Novel strategies to promote children's physical activities and reduce sedentary behavior

Physical activity and sedentary behavior (performed primarily while sitting) play a key role in the current and future health of young people. Most health evidence and intervention strategies targeting reductions in children’s sedentary behavior have focused on television viewing, with mixed evidence as to the effectiveness of these strategies and of the importance of television viewing for children’s health. Evidence from studies with adults using objective measures of sedentary behavior suggests that accumulated sedentary time is independently associated with metabolic health; importantly, emerging evidence suggests that the manner in which the sedentary behavior is accrued (ie, frequency of interruptions to time spent sedentary) may also have independent effects on health. Potential novel intervention approaches to reduce children’s sedentary time include activity breaks during class time at school, delivery of active lessons and homework, and changes to the classroom environment. Further evidence of the importance of sedentary time (both total accumulation and frequency of interruptions) on children’s health is required. Future studies should assess the effectiveness of interventions targeting organizational and pedagogical changes in schools as well as using homework to engage with families in more active ways.

Review : nurses can improve patient nutrition in intensive care

Aims and objectives. To review the literature and identify opportunities for nutritional practice improvement in the critically ill and opportunities to improve nurses’ knowledge relating to enteral feeding.

Background. The literature reports varying nutritional practices in intensive care.

Design. Systematic review.

Methods. A systematic search, selection, analysis and review of nursing, medical and dietetic primary research articles was undertaken. Fifteen studies met the selection criteria.

Results. Delivery of nutrition to the critically ill varied widely. Patients were frequently underfed and less frequently, overfed. Both under- and overfeeding have been linked with unacceptable consequences including infections, extended weaning from mechanical ventilation, increased length of stay and increased mortality. Underfeeding was related to slow initiation and advancement of nutrition support and avoidable feed interruptions. The most common reasons for interrupting feeds were gastrointestinal intolerance and fasting for procedures. Certain nursing practices contributed to underfeeding such as the management of gastric residual volumes.

Conclusions. Consistent and reliable nutrition support in intensive care units is hampered by a lack of evidence leading to varying nutrition practices. Factors impeding delivery of enteral nutrition were considered avoidable. A new concept of a therapeutic range of energy delivery in the critically ill has emerged implying the need for re-evaluation of energy recommendations and improved delivery of enteral nutrition.

Relevance to clinical practice. This review supports the multi-disciplinary development and implementation of an evidence-based enteral feeding protocol in intensive care units as a strategy to improve adequacy of nutritional intake. Critical care nurses are well placed to improve this process.

Multi-media and real fiction theatre making

Visual images, in the process of both the imagination and conception of a theatre production, are central to contemporary practice in drama-making. The use of multi-media in theatre is not only a fruitful way to represent the visual component of a particular experience, it but also constitutes a way of speaking the unspoken. Visual language expresses through multi-media and allows broaching taboo subjects, speaking directly to the audience in spite of the indirect form and drawing subtle connections with the live action so as to make meaning. The tension between live action and any form of visual art blurs the lines between imagination and reality. The multi-media theatre is a metaphor for the human mind exposed to social reality. It consists of interruptions, half-finished conversations and ideological aspersions including its primary function of meta-representation.

Optimising e-mail communication : the impact of seminar-and computer-based training

Employees continue to report multifarious e-mail concerns ('e-mail defects') including ambiguous unclear messages, e-mail overload, security and privacy issues, and e-mail interruptions. These defects have an effect on employee efficiency and effectiveness. This paper explores the importance of identifying e-mail defects and the effectiveness of training employees in efficient use of e-mail at four UK organisations, using Seminar-Based Training (SBT) and Computer-Based Training (CBT) delivery modes. The findings suggest that SBT has a diminishing impact over a very short period of time, but a combined approach of SBT and CBT is more effective and provides better results.

Distributed cognition and IT support for knowledge work in breakdowns : match or mismatch?

Knowledge is instrumental in organisational problem solving and is embedded in organisational processes and routines. We explore the application of IT in breakdowns (forms of interruptions from normal organisational work routines) and illustrate the application of distributed cognition theory (DCT) as a useful lens to explain the exchange of knowledge in breakdowns. DCT also allows for a rich analysis of the role that information technology (IT) can play to foster knowledge exchange in breakdown situations. We use two cases to illustrate that DCT is useful in identifying the matches and mismatches in IT support for exchanging knowledge in breakdowns.

Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context

Background and Aims: Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care.

Approach: An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n = 30). Observations focused on nurses’ interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses.

Findings: Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration.

Implications: Nurses’ abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error.

Conclusions: Nurses displayed behaviours that increased medication administration quality and safety; however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.

Creating spaces in intensive care for safe communication : a video-reflexive ethnographic study

The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins.

The effects of physical environments in medical wards on medication communication processes affecting patient safety

Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.

Instrumentos teóricos e técnicas para construção de consenso: Aplicação nas situações e problemas identificados na evolução das negociações do Acordo da ALCA - Área de Livre Comércio das Américas

The main subject of this study is the analysis of negotiations. The study was developed based on the scenery of paralization and impasse of the negotiations for the Free Trade Area of the Americas - FTAA. Generally speaking, delays and interruptions caused by controversies and impasses end up becoming strong efficiency problems which jeopardize the consensus building during any negotiation. As a justification, the target of this study is to identify processes and recommendations to help obtain, efficiently, agreements in the negotiations. Its final objective was to search for theoretical tools and techniques to be applied in situations of stoppage in a sense of eliminating the difficulties or making them at least easier to deal with. Secondarily other theoretical points of view were considered with the intention of understanding how strategies and theoretical tools can contribute in each situation or in each different scenario of the negotiation. Through the different ways of looking at it for the conduction of the negotiations, for evaluating the dimensions of the negotiations and in order to build up the consensus, the researcher was able to understand the perception and the interpretation of the subject in view. At last the conclusion was that the applicability of the chosen framework is positive in helping solve problems and controversies as well as building up the consensus during the negotiations.

Construção de consenso em negociações de acordos regionais - ARCs

The main subject of this study is the consensus analysis of negotiations of Regional Trade Agreements (RTAs). Generally speaking, delays and interruptions caused by controversies and impasses end up becoming strong efficiency problems which jeopardize the consensus building during any negotiation. As a justification, the target of this study is to identify processes to help obtain, efficiently, agreements in the RTAs negotiations. Its final objective was to search for theoretical tools and techniques to be applied in situations of stoppage in a sense of eliminating the difficulties or making them at least easier to deal with. Secondarily other theoretical points of view were considered with the intention of understanding how strategies and theoretical tools can contribute in each/or different scenario of the negotiation. Through the different ways of looking at it for the conduction of the negotiations, for evaluating the dimensions of the negotiations and in order to build up the consensus, the researcher was able to understand the perception and the interpretation of the subject in view. At last the conclusion was that the applicability of the chosen framework is positive in helping solve problems and controversies as well as building up the consensus during the negotiations.

A importância do objeto transicional no desenvolvimento psíquico sadio

O objeto transicional é um mediador entre mãe e filho, eu e não-eu, mundo interno e mundo externo. A mãe suficientemente boa permitirá esse objeto e através dele a criança passará de um estado de ilusão para um estado de desilusão, do relacionar-se com o objeto para o uso do objeto. A passagem do princípio do prazer para o princípio da realidade permitida pela mãe boa, através de uma adaptação ativa com a criança facilitará uma capacidade do brincar criativo num espaço potencial. O jogo com as pessoas onde haverá amigos e inimigos somente se realizará através desse brincar criativo. Para que exista um desenvolvimento do processo de separação- individualização é necessário a existência de um objeto transicional em sua forma saudável como um acalmador da ansiedade. Daí a importância da disponibilidade da mãe e do objeto transicional para que todo o desenvolvimento psíquico saudável se realize; a importância de uma continuidade no cuidado e uma consequente confiança na mãe para que possa ser bem suportada a sua ausência; e para que no processo de dependência para o rumo à independência a criança possa seguir segura e feliz por essa separação ou independência da mãe e filho ao mesmo tempo. Caso isto não ocorra de uma forma saudável, isto e, se a mãe ou o ambiente não for suficientemente bom, pode haver o desenvolvimento, na criança e posteriormente no adulto, de um objeto transicional sendo o próprio corpo e mais tarde uma idéia fixa. O que é mais importante nisso tudo é que o objeto transicional exista e seja permitido em toda a sua plenitude sem interrupções. O processo deve realizar-se até o final, isto é, até que o objeto perca simplesmente o seu significado e não esquecido ou reprimido. Que fique reduzido somente ao nível de significante. O tempo que ele durará vai variar de criança para criança, de mãe para mãe, de meio para meio. E isto não terá muita importância. O que terá importância será somente que a ele seja permitido existir e se o processo for concluído a criança terá um desenvolvimento psíquico saudável e poderá, pela vida afora,confiar em si mesma e nas pessoas que a rodeiam. Poderá ser um "ser total" pronto para encarar e enfrentar o mundo externo.

Gestão de riscos na cadeia de suprimentos e valoração do custo da escassez de energia elétrica: Modelos e uma proposta de implementação para o Brasil

Este trabalho apresenta as principais aplicações de técnicas de gestão de riscos ao estudo de interrupções em cadeias de fornecimento, tendo como motivação o caso do fornecimento de energia elétrica, assunto de extrema relevância para o Brasil. Neste sentido, o cálculo do “custo do déficit” ou perda de produção dada uma falha no fornecimento de energia elétrica (parâmetro utilizado em todo o planejamento do setor elétrico brasileiro), foi escolhido como fator relevante a ser analisado. As principais metodologias existentes para a apuração desse parâmetro são apresentadas fazendo uma comparação com aquela atualmente em uso no Brasil. Adicionalmente, apresentamos uma proposta de implementação para as metodologias alternativas, utilizadas no exterior, e baseadas no conceito de VOLL (“Value of Lost Load”) - medida do valor da escassez de energia para empresas ou consumidores individuais e fundamental para o desenho de programas de gerenciamento de demanda.

Análise do monitoramento de descargas atmosféricas na área de concessão da companhia força e luz do oeste em Guarapuava, Estado do Paraná

Aiming to analyze the monitoring of the atmospheric discharges incidence, the concession area of Companhia Forca e Luz do Oeste (CFLO) - Western Power and Light Company, located in the district of Guarapuava, state of Parana was chosen for a study developed in 2003, from January to December. After the air masses dynamics description, it was possible to identify the occurrence of atmospheric discharges and to compare them to the energy interruptions. To that end, atmospheric discharges density maps were created within the CFLO concession area for a later analysis of their influence in the electric energy supply. The monitoring of the atmospheric discharges and the comparison between this phenomenon and the occurrence of interruptions in the electric energy supply enabled this study. Results showed that such events are directly related, and that the rural area of the region under study underwent a major interference.

Utilização de redes neurais artificiais para detecção e diagnóstico de falhas

In a real process, all used resources, whether physical or developed in software, are subject to interruptions or operational commitments. However, in situations in which operate critical systems, any kind of problem may bring big consequences. Knowing this, this paper aims to develop a system capable to detect the presence and indicate the types of failures that may occur in a process. For implementing and testing the proposed methodology, a coupled tank system was used as a study model case. The system should be developed to generate a set of signals that notify the process operator and that may be post-processed, enabling changes in control strategy or control parameters. Due to the damage risks involved with sensors, actuators and amplifiers of the real plant, the data set of the faults will be computationally generated and the results collected from numerical simulations of the process model. The system will be composed by structures with Artificial Neural Networks, trained in offline mode using Matlab®

Enhancement of optical absorption by modulation of the oxygen flow of TiO2 films deposited by reactive sputtering

Oxygen-deficient TiO2 films with enhanced visible and near-infrared optical absorption have been deposited by reactive sputtering using a planar diode radio frequency magnetron configuration. It is observed that the increase in the absorption coefficient is more effective when the O-2 gas supply is periodically interrupted rather than by a decrease of the partial O-2 gas pressure in the deposition plasma. The optical absorption coefficient at 1.5 eV increases from about 1 x 10(2) cm(-1) to more than 4 x 10(3) cm(-1) as a result of the gas flow discontinuity. A red-shift of similar to 0.24 eV in the optical absorption edge is also observed. High resolution transmission electron microscopy with composition analysis shows that the films present a dense columnar morphology, with estimated mean column width of 40nm. Moreover, the interruptions of the O-2 gas flow do not produce detectable variations in the film composition along its growing direction. X-ray diffraction and micro-Raman experiments indicate the presence of the TiO2 anatase, rutile, and brookite phases. The anatase phase is dominant, with a slight increment of the rutile and brookite phases in films deposited under discontinued O-2 gas flow. The increase of optical absorption in the visible and near-infrared regions has been attributed to a high density of defects in the TiO2 films, which is consistent with density functional theory calculations that place oxygen-related vacancy states in the upper third of the optical bandgap. The electronic structure calculation results, along with the adopted deposition method and experimental data, have been used to propose a mechanism to explain the formation of the observed oxygen-related defects in TiO2 thin films. The observed increase in sub-bandgap absorption and the modeling of the corresponding changes in the electronic structure are potentially useful concerning the optimization of efficiency of the photocatalytic activity and the magnetic doping of TiO2 films. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4724334]