Efectividade e volume: uma aplicação a hospitais portugueses

RESUMO - Contexto: a avaliação da qualidade como tema potencialmente importante para utentes e prestadores de cuidados de saúde. A taxa de mortalidade como medida de resultados com um adequado ajustamento do risco. A existência de determinadas características estruturais do hospital às quais está associada uma menor mortalidade. Objectivos: identificar diferenças no desempenho e na taxa de mortalidade dos hospitais e investigar que características estruturais justificam essas diferenças. Metodologia: foram seleccionados os episódios de internamento das doenças de maior mortalidade hospitalar. A medida de desempenho considerada foi a comparação entre a mortalidade observada e a mortalidade esperada, calculada a partir da escala preditiva da mortalidade do Disease Staging, recalibrada para Portugal. A medida de desempenho foi analisada por hospital, doença e grupo de doenças. A ordenação dos hospitais pelo desempenho foi comparada com a ordenação dos hospitais pela taxa de mortalidade observada. O desempenho dentro de cada hospital foi analisado para um grupo de doenças seleccionadas. A relação entre o valor da medida de desempenho e as variáveis «número de episódios», «índice tecnológico» e «gravidade dos doentes tratados» foi analisada através da regressão linear para o conjunto dos episódios e para cada doença e grupo de doenças. Resultados: foram incluídos 379 074 episódios, agrupados em 21 doenças e 8 grupos de doenças e tratados em 81 hospitais. A taxa de mortalidade observada foi de 12%. Existiam diferenças no desempenho por hospital, alguns dos quais se destacam pelo seu melhor/pior nível de desempenho. Foram observadas as limitações da taxa de mortalidade bruta como instrumento de análise do desempenho, no contexto de hospitais com diferentes níveis de risco dos doentes tratados. Para além disso, evidenciou-se que a análise do hospital como um todo ou em cada uma das partes tem resultados distintos, dada a existência de diferentes níveis de desempenho dentro do hospital. Finalmente, verificou- se que a relação entre volume e desempenho, quando existe, é, na quase totalidade dos casos, não linear e inversa à referida na literatura.

Crescimento de mudas de pupunheira (Bactris gasipaes) transplantadas em diferentes estádios de plântula, substratos e volume de substrato

A Comissão Estadual de Sementes e Mudas do Estado do Amazonas estabeleceu normas e padrões para a produção de mudas fiscalizadas, mas esses padrões ainda são vagos para a pupunheira (Bactris gasipaes Kunth, Palmae). Visando melhorar esse padrão avaliou-se o desenvolvimento de mudas transplantadas em diferentes estádios de plântula (chifrinhos, uma folha e duas folhas), substrato (sem e com estéreo de galinha: 3: 1 v: v de solo superficial: estéreo) e volume de substrato (0,5, 1 e 2 kg), em Manaus, AM. Foram utilizadas sementes de plantas inermes de Yurimaguas, Peru, colhidas em março de 1997. Adotou-se o delineamento de blocos casualizados, em esquema fatorial 2x3x3, com quatro repetições. As plântulas em substrato com estéreo tiveram maior crescimento em altura (19 cm) em relação às sem estéreo (8 cm) aos 6 meses, e as plântulas transplantadas no estádio de uma folha tiveram maior crescimento (15 cm), seguida de chifrinho (14 cm) e de duas folhas (12 cm). Os sacos com capacidade para 1 kg e 2 kg não diferiram no crescimento das plantas (altura 14,5 e 15,0 cm, respectivamente), superando o de 0,5 kg (11 cm). Portanto, para a produção de mudas de boa qualidade, as plântulas de pupunheira devem ser transplantadas no estádio de uma folha aberta, em sacos de um kg contendo substrato com estéreo.

Eco-efficient self-compacting concrete with reduced Portland cement content and high volume of fly ash and metakaolin

The eco-efficient, self-compacting concrete (SCC) production, containing low levels of cement in its formulation, shall contribute for the constructions' sustainability due to the decrease in Portland cement use, to the use of industrial residue, for beyond the minimization of the energy needed for its placement and compaction. In this context, the present paper intends to assess the viability of SCC production with low cement levels by determining the fresh and hardened properties of concrete containing high levels of fly ash (FA) and also metakaolin (MK). Hence, 6 different concrete formulations were produced and tested: two reference concretes made with 300 and 500 kg/m3 of cement; the others were produced in order to evaluate the effects of high replacement levels of cement. Cement replacement by FA of 60% and by 50% of FA plus 20% of MK were tested and the addition of hydrated lime in these two types of concrete were also studied. To evaluate the self-compacting ability slump flow test, T500, J-ring, V-funnel and L-box were performed. In the hardened state the compressive strength at 3, 7, 14, 21, 28 and 90 days of age was determined. The results showed that it is possible to produce low cement content SCC by replacing high levels of cement by mineral additions, meeting the rheological requirements for self-compacting, with moderate resistances from 25 to 30 MPa after 28 days.

Efeito do volume do tanque-rede na produtividade de tambaqui (Colossoma macropomum) durante a recria

O objetivo desta nota foi avaliar o efeito do volume do tanque-rede na produtividade de juvenis de tambaqui durante a recria. Juvenis de tambaqui foram criados por 60 dias, na densidade de 300 peixes/m³, em tanques-rede de dois diferentes volumes: 1 e 6 m³. Foram avaliados parâmetros de crescimento e de produtividade final. Não houve diferença no crescimento em peso e em comprimento. O coeficiente de variação do comprimento foi significativamente menor para os peixes do tanque-rede pequeno. A sobrevivência, produção por volume e o ganho de peso não diferiram entre os tratamentos. Os peixes do tanque de maior volume foram significativamente mais eficientes na conversão alimentar. A recria pode ser realizada em tanques dos dois volumes testados sem prejuízo zootécnico para o criador.

A sixth-order finite volume method for the 1D biharmonic operator: application to intramedullary nail simulation

A new very high-order finite volume method to solve problems with harmonic and biharmonic operators for one- dimensional geometries is proposed. The main ingredient is polynomial reconstruction based on local interpolations of mean values providing accurate approximations of the solution up to the sixth-order accuracy. First developed with the harmonic operator, an extension for the biharmonic operator is obtained, which allows designing a very high-order finite volume scheme where the solution is obtained by solving a matrix-free problem. An application in elasticity coupling the two operators is presented. We consider a beam subject to a combination of tensile and bending loads, where the main goal is the stress critical point determination for an intramedullary nail.

Improvign mixing processes with the help of numerical tools

In several industrial applications, highly complex behaviour materials are used together with intricate mixing processes, which difficult the achievement of the desired properties for the produced materials. This is the case of the well-known dispersion of nano-sized fillers in a melt polymer matrix, used to improve the nanocomposite mechanical and/or electrical properties. This mixing is usually performed in twin-screw extruders, that promote complex flow patterns, and, since an in loco analysis of the material evolution and mixing is difficult to perform, numerical tools can be very useful to predict the evolution and behaviour of the material. This work presents a numerical based study to improve the understanding of mixing processes. Initial numerical studies were performed with generalized Newtonian fluids, but, due to the null relaxation time that characterize this type of fluids, the assumption of viscoelastic behavior was required. Therefore, the polymer melt was rheologically characterized, and, a six mode Phan-Thien-Tanner and Giesekus models were used to fit the rheological data. These viscoelastic rheological models were used to model the process. The conclusions obtained in this work provide additional and useful data to correlate the type and intensity of the deformation history promoted to the polymer nanocomposite and the quality of the mixing obtained.

Seleção de modelos polinomiais para representar o perfil e volume do fuste de Tectona grandis L.f.

A precisão do volume de um povoamento florestal torna-se importante à medida que as empresas florestais integram verticalmente suas atividades e o resíduo da elaboração de um produto torna-se matéria-prima para outros. Os estudos realizados objetivaram avaliar a acurácia dos modelos polinomiais propostos por Schöepfer (1966), Hradetzky (1976) e Goulding & Murray (1976), na estimativa dos diâmetros e volumes ao longo do fuste de Tectona grandis L.f. de quatro povoamentos localizados na microrregião do Baixo Rio Acre e, ainda, testar a identidade do melhor modelo polinomial, avaliando-se a adequação de manter as áreas agrupadas ou segregá-las em grupos menores ou individualmente. A base de dados foi constituída de 159 árvores cubadas rigorosamente. Na avaliação da acurácia dos modelos foram empregadas estatísticas de desvio médio, desvio padrão das diferenças, soma dos quadrados dos resíduos relativos e resíduos percentuais. O modelo Goulding & Murray (1976) gerou as melhores estimativas de diâmetros e volumes ao longo do fuste, seguido pelos modelos Hradetzky (1976) e Schöepfer (1966). O teste de identidade de modelo mostrou ser mais adequado realizar ajustes independentes para as áreas 1 e 4 e para o subgrupo 2 e 3.

Dielectric relaxation and ferromagnetic resonance in magnetoelectric (Polyvinylidene-fluoride)/ferrite composites

In this work the dielectric properties and ferromagnetic resonance of Polyvinylidene- uoride embedded with 10 wt. % of NiFe2O4 or Ni0.5Zn0.5Fe2O4 nanoparticles are presented. The mechanisms of the dielectric relaxation in these two composites do not differ from each other. For more precise characterization of the dielectric relaxation, a two dimensional distribution of relaxation times was calculated from the temperature dependencies of the complex dielectric permittivity. The results obtained from the 2D distribution and the mean relaxation time are found to be consistent. The dynamics of the dielectric permittivity is described by the Arrhenius law. The energy and attempt time of the dielectric relaxators lie in a narrow energy and time region thus proving that the single type chains of polymer are responsible for a dispersion. The magnetic properties of the composites were investigated using the fer- romagnetic resonance. A single resonance line was observed for both samples. From the temperature dependence (100 K - 310 K) of the resonance eld and linewidth, the origin of the observed line was attributed to the NiFe2O4 and Ni0.5Zn0.5Fe2O4 superparamagnetic nanoparticles. By measuring lms at dif- ferent orientations with respect to the external magnetic eld, the angular dependence of the resonance was observed, indicating the magnetic dipolar in-plane interactions.

Dielectric relaxation dynamics of high-temperature piezoelectric polyimide copolymers

Polyimide co-polymers have been prepared based on different diamines as co-monomers: a diamine without CN groups and a novel synthesized diamine with two CN groups prepared by polycondensation reaction followed by thermal cyclodehydration. Dielectric spectroscopy measurements were performed and the dielectric complex function, ac conductivity and electric modulus of the co-polymers were investigated as a function of CN group content in the frequency range from 0.1 Hz to 107 Hz at temperatures from 25 to 260 °C. For all samples and temperatures above 150ºC, the dielectric constant increases with increasing temperature due to increaseing conductivity. The α-relaxation is just detected for the sample without CN groups, being this relaxation overlapped by the electrical conductivity contributions in the remaining samples. For the copolymer samples and the polymer with CN groups an important Maxwell-Wagner-Sillars contribution is detected. The mechanisms responsible for the dielectric relaxation, conduction process and electric modulus response have been discussed as a function of the CN groups content present in the samples.

Connecting free volume with shape memory properties in noncytotoxic gamma-irradiated polycyclooctene

The free volume holes of a shape memory polymer have been analysed considering that the empty space between molecules is necessary for the molecular motion, and the shape memory response is based on polymer segments acting as molecular switches through variable flexibility with temperature or other stimuli. Therefore, thermomechanical analysis (TMA) and positron annihilation lifetime spectroscopy (PALS) have been applied to analyse shape recovery and free volume hole sizes in gamma irradiated polycyclooctene (PCO) samples, as a non-cytotoxic alternative to more conventional PCO crosslinked via peroxide for future applications in medicine. Thus, a first approach relating structure, free volume holes and shape memory properties in gamma irradiated PCO is presented. The results suggest that free volume holes caused by gamma irradiation in PCO samples facilitate the recovery process by improving movement of polymer chains and open t possibilities for the design and control of the macroscopic response.

Determinação do volume, do fator de forma e da porcentagem de casca de árvores individuais em uma Floresta Ombrófila Aberta na região noroeste de Mato Grosso

O objetivo deste estudo foi testar e selecionar modelos que expressam o volume com e sem casca e determinar o fator de forma e a porcentagem de casca para uma área de floresta ombrófila aberta na região noroeste de Mato Grosso. Foi realizada a cubagem rigorosa de 91 árvores para a obtenção do diâmetro, espessura de casca, altura total do fuste e volume sólido. Dez modelos volumétricos foram testados, sendo que para a seleção do melhor modelo foram usadas as estatísticas do coeficiente de determinação ajustado, erro padrão da estimativa, seguida da análise de resíduos e distribuição gráfica dos resíduos. Os modelos selecionados foram validados pela aplicação do teste L&O. O fator de forma médio obtido foi de 0,7424 e 0,7297 com e sem casca, respectivamente. O volume médio de casca foi de 0,4292 m³ (7,45% do volume total). O modelo de Schumacher-Hall foi o que melhor se ajustou aos dados de volumes com e sem casca.

Estratégia empresarial e produtos inovadores: o impacto da inovação no volume de negócios

Dissertação de mestrado em Economia Industrial e da Empresa

Influence of chitosan coating on protein-based nanohydrogels properties and in vitro gastric digestibility

Chitosan coating was applied in Lactoferrin (Lf)-Glycomacropeptide (GMP) nanohydrogels by layer-by-layer coating process. A volume ratio of 0.1 of Lf-GMP nanohydrogels (0.2 mg.mL-1, at pH 5.0) to chitosan (1 mg.mL-1, at pH 3) demonstrated to be the optimal condition to obtain stable nanohydrogels with size of 230 ± 12 nm, a PdI of 0.22 ± 0.02 and a -potential of 30.0 ± 0.15 mV. Transmission electron microscopy (TEM) images showed that the application of chitosan coating in Lf-GMP did not affect the spherical shape of nanohydrogels and confirmed the low aggregation of nanohydrogels in solution. The analysis of chemical interactions between chitosan and Lf-GMP nanohydrogels were performed by Fourier transform infrared spectroscopy (FTIR) and by circular dichroism (CD) that revealed that a specific chemical interaction occurring between functional groups of protein-based nanohydrogels and active groups of the chitosan was established. The effect of chitosan coating on release mechanisms of Lf-GMP nanohydrogels at acid conditions (pH 2, 37 ºC) was evaluated by the encapsulation of a model compound (caffeine) in these systems. Linear Superposition Model was used to fit the experimental data and revealed that Fick and relaxation mechanisms are involved in caffeine release. It was also observed that the Fick contribution increase with the application of chitosan coating. In vitro gastric digestion was performed with Lf-GMP nanohydrogels and Lf-GMP nanohydrogels with chitosan coating and it was observed that the presence of chitosan improve the stability of Lf and GMP (proteins were hydrolysed at a slower rate and were present in solution by longer time). Native electrophoreses revealed that the nanohydrogels without coating remained intact in solution until 15 min and with chitosan coating remained intact until 60 min, during gastric digestion.

Study of the Myocardial Contraction and Relaxation Velocities through Doppler Tissue Imaging Echocardiography: A New Alternative in the Assessment of the Segmental Ventricular Function

OBJECTIVE: Doppler tissue imaging (DTI) enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS: We studied 35 healthy individuals (27 were male) with ages ranging from 12 to 59 years (32.9 ± 10.6). Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS: The means (and standard deviation) of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls) were respectively, in cm/s, 7.35(1.64), 5.26(1.88), and 3.33(1.58) in systole and 10.56(2.34), 7.92(2.37), and 3.98(1.64) in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (±19.12ms), and diastolic was 459.18ms (±18.13ms) based on the peak of the R wave of the electrocardiogram. CONCLUSION: In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

In-line rheo-optical microstructural characterization of complex polymer systems

Tese de Doutoramento em Ciência e Engenharia de Polímeros e Compósitos.