Iniciativas internacionais de segurança do paciente: contribuições para o refinamento dos sistemas de proteção

Trata-se da temática Segurança do Paciente, que teve como objeto as iniciativas sobre segurança do paciente estabelecidas por organizações internacionais de segurança. O objetivo proposto pelo estudo foi analisar tais iniciativas estabelecidas por organizações internacionais de segurança. Para compor este estudo identificaram-se as principais organizações de segurança, atarvés de uma revisão bibliográfica de literatura realizada com base em fontes eletrônicas primárias, considerando-se as organizações pioneiras na abordagem do tema Segurança do Paciente que fomentam prioritariamente a segurança do paciente e que divulgaram amplamente esta temática no período de 2002 a 2012. Foram encontradas na plataforma Google referências a mais de 100 instituições no mundo que abordam este tema. No entanto somente sete atenderam a todos os critérios de seleção, havendo predomínio de organizações americanas (seis). A organização mais antiga é o Centers for Disease Control and Prevention (1946), e a mais recente é a World Alliance for Patient Safety (2004). Quanto à natureza jurídica, duas são governamentais (CDC e AHRQ), quatro são não governamentais (The Joint Commission, IHI, WHO Alliance e ISMP) e uma organização independente (NCCMERP). Totalizaram-se 103 iniciativas de segurança do paciente no contexto hospitalar. A organização que mais publicou iniciativas para a segurança do paciente no contexto hospitalar foi o ISMP com 20 iniciativas, totalizando 19% das iniciativas exploradas. As iniciativas relacionadas à terapia medicamentosa, higienização das mãos, controle de infecções e cirurgias seguras foram as mais abordadas. Conclui-se que ao atentar para as iniciativas internacionais de Segurança do Paciente o profissional de saúde poderá contextualizar-se, aprimorando seu conhecimento técnico científico, além de pôr em prática o que as principais organizações mundiais voltadas para a Segurança do Paciente preconizam para a realização de um cuidado mais seguro.

Corpo em festa: Juventude, sociabilidade e produção de sentidos nos bailes cariocas

A presente pesquisa consiste em um estudo da representação do corpo jovem a partir de dois bailes: o baile coletivo de debutantes promovido pela Unidade de Polícia Pacificadora (UPP) para as moradoras de algumas comunidades cariocas, e o baile do passinho, vertente do funk carioca, que atrai os meninos das comunidades e ressignifica seu papel social dentro das favelas onde vivem. O recorte para o estudo parte, inicialmente, de questões de gênero atribuídas a ambos os bailes. O fim dos bailes funk no processo de pacificação das favelas tem desdobramentos significativos na rotina dos jovens. De um lado, a reivindicação das jovens deu origem ao baile coletivo de debutantes como estratégia de aproximação da polícia com o público feminino; por outro, levou o passinho para as lan houses e fez dos cômodos das casas cenário para a gravação de vídeos e a sua divulgação e compartilhamento em rede. O objetivo do trabalho é observar nos jovens que participam dos bailes supracitados a maneira pela qual seus corpos são "adequados" para tais festas e quais os aspectos que influenciam e afetam a construção da identidade juvenil. A estratégia metodológica desenvolvida contemplou a pesquisa documental disponível em mídia impressa e digital sobre os bailes e suas danças, a realização de entrevistas abertas e semi-estruturadas, a observação dos jovens participantes nos bailes, e a pesquisa bibliográfica para embasamento teórico - sendo considerado o referencial sócio-antropológico de David Le Breton, Michel Maffesoli, Roberto DaMatta e Hermano Vianna, a sociologia de Émile Durkheim e Marcel Mauss, os estudos culturais de Raymond Williams, Peter Burke, Néstor Garcia Canclini e Stuart Hall, além das pesquisas em comunicação de Denise Siqueira e Christine Greiner. Para a presente pesquisa as projeções no corpo impelem um olhar crítico e o analisar das referências que circundam os jovens moradores das comunidades cariocas. Desta forma, questionar as representações do corpo em festa move este estudo.

Biological survey: River Teign and tributaries with references to the discharge of ball clay wastes

This is the Biological survey of River Teign and tributaries with references to the discharge of ball clay wastes, document produced by South West Water Authority in 1973. This report focuses on on-site assessment of the benthic macro-invertebrates of the lower River Teign, River Bovey, Ugbrooke Stream and Blatchford Brook was undertaken on 19th and 22nd August 1977 to assess the effects of discharges from ball clay mining premises. Inspection of aquatic fauna in the field is of necessity, less extensive than laboratory identification of sorted samples, so that the resulting data underestimates the water quality. This is more pronounced in the Chandler Score than in the Trent Biotic Index which does not take account of species abundance. Chandler should thus be interpreted by the trends described rather than by absolute values calculated.

Holocene climate and El Nino history as recorded in the sediments of northern coastal Peru [abstract, table, and references]

EXTRACT (SEE PDF FOR FULL ABSTRACT): The history of the El Nino phenomena is recorded in both the fluvial and coastal sediments of northern Peru. The fluvial record was presented at the 1987 PACLIM Workshop and is discussed in detail elsewhere (Wells, 1987). However, the number of radiocarbon dated El Nino events has increased since Wells (1987) was published; this data is presented in Table 1.

Phylogeny of fireflies (Coleoptera : Lampyridae) inferred from mitochondrial 16S ribosomal DNA, with references to morphological and ethological traits

We sequenced partial mitochondrial 16S ribosomal DNA (16S rDNA) of 18 firefly species from Southwest of China. Combined with homologous sequences previously reported, phylogenetic trees including Japanese, Korean and Chinese species were reconstructed by

Some Considerations on a Calculus with Weak References

Weak references are references that do not prevent the object they point to from being garbage collected. Most realistic languages, including Java, SML/NJ, and OCaml to name a few, have some facility for programming with weak references. Weak references are used in implementing idioms like memoizing functions and hash-consing in order to avoid potential memory leaks. However, the semantics of weak references in many languages are not clearly specified. Without a formal semantics for weak references it becomes impossible to prove the correctness of implementations making use of this feature. Previous work by Hallett and Kfoury extends λgc, a language for modeling garbage collection, to λweak, a similar language with weak references. Using this previously formalized semantics for weak references, we consider two issues related to well-behavedness of programs. Firstly, we provide a new, simpler proof of the well-behavedness of the syntactically restricted fragment of λweak defined previously. Secondly, we give a natural semantic criterion for well-behavedness much broader than the syntactic restriction, which is useful as principle for programming with weak references. Furthermore we extend the result, proved in previously of λgc, which allows one to use type-inference to collect some reachable objects that are never used. We prove that this result holds of our language, and we extend this result to allow the collection of weakly-referenced reachable garbage without incurring the computational overhead sometimes associated with collecting weak bindings (e.g. the need to recompute a memoized function). Lastly we use extend the semantic framework to model the key/value weak references found in Haskell and we prove the Haskell is semantics equivalent to a simpler semantics due to the lack of side-effects in our language.

A Formal Semantics for Weak References

A weak reference is a reference to an object that is not followed by the pointer tracer when garbage collection is called. That is, a weak reference cannot prevent the object it references from being garbage collected. Weak references remain a troublesome programming feature largely because there is not an accepted, precise semantics that describes their behavior (in fact, we are not aware of any formalization of their semantics). The trouble is that weak references allow reachable objects to be garbage collected, therefore allowing garbage collection to influence the result of a program. Despite this difficulty, weak references continue to be used in practice for reasons related to efficient storage management, and are included in many popular programming languages (Standard ML, Haskell, OCaml, and Java). We give a formal semantics for a calculus called λweak that includes weak references and is derived from Morrisett, Felleisen, and Harper’s λgc. λgc formalizes the notion of garbage collection by means of a rewrite rule. Such a formalization is required to precisely characterize the semantics of weak references. However, the inclusion of a garbage-collection rewrite-rule in a language with weak references introduces non-deterministic evaluation, even if the parameter-passing mechanism is deterministic (call-by-value in our case). This raises the question of confluence for our rewrite system. We discuss natural restrictions under which our rewrite system is confluent, thus guaranteeing uniqueness of program result. We define conditions that allow other garbage collection algorithms to co-exist with our semantics of weak references. We also introduce a polymorphic type system to prove the absence of erroneous program behavior (i.e., the absence of “stuck evaluation”) and a corresponding type inference algorithm. We prove the type system sound and the inference algorithm sound and complete.

Towards Formalizing Java's Weak References

Weak references provide the programmer with limited control over the process of memory management. By using them, a programmer can make decisions based on previous actions that are taken by the garbage collector. Although this is often helpful, the outcome of a program using weak references is less predictable due to the nondeterminism they introduce in program evaluation. It is therefore desirable to have a framework of formal tools to reason about weak references and programs that use them. We present several calculi that formalize various aspects of weak references, inspired by their implementation in Java. We provide a calculus to model multiple levels of non-strong references, where a different garbage collection policy is applied to each level. We consider different collection policies such as eager collection and lazy collection. Similar to the way they are implemented in Java, we give the semantics of eager collection to weak references and the semantics of lazy collection to soft references. Moreover, we condition garbage collection on the availability of time and space resources. While time constraints are used in order to restrict garbage collection, space constraints are used in order to trigger it. Finalizers are a problematic feature in Java, especially when they interact with weak references. We provide a calculus to model finalizer evaluation. Since finalizers have little meaning in a language without side-effect, we introduce a limited form of side effect into the calculus. We discuss determinism and the separate notion of uniqueness of (evaluation) outcome. We show that in our calculus, finalizer evaluation does not affect uniqueness of outcome.

What leads Indians to participate in clinical trials? A meta-analysis of qualitative studies.

BACKGROUND: With the globalization of clinical trials, large developing nations have substantially increased their participation in multi-site studies. This participation has raised ethical concerns, among them the fear that local customs, habits and culture are not respected while asking potential participants to take part in study. This knowledge gap is particularly noticeable among Indian subjects, since despite the large number of participants, little is known regarding what factors affect their willingness to participate in clinical trials. METHODS: We conducted a meta-analysis of all studies evaluating the factors and barriers, from the perspective of potential Indian participants, contributing to their participation in clinical trials. We searched both international as well as Indian-specific bibliographic databases, including Pubmed, Cochrane, Openjgate, MedInd, Scirus and Medknow, also performing hand searches and communicating with authors to obtain additional references. We enrolled studies dealing exclusively with the participation of Indians in clinical trials. Data extraction was conducted by three researchers, with disagreement being resolved by consensus. RESULTS: Six qualitative studies and one survey were found evaluating the main themes affecting the participation of Indian subjects. Themes included Personal health benefits, Altruism, Trust in physicians, Source of extra income, Detailed knowledge, Methods for motivating participants as factors favoring, while Mistrust on trial organizations, Concerns about efficacy and safety of trials, Psychological reasons, Trial burden, Loss of confidentiality, Dependency issues, Language as the barriers. CONCLUSION: We identified factors that facilitated and barriers that have negative implications on trial participation decisions in Indian subjects. Due consideration and weightage should be assigned to these factors while planning future trials in India.

Extent of non-publication in cohorts of studies approved by research ethics committees or included in trial registries

BACKGROUND: The synthesis of published research in systematic reviews is essential when providing evidence to inform clinical and health policy decision-making. However, the validity of systematic reviews is threatened if journal publications represent a biased selection of all studies that have been conducted (dissemination bias). To investigate the extent of dissemination bias we conducted a systematic review that determined the proportion of studies published as peer-reviewed journal articles and investigated factors associated with full publication in cohorts of studies (i) approved by research ethics committees (RECs) or (ii) included in trial registries. METHODS AND FINDINGS: Four bibliographic databases were searched for methodological research projects (MRPs) without limitations for publication year, language or study location. The searches were supplemented by handsearching the references of included MRPs. We estimated the proportion of studies published using prediction intervals (PI) and a random effects meta-analysis. Pooled odds ratios (OR) were used to express associations between study characteristics and journal publication. Seventeen MRPs (23 publications) evaluated cohorts of studies approved by RECs; the proportion of published studies had a PI between 22% and 72% and the weighted pooled proportion when combining estimates would be 46.2% (95% CI 40.2%-52.4%, I2 = 94.4%). Twenty-two MRPs (22 publications) evaluated cohorts of studies included in trial registries; the PI of the proportion published ranged from 13% to 90% and the weighted pooled proportion would be 54.2% (95% CI 42.0%-65.9%, I2 = 98.9%). REC-approved studies with statistically significant results (compared with those without statistically significant results) were more likely to be published (pooled OR 2.8; 95% CI 2.2-3.5). Phase-III trials were also more likely to be published than phase II trials (pooled OR 2.0; 95% CI 1.6-2.5). The probability of publication within two years after study completion ranged from 7% to 30%. CONCLUSIONS: A substantial part of the studies approved by RECs or included in trial registries remains unpublished. Due to the large heterogeneity a prediction of the publication probability for a future study is very uncertain. Non-publication of research is not a random process, e.g., it is associated with the direction of study findings. Our findings suggest that the dissemination of research findings is biased.