Clinical indicators of ineffective airway clearance in children with congenital heart disease

To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power. The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Longitudinal study. Participants consisted of 45 children, <= 1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2-day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data. A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0.99), followed by Adventitious Breath Sounds (0.97), Sputum Production (0.85) and Restlessness (0.53). Specificity was higher for Sputum Production (0.92), followed by Restlessness (0.73), Adventitious Breath Sounds (0.70) and Changes in Respiratory Rates/Rhythms (0.17). The best positive predictive values occurred for Sputum Production (0.93) and Adventitious Breath Sounds (0.80). Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values. The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children.

Optimized harvest scheduling in eucalyptus plantations under operational, spatial and climatic constraints

The representation of sustainability concerns in industrial forests management plans, in relation to environmental, social and economic aspects, involve a great amount of details when analyzing and understanding the interaction among these aspects to reduce possible future impacts. At the tactical and operational planning levels, methods based on generic assumptions usually provide non-realistic solutions, impairing the decision making process. This study is aimed at improving current operational harvesting planning techniques, through the development of a mixed integer goal programming model. This allows the evaluation of different scenarios, subject to environmental and supply constraints, increase of operational capacity, and the spatial consequences of dispatching harvest crews to certain distances over the evaluation period. As a result, a set of performance indicators was selected to evaluate all optimal solutions provided to different possible scenarios and combinations of these scenarios, and to compare these outcomes with the real results observed by the mill in the study case area. Results showed that it is possible to elaborate a linear programming model that adequately represents harvesting limitations, production aspects and environmental and supply constraints. The comparison involving the evaluated scenarios and the real observed results showed the advantage of using more holistic approaches and that it is possible to improve the quality of the planning recommendations using linear programming techniques.

Risk indicators for aggressive periodontitis in an untreated isolated young population from Brazil

This study aimed to assess the prevalence of aggressive periodontitis (AgP), and to investigate the association between demographic, socioeconomic and behavioral risk indicators with AgP in an untreated and isolated young population in Southeastern Brazil. For this cross-sectional survey, 134 subjects aged 12-29 years were selected by a census. Of those eligible, 101 subjects received a full-mouth clinical examination, and were interviewed using a structured written questionnaire. Cases were defined as individuals with 4 or more teeth with attachment loss > 4 mm or > 5 mm in the age groups 12-19 and 20-29, respectively. Overall, 9.9% of the subjects presented AgP (10.3% of the 12-19-year-olds and 9.7% of the 20-29-year-olds). The only risk indicator significantly associated with AgP in this isolated population was a high proportion of sites (> 30%) presenting supragingival calculus [OR = 23.2]. Having experienced an urgency dental treatment was a protective factor for AgP [OR = 0.1]. The authors concluded that this isolated and untreated population from Brazil presented a high prevalence of AgP. Local plaque-retaining factors played a major role in the prevalence of AgP in this isolated population, and should be included in further studies evaluating this destructive periodontal disease form.

Richards growth model and viability indicators for populations subject to interventions

In this work we study the problem of modeling identification of a population employing a discrete dynamic model based on the Richards growth model. The population is subjected to interventions due to consumption, such as hunting or farming animals. The model identification allows us to estimate the probability or the average time for a population number to reach a certain level. The parameter inference for these models are obtained with the use of the likelihood profile technique as developed in this paper. The identification method here developed can be applied to evaluate the productivity of animal husbandry or to evaluate the risk of extinction of autochthon populations. It is applied to data of the Brazilian beef cattle herd population, and the the population number to reach a certain goal level is investigated.

Hanseníase no município de Fortaleza, CE, Brasil: aspectos epidemiológicos e operacionais em menores de 15 anos (1995-2006)

Estudo transversal que objetiva analisar a ocorrência de casos de hanseníase em menores de 15 anos de idade residentes no Município de Fortaleza e notificados no SINAN. Os indicadores epidemiológicos nesta população mostram hiperendemicidade. Operacionalmente observa-se a manutenção da concentração de atendimento em algumas unidades de referência, apesar de alguns avanços. Diagnóstico tardio, elevado grau de incapacidade no diagnóstico e baixo grau de avaliação de contatos registrados revelam a fragilidade das ações de controle. Ressalta-se a possibilidade de erro diagnóstico frente às características da infecção nesta população. A ocorrência de casos de hanseníase nesta população representa um indicador epidemiológico de grande relevância e sua análise amplia a discussão sobre problemas operacionais na rede de serviços de saúde.

Validade de indicadores de atividade física e sedentarismo obtidos por inquérito telefônico

OBJETIVO: Avaliar a reprodutibilidade e a validade de indicadores de atividade física e sedentarismo, obtidos por sistema de vigilância baseado em inquéritos telefônicos. MÉTODOS: Foram realizadas análises de reprodutibilidade e validade em duas subamostras aleatórias (n=110 e n=111, respectivamente) da amostra total (N=2.024) de adultos (>18 anos), estudada pelo sistema, no município de São Paulo, em 2005. Os indicadores avaliados incluíram a freqüência de "suficientemente ativos no lazer", "inativos em quatro domínios da atividade física (lazer, trabalho, transporte e atividades domésticas)" e "ver televisão por longos períodos". A reprodutibilidade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original do sistema e de outra entrevista idêntica repetida após sete a 15 dias e feita por entrevistador diferente do que fez a entrevista original. A validade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original e de três recordatórios de 24 horas (método de referência) realizados na semana seguinte à entrevista original. RESULTADOS: A freqüência dos três indicadores avaliados foi idêntica ou muito próxima entre a primeira e a segunda entrevistas telefônicas, e os coeficientes kappa se situaram entre 0,53 e 0,80, indicando boa reprodutibilidade de todos os indicadores. Relativamente ao método de referência, evidenciou-se especificidade de 80% ou mais para os três indicadores e sensibilidade de 69,7% para "ver televisão por longos períodos", 59,1% para "inativos em quatro domínios" e 50% para "suficientemente ativos no lazer". CONCLUSÕES: Os indicadores de atividade física e sedentarismo empregados pelo sistema aparentam ser reprodutíveis e suficientemente acurados. Se mantido em operação nos próximos anos, o sistema poderá oferecer ao Brasil um instrumento útil para avaliação de políticas públicas de promoção da atividade física e controle das doenças crôni

Microbiological indicators for the assessment of performance in the hazard analysis and critical control points (HACCP) system in meat lasagna production

The HACCP system is being increasingly used to ensure food safety. This study investigated the validation of the control measures technique in order to establish performance indicators of this HACCP system in the manufacturing process of Lasagna Bolognese (meat lasagna). Samples were collected along the manufacturing process as a whole, before and after the CCPs. The following microorganism s indicator (MIs) was assessed: total mesophile and faecal coliform counts. The same MIs were analyzed in the final product, as well as, the microbiological standards required by the current legislation. A significant reduction in the total mesophile count was observed after cooking (p < 0.001). After storage, there was a numerical, however non-significant change in the MI count. Faecal coliform counts were also significantly reduced (p < 0.001) after cooking. We were able to demonstrate that the HACCP system allowed us to meet the standards set by both, the company and the Brazilian regulations, proved by the reduction in the established indicators

Direct Computation of Operational Matrices for Polynomial Bases

Several numerical methods for boundary value problems use integral and differential operational matrices, expressed in polynomial bases in a Hilbert space of functions. This work presents a sequence of matrix operations allowing a direct computation of operational matrices for polynomial bases, orthogonal or not, starting with any previously known reference matrix. Furthermore, it shows how to obtain the reference matrix for a chosen polynomial base. The results presented here can be applied not only for integration and differentiation, but also for any linear operation.

Rotation curve bifurcations as indicators of close recent galaxy encounters

Context. Rotation curves of interacting galaxies often show that velocities are either rising or falling in the direction of the companion galaxy. Aims. We seek to reproduce and analyse these features in the rotation curves of simulated equal-mass galaxies suffering a one-to-one encounter as possible indicators of close encounters. Methods. Using simulations of major mergers in 3D, we study the time evolution of these asymmetries in a pair of galaxies during the first passage. Results. Our main results are: (a) the rotation curve asymmetries appear right at pericentre of the first passage, (b) the significant disturbed rotation velocities occur within a small time interval, of similar to 0.5 Gyr h(-1), and, therefore, the presence of bifurcation in the velocity curve could be used as an indicator of the pericentre occurrence. These results are in qualitative agreement with previous findings for minor mergers and flybys.

Evaluation of biologic occupational risk control practices: Quality indicators development and validation

Background: There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. Methods: The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists` assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Results: Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. Conclusion: The developed indicators were considered validated, and the method used for construction and validation proved to be effective.

Multi-objective analysis of impacts of distributed generation placement on the operational characteristics of networks for distribution system planning

Recent advances in energy technology generation and new directions in electricity regulation have made distributed generation (DG) more widespread, with consequent significant impacts on the operational characteristics of distribution networks. For this reason, new methods for identifying such impacts are needed, together with research and development of new tools and resources to maintain and facilitate continued expansion towards DG. This paper presents a study aimed at determining appropriate DG sites for distribution systems. The main considerations which determine DG sites are also presented, together with an account of the advantages gained from correct DG placement. The paper intends to define some quantitative and qualitative parameters evaluated by Digsilent (R), GARP3 (R) and DSA-GD software. A multi-objective approach based on the Bellman-Zadeh algorithm and fuzzy logic is used to determine appropriate DG sites. The study also aims to find acceptable DG locations both for distribution system feeders, as well as for nodes inside a given feeder. (C) 2010 Elsevier Ltd. All rights reserved.

Influence of the Operational Constraints in the Active Transmission Losses Allocation via Lagrange Multipliers

This paper presents an approach for the active transmission losses allocation between the agents of the system. The approach uses the primal and dual variable information of the Optimal Power Flow in the losses allocation strategy. The allocation coefficients are determined via Lagrange multipliers. The paper emphasizes the necessity to consider the operational constraints and parameters of the systems in the problem solution. An example, for a 3-bus system is presented in details, as well as a comparative test with the main allocation methods. Case studies on the IEEE 14-bus systems are carried out to verify the influence of the constraints and parameters of the system in the losses allocation.

Advanced process of microbiological control of wastewater in combined system of disinfection with UV radiation

The purpose of this study was to present a methodology with superior efficiency for inactivating pathogenic indicators commonly found in domestic sewage. The adopted method was based on synergistic effect resulting from the introduction of a UV radiation pre-disinfection stage of sewage followed by secondary treatment. A pilot unit was installed in the sewage treatment plant of the University of Sao Paulo to simulate the combined system in full-scale operational conditions. Its performance was evaluated through microbiological examinations for determining Escherichia coli, total coliforms and coliphages. The application of UV radiation at 5.1mW/cm(2) for 10 s of exposure in the first disinfection stage was enough to reduce the surviving number of E. coli around 100 times, in comparison to the conventional method. Therefore, based on experimental data, it is possible to conclude that combining treatment and pre-disinfection stage is an effective potential technique to produce effluents with lower degree of contamination by pathogenic organisms.

Physical-chemical and operational performance of an anaerobic baffled reactor (ABR) treating swine wastewater

Since hog raising concentrates a huge amount of swine manure in small areas, it is considered by the environmental government organizations to be one of the most potentially pollutant activities. Therefore the main objective of this research was to evaluate by operational criteria and removal efficiency, the performance of a Anaerobic Baffled Reactor (ABR), working as a biological pre-treatment of swine culture effluents. The physical-chemical analyses carried out were: total COD, BOD(5), total solids (TS), fix (TFS) and volatiles (TVS), temperature, pH, total Kjeldahl nitrogen, phosphorus, total acidity and alkalinity. The ABR unit worked with an average efficiency of 65.2 and 76.2%, respectively, concerning total COD and BOD(5), with a hydraulic retention time (HRT) about 15 hours. The results for volumetric organic loading rate (VOLR), organic loading rate (OLR) and hydraulic loading rate (HLR) were: 4.46 kg BOD m(-3) day(-1); 1.81 kg BOD(5) kg TVS(-1) day(-1) and 1.57 m(3) m(-3) day(-1), respectively. The average efficiency of the whole treatment system for total COD and BOD(5) removal were 66.5 and 77.8%, showing an adequate performance in removing die organic matter from swine wastewater.

A novel approach for Modeling the steady-state VSC-based multiline FACTS controllers and their operational constraints

A new, simple approach for modeling and assessing the operation and response of the multiline voltage-source controller (VSC)-based flexible ac transmission system controllers, namely the generalized interline power-flow controller (GIPFC) and the interline power-flow controller (IPFC), is presented in this paper. The model and the analysis developed are based on the converters` power balance method which makes use of the d-q orthogonal coordinates to thereafter present a direct solution for these controllers through a quadratic equation. The main constraints and limitations that such devices present while controlling the two independent ac systems considered, will also be evaluated. In order to examine and validate the steady-state model initially proposed, a phase-shift VSC-based GIPFC was also built in the Alternate Transients Program program whose results are also included in this paper. Where applicable, a comparative evaluation between the GIPFC and the IPFC is also presented.