Este trabalho apresenta o estudo do processo de esterilização de materiais e instrumentais cirúrgicos em autoclaves que se utilizam do agente esterilizante, o vapor à baixa temperatura de formaldeído. Processo esse utilizado para materiais termosensiveis, ou seja, que não suportam temperaturas superiores a 80°C. Assim objetivo desse trabalho, foi avaliar essa tecnologia de esterilização a baixa temperatura, que já é utilizada há mais de 20 anos em vários países, inclusive aqui no Brasil, porém com pouco detalhes de estudos conclusivos sobre o assunto na literatura nacional e internacional. Este estudo foi baseado nas Normas ABNT NBR 15659 e NF EN ISO 25424 que tratam especificamente dos requisitos, métodos e cuidados na esterilização de vapor a baixa temperatura e formaldeído, implementando um protocolo de verificação para estudo da tecnologia. Para tanto foi elaborada uma metodologia de avaliação, da instalação de esterilizadores que utilizam como agente esterilizante o formaldeído. Na verificação da eficácia da metodologia 3 tipos de equipamentos de esterilização foram testados. Os equipamentos testados são de fabricação brasileira (02 deles) e um de fabricação sueca. Os testes foram feitos em 6 hospitais, onde foram avaliados desde a sua instalação, avaliação dos parâmetros de tempo, temperatura e pressão (com equipamentos calibrados e rastreados pelo INMETRO), avaliação do nível de resíduos no material (com laudos feitos por laboratórios credenciados), uso de indicadores de processo (biológicos e químicos), avaliação ambiental (ar e saída do dejeto para o esgoto), controles de manutenções preventivas e segurança do operador (EPI). Todos os ciclos avaliados apresentaram resultados dentro dos parâmetros mínimos sugerido na Norma ABNT NBR 15659 e NF EN ISO 25424. Concluindo que se seguindo rigorosamente o que pede a Norma e os manuais dos fabricantes dos equipamentos, pode-se perfeitamente obter um processo seguro de esterilização para o Hospital, e atender todos os níveis de segurança tanto para o operador como para o paciente que irá usar o material processado no ciclo de esterilização. / This work presents the study of the sterilization process of surgical materials and instruments in autoclaves using the sterilizing agent, the low temperature vapor of formaldehyde. This process is used for thermosensitive materials, is they do not withstand temperatures above 80 ° C. The objective of this study was to evaluate the low temperature sterilization technology, which has been used for more than 20 years in several countries, including here in Brazil, but with little details of conclusive studies on the subject in the national and international literature. This study was based on the ABNT NBR 15659 and NF EN ISO 25424 standards that specifically deal with the requirements, methods and care in low temperature steam sterilization and formaldehyde, implementing a verification protocol for technology study. For this, an evaluation methodology was elaborated for the installation of sterilizers that use formaldehyde as the sterilizing agent. In the verification of the effectiveness of the methodology 3 types of sterilization equipment were tested. The equipment tested is of Brazilian manufacture (02 of them) and one of Swedish manufacture. The tests were carried out in 6 hospitals, where they were evaluated since its installation, evaluation of parameters of time, temperature and pressure (with equipment calibrated and tracked by INMETRO), evaluation of the level of residues in the material (with reports made by accredited laboratories), use of process indicators (biological and chemical), environmental assessment (air and exits to the sewage), preventive maintenance controls and operator safety (EPI). All the evaluated cycles presented results within the minimum parameters suggested in the Standard ABNT NBR 15659 and NF EN ISO 25424. Concluding that strictly following the norms and the manuals of the equipment manufacturers, it is perfectly possible to obtain a safe process of sterilization To the Hospital, and meet all levels of safety for both the operator and the patient who will use the material processed in the sterilization cycle.

Introdução: Estudos têm encontrado uma transição da obesidade da população adulta para crianças e adolescentes, que por sua vez, pode acarretar manifestações clínicas, como: doenças coronarianas, diabetes tipo 2, e complicações psicossociais cada vez mais precocemente. Contudo, métodos para avaliação da composição corporal para essa faixa etária, principalmente envolvendo técnicas de baixo custo como as medidas de dobras cutâneas (DC) apresentam imprecisões em estudos brasileiros. Fator o qual pode levar a uma interpretação equivocada da composição corporal dos avaliados. Objetivo: desenvolver novos modelos matemáticos utilizando medidas de DC, tendo como referência a absorciometria de raios-X de dupla energia (DXA), para estimativa de massa de gordura (G) em adolescentes. Métodos: Trata-se de um estudo exploratório descritivo onde foram avaliados 416 adolescentes do gênero masculino de 12 a 17 anos, sendo 42 destinados para compor a amostra de validação da pesquisa. Foram coletadas medidas de massa corporal total, estatura, circunferência da cintura e quadril, nove pontos anatômicos baseados em DC: bíceps, tríceps, subescapular, peitoral, axilar média, abdominal, supra-ilíaca, coxa e panturrilha, além da G e densidade mineral óssea (DMO) aferida com a tecnologia de DXA. Para o desenvolvimento das equações foi utilizado um modelo de regressão linear múltipla através do método de mínimos quadrados ordinários (OLS). Resultados: O grupo apresentou índice de massa corporal (IMC) médio de 21,25±4,12kg/m² e %G = 20,57±5,80%. A partir do %G, a prevalência de excesso de gordura foi verificada em 38,3% dos adolescentes. O impacto da gordura na DMO dos adolescentes indicou uma associação na ordem de r = -0,358; p<0,005, sendo verificada redução de até 14% da DMO para a região da coluna em adolescentes com obesidade em comparação aos eutróficos. O desenvolvimento de novos modelos matemáticos que atendessem critérios de alto coeficiente de determinação (R²), baixo erro padrão de estimativa (EPE), controle de colinearidade, normalidades dos resíduos, homoscedasticidade e praticidade, possibilitaram a apresentação de três opções com R² = 0,932 e EPE 1,79; R² = 0,912 e EPE = 1,78; R² = 0,850 e EPE = 1,87, respectivamente. Em todas as opções, as variáveis idade e estatura foram empregadas, bem como as DC de tríceps e subescapular. Conclusão: Os resultados obtidos evidenciam a possibilidade de desenvolvimento de novos modelos matemáticos para a avaliação da gordura corporal em adolescentes com resultados superiores aos modelos existentes na literatura. / Introduction: Studies have found a transition from obesity of the adult population to children and adolescents, which in turn, can lead to clinical manifestations, such as: coronary diseases, type 2 diabetes, and psychosocial complications increasingly early. However, methods for evaluating nutritional status for this age group, mainly involving low cost techniques such as skinfold thickness measurements (ST), are imprecise in Brazilian studies. Factor which can lead to a mistaken interpretation of the body composition of the evaluated ones. Objective: To develop new mathematical models, based on DC measurements, based on dual energy X-rays absorptiometry (DXA), to estimate fat mass (G) in adolescents. Methods: This was an exploratory descriptive study in which 416 male adolescents aged 12 to 17 years were evaluated, 42 of whom were separated to compose the study validation sample. Measurements of total body mass, stature, waist and hip circumference were obtained, nine anatomical points based on ST: biceps, triceps, subscapular, pectoral, mid axillary, abdominal, suprailiac, thigh and calf muscles, as well as G and bone mineral density (BMD) measured with DXA technology. For the development of the equations, a multiple linear regression model was used by the ordinary least square (OLS) method. Results: The group had a mean body mass index (BMI) of 21.25± 4.12 kg / m² and %G = 20.57 ± 5.80%. From %G, the prevalence of excess fat was verified in 38.3% of adolescents. The impact of fat on adolescent BMD indicated an association in the order of r = -0.358; P <0.005, with BMD reduction up to 14% for the spine region in adolescents with obesity compared to eutrophic. The development of new mathematical models that meet criteria of high coefficient of determination (R²), low standard error of estimation (SEE), control of colinearity, residue normalities, homoscedasticity and practicality, allowed the presentation of three options with R² = 0.932 and SEE 1.79; R² = 0.912 and SEE = 1.78; R² = 0.850 and SEE = 1.87, respectively. In all the options, the variables age and height were employed, as well as triceps and subscapular ST. Conclusion: The results obtained evidenced the possibility of developing new mathematical models for the evaluation of body fat in adolescents with results superior to the existing models in the literature.

Comment transformer les contraintes normatives en opportunités ? Réalisée dans le secteur médico-social, la recherche montre que sept normes générales et cinq normes spécifiques au secteur exercent des effets déterminants sur la performance des organisations médico-sociales (résultat 1). Ces effets peuvent être synthétisés en trois fonctions fondamentales des normes : transactionnelle, incitative et rentière (résultat 2). Dans tous les cas, l’appréciation de ces effets comme contraignants ou avantageux par les acteurs reste subjective et subordonnée à quatre facteurs de jugement : leurs intérêts, leurs valeurs, les stratégies qu’ils adoptent pour accroître leur légitimité ou pour acquérir des ressources (résultat 3). Pour tenter d’atténuer les pressions normatives, les acteurs recourent, d’une part, à six stratégies : la conformité, l’arbitrage, la déviance, le découplage, le dépassement ou la manipulation (résultat 4). La thèse présente par ailleurs un recensement des « bonnes pratiques » dans la gestion des normes (résultat 5). D’autre part, ils tentent d’intervenir sur les facteurs susceptibles de réduire ou d’accroître l’effet contraignant ou opportun des normes. Parmi ceux-ci, neuf facteurs sont intrinsèques aux normes ou à l’environnement normatif : la complétude de la norme, l’effet de réduction du champ des possibles, les restrictions engendrés par l'usage de critères de jugement fondés sur des norme, la légitimité conférée par la conformité, le caractère participatif des processus de normalisation, l’intensité de prolifération des normes, l’efficacité des contrôles de conformité, les prescriptions sur l’organisation du travail et, enfin, les prescriptions sur les objectifs à poursuivre (résultat 6). Six facteurs sont endogènes aux organisations ou individuels : la maîtrise des informations, la possession des compétences techniques pour appliquer les normes, la perception du risque par les acteurs, les réseaux et relations entre acteurs, l’adaptabilité à l’évolution des besoins ou de la demande sociale, ainsi que l’idiosyncrasie (résultat 7). / How to convert compliance issues into opportunities? The research was conducted into the French welfare industry, within medical-social centers supporting disabled or dependent persons. The results are as follows. First, seven cross-sectoral and five sector specific norms, i.e. standards and regulations, influence those organizations’ performance. Those effects can be aggregated into three basic functions of norms: a transactional, an incentive and a rent-producing function. In absolute terms, those effects are not constraining or advantageous. Individuals are likely to consider norms as constraints or as opportunities following four judgement criteria: their interest, their values, their strategies for increasing their legitimacy or for acquiring resources.In their attempt to reduce the pressures from their institutional environment, individuals are likely to rely on one of six strategies: compliance, arbitration, deviance, decoupling, exceedance, or manipulation. The thesis also provides a mapping of the “good practices” concerning norms management. They are also likely to intervene on factors magnifying the constraints or advantageous effects of norms. Amongst them, nine factors are inherent to the norms or to the institutional environment: the norm comprehensiveness, the effect of reduction of the scope of possibilities, the restrictions due to the use of norm-based judgment criteria, the legitimacy conferred by compliance, the participation level during normalization processes, the intensity of norms production, the effectiveness of compliance controls, the substantial injunctions about work organization and, finally, about the objectives that must be achieved. Six factors are endogenous or individual: information mastery, possession of technical skills for complying with norms, individuals ‘perception of risk, networks and relations, adaptability to fluctuating needs or social demand, and finally, idiosyncrasy. / ¿Cómo transformar las limitaciones normativas en oportunidades? Realizada en el sector medico-social francés, la investigación muestra que siete normas generales y cinco normas sectoriales específicas ejercen efectos decisivos sobre el desempeño de las organizaciones medico-sociales (resultado 1). Estos efectos se pueden resumir en tres funciones básicas de las normas: transaccional, de incentivo y rentista (resultado 2). En todos los casos, la consideración de estos efectos como restrictivos o ventajosos por los actores es subjetiva y subordinada a cuatro factores de juicio: sus intereses, sus valores, las estrategias que adoptan para aumentar su legitimidad o para adquirir recursos ( resultado 3). En un intento por mitigar las presiones normativas, los actores utilizan seis estrategias: conformidad, arbitraje, desviación, desacoplamiento, excedencia o manipulación (resultado 4). La tesis presenta también un inventario de "buenas prácticas" en la gestión de las normas (resultado 5). Por otro lado, los actores pueden intervenir sobre factores que pueden reducir o aumentar el efecto restrictivo u oportuno de las normas. De estos, nueve factores son intrínsecos a las normas o al entorno normativo: la integridad de la norma, el efecto de reducción del rango de posibilidades, las restricciones causadas por el uso de criterios de juicio basados en normas, la legitimidad conferida por la conformidad, el nivel de participación durante los procesos de normalización, la intensidad de proliferación de las normas, la eficacia de las operaciones de control de conformidad, los requisitos substanciales sobre la organización del trabajo y, por último, los requisitos substanciales sobre los objetivos perseguidos (resultado 6). Seis factores son endógenos para las organizaciones o los individuos: el control de la información, la posesión de habilidades técnicas para aplicar las normas, la percepción del riesgo por los actores, las redes y las relaciones entre los actores, la adaptabilidad a la evolución de las necesidades o demanda social, y la idiosincrasia (resultado 7). / 如何将合规问题转化为机遇？这项研究在法国福利行业中，支持残疾或无依靠人仕的社会医疗中心内进行。研究结果如下。首先，七个跨部门和五个部门的具体规范，即标准和法规，都影响着这些组织的表现。这些影响可以归纳为规范的三个基本功能：交易，激励和租金生成的功能。而这些影响绝对不是约束或有利的。 个别人士或会考虑以以下四个标准，将规范判断为约束或机遇：他们的兴趣，他们的价值观，他们用來提高合法性的策略，或资源的获取。 个别人士或会凭借以下六大策略之一，试图去减轻其体制环境的压力：合规性，仲裁，偏离，脱钩，超越或操纵。论文还提供了有关规范管理的 “良好实践” 制图。他们可能会干涉一些放大规范的限制或有利影响的因素。其中，九个因素是规范或体制环境所固有的：规范的全面性，减少在可能性范围内的影响，使用判断标准所带来的限制性影响，合规所赋予的合法性，正常化过程中的参与程度，规范生产的强度，合规控制的有效性，有关工作机构的实质性禁令，最后，有关目标必须达成。 六个因素是内成或个別的：信息的掌握，拥有遵守规范的技术技能，个人对风险的看法，网络和关系，适应不断变化的需要和社会需求，最后，特质或特有的风格。

"Zur Einscharrung der Cadaver" befasst sich als erste wissenschaftliche Arbeit mit den Begräbnispraktiken und den Begräbnisorten der anatomischen Einrichtungen in Dresden von 1748 bis 1864. Dabei konnte festgestellt werden, dass es sich bei den Begräbnissen um keine ehrvollen christlichen Bestattungen handelte und wo sich diese ehemaligen Bestattungsplätze im heutigen Stadtbild präzise verorten lassen. Die Ergebnisse zu den Begräbnispraktiken sind zudem Erkenntnisse, welche deutschland-, ja sogar weltweit bisher einmalig sind und weitere Fragen eröffnen.:Inhaltsverzeichnis I 1. Einleitung 1 1.1. Einführung 1 1.2. Forschungsstand: Zur Notwendigkeit des Themas der vorliegenden Arbeit 3 1.3. Zielstellung, Methoden und Aufbau der Arbeit 5 1.4. Zu den Quellen 7 2. Zur "Ausmittelung" der Begräbnisplätze 12 2.1. Der Begräbnisplatz des Collegium medico-chirurgicum 12 2.1.1. Kirchhöfe im Interessenfeld des Medizinalkollegs 12 2.1.2. Die Suche nach einem geeigneten Begräbnisort in der Festungsanlage 18 2.1.3. Platzmangel und Standortnachteile – Die Kadaverplätze von 1748 - 1813 26 2.2. Der Begräbnisplatz der Chirurgisch-Medizinischen Akademie 36 2.2.1. Der Anatomiebetrieb läuft – Ein akademieeigener Anatomiefriedhof fehlt 36 2.2.2. Beschwerden drängen auf Verlegung des Begräbnisplatzes 41 2.2.3. Die Schließung des Kadaverplatzes am Eliasfriedhof 51 2.3. Die Bereiche der Kadaverplätze nach deren Schließung 52 2.3.1. Zur Verortung der ehemaligen Kadaverplätz - Methodik und Umsetzung 53 2.3.2. Analyse zu Spätfolgen durch Verortung der Begräbnisplätze 60 3. Die Durchführung des Begräbnisses der Anatomieleichen 65 3.1. Begräbnispraxis unter Differenzierung in „ehrliches“ und „unehrliches“ Begräbnis 65 3.1.1. Der Transport zum Begräbnisplatz 67 3.1.2. Die "Einscharrung" 75 3.1.3. Widerstand gegen die Begräbnispraxis 81 3.2. Der Anatomieaufwärter – Der Schuldige der "nachlässigen Einscharrung"? 84 4. Fazit 89 Abkürzungsverzeichnis II Abbildungsverzeichnis IV Quellen- und Literaturverzeichnis V Anhang XVIII

La tesi approfondisce il complesso rapporto tra diritto, religione e sanità nella realtà americana, concentrandosi in particolare sulle problematiche scaturenti dall’orientamento religioso del paziente, del care provider e della struttura sanitaria. La prima sezione si propone di studiare, sempre in chiave giuridica, l’evoluzione del rapporto tra fede e medicina, presentando altresì due casi di studio: i nativi americani e christian science. Nella seconda sezione, invece, si ricostruiscono le linee interpretative essenziali del primo emendamento con specifico approfondimento tanto della Free exercise clause che dalla establishment clause. Parimenti, viene tracciato un disegno di sintesi del sistema sanitario americano, soffermandosi tanto sugli aspetti pubblicistici che su quelli privatistici dello stesso. La ricerca, poi, si sofferma sull’analisi dettagliata delle problematiche evidenziate dalla giurisprudenza americana con riferimento al care receiver, al care provider e, soprattutto, al contenzioso in materia pediatrica. L’ultima parte è dedicata allo sviluppo di due distinti filoni, ovvero: il rapporto tra scienza e diritto ed il ruolo dell’economia. Questo ultimo aspetto viene approfondito sotto due diversi punti di vista. In primo luogo si ricostruisce l’impatto economico delle policy che garantiscono la libertà religiosa sul “sistema sanità”. In secondo luogo, si approfondisce il tema dell’influenza del dato economico sullo sviluppo della libertà religiosa in ambito sanitario. / This work deals with the complex relationship between law, religion and the sanitary system in the U.S. setting, by focusing on the problems emerging from the religious view of the patient, of the care provider and the religious orientation of the hospital or HMO. The first section of the work aims to study, from a legal point of view, the evolution of the relationship “medicine-religion”, and focuses on two case studies: native Americans and Christian science. In the second section the essential interpretative streamlines about the first amendment are presented, through a deep analysis of the Free Exercise Clause and of the Establishment Clause. At the same time, the American (U.S.) sanitary system is deeply studied both in the private sector and the public one. The research then focuses on a detailed analysis of the jurisprudence related to the care provider and the care receiver, while a specific section is dedicated to the litigation concerning pediatric patients and the related litigation cases. The last part develops two different subjects: the relationship between science and law, and the role of economy. This last subject is deeply analyzed under two different points of view: the economic impact of the religious freedom on the “sanitary system” on the one hand; and the influence of the economic data on the development of religious freedom in the health care system setting on the other.

This by-practice project is the first to provide an extensive investigation of the marginalisation of era appropriate science (EAS) and professional investigators by detective and historical detective fiction authors. The purpose of the thesis is to analyse specific detective fiction authors from the earliest formats of the nineteenth century through to the 1990s and contemporary, selected historical detective fiction authors. Its aim is to examine the creation, development and perpetuation of the marginalisation tradition. This generic trend can be read as the authors privileging their detective’s innate skillset, metonymic connectivity and deductive abilities, while underplaying and belittling EAS and professional investigators. Chapter One establishes the project’s critique of the generic trend by considering parental authors, E. T. A Hoffmann, Edgar Allan Poe, Émile Gaboriau and Wilkie Collins. Reading how these authors instigated and purposed the downplaying demonstrates its founding within detective fiction at the earliest point. By comparing how the authors sidelined and omitted specific EAS and professional investigators, alongside science available at the time, this thesis provides a framework for examining how it continued in detective fiction. In following chapters, the framework established in Chapter One and the theoretical views of Charles Rzepka, Lee Horsley, Stephen Knight and Martin Priestman, are used to discuss how minimising EAS and professional investigators developed into a tradition; and became a generic trend in the recognised detective fiction formula that was used by Sir Arthur Conan Doyle, Freeman Wills Crofts, H. C. Bailey, R. Austin Freeman, Agatha Christie, Ruth Rendell and P. D. James. I then examine how the device transferred to historical detective fiction, using the framework to consider Ellis Peters, Umberto Eco and other selected contemporary authors of historical detective fiction. Throughout, the critical aspect considers how the trivialisation developed and perpetuated through a generic trend. The research concludes that there is a trend embedded within detective and historical detective fiction. One that was created, developed and perpetuated by authors to augment their fictional detective’s innate skillset and to help produce narratives using it is a creative process. It further concludes that the trend can be reimagined to plausibly use EAS and professional investigators in detective and historical detective fiction. The aim of the creative aspect of the project is to employ the research and demonstrate how the tradition can be successfully reinterpreted. To do so, the historical detective fiction novel A Hidden Life uses traditional features of the detective fiction formula to support and strengthen plausible EAS and professional investigators within the narrative. The end result is a historical detective fiction novel. One that proves the thesis conclusion and is fundamentally crafted by the critical research.

No description available.

The topic of the master thesis is new medico-social facility hospice St. Michaela. The purpose of the object is the maximizing of improvement in the quality of life of dying, severely ill and incurable patients, with the use of palliative care. The construction follows the Complex of Regional Hospital Náchod. Together with as a retirement home Náchod completes a support network of health and social care. The building is designed as a four-building storey and is partially embedded into the sloping terrain. Floors are divided into individual facilities and together constitute a functional unit. In the basement is the technical room, warehouses, garages and kitchen facilities. On the ground floor are then socio-public rooms and facilities. On the second floor is located hedmaster of hospice and accommodation area. The third floor is devoted to the accommodation area. The proposed structure made of brick longitudinal system, supplemented by concrete basement walls. The horizontal structure is made of filigree ceiling panels. Stairs are designed as a precast concrete and steel. Individual roof structures is made from unwalkable, walkable and vegetation compositions. The cladding consists of ventilated facade of glass and wooden panels. Foundations are designed from the lineal foundation.