Confiabilidade da informação sobre hospitalizações por causas externas de um hospital público em São José dos Campos, São Paulo, Brasil

OBJETIVO: Conhecer a qualidade dos dados de internação por causas externas em São José dos Campos, São Paulo. MÉTODO: Foram estudadas as internações pelo Sistema Único de Saúde por lesões decorrentes de causas externas no primeiro semestre de 2003, no Hospital Municipal, referência para o atendimento ao trauma no Município, por meio da comparação dos dados registrados no Sistema de Informações Hospitalares com os prontuários de 990 internações. A concordância das variáveis relativas à vítima, à internação e ao agravo foi avaliada pela taxa bruta de concordância e pelo coeficiente Kappa. As lesões e as causas externas foram codificadas segundo a 10ª revisão da Classificação Internacional de Doenças, respectivamente, capítulos XIX e XX. RESULTADOS: A taxa de concordância bruta foi de boa qualidade para as variáveis relativas à vítima e à internação, variando de 89,0% a 99,2%. As lesões tiveram concordância ótima, exceto os traumatismos do pescoço (k=0,73), traumatismos múltiplos (k=0,67) e fraturas do tórax (k=0,49). As causas externas tiveram concordância ótima para acidentes de transporte (k=0,90) e quedas (k=0,83). A confiabilidade foi menor para agressões (k=0,50), causas indeterminadas (k=0,37), e complicações da assistência médica (k=0,03). Houve concordância ótima nos acidentes de transporte em pedestres, ciclistas e motociclistas. CONCLUSÃO: A maioria das variáveis de estudo teve boa qualidade no nível de agregação analisado. Algumas variáveis relativas à vítima e alguns tipos de causas externas necessitam de aperfeiçoamento da qualidade dos dados. O perfil da morbidade hospitalar encontrado confirmou os acidentes de transporte como importante causa externa de internação hospitalar no Município.

Como implementar uma diretriz - da teoria à prática: exemplo da profilaxia para Tromboembolismo Venoso

The objective of this manuscript is to discuss the existing barriers for the dissemination of medical guidelines, and to present strategies that facilitate the adaptation of the recommendations into clinical practice. The literature shows that it usually takes several years until new scientific evidence is adopted in current practice, even when there is obvious impact in patients' morbidity and mortality. There are some examples where more than thirty years have elapsed since the first case reports about the use of a effective therapy were published until its utilization became routine. That is the case of fibrinolysis for the treatment of acute myocardial infarction. Some of the main barriers for the implementation of new recommendations are: the lack of knowledge of a new guideline, personal resistance to changes, uncertainty about the efficacy of the proposed recommendation, fear of potential side-effects, difficulties in remembering the recommendations, inexistence of institutional policies reinforcing the recommendation and even economical restrains. In order to overcome these barriers a strategy that involves a program with multiple tools is always the best. That must include the implementation of easy-to-use algorithms, continuous medical education materials and lectures, electronic or paper alerts, tools to facilitate evaluation and prescription, and periodic audits to show results to the practitioners involved in the process. It is also fundamental that the medical societies involved with the specific medical issue support the program for its scientific and ethical soundness. The creation of multidisciplinary committees in each institution and the inclusion of opinion leaders that have pro-active and lasting attitudes are the key-points for the program's success. In this manuscript we use as an example the implementation of a guideline for venous thromboembolism prophylaxis, but the concepts described here can be easily applied to any other guideline. Therefore, these concepts could be very useful for institutions and services that aim at quality improvement of patient care. Changes in current medical practice recommended by guidelines may take some time. However, if there is a broader participation of opinion leaders and the use of several tools listed here, they surely have a greater probability of reaching the main objectives: improvement in provided medical care and patient safety.

Data Mining Applied to Harmonic Current Sources Identification in Residential Consumers

This work proposes a method based on both preprocessing and data mining with the objective of identify harmonic current sources in residential consumers. In addition, this methodology can also be applied to identify linear and nonlinear loads. It should be emphasized that the entire database was obtained through laboratory essays, i.e., real data were acquired from residential loads. Thus, the residential system created in laboratory was fed by a configurable power source and in its output were placed the loads and the power quality analyzers (all measurements were stored in a microcomputer). So, the data were submitted to pre-processing, which was based on attribute selection techniques in order to minimize the complexity in identifying the loads. A newer database was generated maintaining only the attributes selected, thus, Artificial Neural Networks were trained to realized the identification of loads. In order to validate the methodology proposed, the loads were fed both under ideal conditions (without harmonics), but also by harmonic voltages within limits pre-established. These limits are in accordance with IEEE Std. 519-1992 and PRODIST (procedures to delivery energy employed by Brazilian`s utilities). The results obtained seek to validate the methodology proposed and furnish a method that can serve as alternative to conventional methods.

A Family of Autoconnected Transformers for 12-and 18-Pulse Converters-Generalization for Delta and Wye Topologies

Multipulse rectifier topologies based on autoconnections are increasingly applied as interface stages between mains and power electronics converters. These topologies are attractive and cost-effective solutions for meeting the requirements of low total harmonic distortion of line current and high power factor. Furthermore, as only a small fraction of the total power required by the load is processed in the magnetic core, the overall resulting volume and weight are reduced. This paper proposes a mathematical analysis based on phasor diagrams that results in a single and general expression capable of unifying all delta and wye step-up or step-down autotransformer connections for 12-and 18-pulse ac-dc converters. The expression obtained allows the choice of a wide range of input/output voltage ratio for step-up or step-down autotransformer, and this general expression is also presented in a graphical form for each converter. Moreover, it simplifies the procedure for determining turn ratios and polarities for all windings of the autotransformer. A routine for easy and fast calculations is developed and validated by a design example. Finally, experimental results are presented along with comments on a 6-kW 220-V line voltage, 400-V rectified voltage, and 18-pulse delta-autoconnected prototype.

Three-phase harmonic distortion state estimation algorithm based on evolutionary strategies

This paper presents a new methodology to estimate unbalanced harmonic distortions in a power system, based on measurements of a limited number of given sites. The algorithm utilizes evolutionary strategies (ES), a development branch of evolutionary algorithms. The problem solving algorithm herein proposed makes use of data from various power quality meters, which can either be synchronized by high technology GPS devices or by using information from a fundamental frequency load flow, what makes the overall power quality monitoring system much less costly. The ES based harmonic estimation model is applied to a 14 bus network to compare its performance to a conventional Monte Carlo approach. It is also applied to a 50 bus subtransmission network in order to compare the three-phase and single-phase approaches as well as the robustness of the proposed method. (C) 2010 Elsevier B.V. All rights reserved.

Harmonic Distortion State Estimation Using an Evolutionary Strategy

This paper presents a new methodology to estimate harmonic distortions in a power system, based on measurements of a limited number of given sites. The algorithm utilizes evolutionary strategies (ES), a development branch of evolutionary algorithms. The main advantage in using such a technique relies upon its modeling facilities as well as its potential to solve fairly complex problems. The problem-solving algorithm herein proposed makes use of data from various power-quality (PQ) meters, which can either be synchronized by high technology global positioning system devices or by using information from a fundamental frequency load flow. This second approach makes the overall PQ monitoring system much less costly. The algorithm is applied to an IEEE test network, for which sensitivity analysis is performed to determine how the parameters of the ES can be selected so that the algorithm performs in an effective way. Case studies show fairly promising results and the robustness of the proposed method.

Reconfiguration of distribution networks to minimize loss and disruption costs using genetic algorithms

In this paper a computational implementation of an evolutionary algorithm (EA) is shown in order to tackle the problem of reconfiguring radial distribution systems. The developed module considers power quality indices such as long duration interruptions and customer process disruptions due to voltage sags, by using the Monte Carlo simulation method. Power quality costs are modeled into the mathematical problem formulation, which are added to the cost of network losses. As for the EA codification proposed, a decimal representation is used. The EA operators, namely selection, recombination and mutation, which are considered for the reconfiguration algorithm, are herein analyzed. A number of selection procedures are analyzed, namely tournament, elitism and a mixed technique using both elitism and tournament. The recombination operator was developed by considering a chromosome structure representation that maps the network branches and system radiality, and another structure that takes into account the network topology and feasibility of network operation to exchange genetic material. The topologies regarding the initial population are randomly produced so as radial configurations are produced through the Prim and Kruskal algorithms that rapidly build minimum spanning trees. (C) 2009 Elsevier B.V. All rights reserved.

Feasibility of Electronic Tap-Changing Stabilizers for Medium Voltage Lines-Precedents and New Configurations

Thyristor-based onload tap-changing ac voltage stabilizers are cheap and robust. They have replaced most mechanical tap-changers in low voltage applications from 300 VA to 300 M. Nevertheless, this replacement hardily applies to tap-changers associated to transformers feeding medium-voltage lines (typically 69 kV primary, 34.5 kV line, 10 MVA) which need periodical maintenance of contacts and oil. The Electric Power Research Institute (EPRI) has studied the feasibility of this replacement. It detected economical problems derived from the need for series association of thyristors to manage the high voltages involved, and from the current overload developed under line fault. The paper reviews the configurations used in that field and proposes new solutions, using a compensating transformer in the main circuit and multi-winding coils in the commutating circuit, with reduced overload effect and no series association of thyristors, drastically decreasing their number and rating. The stabilizer can be installed at any point of the line and the electronic circuit can be fixed to ground. Subsequent works study and synthesize several commutating circuits in detail.

Lightning-Induced Voltages on Overhead Lines-Application of the Extended Rusck Model

Lightning-induced overvoltages have a considerable impact on the power quality of overhead distribution and telecommunications systems, and various models have been developed for the computation of the electromagnetic transients caused by indirect strokes. The most adequate has been shown to be the one proposed by Agrawal et al.; the Rusck model can be visualized as a particular case, as both models are equivalent when the lightning channel is perpendicular to the ground plane. In this paper, an extension of the Rusck model that enables the calculation of lightning-induced transients considering flashes to nearby elevated structures and realistic line configurations is tested against data obtained from both natural lightning and scale model experiments. The latter, performed under controlled conditions, can be used also to verify the validity of other coupling models and relevant codes. The so-called Extended Rusck Model, which is shown to be sufficiently accurate, is applied to the analysis of lightning-induced voltages on lines with a shield wire and/or surge arresters. The investigation conducted indicates that the ratio between the peak values of the voltages induced by typical first and subsequent strokes can be either greater or smaller than the unity, depending on the line configuration.

Which one of these is not like the others? An inter-hospital study of the viscosity of thickened fluids

Engineering This investigation examined the rheological (viscosity and yield stress) and material property (density) characteristics of the thickened meal-time and videofluorscopy fluids provided by 10 major metropolitan hospitals. Differences in the thickness of thickened fluids were considered as a source of variability and potential hazard for inter-hospital transfers of dysphagic patients. The results indicated considerable differences in the viscosity, density, and yield stress of both meal-time and videofluoroscopy fluids. In theory, the results suggest that dysphagic patients transferred between hospitals could be placed on inappropriate levels of fluid thickness because of inherent differences in the rheology and material property characteristics of the fluids provided by different hospitals. Slowed improvement or medical complications are potential worst-case scenarios for dysphagic patients if the difference between the thick fluids offered by 2 hospitals are extreme. The investigation outlines the most appropriate way to assess the rheological and material property characteristics of thickened fluids. In addition, it suggests a plan of quality improvement to reduce the variability of the thickness of fluids offered at different hospitals.

Motivation and Benefits of Implementation and Certification according ISO 9001 – the Portuguese Experience

The aim of the research is to analyze the different aspects associated with the motivation and benefits of certified ISO 9001 companies in Portugal. A total of 426 certified Portuguese companies were surveyed. The response rate was equal to 61.03 percent. Our results suggest that the main motivation for certification were “improvement of quality”, “improvement of company image”, “marketing advantage”, “give empowerment to workers / capturing workers knowledge” and “cost reduction”. The main benefits that Portuguese companies have gained from the referred certification have been, among others, the improvement of “procedures”, beneficial effect on the “company’s image”, the improvement of quality products/services, increase of the “customer satisfaction”, improvement of “on-time delivery”; improvement the “morale” of workers’ increase in productivity and decrease of “production costs”, among others. The surveyed firms belong only to the Minho region of the north of Portugal. This paper aims to provide a contribution to the research related to the motivation and benefits associated to the quality management systems. The selection of the motives and benefits were validated through statistical analysis and the relationship between expected and perceived benefits was discussed.

Influence of strawberry jam color and phenolic compounds on acceptance during storage

The objective of this study was to evaluate the influence of the color and phenolic compounds of strawberry jam on acceptance during storage. Jams were processed, stored for 120 days and evaluated monthly for chromatic characteristics, total phenolic compounds, total anthocyanins (ANT), total ellagic acid (TEA), flavonoids and free ellagic acid (FEA), and sensory acceptance as well. Data were submitted to analysis of variance (ANOVA) and the means were compared by the Least Significant Difference (LSD). Cluster Analysis and Partial Least Square Regression (PLS) were performed to investigate the relationships between instrumental data and acceptance. Contents of ANT, TEA and redness decreased during storage. Other chemical characteristics and sensory acceptance showed a nonlinear behavior. Higher acceptance was observed after 60 days, suggesting a trend of quality improvement followed by decline to the initial levels. The same trend was observed for lightness, non-pigment flavonoids and FEA. According to PLS map, for consumers in cluster 2, acceptance was associated to jams at 60 days and to luminosity, FEA, and non-pigment flavonoids. For cluster 1, a positive association between flavor liking, jam at initial storage, and the contents of TEA and ANT was indicated. Jams at 120 days were positively associated to hue and negatively associated to color liking, for cluster 1. Color and texture were positively correlated to overall liking for cluster 2, whereas for cluster 1, overall acceptance seemed to be more associated to flavor liking. Changes in color and phenolic compounds slightly influenced the acceptance of strawberry jams, but in different ways for consumers clusters.

Adaptive deblocking filter for transform domain Wyner-Ziv video coding

Wyner-Ziv (WZ) video coding is a particular case of distributed video coding, the recent video coding paradigm based on the Slepian-Wolf and Wyner-Ziv theorems that exploits the source correlation at the decoder and not at the encoder as in predictive video coding. Although many improvements have been done over the last years, the performance of the state-of-the-art WZ video codecs still did not reach the performance of state-of-the-art predictive video codecs, especially for high and complex motion video content. This is also true in terms of subjective image quality mainly because of a considerable amount of blocking artefacts present in the decoded WZ video frames. This paper proposes an adaptive deblocking filter to improve both the subjective and objective qualities of the WZ frames in a transform domain WZ video codec. The proposed filter is an adaptation of the advanced deblocking filter defined in the H.264/AVC (advanced video coding) standard to a WZ video codec. The results obtained confirm the subjective quality improvement and objective quality gains that can go up to 0.63 dB in the overall for sequences with high motion content when large group of pictures are used.

Implementação de sistemas da qualidade numa empresa de transporte rodoviário fraccionado de mercadorias: indicadores de competitividade

A certificação deixou de ser “apenas” uma vantagem competitiva para passar a ser um critério seleccionador de empresas diferenciando-as das concorrentes. O conceito de melhoria contínua subjacente à norma ISO 9001 transmite para o mercado a imagem de empresas capazes de satisfazer e superar as exigências dos clientes, direccionando todos os colaboradores para esse objectivo comum. O sector dos Transportes aderiu em força a esta inovação mostrando interesse em melhorar a qualidade do serviço prestado e dos processos. O objectivo deste estudo é contribuir para a avaliação da implementação do Sistema de Gestão da Qualidade (SGQ) ISO 9001:2008 numa empresa de Transportes rodoviários de mercadorias porta a porta (TRMPP) – também designado por Transporte Fraccionado de Mercadorias. Elaborou-se um questionário a clientes construindo-se os indicadores de forma a identificar pontos fortes e pontos fracos no sentido da melhoria contínua da qualidade. Destacam-se a competitividade relativamente às devoluções, grau de satisfação relativamente à competitividade geral, classificação do serviço prestado pelos motoristas/ ajudantes. Conclui-se que a principal razão que levou a empresa a implementar o SGQ foi a necessidade de responder a alguns requisitos nomeadamente concursos públicos onde implicitamente existem indicadores de satisfação dos clientes e outros de melhoria da qualidade do produto/serviço. Durante o processo de implementação do SGQ, surgiram dificuldades relacionadas essencialmente com o tempo necessário para tratar de burocracias e com os custos da Qualidade. Concluiu-se ainda que a Gestão de topo, os Directores e os Chefes de Secção, são os principais responsáveis pela detecção e correcção de não conformidades, bem como a empresa que implementou novos métodos de motivação dos colaboradores, destacando a formação e a comunicação.

Transient analysis of variable-speed wind turbines at wind speed disturbances and a pitch control malfunction

As wind power generation undergoes rapid growth, new technical challenges emerge: dynamic stability and power quality. The influence of wind speed disturbances and a pitch control malfunction on the quality of the energy injected into the electric grid is studied for variable-speed wind turbines with different power-electronic converter topologies. Additionally, a new control strategy is proposed for the variable-speed operation of wind turbines with permanent magnet synchronous generators. The performance of disturbance attenuation and system robustness is ascertained. Simulation results are presented and conclusions are duly drawn. (C) 2010 Elsevier Ltd. All rights reserved.