Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

A Harmonized Vocabulary For Water Quality

Interoperability of water quality data depends on the use of common models, schemas and vocabularies. However, terms are usually collected during different activities and projects in isolation of one another, resulting in vocabularies that have the same scope being represented with different terms, using different formats and formalisms, and published in various access methods. Significantly, most water quality vocabularies conflate multiple concepts in a single term, e.g. quantity kind, units of measure, substance or taxon, medium and procedure. This bundles information associated with separate elements from the OGC Observations and Measurements (O&M) model into a single slot. We have developed a water quality vocabulary, formalized using RDF, and published as Linked Data. The terms were extracted from existing water quality vocabularies. The observable property model is inspired by O&M but aligned with existing ontologies. The core is an OWL ontology that extends the QUDT ontology for Unit and QuantityKind definitions. We add classes to generalize the QuantityKind model, and properties for explicit description of the conflated concepts. The key elements are defined to be sub-classes or sub-properties of SKOS elements, which enables a SKOS view to be published through standard vocabulary APIs, alongside the full view. QUDT terms are re-used where possible, supplemented with additional Unit and QuantityKind entries required for water quality. Along with items from separate vocabularies developed for objects, media, and procedures, these are linked into definitions in the actual observable property vocabulary. Definitions of objects related to chemical substances are linked to items from the Chemical Entities of Biological Interest (ChEBI) ontology. Mappings to other vocabularies, such as DBPedia, are in separately maintained files. By formalizing the model for observable properties, and clearly labelling the separate concerns, water quality observations from different sources may be more easily merged and also transformed to O&M for cross-domain applications.

Analysis Of Semi-Distributed And Global Hydrological Models In The Central Tropical Basins Of The Gulf Of Mexico To The Effects Of Extreme Hydrometeorological Phenomena

In the last years extreme hydrometeorological phenomena have increased in number and intensity affecting the inhabitants of various regions, an example of these effects are the central basins of the Gulf of Mexico (CBGM) that they have been affected by 55.2% with floods and especially the state of Veracruz (1999-2013), leaving economic, social and environmental losses. Mexico currently lacks sufficient hydrological studies for the measurement of volumes in rivers, since is convenient to create a hydrological model (HM) suited to the quality and quantity of the geographic and climatic information that is reliable and affordable. Therefore this research compares the semi-distributed hydrological model (SHM) and the global hydrological model (GHM), with respect to the volumes of runoff and achieve to predict flood areas, furthermore, were analyzed extreme hydrometeorological phenomena in the CBGM, by modeling the Hydrologic Modeling System (HEC-HMS) which is a SHM and the Modèle Hydrologique Simplifié à I'Extrême (MOHYSE) which is a GHM, to evaluate the results and compare which model is suitable for tropical conditions to propose public policies for integrated basins management and flood prevention. Thus it was determined the temporal and spatial framework of the analyzed basins according to hurricanes and floods. It were developed the SHM and GHM models, which were calibrated, validated and compared the results to identify the sensitivity to the real model. It was concluded that both models conform to tropical conditions of the CBGM, having MOHYSE further approximation to the real model. Worth mentioning that in Mexico there is not enough information, besides there are no records of MOHYSE use in Mexico, so it can be a useful tool for determining runoff volumes. Finally, with the SHM and the GHM were generated climate change scenarios to develop risk studies creating a risk map for urban planning, agro-hydrological and territorial organization.

Quality of TEC Estimated with Mod Ion Using GPS and GLONASS Data

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Allocation of protective devices in distribution circuits using nonlinear programming models and genetic algorithms

The optimized allocation of protective devices in strategic points of the circuit improves the quality of the energy supply and the system reliability index. This paper presents a nonlinear integer programming (NLIP) model with binary variables, to deal with the problem of protective device allocation in the main feeder and all branches of an overhead distribution circuit, to improve the reliability index and to provide customers with service of high quality and reliability. The constraints considered in the problem take into account technical and economical limitations, such as coordination problems of serial protective devices, available equipment, the importance of the feeder and the circuit topology. The use of genetic algorithms (GAs) is proposed to solve this problem, using a binary representation that does (1) or does not (0) show allocation of protective devices (reclosers, sectionalizers and fuses) in predefined points of the circuit. Results are presented for a real circuit (134 busses), with the possibility of protective device allocation in 29 points. Also the ability of the algorithm in finding good solutions while improving significantly the indicators of reliability is shown. (C) 2003 Elsevier B.V. All rights reserved.

Evaluation of hybrid models for static and multistage transmission system planning

Neste trabalho é analisada a aplicação de algoritmos heurísticos para o Modelo Híbrido Linear - Hybrid Linear Model (HLM) - no problema de planejamento da expansão de sistemas de transmissão. O HLM é um modelo relaxado que ainda não foi suficientemente explorado. Assim, é realizada uma análise das características do modelo matemático e das técnicas de solução que podem ser usadas para resolver este tipo de modelo. O trabalho analisa em detalhes um algoritmo heurístico construtivo para o HLM e faz uma extensão da modelagem e da técnica de solução para o planejamento multi-estágio da expansão de sistemas de transmissão. Dentro deste contexto, também é realizada uma avaliação da qualidade das soluções encontradas pelo HLM e as possibilidades de aplicação deste modelo em planejamento de sistemas de transmissão. Finalmente, são apresentados testes com sistemas conhecidos na literatura especializada.

Health-related behavior and quality of life among the elderly: a population-based study

OBJETIVO: Analisar a associação de comportamentos saudáveis com a qualidade de vida relacionada à saúde em idosos. MÉTODOS: Estudo transversal de base populacional que envolveu 1.958 idosos residentes em quatro áreas do estado de São Paulo, em 2001/2002. A qualidade de vida foi aferida com o uso do instrumento Medical Outcomes Study SF-36-Item Short Form Health Survey. As oito escalas e os dois componentes do instrumento constituíram as variáveis dependentes e as independentes foram atividade física, freqüência semanal de ingestão de bebida alcoólica e hábito de fumar. Modelos de regressão linear múltipla foram usados para controlar o efeito de sexo, idade, escolaridade, trabalho, área de residência e número de doenças crônicas. RESULTADOS: Atividade física foi positivamente associada com as oito escalas do SF-36. As maiores associações foram encontradas em aspectos físicos (β = 11,9), capacidade funcional (β = 11,3) e no componente físico. Idosos que ingeriam bebida alcoólica pelo menos uma vez por semana apresentaram melhor qualidade de vida do que os que não ingeriam. Comparados com os que nunca fumaram, os fumantes tiveram pior qualidade de vida no componente mental (β = -2,4). CONCLUSÕES: Os resultados apresentam que praticar atividade física, consumir bebida alcoólica moderadamente e não fumar são fatores positivamente associados a uma melhor qualidade de vida em idosos.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e. g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Fish assemblage structure and aquatic pollution in a Brazilian stream: some limitations of diversity indices and models for environmental impact studies

The aim of this study was to describe and quantify the effect of aquatic pollution on the fish assemblage structure of the Corumbatai River (Brazil), by comparing two sites with different water quality characteristics. The results revealed that abundance of individuals was low at the polluted site (B). However, the two sites did not differ significantly in species richness (total and average). This fact contradicts theories stating that portions where the transverse area of the channel is larger should present a higher biological richness. It was also observed that the ichthyofauna of site B had higher evenness, and, consequently, a tendency to a higher diversity than that at site A. This demonstrates that diversity estimates should be used cautiously in environmental impact studies, as they do not necessarily indicate better conditions of communities living in more preserved environments.

Evaluation of pre-natal care from the perspective of different models in primary care

OBJETIVOS: avaliar a qualidade do cuidado pré-natal desenvolvido na atenção primária, comparando os modelos tradicional e Estratégia Saúde da Família. MÉTODO: estudo de avaliação de serviço, pautado nas políticas públicas de saúde. Os dados foram obtidos por meio de entrevista com gerentes, observação nas unidades de saúde e análise de prontuários de gestantes, selecionados aleatoriamente. Diferenças nos indicadores de estrutura e processo foram avaliadas pelo teste qui-quadrado, adotando-se p<0,05 como nível crítico, cálculo dos odds ratio e intervalos de confiança de 95%. RESULTADOS: foram evidenciadas estruturas semelhantes em ambos os modelos de atenção. Indicadores-síntese de processo, criados neste estudo, e os indicados pelas políticas públicas apontaram situação mais favorável nas Unidades de Saúde da Família. Para o conjunto de atividades preconizadas para o pré-natal, o desempenho foi deficiente em ambos os modelos, embora pouco melhor nas Unidades de Saúde da Família. CONCLUSÃO: os resultados indicam a necessidade de ações para melhoria da atenção pré-natal nos dois modelos de atenção básica no município avaliado.

Economic design of (X)over-bar and R charts under Weibull shock models

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Relation between quality and rheological properties of lactic beverages

The physicochemical (pH, fat and total solids content), sensory (appearance, consistency and taste), and rheological characteristics of five different commercial brands of lactic beverages were determined. Rheological measurements were obtained at 5 degreesC and 25 degreesC using a Brookfield rheometer. The experimental data were described by the power law and Herschel-Bulkley models. The ANOVA of the results were conducted using an incomplete block design, and using Tukey test. Samples showed a significant difference (P less than or equal to 0.05%) for fat content and pH. There was a significant difference in total solids content only among Nestle (A), Batavo (C), and Parmalat (D) samples. Sensory evaluation showed more global acceptability for Nestle; however, Nestle and Vigor (E) lactic beverages obtained better results for appearance than for consistency and taste. Batavo obtained the best score for taste. All test samples exhibited non-Newtonian behavior, with thixotropy. Upward curves showed pseudoplastic behavior, while downward curves showed dilatant behavior with the exception of the Nestle sample, at 25 degreesC. Lactic beverages from all brands analyzed showed similar rheological behavior. (C) 2001 Elsevier B.V. Ltd. All rights reserved.

Multivariate quality control studies applied to Ca(II) and Mg(II) determination by a portable method

A portable or field test method for simultaneous spectrophotometric determination of calcium and magnesium in water using multivariate partial least squares (PLS) calibration methods is proposed. The method is based on the reaction between the analytes and methylthymol blue at pH 11. The spectral information was used as the X-block, and the Ca(II) and Mg(II) concentrations obtained by a reference technique (ICP-AES) were used as the Y-block. Two series of analyses were performed, with a month's difference between them. The first series was used as the calibration set and the second one as the validation set. Multivariate statistical process control (MSPC) techniques, based on statistics from principal component models, were used to study the features and evolution with time of the spectral signals. Signal standardization was used to correct the deviations between series. Method validation was performed by comparing the predictions of the PLS model with the reference Ca(II) and Mg(II) concentrations determined by ICP-AES using the joint interval test for the slope and intercept of the regression line with errors in both axes. (C) 1998 John Wiley & Sons, Ltd.

Joint conomic design of (x)over-bar and R charts under Weibull shock models

This paper deals with the joint economic design of (x) over bar and R charts when the occurrence times of assignable causes follow Weibull distributions with increasing failure rates. The variable quality characteristic is assumed to be normally distributed and the process is subject to two independent assignable causes (such as tool wear-out, overheating, or vibration). One cause changes the process mean and the other changes the process variance. However, the occurrence of one kind of assignable cause does not preclude the occurrence of the other. A cost model is developed and a non-uniform sampling interval scheme is adopted. A two-step search procedure is employed to determine the optimum design parameters. Finally, a sensitivity analysis of the model is conducted, and the cost savings associated with the use of non-uniform sampling intervals instead of constant sampling intervals are evaluated.