Integrated management systems as complex adaptive systems

It is a difficult task to avoid the “smart systems” topic when discussing smart prevention and, similarly, it is a difficult task to address smart systems without focusing their ability to learn. Following the same line of thought, in the current reality, it seems a Herculean task (or an irreparable omission) to approach the topic of certified occupational health and safety management systems (OHSMS) without discussing the integrated management systems (IMSs). The available data suggest that seldom are the OHSMS operating as the single management system (MS) in a company so, any statement concerning OHSMS should mainly be interpreted from an integrated perspective. A major distinction between generic systems can be drawn between those that learn, i.e., those systems that have “memory” and those that have not. These former systems are often depicted as adaptive since they take into account past events to deal with novel, similar and future events modifying their structure to enable success in its environment. Often, these systems, present a nonlinear behavior and a huge uncertainty related to the forecasting of some events. This paper seeks to portray, for the first time as we were able to find out, the IMSs as complex adaptive systems (CASs) by listing their properties and dissecting the features that enable them to evolve and self-organize in order to, holistically, fulfil the requirements from different stakeholders and thus thrive by assuring the successful sustainability of a company. Based on the revision of literature carried out, this is the first time that IMSs are pointed out as CASs which may develop fruitful synergies both for the MSs and for CASs communities. By performing a thorough revision of literature and based on some concepts embedded in the “DNA” of the subsystems implementation standards it is intended, specifically, to identify, determine and discuss the properties of a generic IMS that should be considered to classify it as a CAS.

Efficacy of a gas permeable contact lens to induce peripheral myopic defocus

Purpose. The purpose of this work was to evaluate the potential of a novel custom-designed rigid gas permeable (RGP) contact lens to modify the relative peripheral refractive error in a sample of myopic patients. Methods. Fifty-two right eyes of 52 myopic patients (mean [TSD] age, 21 [T2] years) with spherical refractive errors ranging from j0.75 to j8.00 diopters (D) and refractive astigmatism of 1.00 D or less were fitted with a novel experimental RGP (ExpRGP) lens designed to create myopic defocus in the peripheral retina. A standard RGP (StdRGP) lens was used as a control in the same eye. The relative peripheral refractive error was measured without the lens and with each of two lenses (StdRGP and ExpRGP) using an open-field autorefractometer from 30 degrees nasal to 30 degrees temporal, in 5-degree steps. The effectiveness of the lens design was evaluated as the amount of relative peripheral refractive error difference induced by the ExpRGP compared with no lens and with StdRGP conditions at 30 degrees in the nasal and temporal (averaged) peripheral visual fields. Results. Experimental RGP lens induced a significant change in relative peripheral refractive error compared with the nolens condition (baseline), beyond the 10 degrees of eccentricity to the nasal and temporal side of the visual field (p G 0.05). The maximum effect was achieved at 30 degrees. Wearing the ExpRGP lens, 60% of the eyes had peripheral myopia exceeding j1.00 D, whereas none of the eyes presented with this feature at baseline. There was no significant correlation (r = 0.04; p = 0.756) between the degree of myopia induced at 30 degrees of eccentricity of the visual field with the ExpRGP lens and the baseline refractive error. Conclusions. Custom-designed RGP contact lenses can generate a significant degree of relative peripheral myopia in myopic patients regardless of their baselin spherical equivalent refractive error.

Postoperative self-efficacy and psychological morbidity in radical prostatectomy

Objective: evaluate the general and perceived self-efficacy, psychological morbidity, and knowledge about postoperative care of patients submitted to radical prostatectomy. Identify the relationships between the variables and know the predictors of self-efficacy. Method: descriptive, cross-sectional study, conducted with 76 hospitalized men. The scales used were the General and Perceived Self-efficacy Scale and the Hospital Anxiety and Depression Scale, in addition to sociodemographic, clinical and knowledge questionnaires. Results: a negative relationship was found for self-efficacy in relation to anxiety and depression. Psychological morbidity was a significant predictor variable for self-efficacy. An active professional situation and the waiting time for surgery also proved to be relevant variables for anxiety and knowledge, respectively. Conclusion: participants had a good level of general and perceived self-efficacy and small percentage of depression. With these findings, it is possible to produce the profile of patients about their psychological needs after radical prostatectomy and, thus, allow the nursing professionals to act holistically, considering not only the need for care of physical nature, but also of psychosocial nature.

Cognitive stimulation for portuguese older adults with cognitive impairment: a randomized controlled trial of efficacy, comparative duration, feasibility and experiential relevance

Although some studies point to cognitive stimulation as a beneficial therapy for older adults with cognitive impairments, this area of research and practice is still lacking dissemination and is underrepresented in many countries. Moreover, the comparative effects of different intervention durations remain to be established and, besides cognitive effects, pragmatic parameters, such as cost-effectiveness and experiential relevance to participants, are seldom explored. In this work, we present a randomized con- trolled wait-list trial evaluating 2 different intervention durations (standard 1⁄4 17 vs brief 1⁄4 11 sessions) of a cognitive stimulation program developed for older adults with cognitive impairments with or without dementia. 20 participants were randomly assigned to the standard duration intervention program (17 sessions, 1.5 months) or to a wait-list group. At postintervention of the standard intervention group, the wait-list group crossed over to receive the brief intervention program (11 sessions, 1 month). Changes in neuropsychological, functionality, quality of life, and caregiver outcomes were evaluated. Experience during intervention and costs and feasibility were also evaluated. The current cognitive stimulation programs (ie, standard and brief) showed high values of experiential relevance for both intervention durations. High adherence, completion rates, and reasonable costs were found for both formats. Further studies are needed to definitively establish the potential efficacy, optimal duration, cost-effectiveness, and experiential relevance for participants of cognitive intervention approaches.

Adaptive facade systems - review of performance requirements, design approaches, use cases and market needs

The paper reflects the work of COST Action TU1403 Workgroup 3/Task group 1. The aim is to identify research needs from a review of the state of the art of three aspects related to adaptive façade systems: (1) dynamic performance requirements; (2) façade design under stochastic boundary conditions and (3) experiences with adaptive façade systems and market needs.

Cognitive functioning and efficacy of cognitive intervention in Multiple Sclerosis

Tese de Doutoramento em Psicologia Clínica / Psicologia

Pervasive adaptive data acquisition gateway for critical healthcare

The data acquisition process in real-time is fundamental to provide appropriate services and improve health professionals decision. In this paper a pervasive adaptive data acquisition architecture of medical devices (e.g. vital signs, ventilators and sensors) is presented. The architecture was deployed in a real context in an Intensive Care Unit. It is providing clinical data in real-time to the INTCare system. The gateway is composed by several agents able to collect a set of patients’ variables (vital signs, ventilation) across the network. The paper shows as example the ventilation acquisition process. The clients are installed in a machine near the patient bed. Then they are connected to the ventilators and the data monitored is sent to a multithreading server which using Health Level Seven protocols records the data in the database. The agents associated to gateway are able to collect, analyse, interpret and store the data in the repository. This gateway is composed by a fault tolerant system that ensures a data store in the database even if the agents are disconnected. The gateway is pervasive, universal, and interoperable and it is able to adapt to any service using streaming data.