Estratégia de conversor para interligação de sistemas de geração eólica à rede elétrica

Currently, there are several power converter topologies applied to wind power generation. The converters allow the use of wind turbines operating at variable speed, enabling better use of wind forces. The high performance of the converters is being increasingly demanded, mainly because of the increase in the power generation capacity by wind turbines, which gave rise to various converter topologies, such as parallel or multilevel converters. The use of converters allow effective control of the power injected into the grid, either partially, for the case using partial converter, or total control for the case of using full converter. The back-to-back converter is one of the most used topologies in the market today, due to its simple structure, with few components, contributing to robust and reliable performance. In this work, is presented the implementation of a wind cogeneration system using a permanent magnet synchronous generator (PMSG) associated with a back-to-back power converter is proposed, in order to inject active power in an electric power system. The control strategy of the active power delivered to the grid by cogeneration is based on the philosophy of indirect control

Caracterização do processo de trabalho do cirurgiãodentista na estratégia de saúde da família do município de Parnamirim-RN

Family Health Strategy (FHS), founded in 1994 has appeared to play a strategic role in the SUS construction and consolidation. It has reaffirmed its Principles and Guidelines and has elected family as core of attention. The principle that has guided the work concerns the quality of the relationship between professional and family. Thus, the FHS has the family as a subject of health-disease process, and relations with its own characteristics and can be partners in building their health and improvement of quality of life of its members and the entire community. This study aims to characterize the surgeon-dentist (SD) working process in the family health strategy, from the knowledge of the SD integration with other team members; organization of services; development of shares, changes perceived by SDs, as well as knowing the surgeon-dentist profile who is part of this strategy. The collecting tool used was a semi-structured questionnaire, in which participated 30 professionals. As for profile, most professionals were women, completed the graduation in public university and did not have any training to work by joining the FHS. Almost all have other public or private working ties. They often carry out activities with students, and occasionally do home visits. In relation to team work, in activities such as home visits, school health, community activities, among others, they sometimes seek the cooperation of other members. The way of accessing for users in the most part has occurred through the schedule. The most frequently activities made to the Centro Especialidades Odontológicas (CEO), are in Endodontics and Prosthesis. The majority of them participate in team meetings, but they do not have frequency set to happen. As for the planning and programming of activities to be conducted, most said that individually develops them. Concerning the performance of their duties, most reported being satisfied, but that improvements could happen. Besides, they reported improvements in dental care following the inclusion of SD in the FHS in various aspects, such as access, organization, humanization, care and oral disease prevention. The professionals had poor integration with other team members, in addition to have a profile to more individualistic work, a fact seized by way of development and planning of actions. They work the actions in individual and curative way, in detriment promotion and collective ones. They work humanization, definition of territory and adscript population. Thus, it is concluded that the working process developed by SDs, includes the part which is advocated by FHS. This points out to a greater undertaking of this process aiming to detect the weakness met in order to reach the potential that the FHS represents in organization of basic attention

Impacto do Programa de Saúde da Família sobre indicadores de saúde bucal na população de Natal -RN

The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health

Parâmetros parasitológicos e desempenho produtivo de ovinos naturalmente infectados com nematoides gastrintestinais mantidos em diferentes pastagens tropicais

The control of gastrointestinal nematodes of small ruminants is usually done with anthelmintics. However, due to the emergence of ever-increasing parasite resistance to these drugs, looking up an alternative control parasites. One of this is sought in pasture management, as these are the sources of animals` infection by L3 infective larvae of helminths. The aim of this study was to evaluate the performance of sheep to natural infections by gastrointestinal nematodes grazing Panicum maximum cv. Massai and cv. Aruana, and Brachiaria brizantha cv. Piatã and cv. Marandu. The work was conducted from May to August-2011 with 48 male sheeps SRD versus Santa Inês breed. The animals were naturally infected with gastrointestinal nematodes, and maintained in four different cultivars of tropical forage grasses, naturally contaminated with eggs and larvae of gastrointestinal nematodes. Each week the animals were phenotypically characterized by parasitological examinations (eggs per gram of feces - EPG, and feces culture), hematological (packed cell volume PCV, and blood eosinophil count) method to evaluate the Famacha© colorof ocular mucosa, and the measures of body condition score and weight. In pastures was made the recovery of infective larvae in order to determine the quantity of L3 present in the pasture. The experimental design was a randomized completed block with two replications and before the entry of animals in the paddocks, they have been wormed. The experiment was ended when the animals reached 32.0 kg liveweight, and then were slaughtered and autopsies performed for the recovery and identify parasites of the abomasum, small intestine and large intestine. Results were subjected to analysis of variance, t test and Tukey`s test. The animals kept on pastures of Marandu grass had lower EPG counts, higher percentage of packed cell volume and higher average weight; those who remained in the Piatã pasture had lower eosinophil counts per microliter of blood. About the Famacha©, the highest prevalence was Famacha 2, and the body condition score ranged between 2 and 3. The results of feces cultures and recovery of larvae on pastures showed the presence of larvae of Trichostrongylus sp., and at the necropsy too. This way, it was concluded that the grass cultivars influences the sheep parasite load; the Famacha, together with EPG and packed cell volume are important indicators for use in controlling gastrointestinal nematode infections. The Trichostrongylus sp. was the most prevalent parasite in sheep during the rainy season

Bem-estar psicológico de servidores e funcionários técnico-administrativos das Instituições de Ensino Superior Públicas e Privadas : indicadores e antecedentes

The elaboration of this thesis aimed at getting to know the structure of the psychological well-being (PWB) at work and analysing the differences in the PWB levels among technical-administrative servants in public and private Institutions of Higher Education (IES) in the municipality of João Pessoa. Two hundred and thirty-three public and private IES male and female servants of João Pessoa participated in the research, replying to an instrument composed of questionnaires referring to the elaborated model. Factorial and regression analyses were accomplished in order to test the hypotheses in respect of the proposed model. The results showed that the PWB related with the work is composed of indicators such as affection, vitality, anxiety, depression, satisfaction at work and aspiration for accomplishment and reduction of the self-efficiency. The observed PWB predictors at work were the IES type, presence of children, age and the escape and back-out facing strategy. These predictors possess relationship of moderation among them in the explanation of PWB. On comparing the PWB experienced by the technical-administrative servants, it was observed that those linked to private IES showed higher PWB rates. Furthermore, there are differences among PWB predictors in accordance with the IES type. The applicability of the results of this thesis is wide as regards social interventions in the search of health improvement under a psycho-sociological perspective. Eventually, the thematic of this thesis intends to reinforce the studies on the worker s health, since by knowing what would lead him into a feeling of accomplishment and well-being will result in more chances of promoting him, while creating opportunities of a sounder life for these people in psychological terms

Análise da mobilidade urbana de Natal/RN a partir do uso de indicadores de sustentabilidade

In contemporary times, the urban mobility is presented as one of the main challenges of large and medium-sized Brazilian cities , it presents signs of unsustainability , above all due to the increase in motorized transport system , especially the individual . Thus , it is clear that mobility is considered of special interest for sustainable urban development , is facing a crisis that is reflected in negative externalities , particularly with regard to congestion , accidents , air pollution , social exclusion , among others. The complexity of these problems requires an integrated analysis based on the principles of sustainability . In this sense , trying to understand this problem and in the attempt to minimize its impacts, Costa (2008 ) proposed the Index of Sustainable Urban Mobility (I_SUM) with the goal of providing a methodology capable to assess relevant aspects of mobility , including social dimensions , political, economic and environmental . Given the above, was elected as the main objective of this study is to analyze urban mobility in Natal / RN from the perspective of sustainability . Like specific objectives will seek to analyze Natal´s urban mobility, using the I_SUM like a tool for both the city as a whole and for each of its four administrative regions; evaluate Natal s urban accessibility conditions and verify to what extent the access to urban services and equipment is facilitated or hindered because of the location and incomes of the population . For this, it was necessary to use bibliographic , documentary and field research . The index , which varies from 0.00 to 1.00, revealed for Natal an Global value of 0,510, and that refers to its administrative regions, it was found that there are very small percentage differences from the overall index calculated for the city . The performance of I_SUM by administrative region showed that although there are differences , the results were very similar , varying between 0,494 and 0,537. Particularly in relation to urban accessibility, it appears that Natal presents as an unequal city and this inequity , which is not only income is reflected in the issues related to accessibility and hence urban mobility

O efeito da autocorrelação no desempenho do gráfico T2 de hotelling: caso bivariado

The chart of control of Hotelling T2 has been the main statistical device used in monitoring multivariate processes. Currently the technological development of control systems and automation enabled a high rate of collection of information of the production systems in very short time intervals, causing a dependency between the results of observations. This phenomenon known as auto correlation causes in the statistical control of the multivariate processes a high rate of false alarms, prejudicing in the chart performance. This entails the violation of the assumption of independence and normality of the distribution. In this thesis we considered not only the correlation between two variables, but also the dependence between observations of the same variable, that is, auto correlation. It was studied by simulation, the bi variate case and the effect of auto correlation on the performance of the T2 chart of Hotelling.

Contribuições à estratégia de controle sem detecção de harmônicos aplicada a um filtro ativo de potência paralelo

The conventional control schemes applied to Shunt Active Power Filters (SAPF) are Harmonic extractor-based strategies (HEBSs) because their effectiveness depends on how quickly and accurately the harmonic components of the nonlinear loads are identified. The SAPF can be also implemented without the use of the load harmonic extractors. In this case, the harmonic compensating term is obtained from the system active power balance. These systems can be considered as balanced-energy-based schemes (BEBSs) and their performance depends on how fast the system reaches the equilibrium state. In this case, the phase currents of the power grid are indirectly regulated by double sequence controllers with two degrees of freedom, where the internal model principle is employed to avoid reference frame transformation. Additionally the DSC controller presents robustness when the SAPF is operating under unbalanced conditions. Furthermore, SAPF implemented without harmonic detection schemes compensate simultaneously harmonic distortion and reactive power of the load. Their compensation capabilities, however, are limited by the SAPF power converter rating. Such a restriction can be minimized if the level of the reactive power correction is managed. In this work an estimation scheme for determining the filter currents is introduced to manage the compensation of reactive power. Experimental results are shown for demonstrating the performance of the proposed SAPF system.

ArchWiSeN: uma estratégia baseada em modelos para desenvolvimento de aplicações para redes de sensores e atuadores sem fio

Wireless Sensor and Actuator Networks (WSAN) are a key component in Ubiquitous Computing Systems and have many applications in different knowledge domains. Programming for such networks is very hard and requires developers to know the available sensor platforms specificities, increasing the learning curve for developing WSAN applications. In this work, an MDA (Model-Driven Architecture) approach for WSAN applications development called ArchWiSeN is proposed. The goal of such approach is to facilitate the development task by providing: (i) A WSAN domain-specific language, (ii) a methodology for WSAN application development; and (iii) an MDA infrastructure composed of several software artifacts (PIM, PSMs and transformations). ArchWiSeN allows the direct contribution of domain experts in the WSAN application development without the need of specialized knowledge on WSAN platforms and, at the same time, allows network experts to manage the application requirements without the need for specific knowledge of the application domain. Furthermore, this approach also aims to enable developers to express and validate functional and non-functional requirements of the application, incorporate services offered by WSAN middleware platforms and promote reuse of the developed software artifacts. In this sense, this Thesis proposes an approach that includes all WSAN development stages for current and emerging scenarios through the proposed MDA infrastructure. An evaluation of the proposal was performed by: (i) a proof of concept encompassing three different scenarios performed with the usage of the MDA infrastructure to describe the WSAN development process using the application engineering process, (ii) a controlled experiment to assess the use of the proposed approach compared to traditional method of WSAN application development, (iii) the analysis of ArchWiSeN support of middleware services to ensure that WSAN applications using such services can achieve their requirements ; and (iv) systematic analysis of ArchWiSeN in terms of desired characteristics for MDA tool when compared with other existing MDA tools for WSAN.

Promoção, vencimento e avaliação de desempenho do professor do ensino fundamental: o PCCR da rede municipal de ensino de Natal/RN (2004-2010)

This study is about the enhancement of the elementary school in Natal/RN, (PCCR - Law No. 058/2004), concerning to the horizontal promotion through the performance evaluation. It uses as reference the education policy on the legislative field hegemony and the managerial model. The analysis of the teacher´s valorization is based on the policy of Funds (Fundef and Fundeb) in the Brazilian social and educational agenda. The study focuses on the Career Plan, Career and Remuneration of teachers in the period (2004-2010).The study focuses on the Career Plan, Career and Remuneration of teachers in the period (2004-2010). The thesis argues for the necessity to adopt a direct relationship between career development and horizontal promotion for more others fifteen classes, no matter to any conditioning variables. In addition, the performance shall be evaluated by interval of 25 years to reach at least the provisions decided in the law, which determines the salary adjustment in 5% at every two years, as pointed at the PCCR, about teachers remuneration, and teachers qualifications. A work of a bibliographic and a documental review about the education funding with the purpose of enhancement of educational work, career concepts, and also promotion and evaluation performance as well was performed based on experts authors in this field. The survey was organized with the aim of articulating quantitative and qualitative information, analyzing data from the teacher's salary - payrolls and paychecks - also applying a questionnaire. After the implementation of the PCCR, it was found that the wage indices for horizontal promotion during the teaching career are tied to a strategy for evaluating the performance which disqualifies the teacher‟s salaries in a minimum percentage of 25% (up to 25 years) and there are also elements that disturb the promotion strategy. The national minimum wage was set in three salaries by the PSPN Lei nº11.738/2008 but it never reaches the three salaries at Natal/RN educational system.Otherwise, the elements that structure the horizontal promotion in fifteen classes, throughout the career, flout the minimum years of teaching work, long established in 25 years. In addition, changes in terms in the salary increase depend on individual efforts by professional development through titration. Concerning to the career, despite of the category approving its PCCR, neither this instrument nor the Funds Policy managed to establish regulations were able to cope effective rules for valuing the teachers in the educational district system. It is necessary to ensure, in percentage terms and financial, the real remuneration of teachers with the attainment of horizontal promotion, reviewing the elements that structure the career and the determinants of performance evaluation.

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

Análise do processo de avaliação de desempenho ambiental face às diretrizes da ISO 14031: um estudo de caso

The present dissertation aims to analyze the evaluation process of environmental performance inside an organization from the building construction section of civil construction based on the NBR ISO 14031 guidelines, which provide orientation regarding the implementation of this project towards the internal organizational management. The theoretical research has addressed concepts and historical development of environmental management inside organizations, from the emergence of the first models to the strengthening of environmental management through the standardization of the Environmental Management System caused by the publication of ISO 14001. It has also addressed the evaluation of environmental performance, the NBR ISO 14031 (concepts, types of indicators of evaluation of environmental performance, the elaboration process of such indicators, as well as its use and evaluation by the high administration). The research has an applied character, with exploratory and descriptive goals, and a qualitative approach based on case study. The data collection will be made through questionnaires, interviews, and documental analysis. Through the present research project, one expects to learn the elements taken into consideration by the organization for the elaboration and selection of indicators; to identify which interested parties contribute in the aforementioned process; to discover which sources are taken into consideration by the organization while establishing its environmental performance goals; to learn how the different kinds of environmental indicators are handled by organizations on daily basis, considering the existence of interferences on the decision making process, whether or not the interested parties are integrated, and if there is an periodical evaluation of environmental performance and how it is handled. One also expects to identify the opportunities for improvement regarding the organization that is object of study.

AdaptMCloud: uma estratégia para adaptação dinâmica de aplicações Multi-Cloud

Multi-Cloud Applications are composed of services offered by multiple cloud platforms where the user/developer has full knowledge of the use of such platforms. The use of multiple cloud platforms avoids the following problems: (i) vendor lock-in, which is dependency on the application of a certain cloud platform, which is prejudicial in the case of degradation or failure of platform services, or even price increasing on service usage; (ii) degradation or failure of the application due to fluctuations in quality of service (QoS) provided by some cloud platform, or even due to a failure of any service. In multi-cloud scenario is possible to change a service in failure or with QoS problems for an equivalent of another cloud platform. So that an application can adopt the perspective multi-cloud is necessary to create mechanisms that are able to select which cloud services/platforms should be used in accordance with the requirements determined by the programmer/user. In this context, the major challenges in terms of development of such applications include questions such as: (i) the choice of which underlying services and cloud computing platforms should be used based on the defined user requirements in terms of functionality and quality (ii) the need to continually monitor the dynamic information (such as response time, availability, price, availability), related to cloud services, in addition to the wide variety of services, and (iii) the need to adapt the application if QoS violations affect user defined requirements. This PhD thesis proposes an approach for dynamic adaptation of multi-cloud applications to be applied when a service is unavailable or when the requirements set by the user/developer point out that other available multi-cloud configuration meets more efficiently. Thus, this work proposes a strategy composed of two phases. The first phase consists of the application modeling, exploring the similarities representation capacity and variability proposals in the context of the paradigm of Software Product Lines (SPL). In this phase it is used an extended feature model to specify the cloud service configuration to be used by the application (similarities) and the different possible providers for each service (variability). Furthermore, the non-functional requirements associated with cloud services are specified by properties in this model by describing dynamic information about these services. The second phase consists of an autonomic process based on MAPE-K control loop, which is responsible for selecting, optimally, a multicloud configuration that meets the established requirements, and perform the adaptation. The adaptation strategy proposed is independent of the used programming technique for performing the adaptation. In this work we implement the adaptation strategy using various programming techniques such as aspect-oriented programming, context-oriented programming and components and services oriented programming. Based on the proposed steps, we tried to assess the following: (i) the process of modeling and the specification of non-functional requirements can ensure effective monitoring of user satisfaction; (ii) if the optimal selection process presents significant gains compared to sequential approach; and (iii) which techniques have the best trade-off when compared efforts to development/modularity and performance.

Influência da pressão e da vazão de concentrado sobre o desempenho de ultrafiltração no pós-tratamento de esgotos

Despite the numerous advantages resulting from the use of membrane filters technology, intrinsic limitations fouling process become relevant to its applicability. The control of operating conditions is an important tool to mitigate fouling and achieve good levels of efficiency. In this sense, the objective of this study was to investigate the effect of transmembrane pressure and concentrate flow in the performance of ultrafiltration, applied to the post-treatment of domestic sewage. The process was evaluated and optimized by varying the pressure (0.5 and 1.5 bar) and the concentrate flow (300 and 600 L/h), using a 22 factorial design, in order to investigate the effects on the permeate flow and quality of effluents generated at each operating condition. We evaluated the following quality indicators for permeate: pH, electrical conductivity, total suspended solids, turbidity, calcium and Chemical Oxygen Demand (COD). In all tests, we observed marked reduction in the permeate flux at the early stages, followed by a slow decline that lasted until it reaches a relatively constant level, around 120 minutes of filtration. The increased pressure resulted in a higher initial permeate flux, but the decrease of the flow with time is greater for tests at higher pressure, indicating a more pronounced fouling process. On the other hand, increasing the concentrate flow resulted in a slower decline in permeate flux with the filtration time. Regarding the quality of permeate, the transmembrane pressure of 0,5 bar was the one that allowed better results, and was statistically confirmed through the two-way ANOVA test with repeated measures, significant effect of pressure on the turbidity of the permeate. The concentrate flow, in turn, showed no significant influence on any of the quality parameters. Thus, we conclude that, from an economic and environmental point of view, it is more interesting to operate ultrafiltration membrane system with a lower concentrate flow associated with a low transmembrane pressure, since under these conditions will produce less waste, and the permeate will present lower concentrations of the analyzed constituent, especially lower turbidity.

Perfis epidemiológicos de saúde bucal no Brasil e os modelos de vigilância

National surveys are important tools for public health surveillance and thus key elements in monitoring health conditions and system performance. In the field of oral health, such surveys began with the oral health survey in 1986 and later in 1996 and with the SBBrasil Project in 2003. The 2010 edition of SBBrasil is the principal oral health surveillance strategy for the production of primary data. In order to contribute to this discussion, this article proposes: (a) to present and discuss the Brazilian experience with nationwide oral health surveys and (b) to discuss the use of data in health surveillance models. One can conclude that oral health surveys in Brazil have great possibilities as a tool for health services and academia. Such surveys have shown evident potential for verifying trends in the oral health profile, as well as for producing valid indicators for use in health services.