F components. Women and the lower social class showed the highest DMFT index. Treatment needs reach a mean value of 12.1 teeth per person. Pontics are the most needed treatment, the mean value increases with age while the differences among age groups and social classes are statistically significant. The next most needed dental treatment is filling of one surface which decreases with age, is the same for men and women and higher among the middle social class; the differences are statistically significant among the social classes.

Nitrogen use and carbon sequestered by corn rotations in the northern corn belt, U.S.

Diversified crop rotation may improve production efficiency, reduce fertilizer nitrogen (N) requirements for corn (Zea mays L.), and increase soil carbon (C) storage. Objectives were to determine effect of rotation and fertilizer N on soil C sequestration and N use. An experiment was started in 1990 on a Barnes clay loam (U.S. soil taxonomy: fine-loamy, mixed, superactive, frigid Calcic Hapludoll) near Brookings, SD. Tillage systems for corn-soybean ( Glycine max [L.] Merr.) rotations were conventional tillage (CS) and ridge tillage (CSr). Rotations under conventional tillage were continuous corn (CC), and a 4-year rotation of corn-soybean-wheat ( Triticum aestivum L.) companion-seeded with alfalfa ( Medicago sativa L.)-alfalfa hay (CSWA). Additional treatments included plots of perennial warm season, cool season, and mixtures of warm and cool season grasses. N treatments for corn were corn fertilized for a grain yield of 8.5 Mg ha(-1) (highN), of 5.3 Mg ha(-1) (midN), and with no N fertilizer (noN). Total (1990-2000) corn grain yield was not different among rotations at 80.8 Mg ha(-1) under highN. Corn yield differences among rotations increased with decreased fertilizer N. Total (1990-2000) corn yields with noN fertilizer were 69 Mg ha-1 under CSWA, 53 Mg ha(-1) under CS, and 35 Mg ha(-1) under CC. Total N attributed to rotations (noN treatments) was 0.68 Mg ha(-1) under CSWA, 0.61 Mg ha(-1) under CS, and 0.28 Mg ha(-1) under CC. Plant carbon return depended on rotation and N. In the past 10 years, total C returned from above- ground biomass was 29.8 Mg ha(-1) under CC with highN, and 12.8 Mg ha(-1) under CSWA with noN. Soil C in the top 15 cm significantly increased (0.7 g kg(-1)) with perennial grass cover, remained unchanged under CSr, and decreased (1.7 g kg(-1)) under CC, CS, and CSWA. C to N ratio significantly narrowed (-0.75) with CSWA and widened (0.72) under grass. Diversified rotations have potential to increase N use efficiency and reduce fertilizer N input for corn. However, within a corn production system using conventional tillage and producing (averaged across rotation and N treatment) about 6.2-Mg ha(-1) corn grain per year, we found no gain in soil C after 10 years regardless of rotation.

Passive wedge.

The article describes a new technique for fabricating a wedge directly in the mouth during clinical procedures. It is called a passive wedge because it is kind to the soft tissues, exerting neither compression nor traction on them. A conventional rigid wedge may hurt the interdental papilla, initiating bleeding and the flow of fluids through the rubber dam. This new technique is very useful during adhesive procedures, because the wedge prevents moisture from invading the working area and the cavity, maintains the matrix in place, and causes no harm to the soft tissues, allowing the restoration to be finished properly.

Simplified method of odontograms for individual identification.

A computerized method of codifying dental lesions and treatment is presented to enable faster identification of victims of catastrophes. Each tooth is assigned a bidigital value. The first digit refers to the root and designates whether it is found to be perfect, damaged and/or treated, or absent. The second digit refers to the crown and is assigned according to the number of surfaces showing lesions or treatment. For the identification of corpses, missing individuals whose record reveals values less than or equal to those of the subject in every tooth (or of each quadrant in cases of doubt) are selected for consideration from the data base. Individuals who have even one tooth with a value greater than that of the subject are eliminated.

Using operational equipment to read accident dosemeters.

Analysis of accident dosemeters usually involves the use of laboratory-based counting equipment. Gamma spectrometers are used for indium, copper and gold, and alpha-beta detectors for sulphur. This equipment is usually not easily transported due to the shielding required and the weight and delicacy of the counters. For intercomparison studies that require reading the dosemeters on site, a transportable system is required unless the site operating the study can count samples for all the participants. In the case of an actual accident these systems would have a difficulty in counting a large number of accident dosemeters. In an accident, personnel are usually subdivided according to their level of exposure. Those exposed to higher doses are treated immediately. An alternate system should be made available to handle the dosemeters worn by those personnel are likely to receive lower doses. Improvements in portable operational equipment for gamma and beta monitoring allow their use as spectrometers. Such a system was used for the SILENE intercomparison conducted at IRSN Valduc on 12 June and 19, 2002, and the preliminary results compared well with the other participants.

Determination of the horizontal movement of the working-side condyle during lateral movements of the mandible using computed tomography.

The purpose of this study was to evaluate the horizontal movement of the working-side condyle during lateral movements of the mandible using computed tomography. The results showed that the working-side condyle moves in an outward and forward direction from the position of maximum intercuspation. The average movement is less than 1 mm.

[Evaluation of the analgesic effectiveness of ketorolac in intravenous regional anesthesia induced by lidocaine]. / Evaluación de la eficacia analgésica del ketorolaco en la anestesia regional intravenosa inducida con lidocaína.

OBJECTIVES: Intravenous regional anesthesia (i.v.r.) is a safe, effective technique for surgery on the upper extremities, but it provides no postoperative analgesia. The aim of this study was to evaluate the analgesic efficacy of ketorolac during and after surgery with i.v.r. induced by lidocaine. PATIENTS AND METHODS: A double blind, placebo-controlled clinical trial. Twenty-six patients undergoing elective surgery on the upper extremities under i.v.r. were studied. In the anteroom of the operating theater, an anesthesiologist prepared the anesthetic solution to be administered from two syringes. One contained 3 mg/kg of 0.5% lidocaine (0.6 ml/kg). The second syringe (2 ml) contained 1 ml of 0.9% saline solution for the control group or 1 ml with 30 mg of ketorolac for the treatment group. A second anesthesiologist received the patient in the operating theater and used the syringes provided to induce the blockade. After releasing the pneumatic tourniquets we assessed the appearance of postoperative pain on a visual analog scale over the first 24 hours. The dats were compared using parametric (Student t test) and non parametric tests (Mann-Whitney U test and Fisher's exact test). RESULTS: No significant differences in the characteristics or hemodynamic parameters analyzed were found between the two groups. Nor did we find any differences in analgesia during surgery. Ten of the 13 patients (77%) in the control group required analgesia within the first two hours, whereas none of the patients in the treatment group required analgesia during that time (p < 0.0001). There were no statistically significant differences between the two groups in the total amount administered altogether, both during and after surgery. No local or systemic side effects were observed.

[Ondansetron in the prophylaxis of postoperative nausea and vomiting in ambulatory cataract surgery]. / Ondansetrón en la profilaxis de las náuseas y los vómitos postoperatorios en cirugía de cataratas ambulatoria.

INTRODUCTION AND OBJECTIVE: Postoperative nausea and vomiting (PONV) are potentially serious complications of ophthalmic surgery. We assess the efficacy of ondansetron for antiemetic prophylaxis in outpatient unilateral cataract surgery under retrobulbar blockade. PATIENTS AND METHODS: Cohort study of patients undergoing unilateral cataract surgery between January 1996 and March 1997. The main predictive variable was intravenous administration of 4 mg of ondansetron 30 min before surgery and the main effect variable was the presence of PONV during the first 24 h after surgery. The incidence of PONV was calculated and an analysis of statistical significance was performed using a Mantel-Haenszel chi 2 test, describing the magnitude of association between relative risk and the corresponding confidence interval (95% CI). RESULTS: One hundred sixty-two patients were enrolled. Eighty-two patients received ondansetron and 80 did not. The two groups were similar with respect to control variables. PONV occurred in 23 patients (14.2%): in 16 (20%) who did not receive ondansetron and in 7 (8.2%) who did (p < 0.05). The relative risk of patients who received ondansetron was 0.42 (95% CI: 0.19-0.98) in comparison with those who did not. CONCLUSION: We found a high incidence of PONV, although the administration of ondansetron reduced PONV significantly.

EMS in the pueblos.

Imagine creating a movie by excerpting scenes from "Dances With Wolves," splicing it with footage from "Code 3" or "Emergency Response" and then flavoring the script with the mystery of a Tony Hillerman novel. A film producer would probably find it quite difficult to choreograph a finished product from such a compilation of material. To hundreds of Native American EMS providers, however, such a movie is played out every day in Indian country. And with this movie come some real-life problems, including trauma, which is the number-one cause of premature death among Native Americans. But a high trauma rate is just one of the challenges facing tribal EMS responders. There's also prolonged response and transport, the problems involved in maintaining the unique culture and standard of care, the challenges of tribal EMS administration and EMS education of Native American students, and the unsure future of Native American EMS. Beyond that, there's the fact that EMS is a s unique to each Indian reservation as are the cultures of the native peoples who reside on these lands. Yet while no two systems are alike, most tribal EMS providers face similar challenges.

Instrumentos que miden la comunicación enfermera-paciente / Instruments measuring nurse-patient communication / Instrumentos que medem a comunicação enfermeira-paciente

Resumen Introducción Por la importancia que tiene la comunicación al ofrecer un cuidado de calidad, las enfermeras se han preocupado por la evaluación de la interacción con su paciente en el ejercicio de su práctica profesional. Objetivo Identificar instrumentos que midan la interacción enfermera paciente, por el valor que puede implicar para la evaluación de la calidad de la atención en la dimensión interpersonal. Metodología Se revisó la literatura y consultaron las bases de Scielo, Medline, Redalyc, BVS y, CINHAL. De acuerdo con el propósito enunciado se seleccionaron 25 artículos que investigan sobre el diseño, validación, aplicación y adaptación de instrumentos que miden la comunicación enfermera-paciente en diversos servicios y niveles de salud. Resultados Los artículos seleccionados se clasificaron en tres grupos: a) aplicación y validación de instrumentos; b) adaptación y validación de instrumentos; c) diseño y validación de instrumentos. Nueve hacen referencia a la aplicación y validación de instrumentos, 10 tanto a la adaptación como la validación, por último, seis al diseño y validación. Conclusiones Aunque se han diseñado, validado, aplicado y ajustado instrumentos, aún existen retos en este campo de investigación, con el fin de ofrecer nuevas estrategias que diagnostiquen y brinden alternativas específicas, para mejorar la comunicación enfermera-paciente en la práctica diaria de enfermería.

Abstract Introduction Given the importance which communication has in healthcare of quality, nurses have been concerned about the assessment of professional interactions with their patients. Objective To identify instruments measuring the nurse-patient interactions in order to assess the quality of attention provided within an interpersonal dimension. Methodology The related literature was reviewed by consulting the Scielo, Medline, Redalyc, BVS and CINHAL databases. 25 articles researching on the design, validation, application, and adaptation of instruments measuring nurse-patient communications in diverse services and levels of care were selected. Results Selected articles were classified into three groups: a) application and validation of instruments; b) adaptation and validation of instruments; c) design and validation of instruments. Nine articles make reference to the application and validation of instruments, 10 make it to adaptation and validation, and 6 make it to the design and validation. Conclusions Although diverse articles addressing the issue have been designed, validated, applied and adjusted, challenges in this research area still exist regarding new strategies which can diagnose and offer alternatives to improve the communication between the nurses and their patients in the daily nursing practice.

Resumo Introdução Pela importância que tem a comunicação para oferecer um cuidado de qualidade, as enfermeiras têm se preocupado pela avaliação da interação com seu paciente no exercício de sua prática profissional. Objetivo Identificar instrumentos que medem a interação enfermeira paciente, pelo valor que pode envolver para a avaliação da qualidade da atenção na dimensão interpessoal. Metodologia Revisou-se a literatura e consultaram as bases de Scielo, Medline, Redalyc, BVS e, CINHAL. Conforme no propósito enunciado selecionaram-se 25 artigos que pesquisam sobre o desenho, validação, aplicação e adaptação de instrumentos que medem a comunicação enfermeira-paciente em diversos serviços e níveis de saúde. Resultados Os artigos selecionados classificaram-se em três grupos: a) aplicação e validação de instrumentos; b) adaptação e validação de instrumentos; c) desenho e validação de instrumentos. Nove fazem referência à aplicação e validação de instrumentos, 10 tanto na adaptação quanto na validação, por último, seis no desenho e validação. Conclusões Ainda que se tenham desenhado, validado, aplicado e ajustado instrumentos, ainda existem desafios neste campo de pesquisa com o fim de oferecer novas estratégias que diagnostiquem e forneçam alternativas específicas, para melhorar a comunicação enfermeira-paciente na prática diária de enfermagem.

Programa cognitivo conductual para fortalecer habilidades de comunicación enfermera paciente / Cognitive-behavioral program to strengthen the nurse-patient communication / Programa cognitivo comportamental para fortalecer habilidades de comunicação enfermeira paciente

Introducción: La comunicación enfermera paciente es eje articulador de los cuidados, requiere habilidades específicas de comunicación verbal y no verbal. El entrenamiento con estrategias cognitivo conductuales para el fomento de estas habilidades coadyuva en forma importante en el establecimiento de relaciones terapéuticas de la práctica profesional de enfermería; estas técnicas han sido ampliamente aplicadas, en el presente caso se utilizó el Aprendizaje Estructurado, cuyo objetivo se centra en el cambio de comportamiento, sin dejar de reconocer que también propicia cambios favorables en sentimientos y actitudes. Este artículo se enfoca en dar a conocer la aplicación práctica de un programa para enfermeras sobre el fortalecimiento de habilidades de comunicación. Desarrollo: Las habilidades seleccionadas en el desarrollo de este programa con el apoyo de la estrategia Aprendizaje Estructurado fueron: Escuchar, Expresar aliento, Expresar un cumplido, Responder a los sentimientos del otro, Responder a una queja, Responder al enojo y Expresar afecto. Se registraron conductas verbales y no verbales individuales durante el entrenamiento, para mostrar la presencia o ausencia del comportamiento, en su caso la adquisición y el número de ensayos necesarios para lograrlo. Se presentan los registros de tres de las siete habilidades incluidas en el programa, con la finalidad de dar a conocer el desarrollo del aprendizaje durante la implementación. Conclusiones: El programa de entrenamiento dio la oportunidad de fortalecer habilidades de comunicación en las enfermeras, especialmente en el ámbito de la comunicación verbal, elemento que favorecerá una mayor identificación entre enfermeras y pacientes con el indudable beneficio para la detección de necesidades del paciente y establecimiento de planes de cuidado.

Introduction: Nurse-patient communication is the axis of care provision, and thus requires specific verbal and non-verbal abilities. Training using cognitive behavioral strategies can help establish the appropriate therapeutic relationships of the nursing professional practice. These methodologies have been broadly utilized, and we used the Structured Learning approach which promotes behavior changes, including improvements in the feelings and attitudes. This article focuses on publicizing the practical application of a program for nurses on strengthening communication skills. Development The skills of interest were: Listening; Expressing value; Expressing compliment; Responding to the feelings of others; Responding to a complaint; Responding to anger; and Expressing affection. Individual verbal and non-verbal behaviors were registered during the training sessions to acknowledge the absence of the desired behaviors, as well as number of trials needed to acquire the abilities of interest. In order to show the development of the program, registers of three of the seven abilities considered are displayed. Conclusions: The training program provided the opportunity to strengthen the communication abilities of nurses, particularly around verbal communication. The resulting improvements will favor a greater identification and interaction between nurses and patients and will allow the design and execution of better plans of care.

Introdução: A comunicação enfermeira-paciente é eixo articulador dos cuidados, requer habilidades específicas de comunicação verbal e não verbal. O treinamento com estratégias cognitivo-comportamentais para o fomento destas habilidades contribui em forma importante no estabelecimento de relações terapêuticas da prática profissional de enfermagem; estas técnicas foram largamente aplicadas, no presente caso utilizou-se a Aprendizagem Estruturada, cujo objetivo centra-se na mudança de comportamento, sem deixar de reconhecer que também propicia câmbios favoráveis em sentimentos e atitudes. Deste artigo focaliza-se em dar a conhecer a aplicação prática de um programa para enfermeiras sobre o fortalecimento de habilidades de comunicação. Desenvolvimento As habilidades escolhidas no desenvolvimento deste programa com o apoio da estratégia Aprendizagem Estruturada foram: Escutar, Encorajar, Expressar um elogio, Responder aos sentimentos do outro, Responder a uma queixa, Responder à raiva e Expressar afeto. Realizaram-se registros de comportamentos verbais e não verbais individuais durante o treinamento, com o fim de mostrar a presença ou ausência do comportamento, em seu caso a aquisição e o número de ensaios necessários para consegui-lo. Apresentaram-se os registros de três das sete habilidades incluídas no programa, com a finalidade de dar a conhecer o desenvolvimento da aprendizagem durante a implementação. Conclusões: A execução do programa de treinamento deu a oportunidade de fortalecer habilidades de comunicação nas enfermeiras, especialmente no âmbito da comunicação verbal, elemento que favorecerá uma maior identificação entre enfermeiras e pacientes com o indubitável benefício para a detecção de necessidades do paciente e estabelecimento de planos de cuidado.

La técnica Delphi para el rediseño y validación de un instrumento que mide la comunicación enfermera-paciente / Using the Delphi method to redesign and validate an instrument measuring nurse-patient communication / A técnica Delphi para o redesenho e validação de um instrumento que mede a comunicação enfermeira-paciente

Resumen Introducción: La evaluación de la comunicación entre la enfermera y el paciente da cuenta de la dimensión interpersonal en la calidad del cuidado. Esta relación ha sido estudiada desde diversos enfoques con énfasis en algunos aspectos, como el diseño y validación de instrumentos. Objetivo: Rediseño y validación de contenido de un instrumento que mide comunicación enfermera-paciente, con base en la técnica Delphi. Metodología: Se enfoca al rediseño y validación de un instrumento, con la aplicación de la técnica Delphi, con la participación de enfermeras expertas, sensibles a la relación terapéutica; se realizaron tres rondas con integración de contenidos por las coordinadoras y la aplicación de los coeficientes de validación de contenido por reactivo (CVR) y validación de contenido integral (CVI). Resultados: El CVI del instrumento en cuestión (CECOP-23) en la primera ronda fue 0.84, posterior a ello se eliminaron cuatro reactivos y se sustituyeron dos que fueron sugeridos por los expertos. En la segunda ronda el instrumento alcanzó un CVI de 0.95, el grupo sugirió la utilización de términos más sencillos que propiciaran la cercanía con el paciente. En la tercera ronda se obtuvo un CVI de 0.96. El CECOP quedó integrado por 21 reactivos, diez que exploran empatía y once que exploran respeto. Conclusiones: El trabajo con los expertos permitió analizar los reactivos del CECOP-23, obteniendo el CECOP-21, con reactivos de mayor calidez y exploración más precisa, cumpliendo con el objetivo de diseñar un instrumento que explore ambas dimensiones manteniendo el equilibrio entre la empatía y el respeto.

Abstract Introduction: The assessment of the communication between nurses and patients is part of the interpersonal dimension of quality of care. This relationship has been studied from diverse points of view which focus on issues such as the design and validation of measuring instruments. Objective: Using the Delphi method, to redesign and validate a nurse-patient communication measuring instrument. Methodology: Together with expert and sensitive to the therapeutic relationship nurses, the Delphi method was used to redesign and validate a communication measuring instrument. The coordinators assessed the contents in three cycles calculating the Item Content Validity and Integral Content Validity coefficients. Results: The Integral Content Validity of the CECOP-23 instrument was 0.84 in the first cycle. Four items were deleted and two were substituted in agreement with the suggestions of the experts. The Integral Content Validity of the instrument was 0.95 in the second cycle. The group suggested using simpler terms which could foster closeness to the patient. The Integral Content Validity was 0.96 in the third cycle. The CECOP instrument was finally constituted by 21 items, 10 exploring empathy and 11 exploring respect. Conclusions: Working along with the experts prompted the analysis of the CECOP-23 instrument in order to produce the CECOP-21 which has more precise and "warm" items. The objective of redesigning and instrument which, maintaining the equilibrium between empathy and respect, could measure the nurse-patient communication was achieved.

Resumo Introdução: A avaliação da comunicação entre a enfermeira e o paciente dá conta da dimensão interpessoal na qualidade do cuidado. Esta relação tem sido estudada desde diversos enfoques com ênfase em alguns aspectos, como o desenho e a validação de instrumentos. Objetivo: redesenho e validação de conteúdo de um instrumento que meça a comunicação enfermeira-paciente, com base na técnica Delphi. Metodologia: Foca-se no redesenho e validação de um instrumento, com a aplicação da técnica Delphi, com a participação de enfermeiras experientes, sensíveis à relação terapêutica; realizaram-se três ciclos com integração de conteúdos pelas coordenadoras e a aplicação dos coeficientes de validação de conteúdo por item (CVR) e a validação de conteúdo integral (CVI). Resultados: O CVI do instrumento em questão (CECOP-23) na primeira volta foi 0.84, posterior a isto, eliminaram-se quatro itens e substituíram-se dois que foram sugeridos pelos especialistas. Na segunda volta o instrumento atingiu um CVI de 0.95, o grupo sugeriu a utilização de termos mais simples que propiciaram a proximidade com o paciente. Na terceira volta obteve-se um CVI de 0.96. O CECOP ficou integrado por 21 itens, dez que exploram empatia e onze respeito. Conclusões: O trabalho com os especialistas permitiu analisar os itens de CECOP-23, obtendo o CECOP-21, com itens de maior qualidade e exploração mais precisa, cumprindo com o objetivo de desenhar um instrumento que explore ambas as dimensões mantendo o equilíbrio entre a empatia e o respeito.

Architecture, implementation, and testing of a multiple-shell gas injection system for high current implosions on the Z accelerator.

Tests are ongoing to conduct ~20 MA z-pinch implosions on the Z accelerator at Sandia National Laboratory using Ar, Kr, and D2 gas puffs as the imploding loads. The relatively high cost of operations on a machine of this scale imposes stringent requirements on the functionality, reliability, and safety of gas puff hardware. Here we describe the development of a prototype gas puff system including the multiple-shell nozzles, electromagnetic drivers for each nozzle's valve, a UV pre-ionizer, and an inductive isolator to isolate the ~2.4 MV machine voltage pulse present at the gas load from the necessary electrical and fluid connections made to the puff system from outside the Z vacuum chamber. This paper shows how the assembly couples to the overall Z system and presents data taken to validate the functionality of the overall system.