Carmel Research Center

Objetivo: Identificar as principais barreiras no manejo da dor neonatal relatadas por estudos científicos, a fim de criar subsídios para aprimoramento da prevenção e controle da dor em RNs. Método: Trata-se de uma Revisão Integrativa realizada entre Março e Maio de 2021. Resultado: Constatou-se como barreiras no manejo da dor neonatal a carência de conhecimento profissional, julgamento subjetivo e abordagem empírica, abismo entre teoria e prática, não uso de protocolos e escalas, ausência de consensos das intervenções, falta de trabalho em equipe, sobrecarga da enfermagem, receios para aplicação de intervenções farmacológicas, déficits de educação permanente e continuada, dentre outras. Conclusão: Nos resta admitir que a superação das barreiras ainda existentes no manejo da dor neonatal é complexa, mas exige emergencial conscientização e atenção dos profissionais e instituições de saúde, tendo em vista as repercussões negativas da dor na vida de recém-nascidos pré-termos em condições clínicas indicativas de variadas abordagens assistenciais.

Abstract Naturally occurring populations of most species are distributed non‐uniformly across their ranges. Observed changes in range‐wide population size are attributed to local‐scale processes such as fecundity and survival and to regional scale demographic processes such as immigration. It is often infeasible to study a species across its entire range, and we frequently make inferences on populations as a whole based on the demographic rates of a more restricted area. Extrapolating inferences about demographic processes from study areas to the entire species' range can lead to erroneous estimations, particularly when permanent emigrants contribute significantly to individual population processes. In this paper, we evaluated demographic processes and population trends at multiple scales for tricolored blackbirds (Agelaiustricolor) in California using site‐specific banding data and range‐wide citizen‐science data. First, we found that a previous estimate of statewide decline of 34% is largely driven by an estimated decline of 51.7% for the southern population. Second, we found evidence of a pseudo‐source and sink system, with the northern region acting as a sink for individuals moving from the declining southern region. The southern region is a “pseudo‐source” since it has lower rates of adult survival and an annual growth rate ofr = −0.099, while still acting as a source of immigrants for the northern region. In turn, the north fits the traditional definition of a sink by an annual growth rate near zero, in addition to declining at a rate of 2.5% even though it is estimated to receive immigrants from the south at rates ranging from 8.3% to 13.2% per year. Our results suggest that the loss of wetland habitats in Southern California, coupled with increasing severity of droughts driven by changing climatic conditions, has created this pseudo‐source and sink system. Long term, tricolored blackbirds are likely to experience range contraction in the south, and the northern region is likely to undergo declines due to a loss of immigrants from the south.

The Voyager 1 and 2 (V1 and V2) crossings of the heliopause (HP) have generated new estimates of the shape of the heliosphere, helped elucidate plasma wave features, and helped clarify particle and field phenomena, all of which provide insights into the overall configuration of the heliosphere and its interaction with the local interstellar medium (LISM). Webber and Intriligator (2011) suggested a consistent offset in the V1 and V2 locations of the termination shock (TS), predicted a shrunken and squashed geometry of the heliosphere, and correctly predicted that V1 would encounter the HP in 2012.0 ± 1 year. Intriligator et al. (2005, 2008) examined how the Halloween 2003 solar events were manifested from the Sun to V1 and V2 at 92.6 and 73.2 AU, giving rise to Global Merged Interaction Regions (GMIRs) and to broad particle, plasma, and magnetic field offsets that could affect the configuration of the heliosphere. The 2012 solar events (Intriligator et al., 2015) appeared to cause a tsunami at V1 and V2 at 128.7 and 102.5 AU and emphasized that space weather often could be interpreted as TS or HP or heliospheric crossings. Washimi et al. (2017) suggested that further complications of these events could propagate from the LISM back into the heliosphere. We conclude that in addition to the LISM magnetic field, the size and shape of the heliosphere are affected on differing time and space scales by changes in the average solar wind dynamic pressure over solar cycles with changing configurations of coronal holes, by pressure increases from GMIRs, and by magnetohydrodynamic instabilities that may be enhanced by energetic neutral atoms formed in GMIRs. We suggest the value of additional simulations that would combine our use of source surface maps of solar activity with other computational refinements.

Abstract The July 2012 major solar events gave rise to manifestations observed at many longitudes/latitudes/radial locations throughout the heliosphere, heliosheath, and into the interstellar medium. For these solar events we present our initial results at 1 AU from our HAFSS (Hakamada‐Akasofu‐Fry Source Surface) three‐dimensional time‐dependent kinematic modeling. Our simulations, using Wang‐Sheeley‐Arge maps and solar event observations, start at 2.5RSfrom the center of the Sun. We use both the quiescent background solar conditions and the solar events (e.g., coronal mass ejections (CMEs)) as inputs and propagate outward. We compare HAFSS predictions with in situ spacecraft measurements and conclude that the July 2012 solar events caused a metaphorical “tsunami” in the plasma and magnetic field throughout the heliosphere/heliosheath/interstellar medium. The simulations show evidence of shocks, interaction regions, and rarefaction regions in the inner heliosphere (1 AU) and shocks, global merged interaction regions (GMIRs) and rarefaction regions in the heliosheath. The shocks/interaction regions/GMIRs and the rarefaction regions are, respectively, analogous to the tsunami “crests” and “troughs”. To provide important insights into 3‐D processes, we simulated 1 AU observations (STEREO A and ACE) and observations at Voyager 2 (V2) and Voyager 1 (V1) far off the ecliptic plane: V2 at ~ 30°S, 217° longitude, and 102 AU; V1 at 34°N, 174° longitude, and 124 AU. HAFSS successfully predicted observed CME arrival times at 1 AU. Our results for this tsunami are the first simulations for these events in the distant V2/V1 radial/latitudinal/longitudinal regions based on 3‐D time‐dependent modeling originating at the Sun.

Using our three dimensional (3D) time-dependent kinematic HAFSS model we propagate the March 2012 solar events from the Sun to Voyager 1 (V1) to investigate if these solar events could be responsible for the V1 April-May 2013 Plasma Wave Spectrometer (PWS) measurements of enhanced 2-3 kHz signals. These PWS measurements provided the basis for the confirmation that V1 entered the interstellar medium (ISM). These enhanced PWS signals also were associated with significantly increased plasma densities consistent with expectations for the ISM. The origin of these enhanced plasma densities was attributed to the April-May 2013 arrival at the heliopause of the disturbances associated with the March 2012 solar events. Using HAFSS we propagate from the Sun the March 2012 solar wind ambient background and the solar wind impulsive events for comparisons with in-situ spacecraft measurements at Earth, V1 (at 34 degrees North), and Voyager 2 (at 30 degrees South). The in-situ measurements of the March 2012 events were obtained over a wide range in radial distance, longitude, and latitude. This emphasizes the importance of using a 3D time-dependent model that originates at the Sun. From our analyses we conclude that the March 2012 solar events could have been responsible for the April-May 2013 V1 enhanced plasma wave signals and their associated increased plasma densities measured by the PWS indicating V1 was in the ISM.

We report the first comparisons of pickup proton simulation results with in situ measurements of pickup protons obtained by the SWICS instrument on Ulysses. Simulations were run using the three dimensional (3D) time‐dependent Hybrid Heliospheric Modeling System with Pickup Protons (HHMS‐PI). HHMS‐PI is an MHD solar wind model, expanded to include the basic physics of pickup protons from neutral hydrogen that drifts into the heliosphere from the local interstellar medium. We use the same model and input data developed by Detman et al. (2011) to now investigate the pickup protons. The simulated interval of 82 days in 2003–2004, includes both quiet solar wind (SW) and also the October–November 2003 solar events (the “Halloween 2003” solar storms). The HHMS‐PI pickup proton simulations generally agree with the SWICS measurements and the HHMS‐PI simulated solar wind generally agrees with SWOOPS (also on Ulysses) measurements. Many specific features in the observations are well represented by the model. We simulated twenty specific solar events associated with the Halloween 2003 storm. We give the specific values of the solar input parameters for the HHMS‐PI simulations that provide the best combined agreement in the times of arrival of the solar‐generated shocks at both ACE and Ulysses. We show graphical comparisons of simulated and observed parameters, and we give quantitative measures of the agreement of simulated with observed parameters. We suggest that some of the variations in the pickup proton density during the Halloween 2003 solar events may be attributed to depletion of the inflowing local interstellar medium (LISM) neutral hydrogen (H) caused by its increased conversion to pickup protons in the immediately preceding shock.