A comparative analysis of hospital -based physician monitoring systems

The purpose of the multiple case-study was to determine how hospital subsystems (such as physician monitoring and credentialing; quality assurance; risk management; and peer review) were supporting the monitoring of physicians? Three large metropolitan hospitals in Texas were studied and designated as hospitals #1, #2, and #3. Realizing that hospital subsystems are a unique entity and part of a larger system, conclusions were made on the premises of a quality control system, in relation to the tools of government (particularly the Health Care Quality Improvement Act (HCQIA)), and in relation to itself as a tool of a hospital.^ Three major analytical assessments were performed. First, the subsystems were analyzed as to their "completeness"; secondly, the subsystems were analyzed for "performance"; and thirdly, the subsystems were analyzed in reference to the interaction of completeness and performance.^ The physician credentialing and monitoring and the peer review subsystems as quality control systems were most complete, efficient, and effective in hospitals #1 and #3. The HCQIA did not seem to be an influencing factor in the completeness of the subsystem in hospital #1. The quality assurance and risk management subsystem in hospital #2 was not representative of completeness and performance and the HCQIA was not an influencing factor in the completeness of the Q.A. or R.M. systems in any hospital. The efficiency (computerization) of the physician credentialing, quality assurance and peer review subsystems in hospitals #1 and #3 seemed to contribute to their effectiveness (system-wide effect).^ The results indicated that the more complete, effective, and efficient subsystems were characterized by (1) all defined activities being met, (2) the HCQIA being an influencing factor, (3) a decentralized administrative structure, (4) computerization an important element, and (5) staff was sophisticated in subsystem operations. However, other variables were identified which deserve further research as to their effect on completeness and performance of subsystems. They include (1) medical staff affiliations, (2) system funding levels, (3) the system's administrative structure, and (4) the physician staff "cultural" characteristics. Perhaps by understanding other influencing factors, health care administrators may plan subsystems that will be compatible with legislative requirements and administrative objectives. ^

Desafíos para el neoliberalismo, ordenamiento territorial y planificación estratégica

Luego de una década en la cual la planificación no es tenida en cuenta, donde todo se deja librado al juego de oferta y demanda, a la lógica concentradora de la economía, comienza a reclamarse su participación como un paliativo frente a las consecuencias adversas producidas: desequilibrios espaciales, desempleo, pobreza, marginación, contaminación, generación de deseconomías, etc., problemáticas que reclaman en general un mejoramiento de la calidad de vida de la población. En este marco no sólo se profundiza la preocupación por las cuestiones socioeconómicas y ambientales, sino por la competitividad y búsqueda de eficiencia en el uso de los recursos y las ventajas de que dispone cada territorio, hechos que encuentran su explicación en la necesidad de no quedar marginados frente a los procesos de cooperación y asociación propios de un mundo cada vez más interdependiente y más integrado debido al avance tecnológico de los medios de comunicación.

Assessment of Youth-Friendly Postabortion Care Services: A Global Tool for Assessing and Improving Postabortion Care for Youth

This tool is designed to help assessment teams, project managers, supervisors, and providers collect detailed information on the quality of Postabortion Care (PAC) services provided to adolescents at a given facility in order to make services more youth-friendly. It can also be used before PAC services have been established to see how best to design PAC services to meet youth’s needs. The assessment process facilitates the development of action plans for quality improvement that can help facilities address policy, operations, training, and other program areas needing adjustments and change. The tool also provides essential baseline information, allowing for repeated applications to measure changes and the impact of program interventions. Although the tool is primarily for use by a team, it may also be used by an individual.

La internacionalización de la educación a distancia en América Latina

El artículo analiza como la región está inserta en un proceso de internacionalización, pero ella es de dimensiones muy reducida, lo cual redunda negativamente en el mejoramiento de la calidad. La educación transfronteriza es una de las cuatro modalidades a través de las cuales se desarrolla la educación internacional. El artículo analiza las manifestaciones de esta dimensión de la internacionalización y constata la existencia de un conjunto más amplio de bienes y servicios asociados que están siendo sometidos a complejos y diversos procesos de internacionalización. A partir de allí se sostiene la hipótesis de una nueva dimensión en el intercambio internacional educativo referido a servicios de apoyo. Ello está siendo impulsado tanto por la digitalización de la enseñanza, como por la creciente terciarización de la gestión universitaria en un creciente contexto global y competitivo, lo cual muestra a su vez una más amplia articulación entre la virtualización educativa y la internacionalización de los procesos de enseñanza y aprendizaje

La internacionalización de la educación a distancia en América Latina

El artículo analiza como la región está inserta en un proceso de internacionalización, pero ella es de dimensiones muy reducida, lo cual redunda negativamente en el mejoramiento de la calidad. La educación transfronteriza es una de las cuatro modalidades a través de las cuales se desarrolla la educación internacional. El artículo analiza las manifestaciones de esta dimensión de la internacionalización y constata la existencia de un conjunto más amplio de bienes y servicios asociados que están siendo sometidos a complejos y diversos procesos de internacionalización. A partir de allí se sostiene la hipótesis de una nueva dimensión en el intercambio internacional educativo referido a servicios de apoyo. Ello está siendo impulsado tanto por la digitalización de la enseñanza, como por la creciente terciarización de la gestión universitaria en un creciente contexto global y competitivo, lo cual muestra a su vez una más amplia articulación entre la virtualización educativa y la internacionalización de los procesos de enseñanza y aprendizaje

La internacionalización de la educación a distancia en América Latina

El artículo analiza como la región está inserta en un proceso de internacionalización, pero ella es de dimensiones muy reducida, lo cual redunda negativamente en el mejoramiento de la calidad. La educación transfronteriza es una de las cuatro modalidades a través de las cuales se desarrolla la educación internacional. El artículo analiza las manifestaciones de esta dimensión de la internacionalización y constata la existencia de un conjunto más amplio de bienes y servicios asociados que están siendo sometidos a complejos y diversos procesos de internacionalización. A partir de allí se sostiene la hipótesis de una nueva dimensión en el intercambio internacional educativo referido a servicios de apoyo. Ello está siendo impulsado tanto por la digitalización de la enseñanza, como por la creciente terciarización de la gestión universitaria en un creciente contexto global y competitivo, lo cual muestra a su vez una más amplia articulación entre la virtualización educativa y la internacionalización de los procesos de enseñanza y aprendizaje

Uso de marcadores moleculares para la racionalización y evaluación de la calidad en las colecciones de Recursos Fitogenéticos de trigo

Esta tesis tiene dos objetivos generales: el primero, analizar el uso de proteínas del endospermo y SSRs para la racionalización de las colecciones de trigo, y el segundo, estudiar la influencia de las proteínas del endospermo, del año de cultivo y del abonado nitrogenado en la calidad en un grupo de variedades locales españolas. Dentro del primer objetivo, se estudió la diversidad genética de la colección de Triticum monococcum L. (escaña menor), y de una muestra de la colección de Triticum turgidum L. (trigo duro) del CRF-INIA, con 2 y 6 loci de gliadinas, y 6 y 24 SSRs, para la escaña menor y el trigo duro, respectivamente. Ambas colecciones presentaron una gran diversidad genética, con una gran diferenciación entre las variedades y pequeña dentro de ellas. Los loci de gliadinas mostraron una gran variabilidad, siendo los loci Gli-2 los más útiles para distinguir variedades. En la escaña menor, las gliadinas presentaron mayor poder de discriminación que los SSRs; aunque en trigo duro los SSRs identificaron más genotipos. El número de alelos encontrado fue alto; 24 y 38 en gliadinas, y 29 y 203 en SSRs, en escaña menor y trigo duro, respectivamente. En trigo duro, se identificaron 17 alelos nuevos de gliadinas lo que demuestra que el germoplasma español es muy singular. En ambas especies, se detectaron asociaciones entre la variación alélica en prolaminas y el origen geográfico y filogenético de las variedades. La utilidad de las proteínas (6 loci de gliadinas, 2 loci de gluteninas y proteína total) y de los SSRs (24 loci) para verificar duplicados, y analizar la variabilidad intraaccesión, se estudió en 23 casos de duplicados potenciales de trigo duro. Los resultados indicaron que tanto los biotipos como las accesiones duplicadas mostraban el mismo genotipo en gliadinas, pocas diferencias o ninguna en las subunidades de gluteninas HMW y proteína total, y diferencias en menos de tres loci de SSRs. El mismo resultado se obtuvo para los biotipos de la colección de T. monococcum. Sin embargo, las discrepancias observadas en algunos casos entre proteínas y SSRs demostraron la utilidad del uso conjunto de ambos tipos de marcadores. Tanto las proteínas como los SSRs mostraron gran concordancia con los caracteres agro-morfológicos, especialmente cuando las diferencias entre los genotipos eran grandes. Sin embargo, los caracteres agro-morfológicos fueron menos discriminantes que los marcadores moleculares. Para el segundo objetivo de la tesis, se analizó la variación alélica en siete loci de prolaminas relacionados con la calidad en trigo duro: Glu-A1 y Glu-B1 de gluteninas HMW, Glu-A3, Glu-B3 y Glu-B2 de gluteninas B-LMW, y Gli-A1 y Gli-B1 de gliadinas. La submuestra analizada incluía variedades locales de todas las provincias españolas donde se ha cultivado tradicionalmente el trigo duro. Todos los loci, excepto el Glu-B2, mostraron gran variabilidad genética, siendo los Glu-3 los más polimórficos. En total, se identificaron 65 alelos, de los que 29 eran nuevos, que representan una fuente importante de variabilidad genética para la mejora de la calidad. Se detectaron diferencias en la composición en prolaminas entre la convar. turgidum y la zona norte, y la convar. durum y la zona sur; el genotipo Glu-B3new-1 - Gli-B1new-1 fue muy común en la convar. turgidum, mientras que el Glu-B3a - Gli-B1c, asociado con mejor calidad, fue más frecuente en la convar. durum. En la convar. turgidum, se observó mayor variabilidad que en la convar. durum, principalmente en los loci Glu-B1 y Glu-B3, lo que indica que esta convariedad puede ser una fuente valiosa de nuevos alelos de gluteninas. Esta submuestra fue evaluada para calidad (contenido en proteína, P, y test de sedimentación, SDSS) con dos dosis de abonado nitrogenado (N), y en dos años diferentes. No se detectaron interacciones Variedad × Año, ni Variedad × N en la calidad. Para la P, los efectos ambientales (año y N) fueron mayores que el efecto de la variedad, siendo, en general, mayor la P con dosis altas de N. La variedad influyó más en el test SDSS, que no se vio afectado por el año ni el N. El aumento del contenido en proteína no influyó significativamente sobre la fuerza del gluten estimada con el SDSS. Respecto a la influencia de las prolaminas en la fuerza del gluten, se confirmó la superioridad del Glu-B3a; aunque también se detectó una influencia alta y positiva de los alelos nuevos Glu-A3new-1, y Glu-B3new-6 y new-9. La no correlación entre el rendimiento (evaluado en un trabajo anterior) y la P, en las variedades adaptadas a bajo N, permitió seleccionar cuatro variedades locales con alto rendimiento y buena fuerza del gluten para producción con bajo N. SUMMARY There are two main objectives in this thesis: The first, to analyse the use of endosperm proteins and SSRs to rationalize the wheat collections, and the second, to study the influence on quality of endosperm proteins, year and nitrogen fertilization in a group of Spanish landraces. For the first objective, we studied the genetic diversity of the collection of Triticum monococcum L. (cultivated einkorn), and of a sample of the collection of Triticum turgidum L. (durum wheat) maintained at the CRF-INIA. Two and 6 gliadin loci, and 6 and 24 SSRs, were used for einkorn and durum wheat, respectively. Both collections possessed a high genetic diversity, being the differentiation large between varieties and small within them. Gliadin loci showed great variability, being the loci Gli-2 the most useful for distinguish among varieties. In einkorn, the gliadins showed higher discrimination power than SSRs; although SSRs identified more genotypes in durum wheat. Large number of alleles were found; 24 and 38 in gliadins, and 29 and 203 in SSRs, for einkorn and durum wheat, respectively. In durum wheat, 17 new alleles of gliadins were identified, which indicate that Spanish durum wheat germplasm is rather unique. Some associations between prolamin alleles and geographical and phylogenetic origin of varieties were found in both species. The value of endosperm proteins (6 gliadin loci, 2 glutenin loci and total protein) and SSRs (24 loci) for validation of duplicates, and monitoring the intra-accession variability, was studied in 23 potential duplicates of durum wheat. The results indicated that biotypes and duplicated accessions showed identical gliadin genotype, few or none differences in HMW glutenin subunits and total protein, and less than three different SSR loci. A similar result was obtained for biotypes of T. monococcum. However, the discrepancies in some cases support the convenience to use together both marker systems. A good concordance among endosperm proteins, agro-morphological traits and SSRs were also found, mainly when differences between genotypes were high. However, agro-morphological traits discriminated less between accessions than molecular markers. For the second objective of the thesis, we analysed the allelic variation at seven prolamin loci, involved in durum wheat quality: Glu-A1 and Glu-B1 of HMW glutenin, Glu-A3, Glu-B3 and Glu-B2 of B-LMW glutenin, and Gli-A1 and Gli-B1 of gliadin. The subsample analysed included landraces from all the Spanish provinces where the crop was traditionally cultivated. All the loci, except for Glu-B2, showed high genetic variability, being Glu-3 the most polymorphic. A total of 65 alleles were studied, 29 of them being new, which represent an important source of variability for quality improvement. Differences in prolamin composition were detected between convar. turgidum and the North zone, and the convar. durum and the South zone; the genotype Glu-B3new-1 - Gli-B1new-1 was very common in the convar. turgidum, while the Glu- B3a - Gli-B1c, associated with better quality, was more frequent in the convar. durum. Higher variability was detected in the convar. turgidum than in the convar. durum, mainly at the Glu-B1 and Glu-B3, showing that this convariety could be a valuable source of new glutenin alleles. The subsample was evaluated for quality (protein content, P, and sedimentation test, SDSS) with two doses of nitrogen fertiliser (N), and in two different years. No significant Variety x Year or Variety x Nitrogen interactions were detected. For P, environmental (year and N) effects were higher than variety effect, being P values , in general, larger with high dose of N. The variety exhibited a strong influence on SDSS test, which was not affected by year and N. Increasing values of P did not significantly influence on gluten strength, estimated with the SDSS. Respect to the prolamin effects on gluten strength, the superiority of Glu-B3a was confirmed; although a high positive effect of the new alleles Glu-A3new-1, and Glu-B3new-6 and new-9 was also detected. The no correlation between yield (evaluated in a previous research) and P, in the landraces adapted to low N, allowed to select four landraces with high yield and high gluten strength for low N production.

Use of STATCOM in wind farms with fixed-speed generators for grid code compliance

The increasing penetration of wind energy into power systems has pushed grid operators to set new requirements for this kind of generating plants in order to keep acceptable and reliable operation of the system. In addition to the low voltage ride through capability, wind farms are required to participate in voltage support, stability enhancement and power quality improvement. This paper presents a solution for wind farms with fixed-speed generators based on the use of STATCOM with braking resistor and additional series impedances, with an adequate control strategy. The focus is put on guaranteeing the grid code compliance when the wind farm faces an extensive series of grid disturbances.

Application of user-centered design in the development of an atomated/assisted testing system for self-service devices

Automated Teller Machines (ATMs) are sensitive self-service systems that require important investments in security and testing. ATM certifications are testing processes for machines that integrate software components from different vendors and are performed before their deployment for public use. This project was originated from the need of optimization of the certification process in an ATM manufacturing company. The process identifies compatibility problems between software components through testing. It is composed by a huge number of manual user tasks that makes the process very expensive and error-prone. Moreover, it is not possible to fully automate the process as it requires human intervention for manipulating ATM peripherals. This project presented important challenges for the development team. First, this is a critical process, as all the ATM operations rely on the software under test. Second, the context of use of ATMs applications is vastly different from ordinary software. Third, ATMs’ useful lifetime is beyond 15 years and both new and old models need to be supported. Fourth, the know-how for efficient testing depends on each specialist and it is not explicitly documented. Fifth, the huge number of tests and their importance implies the need for user efficiency and accuracy. All these factors led us conclude that besides the technical challenges, the usability of the intended software solution was critical for the project success. This business context is the motivation of this Master Thesis project. Our proposal focused in the development process applied. By combining user-centered design (UCD) with agile development we ensured both the high priority of usability and the early mitigation of software development risks caused by all the technology constraints. We performed 23 development iterations and finally we were able to provide a working solution on time according to users’ expectations. The evaluation of the project was carried out through usability tests, where 4 real users participated in different tests in the real context of use. The results were positive, according to different metrics: error rate, efficiency, effectiveness, and user satisfaction. We discuss the problems found, the benefits and the lessons learned in the process. Finally, we measured the expected project benefits by comparing the effort required by the current and the new process (once the new software tool is adopted). The savings corresponded to 40% less effort (man-hours) per certification. Future work includes additional evaluation of product usability in a real scenario (with customers) and the measuring of benefits in terms of quality improvement.

Respuesta adaptada a las necesidades específicas de estudiantes con de espectro austista (TEA) trastorno en la materia de tecnología

El trabajo desarrollado pretende dar a conocer cuales son las necesidades especificas de alumnos con trastorno del espectro autista (TEA).Se enmarca en los estudios que afrontan la temática de la Atención a Diversidad y la inclusión de los alumnos con TEA en centros ordinarios educativos. Se pretende desarrollar recursos metodológicos para ofrecer una respuesta adaptativa ante el reto de afrontar las competencias clave a través de la nueva asignatura de “Tecnología, programación y robótica”; Para ello se analizan las características de cuatro estudiantes con TEA escolarizados en secundaria del centro concertado Colegio Lourdes (FUHEM) de la comunidad de Madrid y se ofrecen respuestas diferentes en función de ellas, apoyándonos en sus fortalezas para vencer sus dificultades, con el objetivo de alcanzar las mismas competencias claveque el resto de compañeros, como marca la Ley Orgánica de Mejora de la Calidad de la Educación, LOMCE, que entra en vigor en este nivel en el curso 2015-2016. ABSTRACT The developed work seeks to highlight what are the specific needs of students with autism spectrum (ASDs).The part of the studies faced the issue of Attention to diversity and the inclusion of students with ASD in mainstream schools educational disorder. It aims to develop methodological resources to offer an adaptive response to the challenge of addressing key skills through the new subject of "Technology, Programming and Robotics"; To do the characteristics of four students with ASD are discussed in secondary school concerted Lourdes (FUHEM) of the Madrid and different responses depending on them are offered, building on their strengths to overcome their difficulties, in order to achieve the same core competencies of other colleagues as brand organic law of Quality Improvement of Education, LOMCE, which takes effect in the 2015-2016 year.

Compostabilidad de envases de bolsas de PBAT+PLA y envases rígidos de PLA mediante tecnologías de pila y túnel

Los polímeros compostables suponen en torno al 30% de los bioplásticos destinados a envasado, siendo a su vez esta aplicación el principal destino de la producción de este tipo de materiales que, en el año 2013, superó 1,6 millones de toneladas. La presente tesis aborda la biodegradación de los residuos de envases domésticos compostables en medio aerobio para dos tipos de formato y materiales, envase rígido de PLA (Clase I) y dos tipos de bolsas de PBAT+PLA (Clases II y III). Sobre esta materia se han realizado diversos estudios en escala de laboratorio pero para otro tipo de envases y biopolímeros y bajo condiciones controladas del compost con alguna proyección particularizada en plantas. La presente tesis da un paso más e investiga el comportamiento real de los envases plásticos compostables en la práctica del compostaje en tecnologías de pila y túnel, tanto a escala piloto como industrial, dentro del procedimiento y con las condiciones ambientales de instalaciones concretas. Para ello, con el método seguido, se han analizado los requisitos básicos que debe cumplir un envase compostable, según la norma UNE – EN 13432, evaluando el porcentaje de biodegradación de los envases objeto de estudio, en función de la pérdida de peso seco tras el proceso de compostaje, y la calidad del compost obtenido, mediante análisis físico-químico y de fitotoxicidad para comprobar que los materiales de estudio no aportan toxicidad. En cuanto a los niveles de biodegrabilidad, los resultados permiten concluir que los envases de Clase I se compostan adecuadamente en ambas tecnologías y que no requieren de unas condiciones de proceso muy exigentes para alcanzar niveles de biodegradación del 100%. En relación a los envases de Clase II, se puede asumir que se trata de un material que se composta adecuadamente en pila y túnel industrial pero que requiere de condiciones exigentes para alcanzar niveles de biodegradación del 100% al afectarle de forma clara la ubicación de las muestras en la masa a compostar, especialmente en el caso de la tecnología de túnel. Mientras el 90% de las muestras alcanza el 100% de biodegradación en pila industrial, tan sólo el 50% lo consigue en la tecnología de túnel a la misma escala. En cuanto a los envases de Clase III, se puede afirmar que es un material que se composta adecuadamente en túnel industrial pero que requiere de condiciones de cierta exigencia para alcanzar niveles de biodegradación del 100% al poderle afectar la ubicación de las muestras en la masa a compostar. El 75% de las muestras ensayadas en túnel a escala industrial alcanzan el 100% de biodegradación y, aunque no se ha ensayado este tipo de envase en la tecnología de pila al no disponer de muestras, cabe pensar que los resultados de biodegrabilidad que hubiera podido alcanzar habrían sido, como mínimo, los obtenidos para los envases de Clase II, al tratarse de materiales muy similares en composición. Por último, se concluye que la tecnología de pila es más adecuada para conseguir niveles de biodegradación superiores en los envases tipo bolsa de PBAT+PLA. Los resultados obtenidos permiten también sacar en conclusión que, en el diseño de instalaciones de compostaje para el tratamiento de la fracción orgánica recogida selectivamente, sería conveniente realizar una recirculación del rechazo del afino del material compostado para aumentar la probabilidad de someter este tipo de materiales a las condiciones ambientales adecuadas. Si además se realiza un triturado del residuo a la entrada del proceso, también se aumentaría la superficie específica a entrar en contacto con la masa de materia orgánica y por tanto se favorecerían las condiciones de biodegradación. En cuanto a la calidad del compost obtenido en los ensayos, los resultados de los análisis físico – químicos y de fitotoxicidad revelan que los niveles de concentración de microorganismo patógenos y de metales pesados superan, en la práctica totalidad de las muestras, los niveles máximos permitidos en la legislación vigente aplicable a productos fertilizantes elaborados con residuos. Mediante el análisis de la composición de los envases ensayados se constata que la causa de esta contaminación reside en la materia orgánica utilizada para compostar en los ensayos, procedente del residuo de origen doméstico de la denominada “fracción resto”. Esta conclusión confirma la necesidad de realizar una recogida selectiva de la fracción orgánica en origen, existiendo estudios que evidencian la mejora de la calidad del residuo recogido en la denominada “fracción orgánica recogida selectivamente” (FORM). Compostable polymers are approximately 30% of bioplastics used for packaging, being this application, at same time, the main destination for the production of such materials exceeded 1.6 million tonnes in 2013. This thesis deals with the biodegradation of household packaging waste compostable in aerobic medium for two format types and materials, rigid container made of PLA (Class I) and two types of bags made of PBAT + PLA (Classes II and III). There are several studies developed about this issue at laboratory scale but for other kinds of packaging and biopolymers and under composting controlled conditions with some specifically plants projection. This thesis goes one step further and researches the real behaviour of compostable plastic packaging in the composting practice in pile and tunnel technologies, both at pilot and industrial scale, within the procedure and environmental conditions of concrete devices. Therefore, with a followed method, basic requirements fulfilment for compostable packaging have been analysed according to UNE-EN 13432 standard. It has been assessed the biodegradability percentage of the packaging studied, based on loss dry weight after the composting process, and the quality of the compost obtained, based on physical-chemical analysis to check no toxicity provided by the studied materials. Regarding biodegradability levels, results allow to conclude that Class I packaging are composted properly in both technologies and do not require high exigent process conditions for achieving 100% biodegradability levels. Related to Class II packaging, it can be assumed that it is a material that composts properly in pile and tunnel at industrial scale but requires exigent conditions for achieving 100% biodegradability levels for being clearly affected by sample location in the composting mass, especially in tunnel technology case. While 90% of the samples reach 100% of biodegradation in pile at industrial scale, only 50% achieve it in tunnel technology at the same scale. Regarding Class III packaging, it can be said that it is a material properly composted in tunnel at industrial scale but requires certain exigent conditions for reaching 100% biodegradation levels for being possibly affected by sample location in the composting mass. The 75% of the samples tested in tunnel at industrial scale reaches 100% biodegradation. Although this kind of packaging has not been tested on pile technology due to unavailability of samples, it is judged that biodegradability results that could be reached would have been, at least, the same obtained for Class II packaging, as they are very similar materials in composition. Finally, it is concluded that pile technology is more suitable for achieving highest biodegradation levels in bag packaging type of PBAT+PLA. Additionally, the obtained results conclude that, in the designing of composting devices for treatment of organic fraction selectively collected, it would be recommended a recirculation of the refining refuse of composted material in order to increase the probability of such materials to expose to proper environmental conditions. If the waste is grinded before entering the process, the specific surface in contact with organic material would also be increased and therefore biodegradation conditions would be more favourable. Regarding quality of the compost obtained in the tests, physical-chemical and phytotoxicity analysis results reveal that pathogen microorganism and heavy metals concentrations exceed, in most of the samples, the maximum allowed levels by current legislation for fertilizers obtained from wastes. Composition analysis of tested packaging verifies that the reason for this contamination is the organic material used for composting tests, comes from the household waste called “rest fraction”. This conclusion confirms the need of a selective collection of organic fraction in the origin, as existing studies show the quality improvement of the waste collected in the so-called “organic fraction selectively collected” (FORM).

Maternal death and obstetric care audits in Nigeria : a systematic review of barriers and enabling factors in the provision of emergency care

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INP

Percepção do clima de segurança do paciente em instituições hospitalares

Quase um em cada dez pacientes é lesionado ao receber cuidados de saúde e, destes, muitos sofrem lesões incapacitantes ou morte todos os anos. Entendendo a importância e o impacto negativo das falhas na segurança do paciente em âmbito global e a influência que a cultura e o clima de segurança exercem sobre a adoção de ações e decisões mais seguras, este estudo teve por objetivo a analise da cultura de segurança do paciente em instituições hospitalares, por meio da mensuração do clima de segurança. Trata-se de pesquisa quantitativa, transversal, do tipo Survey, em que para a realização da coleta de dados foi aplicado o Questionário de Atitudes de Segurança, adaptação transcultural para o Brasil do Safety Attitudes Questionnaire (SAQ) - Short Form 2006. O estudo ocorreu em dois hospitais gerais do estado de São Paulo, localizados em diferentes regiões metropolitanas, sendo um público e o outro privado. Os profissionais Médicos, Enfermeiros, Técnicos e Auxiliares de Enfermagem, Fisioterapeutas, Farmacêuticos e Nutricionistas, que atuavam nestes hospitais há pelo menos 6 meses, com carga horária de trabalho semanal de no mínimo 20 horas, constituíram a população deste estudo. Foi realizado um estudo piloto com 25 profissionais em cada hospital e a prevalência resultante deste teste foi utilizada no cálculo do tamanho amostral com nível de significância de 5%, erro relativo de 10% e perda de 20%, resultando em um total de 235 participantes. Os profissionais escolhidos como parte da amostra foram sorteados empregando-se amostragem aleatória simples computadorizada. As variáveis de cada domínio da escala quando testadas pelo Teste Kolmogorov-Smirnov não apresentaram normalidade. Deste modo, foi aplicado o Teste Mann-Whitney para comparar os valores das pontuações entre os hospitais e entre as categorias profissionais. Com relação aos resultados houve índice de participação de 86,8% da amostra sorteada, prevalecendo os sujeitos com 5 a 20 anos de tempo na especialidade, do gênero feminino, e trabalhadores da enfermagem. Não houve diferenças significantes dentre as pontuações obtidas pelos dois hospitais. Os participantes do estudo apresentaram percepção negativa quanto ao clima de segurança do paciente, com domínios Reconhecimento do Estresse e Percepção da Gestão apresentando resultados negativos, tanto para a amostra como um todo quanto por hospital. Os domínios Clima de Trabalho em Equipe, Satisfação no Trabalho e Comportamento Seguro/Práticas Seguras resultaram em percepções positivas para todas as categorias profissionais. Já o domínio Percepção da Gestão do Hospital resultou em percepção negativa para todas estas. Os Médicos e os Técnicos e Auxiliares de Enfermagem apresentaram percepções negativas em mais domínios. Em contrapartida, os Enfermeiros foram os únicos a apresentar atitude de segurança do paciente positiva, com escore total do SAQ exibindo diferença significante quando comparado a todas as outras categorias, apresentando também percepção positiva em maior número de domínios. Concluiu-se que existe a necessidade de abordagem relacionada ao Reconhecimento do Estresse dos profissionais, além dos aspectos do Gerenciamento. As categorias profissionais diferiram entre si com relação às percepções sobre a atitude de segurança do paciente. Desta forma, o desenvolvimento da cultura de segurança deve englobar todas as categorias profissionais, uma vez que esta abrange toda a organização, destacando-se a necessidade de enfoque de ações com relação a categoria dos Médicos e dos Técnicos e Auxiliares de Enfermagem. Além disso, ficou evidente o papel de destaque e liderança dos profissionais Enfermeiros nos processos de melhoria da qualidade, e colocando-os em posição privilegiada para conduzir os esforços de melhoria contínua da qualidade nos serviços de saúde

Singularidades da intervenção psicológica nos cuidados paliativos

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica da Diretora da ESALD Doutora Ana Paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco, e orientação científica do Assistente Convidado pela Escola Superior de Saúde Dr. Lopes Dias, Mestre Eduardo Manuel Neves Oliveira Carqueja.

The Economics of EU Railway Reform. Bruges European Economic Policy (BEEP) Briefing 8/2004

The EU began railway reform in earnest around the turn of the century. Two ‘railway packages’ have meanwhile been adopted amounting to a series of directives and a third package has been proposed. A range of complementary initiatives has been undertaken or is underway. This BEEP Briefing inspects the main economic aspects of EU rail reform. After highlighting the dramatic loss of market share of rail since the 1960s, the case for reform is argued to rest on three arguments: the need for greater competitiveness of rail, promoting the (market driven) diversion of road haulage to rail as a step towards sustainable mobility in Europe, and an end to the disproportional claims on public budgets of Member States. The core of the paper deals respectively with market failures in rail and in the internal market for rail services; the complex economic issues underlying vertical separation (unbundling) and pricing options; and the methods, potential and problems of introducing competition in rail freight and in passenger services. Market failures in the rail sector are several (natural monopoly, economies of density, safety and asymmetries of information), exacerbated by no less than 7 technical and legal barriers precluding the practical operation of an internal rail market. The EU choice to opt for vertical unbundling (with benefits similar in nature as in other network industries e.g. preventing opaque cross-subsidisation and greater cost revelation) risks the emergence of considerable coordination costs. The adoption of marginal cost pricing is problematic on economic grounds (drawbacks include arbitrary cost allocation rules in the presence of large economies of scope and relatively large common costs; a non-optimal incentive system, holding back the growth of freight services; possibly anti-competitive effects of two-part tariffs). Without further detailed harmonisation, it may also lead to many different systems in Member States, causing even greater distortions. Insofar as freight could develop into a competitive market, a combination of Ramsey pricing (given the incentive for service providers to keep market share) and price ceilings based on stand-alone costs might be superior in terms of competition, market growth and regulatory oversight. The incipient cooperative approach for path coordination and allocation is welcome but likely to be seriously insufficient. The arguments to introduce competition, notably in freight, are valuable and many e.g. optimal cross-border services, quality differentiation as well as general quality improvement, larger scale for cost recovery and a decrease of rent seeking. Nevertheless, it is not correct to argue for the introduction of competition in rail tout court. It depends on the size of the market and on removing a host of barriers; it requires careful PSO definition and costing; also, coordination failures ought to be pre-empted. On the other hand, reform and competition cannot and should not be assessed in a static perspective. Conduct and cost structures will change with reform. Infrastructure and investment in technology are known to generate enormous potential for cost savings, especially when coupled with the EU interoperability programme. All this dynamism may well help to induce entry and further enlarge the (net) welfare gains from EU railway reform. The paper ends with a few pointers for the way forward in EU rail reform.