Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, CI95% $595-$895, n = 13) were significantly lower (p < 0.01) than the hospital group ($2543, CI95% $1766-$3321, n = 12). There was an improvement in lung function in the hospital-managed group at the Outpatient Department review, decreased anxiety in the Emergency Department in the home-managed group and equal patient satisfaction with care delivery. Acute care at home schemes can substitute for usual hospital care for some patients without adverse effects, and potentially release resources. A funding model that allows adequate resource delivery to the community will be needed if there is a move to devolve acute care to community providers.

Was there a second adaptive radiation of giant tortoises in the Indian Ocean? Using mitochondrial DNA to investigate speciation and biogeography of Aldabrachelys (Reptilia, Testudinidae)

A radiation of five species of giant tortoises (Cylindraspis ) existed in the southwest Indian Ocean, on the Mascarene islands, and another (of Aldabrachelys ) has been postulated on small islands north of Madagascar, from where at least eight nominal species have been named and up to five have been recently recognized. Of 37 specimens of Madagascan and small-island Aldabrachelys investigated by us, 23 yielded significant portions of a 428-base-pair (bp) fragment of mitochondrial (cytochrome b and tRNA-Glu), including type material of seven nominal species (A. arnoldi, A. dussumieri, A. hololissa, A. daudinii, A. sumierei, A. ponderosa and A. gouffei ). These and nearly all the remaining specimens, including 15 additional captive individuals sequenced previously, show little variation. Thirty-three exhibit no differences and the remainder diverge by only 1-4 bp (0.23-0.93%). This contrasts with more widely accepted tortoise species which show much greater inter- and intraspecific differences. The non-Madagascan material examined may therefore only represent a single species and all specimens may come from Aldabra where the common haplotype is known to occur. The present study provides no evidence against the Madagascan origin for Aldabra tortoises suggested by a previous molecular phylogenetic analysis, the direction of marine currents and phylogeography of other reptiles in the area. Ancient mitochondrial DNA from the extinct subfossil A. grandidieri of Madagascar differs at 25 sites (5.8%) from all other Aldabrachelys samples examined here.

Existence of multiple solutions for finite difference approximations to second-order boundary value problems

Error condition detected We consider discrete two-point boundary value problems of the form D-2 y(k+1) = f (kh, y(k), D y(k)), for k = 1,...,n - 1, (0,0) = G((y(0),y(n));(Dy-1,Dy-n)), where Dy-k = (y(k) - Yk-I)/h and h = 1/n. This arises as a finite difference approximation to y" = f(x,y,y'), x is an element of [0,1], (0,0) = G((y(0),y(1));(y'(0),y'(1))). We assume that f and G = (g(0), g(1)) are continuous and fully nonlinear, that there exist pairs of strict lower and strict upper solutions for the continuous problem, and that f and G satisfy additional assumptions that are known to yield a priori bounds on, and to guarantee the existence of solutions of the continuous problem. Under these assumptions we show that there are at least three distinct solutions of the discrete approximation which approximate solutions to the continuous problem as the grid size, h, goes to 0. (C) 2003 Elsevier Science Ltd. All rights reserved.

Basis set convergence in Hartree-Fock calculations of some diatomic molecules containing first and second-row atoms

Investiga-se a convergência de conjuntos de bases em direção ao limite numérico da energia Hartree-Fock (HF) total para as seqüências hierárquicas dos conjuntos de bases XZP e ccpVXZ. Para as duas hierarquias, melhoramentos significativos são obtidos com cada incremento em X. Para estimar o limite do conjunto de base completo, uma forma exponencial foi usada. Entre as várias aproximações consideradas aqui, uma extrapolação exponencial de três parâmetros aplicada aos resultados TZP, QZP e 5ZP deu os limites do conjunto de bases mais precisos. Em adição, energias HF dos orbitais moleculares ocupados mais altos de algumas moléculas diatômicas foram calculadas com o conjunto 5ZP e comparadas com as correspondentes obtidas com o conjunto cc-pV5Z e com um método numérico HF.

Percepção dos agentes comunitários de saúde frente ao risco de infecção da tuberculose

A Tuberculose é um serio problema de saúde, os níveis mundiais no ano 2011 ocorreram 8,7 milhões de casos novos e 1,4 milhões de pessoas morreram de TB. Para horizontalizar as ações no combate da TB na atenção primaria o Agente Comunitário de Saúde assume um papel muito importante, pois eles além de trabalhar na comunidade onde mora ele é um mediador de saberes, espera-se que esse profissional seja capaz de identificar por meio de visitas domiciliares sintomáticos respiratórios. Objetivos: Conhecer a percepção que os ACS têm sobre o risco de infecção à tuberculose no cotidiano de sua prática profissional e analisar como eles se organizam e estruturam sua prática frente a essa percepção. Abordagem Metodológica: O estudo foi dividido em duas fases a primeira responde ao primer objetivo e foi escolhido o Grupo Focal e para a segunda fase que responde ao segundo objetivo foi escolhido a Observação Participante como técnicas de trabalho em campo e Analise de Conteúdo Temático como técnica de análise das informações colhidas que consiste em descobrir os núcleos de sentidos que são temas os quais são unidades de significação que se libertam naturalmente de um texto analisado. Resultados: Na primeira fase do estudo observou-se que o Agente Comunitário de Saúde percebe os riscos que estão expostos, mas muitas vezes eles não sabem como agir em situações, especificas, na segunda fase indicam que o risco não esta presente o tempo todo na vida e no trabalho deles. Conclusão: O PACS é apresentado pelo Ministério da Saúde como uma estratégia de saúde para horizontalizar as ações no controle da TB, neste estudo foi encontrado que o ACS percebe o risco que esta exposto, mas que aquele risco não esta sempre presenta na vida deles, pois eles muitas vezes minimizam os riscos pensando que nada acontece nem acontecera com eles.

Sensor-driven agenda for intelligent home care of the elderly

The exponential increase of home-bound persons who live alone and are in need of continuous monitoring requires new solutions to current problems. Most of these cases present illnesses such as motor or psychological disabilities that deprive of a normal living. Common events such as forgetfulness or falls are quite common and have to be prevented or dealt with. This paper introduces a platform to guide and assist these persons (mostly elderly people) by providing multisensory monitoring and intelligent assistance. The platform operates at three levels. The lower level, denominated ‘‘Data acquisition and processing’’performs the usual tasks of a monitoring system, collecting and processing data from the sensors for the purpose of detecting and tracking humans. The aim is to identify their activities in an intermediate level called ‘‘activity detection’’. The upper level, ‘‘Scheduling and decision-making’’, consists of a scheduler which provides warnings, schedules events in an intelligent manner and serves as an interface to the rest of the platform. The idea is to use mobile and static sensors performing constant monitoring of the user and his/her environment, providing a safe environment and an immediate response to severe problems. A case study on elderly fall detection in a nursery home bedroom demonstrates the usefulness of the proposal.

Find It - An Assistant Home Agent

Cognitive impaired population face with innumerable problems in their daily life. Surprisingly, they are not provided with any help to perform those tasks for which they have difficulties. As a consequence, it is necessary to develop systems that allow those people to live independently and autonomously. Living in a technological era, people could take advantage of the available technology, being provided with some solutions to their needs. This paper presents a platform that assists users with remembering where their possessions are. Mainly, an object recognition process together with an intelligent scheduling applications are integrated in an Ambient Assisted Living (AAL) environment.

Travel preferences of the residents of Guimarães: a revised model of push and pull motives

The historic center of the Portuguese city of Guimarães is a world heritage site (UNESCO) since 2001, having hosted the European Capital of Culture (ECOC) in 2012. In this sense, Guimarães has made a major effort in promoting tourism, positioning itself as an urban and cultural tourism destination. The present paper has two objectives. The first, to examine if an existing push and pull motivation model finds statistical support with regard to the population of the municipality of Guimarães, a cultural tourism destination. The second, to study the role that important socio-demographic variables, such as gender, age, and education, play in determining travel motivations of residents from this municipality. Insight on tourism motivation may be an important policy tool for tourism planners and managers in the development of products and marketing strategies. The empirical analysis is undertaken based on questionnaires administered in 2012 to residents of Guimarães. The present study shows that gender, age and education make a difference with regard to travel motivations.

Gender wage and productivity differentials in the Portuguese tourism industry

The objective of this paper is to provide empirical evidence on the determinants of gender wage inequality in the Portuguese tourism industry. Relying on firm level wage equations and production functions, gender wage and productivity differentials are estimated and then compared in order to infer whether observed gender disparities are justifiable on the grounds that women are relatively less productive than men, or instead disparities are due to gender wage discrimination. This approach is applied to tourism industry data gathered in the matched employer-employee data set Quadros de Pessoal (Employee Records). The main findings indicate that female employees in the tourism industry in Portugal are less productive than their male colleagues and that gender differences in wages are fully explained by gender differences in productivity.

Gender, wages, and productivity: an analysis of the tourism industry in northern Portugal

Tourism represents a major economic activity in Portugal, with an enormous wealth and employment growth potential. A significant proportion of jobs in the industry tourism are occupied by women, given that this industry is characterized by a relatively higher percentage of female employees. Despite the evidence of female progress with regard to their role in the Portuguese labor market, women continue to earn less than their male counterparts. This is clearly the case of the tourism industry, where statistics reveal a persistent gender wage gap. The objective of this paper is to provide empirical evidence on the determinants of gender wage inequality in the tourism industry in northern Portugal. Relying on firm-level wage equations and production functions, gender wage and productivity differentials are estimated and then compared. The comparison of these differentials allows inferring whether observed wage disparities are attributable to relatively lower female productivity, or instead disparities are due to gender wage discrimination. This approach is applied to tourism industry data gathered in the matched employer-employee data set Quadros de Pessoal (Employee Records). The main findings indicate that female employees in the tourism industry in northern Portugal are less productive than their male colleagues and that gender differences in wages are fully explained by gender differences in productivity.

Residents’ perceptions of tourism impacts in Guimarães (Portugal): a cluster analysis

In this investigation, a cluster analysis was used to separate Guimara˜es (Portugal) residents into clusters according to their perceptions of the impacts of tourism development. This approach is uncommonly applied to Portugal data and is even rarer for world heritage sites. The world heritage designation is believed to make an area more attractive to tourists. The clustering procedure analysed 400 data observations from a Guimara˜es resident survey and revealed the existence of three clusters: the Sceptics, the Moderately Optimistic and the Enthusiasts. The results were consistent with the empirical literature’s results, with the emergent nature of the destination found to be relevant. The fact that tourism is relatively recent in this destination has its major reflex in the devaluation by most of the residents of the negative impacts of tourism development.

Cultural tourism in Northwest Portugal – the case of the world heritage site of Guimarães

A cidade de Guimarães, no noroeste português, é um espaço imbuído de um forte significado simbólico e cultural. A acreditação pela U.N.E.S.C.O. do seu centro histórico como Património Cultural da Humanidade, em Dezembro de 2001, contribuiu significativamente para aumentar o seu potencial em termos turísticos. Na realidade, desde aquela data, tem-se assistido a um aumento sustentado do número de visitantes. O presente capítulo debruça-se sobre a análise de alguns resultados de um inquérito por questionário aplicado aos residentes do município de Guimarães com o objetivo de avaliar a sua perceção dos benefícios que a atividade turística pode trazer. O inquérito foi implementado entre Janeiro e Março de 2010. Os resultados mostram que aqueles revelam uma perceção favorável dos impactos do turismo e que esta perceção está correlacionada com a idade e o nível de instrução dos inquiridos.