Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

As políticas da insegurança : da Scuderie Detetive Le Cocq às masmorras do novo Espírito Santo

A presente dissertação tem como objetivo a análise das políticas de segurança pública e justiça criminal no Espírito Santo entre 1989 e 2013, utilizando metodologia historiográfica e observando a distância entre os objetivos oficiais e as consequências práticas. No primeiro capítulo, me concentro na contextualização histórica das políticas criminais, analisando a formação organizacional do sistema punitivo brasileiro. Coloco ênfase, de um lado, no processo de militarização, isto é, a adoção de hierarquia, disciplina e formação militares nas agências de segurança pública, e de outro lado, e nas sucessivas legislações penais aprovadas pelo Congresso Nacional. Tais processos nacionais se refletem no Espírito Santo, onde se difundiram “grupos de extermínio” como a Scuderie Le Cocq, mas não havia política de segurança pública. A primeira surge em meio a grave crise política, entre 1999 e 2002. Mas os seus propósitos são mais avançados com o processo de reforma administrativa após 2003, quando o governo se esforça por impôr modelos de gestão empresariais e parcerias público privadas à administração estadual, incluindo a segurança pública e sistema penitenciário. Com isto, ocorre uma rápida expansão do encarceramento seletivo em condições extremas de superlotação e violência, desenvolvendo uma indústria carcerária. No segundo capítulo, realizo uma análise na qual relaciono informações criminais, penitenciárias, econômicas e demográficas, tanto no contexto do Brasil quanto do Espírito Santo. Constato que a repressão estatal tem “preferência” por homens, negros, jovens e de baixa escolaridade; por crimes de drogas e contra o patrimônio, com a utilização cada vez maior da prisão provisória. No Espírito Santo o encarceramento seletivo cresce em maior velocidade que na média nacional, o que se reflete no perfil da população carcerária, sendo esta ainda mais negra, jovem, de baixa escolaridade e presa por tráfico e drogas e em regime provisório, com frequentes denúncias fundamentadas de torturas, mortes e desaparecimentos forçados entre as populações criminalizadas.

Determining factors of environmental management practices in portuguese local entities

Purpose: The aim of this paper is to analyse the development of environmental management practices by Portuguese local entities and their determining factors. Design/methodology/approach: The data were collected by sending a postal questionnaire. In order to measure the degree of development of environmental management practices an index of environmental management practices (EMPI) was developed, which reflects the extent to which a set of 16 environmental management practices have been implemented by the entities included in the sample. Four variables are considered in this study as possible factors that drive the development of environmental management practices by local entities, namely type of entity, size, proactive environmental strategy and Local Agenda 21 Findings: Results indicate the degree of development of environmental management practices in Portuguese local entities is low. Additionally, entity size, the adoption of proactive environmental strategies and the implementation of Local Agenda 21 are explaining factors of the degree of development of such practices. Originality/value: This study adds to the international research on environmental management in public sector by providing empirical data from a country, Portugal, where empirical evidence is still relatively limited.

Determining factors of environmental management practices in portuguese local entities

Purpose – The purpose of this paper is to analyse the development of environmental management practices by Portuguese local entities and their determining factors. Design/methodology/approach – The data were collected by sending a postal questionnaire. In order to measure the degree of development of environmental management practices, an index of environmental management practices (EMPI) was developed, which reflects the extent to which a set of 16 environmental management practices have been implemented by the entities included in the sample. In total, four variables are considered in this study as possible factors that drive the development of environmental management practices by local entities: type of entity; size; proactive environmental strategy; and Local Agenda 21. Findings – Results indicate the degree of development of environmental management practices in Portuguese local entities is low. Additionally, entity size, the adoption of proactive environmental strategies and the implementation of Local Agenda 21 are explaining factors of the degree of development of such practices. Originality/value – The paper adds to the international research on environmental management in the public sector by providing empirical data from a country, Portugal, where empirical evidence is still relatively limited.

Integration of Individualized Management Systems (MSs) as an Aggregating Factor of Sustainable Value for Organizations: An Overview Through a Review of the Literature

Nowadays, there exist various standards for individual management systems (MSs), at least, one for each stakeholder. New ones will be published. An integrated management system (IMS) aims to integrate some or all components of the business into one coherent and efficient MS. Maximizing integration is more and more a strategic priority in that it constitutes an opportunity to eliminate and/or reduce potential factors of destruction of value for the organizations and also to be more competitive and consequently promote its sustainable success. A preliminary investigation was conducted on a Portuguese industrial company which, over the years, has been adopting gradually, in whole or in part, individualized management system standards (MSSs). A research, through a questionnaire, was performed with the objective to develop, in a real business environment, an adequate and efficient IMS-QES (quality, environment, and safety) model and to potentiate for the future a generic IMS model to integrate other MSSs. The strategy and research methods have taken into consideration the case study. It was obtained a set of relevant conclusions resulting from the statistical analyses of the responses to the survey. Globally, the investigation results, by themselves, justified and prioritized the conception of a model of development of the IMS-QES and consequent definition and validation of a structure of an IMS-QES model, to be implemented at the small- and medium-sized enterprise (SME) where the investigation was conducted.

Integration of risk management in occupational health and safety systems

Risk management can be considered as part of the Occupational Health and Safety System (OHS) of an organization and can be used to develop and implement the OHS policy and manage the associated risks. The success of the integration of risk management in OHS depends on both technical and human aspects. Thus, this paper presents and discusses the case of a company working in the area of solid waste treatment. This company was certified in 2009 with an Integrated Management Systems for Quality, Environment, Occupational Health and Safety. The evolution of accidents before and after the implementation of the integrated system was analysed and a questionnaire was used to capture the perceptions of the technicians on the risk management system. The analysis of the findings showed that the frequency of accidents increased since 2009 but the severity has been reduced. Several interrelated causes and consequences were analysed and discussed. Furthermore, the analysis of the opinions of the company’s technicians permitted to highlight some important aspects on the integration of risk management in the OHS system of the company. In line with this discussion some hypothesis have been formulated.

The condensation and ordering of models of empty liquids

We consider a simple model consisting of particles with four bonding sites ("patches"), two of type A and two of type B, on the square lattice, and investigate its global phase behavior by simulations and theory. We set the interaction between B patches to zero and calculate the phase diagram as the ratio between the AB and the AA interactions, epsilon(AB)*, varies. In line with previous work, on three-dimensional off-lattice models, we show that the liquid-vapor phase diagram exhibits a re-entrant or "pinched" shape for the same range of epsilon(AB)*, suggesting that the ratio of the energy scales - and the corresponding empty fluid regime - is independent of the dimensionality of the system and of the lattice structure. In addition, the model exhibits an order-disorder transition that is ferromagnetic in the re-entrant regime. The use of low-dimensional lattice models allows the simulation of sufficiently large systems to establish the nature of the liquid-vapor critical points and to describe the structure of the liquid phase in the empty fluid regime, where the size of the "voids" increases as the temperature decreases. We have found that the liquid-vapor critical point is in the 2D Ising universality class, with a scaling region that decreases rapidly as the temperature decreases. The results of simulations and theoretical analysis suggest that the line of order-disorder transitions intersects the condensation line at a multi-critical point at zero temperature and density, for patchy particle models with a re-entrant, empty fluid, regime. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3657406]

Facebook vs moodle : Surveying university students on the use of learning management systems to support learning activities outside the classroom

CISTI'2015 - 10ª Conferência Ibérica de Sistemas e Tecnologias de Informação, 17 a 20 de junho de 2015, Águeda, Aveiro, Portugal.

Simulation and life cycle assessment of process design alternatives for biodiesel production from waste vegetable oils

This study uses the process simulator ASPEN Plus and Life Cycle Assessment (LCA) to compare three process design alternatives for biodiesel production from waste vegetable oils that are: the conventional alkali-catalyzed process including a free fatty acids (FFAs) pre-treatment, the acid-catalyzed process, and the supercritical methanol process using propane as co-solvent. Results show that the supercritical methanol process using propane as co-solvent is the most environmentally favorable alternative. Its smaller steam consumption in comparison with the other process design alternatives leads to a lower contribution to the potential environmental impacts (PEI’s). The acid-catalyzed process generally shows the highest PEI’s, in particular due to the high energy requirements associated with methanol recovery operations.

Fractional order models of leaves

Leaves are mainly responsible for food production in vascular plants. Studying individual leaves can reveal important characteristics of the whole plant, namely its health condition, nutrient status, the presence of viruses and rooting ability. One technique that has been used for this purpose is Electrical Impedance Spectroscopy, which consists of determining the electrical impedance spectrum of the leaf. In this paper we use EIS and apply the tools of Fractional Calculus to model and characterize six species. Two modeling approaches are proposed: firstly, Resistance, Inductance, Capacitance electrical networks are used to approximate the leaves’ impedance spectra; afterwards, fractional-order transfer functions are considered. In both cases the model parameters can be correlated with physical characteristics of the leaves.

Modelling of the kinetics of municipal solid waste composting in full-scale mechanical-biological treatment plants

A thesis submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Sanitary Engineering in the Faculty of Sciences and Technology of the New University of Lisbon