Reasons why emergency department providers do not rely on the pneumonia severity index to determine the initial site of treatment for patients with pneumonia.

BACKGROUND: Many emergency department (ED) providers do not follow guideline recommendations for the use of the pneumonia severity index (PSI) to determine the initial site of treatment for patients with community-acquired pneumonia (CAP). We identified the reasons why ED providers hospitalize low-risk patients or manage higher-risk patients as outpatients. METHODS: As a part of a trial to implement a PSI-based guideline for the initial site of treatment of patients with CAP, we analyzed data for patients managed at 12 EDs allocated to a high-intensity guideline implementation strategy study arm. The guideline recommended outpatient care for low-risk patients (nonhypoxemic patients with a PSI risk classification of I, II, or III) and hospitalization for higher-risk patients (hypoxemic patients or patients with a PSI risk classification of IV or V). We asked providers who made guideline-discordant decisions on site of treatment to detail the reasons for nonadherence to guideline recommendations. RESULTS: There were 1,306 patients with CAP (689 low-risk patients and 617 higher-risk patients). Among these patients, physicians admitted 258 (37.4%) of 689 low-risk patients and treated 20 (3.2%) of 617 higher-risk patients as outpatients. The most commonly reported reasons for admitting low-risk patients were the presence of a comorbid illness (178 [71.5%] of 249 patients); a laboratory value, vital sign, or symptom that precluded ED discharge (73 patients [29.3%]); or a recommendation from a primary care or a consulting physician (48 patients [19.3%]). Higher-risk patients were most often treated as outpatients because of a recommendation by a primary care or consulting physician (6 [40.0%] of 15 patients). CONCLUSION: ED providers hospitalize many low-risk patients with CAP, most frequently for a comorbid illness. Although higher-risk patients are infrequently treated as outpatients, this decision is often based on the request of an involved physician.

Nursing staff sizing in the emergency room of a university hospital

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

Risks in R&D Collaboration between Small and Large Firms

The main aim of this thesis was to find out what kinds of risks arise from collabo-ration in R&D between small and large firms. The suitability and gain of some buyer/supplier risk frameworks in examining of R&D collaboration has been in-vestigated. A risk model has been based on the buyer/supplier risks models found in the literature. Its applicability has been tested empirically by means of theme interviews with firm representatives. The risk classification framework received some confirmation. But the study also showed that the theoretical framework was not completely adequate, as a new risk class arose from communication. Collaboration causes risks, and these risks should be taken into account when R&D collaboration is planned. The advantage of risk examination is the possibility to decrease failures and losses, and to in-crease possibilities for success and economical benefits. This study should be used as a managerial analysis tool in trying to understand the form and concept of risk in risk expectancy.

Digitalización del sistema de control de nivel en calentadores y tanques de drenaje de una Central Nuclear

Contexto Una central nuclear, al igual que cualquier otro tipo de central generadora de energía eléctrica, mediante turbinas de vapor, está basada en un proceso termodinámico. El rendimiento de las mismas es función del salto entálpico del vapor, para mejorarlo las centrales están constituidas por un ciclo compound formado por turbina de alta presión y turbinas de baja presión, y un ciclo regenerativo consistente en calentar el agua de alimentación antes de su introducción a los generadores de vapor. Un ciclo regenerativo está basado en etapas de calentadores o cambiadores de calor para aprovechar al máximo la energía térmica del vapor, este proyecto está basado en la mejora y optimización del proceso de control de estos para contribuir a mejorar el rendimiento de la central. Objetivo Implementar un sistema de control que nos permita modernizar los clásicos sistemas basados en controles locales y comunicaciones analógicas. Mejorar el rendimiento del ciclo regenerativo de la central, aprovechando las mejoras tecnológicas que ofrece el mercado, tanto en el hardware como en el software de los sistemas de instrumentación y control. Optimizar el rendimiento de los lazos de control de cada uno de los elementos del ciclo regenerativo mediante estrategias de control. Procedimiento Desarrollo de un sistema de control actualizado considerando, como premisa principal, la fiabilidad del sistema, el análisis de fallos y la jerarquización del riesgo. Análisis y cálculo de los lazos de control considerando las premisas establecidas. Configuración de los lazos mediante estrategias de control que nos permitan optimizar y minimizar los efectos del fallo. Para ello se han utilizado parámetros y datos extraídos de la Central Nuclear de Ascó. Conclusiones Se ha modernizado y optimizado el sistema de control mejorando el rendimiento del ciclo regenerativo. Se ha conseguido un sistema más fiable, reduciendo el riesgo del fallo y disminuyendo los efectos de los mismos. El coste de un proyecto de estas características es inferior al de un sistema convencional y ofrece más posibilidades. Es un sistema abierto que permite utilizar e interconectar equipos de diferentes fabricantes, lo que favorece tanto el mantenimiento como las posibles ampliaciones futuras del sistema.

Added value of SPECT/CT in addition to whole-body scintigraphy augmented with prone lateral views in patients with well-differentiated thyroid carcinoma

Purpose: We aimed to determine the impact of SPECT/CT performed in addition to whole-­‐body scintigraphy augmented with prone lateral views in patients with well-­‐differentiated thyroid carcinoma. Methods and Materials: This retrospective study included 141 patients (87 female, 54 male, mean age 47 years) with well-­‐differentiated thyroid carcinoma (105 papillary, 31 follicular, 1 Hürthle cell and 4 poorly differentiated) treated with radioiodine therapy (1000-7400 MBq). Patients were referred for either first postsurgical therapy (n=76) or further treatment (n=65). Two nuclear medicine physicians interpreted the scans in consensus (first whole-­‐body scintigraphy with prone lateral view, then SPECT/CT) reporting abnormal iodine uptake in the thyroid bed, lymph nodes and distant metastasis. The corresponding ATA risk score was calculated for each patient before and after SPECT/CT, as well as change in disease extension Results: The analysis showed a difference between scintigraphy and SPECT/CT in n=17 lesions in 14 patients (9.9%): 12 were described as suspicious on scintigraphy and could be considered as benign on SPECT/CT (3 corresponded to local iodine uptake, 6 to lymph nodes metastases and 3 to distant metastases). The others 5 corresponded to metastases (4 lymph nodes and 1 distant) that were not seen on whole-­‐body scintigraphy augmented with prone lateral views. In 10 of 141 (7.1%) patients, we observed a change in ATA risk stratification, with a risk increase in 4 of them (2.8%). Conclusion: SPECT/CT allowed detecting 5 focal lesions missed on planar scintigraphy, and to precise benignity of 12 suspicious lesions on planar scintigraphy. Moreover, SPECT/CT improved the risk stratification in 10 patients with a significant change in the patient management

Estudio piloto de la relación entre el aumento de la velocidad de onda del pulso en arteria carótida común medida por resonancia magnética y los factores de riesgo vasculares clásicos en sujetos con sospecha de lesión cerebrovascular isquémica

Arterial stiffness assessed by carotid-femoral pulse wave velocity (cfPWV) measurement is now well accepted as an independent predictor of vascular mortality and morbidity. However, the value of cfPWV has been considered to be limited for risk classification in patients with several vascular risk factors. Magnetic resonance (MR) allows measurement of PWV between two points, though to date mainly used to study the aorta. To assess the common carotid artery pulse wave velocity by magnetic resonance, determine their association with classical vascular risk factors and ischemic brain injury burden in patients with suspected ischemic cerebrovascular disease

Impacto de la venta de acciones en la salud financiera y el riesgo en los grupos financieros

Esta investigación tiene como objetivo general el análisis del impacto de la venta de acciones sobre la salud financiera y el riesgo en el grupo Aval. La necesidad por este estudio nace del interés por conocer los costos y beneficios que tienen las empresas a la hora de emitir acciones, siendo ésta última una práctica común en las últimas décadas. Algunas de las motivaciones relevantes para emitir acciones, son la financiación de nuevos proyectos de la empresa, el status que le pueda dar a la misma, una manera de hacer frente a la deuda, etc. Es importante conocer las implicaciones que tienen sobre la empresa la venta de acciones en términos de sus resultados, el impacto sobre los accionistas y sobre la misma sociedad. Esta investigación busca responder a la pregunta: ¿Cuál es el impacto de la venta de acciones sobre la salud financiera y el riesgo en los grupos financieros? Nos interesaremos por la revisión bibliográfica acerca de la salud financiera abordando autores que hablan de la misma desde el punto de vista de la posición de la empresa, refiriéndonos siempre a tres indicadores relevantes para el estudio y que son utilizados en la literatura para medir la salud financiera: liquidez, rentabilidad y endeudamiento. En la revisión de la literatura se ha encontrado una relación entre la salud financiera y el riesgo, por lo tanto buscaremos identificar cuál es el riesgo que afecta a las empresas cuando se emiten acciones centrándonos en tres tipos de riesgos financieros: riesgo de mercado, de interés y riesgo operacional; se ha escogido el grupo Aval para éste estudio ya que es uno de los grupos financieros más importantes en Colombia, con varios años de gestión y que actualmente realiza la práctica de emitir acciones.

Estudio piloto de la relación entre el aumento de la velocidad de onda del pulso en arteria carótida común medida por resonancia magnética y los factores de riesgo vasculares clásicos en sujetos con sospecha de lesión cerebrovascular isquémica

Arterial stiffness assessed by carotid-femoral pulse wave velocity (cfPWV) measurement is now well accepted as an independent predictor of vascular mortality and morbidity. However, the value of cfPWV has been considered to be limited for risk classification in patients with several vascular risk factors. Magnetic resonance (MR) allows measurement of PWV between two points, though to date mainly used to study the aorta. To assess the common carotid artery pulse wave velocity by magnetic resonance, determine their association with classical vascular risk factors and ischemic brain injury burden in patients with suspected ischemic cerebrovascular disease

A influência dos ativos intangíveis na análise de risco de crédito de empresas de base tecnológica

Evolution is present in world dynamics. And it is just in such transformational environment where companies have been encapsulated. In an economy of knowledge, physical assets alone are unable to provide profits to meet shareholders' demands. Now there comes an invisible component with the purpose of defining strategies and impelling results: Intangible Assets. Banking financing systems, however, have not kept pace with this knowledge revolution and its resulting new income generation techniques. Credit analysis methods for most financing agents would not employ any intangible parameters in their methodology of study as yet. This paper seeks to discuss the importance of intangible assets by focusing their role of influencial factor in decisions to finance technology-based companies. By studying the credit risk classification system employed by FINEP, Brazil's Federal Agency for innovation development, we wished to suggest indicators for intangibles which might be put to use in the Financiadora.

Provisionamento de processos judiciais e administrativos : análise crítica e propostas de boas práticas

O presente trabalho examina as normas brasileiras relativas ao provisionamento e à divulgação de passivos contingentes com vistas especificamente à sua aplicação para processos judiciais e administrativos, que representam o tipo de passivo contingente que mais impacta o resultado da maior parte das companhias nacionais, de todos os segmentos. O texto das normas, portanto, é confrontado com a realidade prática do mercado e as especificidades inerentes aos processos judiciais e administrativos. Além de contextualizar e explicar o funcionamento das regras aplicáveis, com destaque para o Pronunciamento Técnico nº. 25, do Comitê de Pronunciamentos Contábeis, que se tornou obrigatório para as companhias abertas por meio da Deliberação CVM nº. 594, de 15 de setembro de 2009, é realizada sua análise crítica, identificando omissões que podem dificultar o desempenho das atividades de provisionamento de tais demandas pelos profissionais competentes, fomentando a falta de uniformidade desses registros entre as demonstrações financeiras das companhias, bem como possibilitando o gerenciamento de resultados. Em seguida, são avaliadas e propostas soluções para os problemas identificados, com destaque para o estabelecimento de valores percentuais aos critérios de classificação de risco e a definição de critérios para classificação de risco de perda e mensuração de valores de passivos contingentes, organizadas em forma de diretrizes de boas práticas de provisionamento e de divulgação de passivos contingentes decorrentes de processos judiciais e administrativos.

Modelos matemáticos para estimativa do consumo máximo de oxigênio pela ventilometria de esforço em indivíduos saudáveis

The relation between metabolic demand and maximal oxygen consumption during exercise have been investigated in different areas of knowledge. In the health field, the determination of maximal oxygen consumption (VO2max) is considered a method to classify the level of physical fitness or the risk of cardiocirculatory diseases. The accuracy to obtain data provides a better evaluation of functional responses and allows a reduction in the error margin at the moment of risk classification, as well as, at the moment of determination of aerobic exercise work load. In Brasil, the use of respirometry associated to ergometric test became an opition in the cardiorespiratory evaluation. This equipment allows predictions concerning the oxyredutase process, making it possible to identify physiological responses to physical effort as the respiratory threshold. This thesis focused in the development of mathematical models developed by multiple regression validated by the stepwise method, aiming to predict the VO2max based on respiratory responses to physical effort. The sample was composed of a ramdom sample of 181 healthy individuals, men and women, that were randomized to two groups: regression group and cross validation group (GV). The voluntiars were submitted to a incremental treadmill test; objetiving to determinate of the second respiratory threshold (LVII) and the Peak VO2max. Using the método forward addition method 11 models of VO2max prediction in trendmill were developded. No significative differences were found between the VO2max meansured and the predicted by models when they were compared using ANOVA One-Way and the Post Hoc test of Turkey. We concluded that the developed mathematical models allow a prediction of the VO2max of healthy young individuals based on the LVII

Dental caries experience in children attending an infant oral health program

Aim: To investigate: a) caries experience in 5 year-old children and its relationship to the caries risk evaluation made before 1 year of age; b) compliance of parents to an infant oral health program as well as the abandonment reasons. Methods: Group A (GA) - 242 children (60-71 months old) who stayed in the program and had been enrolled since their first year of life underwent a clinical examination according to the WHO's criteria; their parents/caregivers were interviewed to ascertain their compliance to the program. Group B (GB) - parents of 60 children, who had dropped out of the program, were interviewed to check the reasons of withdrawing. The caries risk classification was based on the file at the first appointment. Chi-square test was used (α=0.05) for statistical analyses. Results: Most of the children were free of caries (71.1%). Caries risk evaluation showed low sensibility (34.3%, 95% CI = 22.4-46.1) and high specificity (74.4%, 95% CI = 67.6-81.2) to caries experience. Sixty-two mothers (25.6%) reported difficulty to follow the guidelines. The main reason for dropping out was changing to similar health services (40.0%). Conclusions: Caries risk in the first year of life was not efficient to predict dental caries experience at 5 years of age. Educational practice should be improved to increase the compliance of the parents to the program.

Specialist tool for monitoring the measurement degradation process of induction active energy meters

This paper presents a methodology and a specialist tool for failure probability analysis of induction type watt-hour meters, considering the main variables related to their measurement degradation processes. The database of the metering park of a distribution company, named Elektro Electricity and Services Co., was used for determining the most relevant variables and to feed the data in the software. The modeling developed to calculate the watt-hour meters probability of failure was implemented in a tool through a user friendly platform, written in Delphi language. Among the main features of this tool are: analysis of probability of failure by risk range; geographical localization of the meters in the metering park, and automatic sampling of induction type watt-hour meters, based on a risk classification expert system, in order to obtain information to aid the management of these meters. The main goals of the specialist tool are following and managing the measurement degradation, maintenance and replacement processes for induction watt-hour meters. © 2011 IEEE.

Seleção de bioindicadores aquáticos pela toxicidade aguda e risco ambiental do inseticida fipronil

Pós-graduação em Aquicultura - FCAV

Caracterização gfeológico-geotécnica aplicada a gestão de risco no gasoduto GASBOL, trecho Ipeúna/SP - Itirapina/SP

The pipelines are characterized by the great length and linearity, these enterprises are usually associated with the horizon of soil and decomposed rock and accidents in this system usually have high complexity. So this work proposes a study of geological and geotechnical characterization of approximately 40 km ² and a study of risk analysis along 18.3 km of gas pipeline GASBOL, in the municipalities of Ipeúna-SP and Itirapina-SP, in scale 1:25.000, besides correlation between studies. The method for geological and geotechnical characterization is based on physiographic integrated analysis technique, which is supported by literature research, observation and interpretation of satellite imagery (photointerpretation), correlation of products numerical model of ground, fieldwork. The method adopted for risk classification is based on preliminary analysis of hazards (APP) technique, which is identified the geological process, this feature is classified as the susceptibility of occurrence, and then classified as the possible consequence of the process, if this evolves. As a product of the research, we designed a map in 1:25,000 scale, containing a table of geological and geotechnical characteristics of the mapped drives, as well as sectorization risk in each section of the pipeline. Were mapped geological and geotechnical seven units in the study area, delimited in excerpts of which five are classified as high risk, totaling 1.1 km in length of 18.3 km total