Infornut® Process; improves accessibility to diagnosis and nutritional support for the malnourished hospitalized patient; impact on management indicators; two-year assessment.

Introduction: The high prevalence of disease-related hospital malnutrition justifies the need for screening tools and early detection in patients at risk for malnutrition, followed by an assessment targeted towards diagnosis and treatment. At the same time there is clear undercoding of malnutrition diagnoses and the procedures to correct it Objectives: To describe the INFORNUT program/ process and its development as an information system. To quantify performance in its different phases. To cite other tools used as a coding source. To calculate the coding rates for malnutrition diagnoses and related procedures. To show the relationship to Mean Stay, Mortality Rate and Urgent Readmission; as well as to quantify its impact on the hospital Complexity Index and its effect on the justification of Hospitalization Costs. Material and methods: The INFORNUT® process is based on an automated screening program of systematic detection and early identification of malnourished patients on hospital admission, as well as their assessment, diagnoses, documentation and reporting. Of total readmissions with stays longer than three days incurred in 2008 and 2010, we recorded patients who underwent analytical screening with an alert for a medium or high risk of malnutrition, as well as the subgroup of patients in whom we were able to administer the complete INFORNUT® process, generating a report for each.

Family health nursing care: weaknesses and strengths in the Unified Health System

OBJECTIVETo analyze the weaknesses and strengths of nursing care in the Family Health Strategy and its interfaces with the Unified Health System network.METHODA qualitative study performed by means of semi-structured interviews and systematic observations, with the participation of a nursing team of 15 people from October of 2012 to January of 2013.RESULTSStrengths that were emphasized: the nurse's versatility in conducting users within the unit and the health system, therefore directly acting upon access to these services. The nurse is the main subject that participates in the care processes for the person, family and social groups. Weaknesses that were highlighted: fragile embracement and low resolution of users' and families' problems.CONCLUSIONThe nursing care process in health units still lacks collective articulation, involvement of the team, and decentralization of the decisions.

Solar Powered Highway Delineator System, HR-367, 1993

Currently, many drivers experience some difficulty in viewing the road ahead of them during times of reduced visibility, such as rain, snow, fog, or the darkness of night- Recent studies done by the National Safety Council provide a detailed contrast between fatal accidents occurring during the day and night. Revealed was that the motor vehicle night death rate (4.41 deaths per 100 million miles driven) was sharply higher than the corresponding death rate during daylight hours (1.21). By providing a delineating system powered by the natural resource of solar power, a constant source of visibility may be maintained throughout the evening. Along with providing enough light to trace the outline of the road, other major goals defined in producing this delineator system are as follows: 1. A strong and durable design that would protect the internal components and survive extreme weather conditions. 2. A low maintenance system where components need few repairs or replacements. 3. A design which makes all components accessible in the event that maintenance is needed, but also prevents vandalism. 4. A design that provides greater visibility to drivers and will not harm a vehicle or its passengers in the event of a collision. This solar powered highway delineator consists of an adjustable solar array, a light fixture, and a standard delineator pole. The solar array houses and protects the solar panels, and can be easily adjusted to obtain a maximum amount of sunlight. The light fixture primarily houses the battery, the circuit and the light assembly. Both components allow for easy accessibility and reduce vandalism using internal connections for bolts and wires. The delineator mounting pole is designed to extensively deform in the event of a collision, therefore reducing any harm caused to the vehicle and/or the passengers. The cost of a single prototype to be produced is approximately $70.00 excluding labor costs. However, these material and labor costs will be greatly reduced if a large number of delineators are produced. It is recommended that the Iowa Department of Transportation take full advantage of the research and development put into this delineator design. The principles used in creating this delineator can be used to provide an outline for drivers to follow, or on a larger scale, provide actual roadway lighting in areas where it was never before possible or economically feasible. In either event, the number of fatal accidents will be decreased due to the improved driver visibility in the evening.

La PMU au carrefour des nouveaux chemins du système de santé [Redesigning Swiss ambulatory health care system].

Primary care medicine is first in line to meet the necessary changes in our health care system. Innovations in this field pursue three types of objectives: accessibility, quality and continuity of care. The Department of ambulatory care and community medicine of the University of Lausanne (Policlinique médicale universitaire) is committed to this path, emphasizing interprofessional collaboration. The doctor, nurse and medical assistant coordinate their activities to contribute efficiently to meet the needs of patients today and tomorrow. This paper also addresses how our department, as a public and academic institution, might play a major role as a health care network actor. A master degree dissertation in health management has started to identify the critical success factors and the strategic core competencies needed to achieve this development.

Job accessibility, employment and job-education mismatch in the metropolitan area of Barcelona

This paper analyses the effect of job accessibility by public and private transport on labour market outcomes in the metropolitan area of Barcelona. Beyond employment, we consider the effect of job accessibility on job-education mismatch, which represents a relevant aspect of job quality. We adopt a recursive system of equations that models car availability, employment and mismatch. Public transport accessibility appears as an exogenous variable in the three equations. Even though it may reflect endogenous residential sorting, falsification proofs suggest that the estimated effect of public transport accessibility is not entirely driven by the endogenous nature of residential decisions.

Accessibility, equity and the sharing of water resources

While the supply of water to dry or arid mountain regions has long been a major challenge, the on-going processes of climatic and socio-economic change currently affecting the hydrosystems of the Alps raise the spectre of renewed pressure on water resources and possible local shortages. In such a context, questions relating to fair distribution of water are all the more sensitive given the tendency to neglect the social dimension of sustainability. The present paper makes both a conceptual and empirical contribution to this debate by analysing a system of distribution that has a long experience of water scarcity management: the community governance models traditionally linked to the irrigation channels, or bisses, typical of the Swiss Alpine canton of Valais. More specifically, we evaluate these models in terms of accessibility and equity, characteristics that we use to operationalize the notion of 'fair distribution'. We examine these dimensions in three case studies with a view to highlighting the limitations of the aforementioned models. Indeed, despite their cooperative and endogenous nature, they tend to not only exclude certain members of the population, but also to reproduce rather than reduce social inequalities within the community. In general, these results challenge the rosy picture generally found in the literature relating to these community governance models.

Exploring Perceptions of Accessibility, Necessity and Use of Social Support for Wilderness Therapy Field Instructors

Organizations offering therapeutic wilderness programming have a responsibility to ensure the well-being of their front line employees. A system of social support that is formed through communication with others, either personally or professionally, can assist field instructors in effectively managing the demands arising from their work. Phenomenological analysis of semi-structured interview transcripts from seven participants provided insight on perceptions of necessity, accessibility and use of social support. Fourteen main themes and thirteen subthemes emerged from the data. Findings are presented using the six components of Parsons’ (1980) staff development model and strongly suggest program managers consider and apply specific measures aimed at increasing the social support for front line field instructors in a wilderness therapy work context.

The Discourse of Home Recording : Accessibility, Exclusion and Power

Ce mémoire propose une analyse critique du discours de l’enregistrement sonore à domicile (home recording). Dans la foulée des propos mettant de l’avant l’ «accessibilité» et la «démocratisation» de l’enregistrement sonore, ce mémoire analyse les relations de savoir/pouvoir produites et légitimées par le discours, ce qu’elles permettent et contraignent, autorisent et excluent. Le corpus à l’étude est issu de la presse musicale ainsi que de forums de discussion en ligne relevant de sites spécialisés. Les méthodes utilisées sont inspirées de l’approche du discours développées par Michel Foucault et de ce que Johnson et. al. (2004) appellent l’interprétation critique. L’analyse met en évidence les deux principaux sujets du discours de l’enregistrement sonore à la maison : les professionnels de l’enregistrement et les «pros» de l’enregistrement à domicile, deux groupes constitués d’hommes financièrement aisés. Les règles qui régissent l’enregistrement à domicile semblent reprendre, en les adaptant, celles régissant les studios professionnels. Ce mémoire suggère que la «démocratisation» telle qu'énoncée dans ce discours articule l'«accessibilité contemporaine» à certains savoirs et certaines technologies à des exclusions singulières – comme des femmes et des personnes de moyens limités – qui rendent ce discours possible. Être dans le vrai, dans ce discours, c’est échanger, argumenter, discuter et prescrire des façons de faire et de dire qui font des studios professionnels l’espace des normes et des légitimités. Mots clés: enregistrement, musique, maison, domicile, studio, démocratisation, technologie, l'analyse du discours, relations de pouvoir/savoir, Michel Foucault.

Contradictions within the Modern Food System: Nutritional Disbalance across the Globe, Its Main Drivers and Possible Ways Out

Contemporary food production, given the degree of technology being applied in it and the present state of scientific knowledge, should be able to feed the world. Corresponding statistics show that in fact the volumes of modern food production confirm this statement. Yet, the present nutritional situation across the globe leaves much to be desired: on the one hand the numbers of undernourished and malnourished people are still high and even growing in some regions, and on the other hand there is an increasing number of overweight and obese people who are experiencing (or are at risk of) adverse health impacts as consequences. The question arises how this situation is possible given the present state of food production and knowledge, and also in terms of nutrition basics when talking about the latter. When arguing about the main causes of the present situation with nutrition across the globe, it is the modern food system with its distortions that is often criticised with emphasis placed on inappropriate food distribution as one of the key problems. However it is not only food distribution that shapes inequalities in terms of food availability and accessibility – there is a number of other factors contributing to this situation including political influences. Each of the drivers of the present situation might affect more than one part and have outcomes in different dimensions. Therefore it makes sense to apply a holistic approach when viewing the modern food system, embracing all the elements and existing relationships between them for this will facilitate taking appropriate actions in order to target the desired outcome in the best possible way. Applying a systematic approach and linking various elements with corresponding interactions among them allows for picturing all the possible outcomes and hence finding the way for a better solution on global level – a solution to the present problem with nutritional disbalance across the globe.

SIDUR: development of an information system, using controlled vocabulary designed to the characterization and sample of population with and without disability, attended by Rehabilitation programs, University of Rosario

Introduction: the statistical record used in the Field Academic Programs (PAC for it’s initials in Spanish) of Rehabilitation denotes generalities in the data conceptualization, which complicates the reliable guidance in making decisions and provides a low support for research in rehabilitation and disability. In response, the Research Group in Rehabilitation and Social Integration of Persons with Disabilities has worked on the creation of a registry to characterize the population seen by Rehabilitation PAC. This registry includes the use of the International Classification of Functioning, Disability and Health (ICF) of the WHO. Methodology: the proposed methodology includes two phases: the first one is a descriptive study and the second one involves performing methodology Methontology, which integrates the identification and development of ontology knowledge. This article contextualizes the progress made in the second phase. Results: the development of the registry in 2008, as an information system, included documentary review and the analysis of possible use scenarios to help guide the design and development of the SIDUR system. The system uses the ICF given that it is a terminology standardization that allows the reduction of ambiguity and that makes easier the transformation of health facts into data translatable to information systems. The record raises three categories and a total of 129 variables Conclusions: SIDUR facilitates accessibility to accurate and updated information, useful for decision making and research.

Using QR codes to aid accessibility in a museum

Purpose – This paper describes visitors' reactions to using an Apple iPad or smartphone to follow trails in a museum by scanning QR codes and draws conclusions on the potential for this technology to help improve accessibility at low-cost. Design/methodology/approach – Activities were devised which involved visitors following trails around museum objects, each labelled with a QR code and symbolised text. Visitors scanned the QR codes using a mobile device which then showed more information about an object. Project-team members acted as participant-observers, engaging with visitors and noting how they used the system. Experiences from each activity fed into the design of the next. Findings – Some physical and technical problems with using QR codes can be overcome with the introduction of simple aids, particularly using movable object labels. A layered approach to information access is possible with the first layer comprising a label, the second a mobile-web enabled screen and the third choices of text, pictures, video and audio. Video was especially appealing to young people. The ability to repeatedly watch video or listen to audio seemed to be appreciated by visitors with learning disabilities. This approach can have low equipment-cost. However, maintaining the information behind labels and keeping-up with technological changes are on-going processes. Originality/value – Using QR codes on movable, symbolised object labels as part of a layered information system might help modestly-funded museums enhance their accessibility, particularly as visitors increasingly arrive with their own smartphones or tablets.

A structure-dynamic approach to cortical organization: Number of paths and accessibility

A structure-dynamic approach to cortical systems is reported which is based on the number of paths and the accessibility of each node. The latter measurement is obtained by performing self-avoiding random walks in the respective networks, so as to simulate dynamics, and then calculating the entropies of the transition probabilities for walks starting from each node. Cortical networks of three species, namely cat, macaque and humans, are studied considering structural and dynamical aspects. It is verified that the human cortical network presents the highest accessibility and number of paths (in terms of z-scores). The correlation between the number of paths and accessibility is also investigated as a mean to quantify the level of independence between paths connecting pairs of nodes in cortical networks. By comparing the cortical networks of cat, macaque and humans, it is verified that the human cortical network tends to present the largest number of independent paths of length larger than four. These results suggest that the human cortical network is potentially the most resilient to brain injures. (C) 2009 Elsevier B.V. All rights reserved.

The financial protection impact of the public health system and private insurance in Brazil

Includes bibliography

A support system that delineates location-choice sets for firms seeking office space

Factors influencing the location decisions of offices include traffic, accessibility, employment conditions, economic prospects and land-use policies. Hence tools for supporting real-estate managers and urban planners in such multidimensional decisions may be useful. Accordingly, the objective of this study is to develop a GIS-based tool to support firms who seek office accommodation within a given regional or national study area. The tool relies on a matching approach, in which a firm's characteristics (demand) on the one hand, and environmental conditions and available office spaces (supply) on the other, are analyzed separately in a first step, after which a match is sought. That is, a suitability score is obtained for every firm and for every available office space by applying some value judgments (satisfaction, utility etc.). The latter are powered by a focus on location aspects and expert knowledge about the location decisions of firms/organizations with respect to office accommodation as acquired from a group of real-estate advisers; it is stored in decision tables, and they constitute the core of the model. Apart from the delineation of choice sets for any firm seeking a location, the tool supports two additional types of queries. Firstly, it supports the more generic problem of optimally allocating firms to a set of vacant locations. Secondly, the tool allows users to find firms which meet the characteristics of any given location. Moreover, as a GIS-based tool, its results can be visualized using GIS features which, in turn, facilitate several types of analyses.

Accessibility in Digital Television: Designing Remote Controls

Free to air television is still an important tool to provide information and communication in many countries. Therefore, the universal access to the television system is very important. This paper presents a set of Digital Television accessible remote control devices designed for the Brazilian Digital Television. A research was conducted, interviewing people with disabilities in Brazil. Three remote control models were proposed, consolidating the main identified requirements, being accessible for a diverse group of impairments.