Use of an accelerated chest pain assessment protocol in patients at intermediate risk of adverse cardiac events

Objective: To determine the feasibility, safety and effectiveness of a structured clinical pathway for stratification and management of patients presenting with chest pain and classified as having intermediate risk of adverse cardiac outcomes in the subsequent six months. Design: Prospective clinical audit. Participants and setting: 630 consecutive patients who presented to the emergency department of a metropolitan tertiary care hospital between January 2000 and June 2001 with chest pain and intermediate-risk features. Intervention: Use of the Accelerated Chest Pain Assessment Protocol (ACPAP), as advocated by the Management of unstable angina guidelines - 2000 from the National Heart Foundation and the Cardiac Society of Australia and New Zealand. Main outcome measure: Adverse cardiac events during six-month follow-up. Results: 409 patients (65%) were reclassified as low risk and discharged at a mean of 14 hours after assessment in the chest pain unit. None had missed myocardial infarctions, while three (1%) had cardiac events at six months (all elective revascularisation procedures, with no readmissions with acute coronary syndromes). Another 110 patients (17%) were reclassified as high risk, and 21 (19%) of these had cardiac events (mainly revascularisations) by six months. Patients who were unable to exercise or had non-diagnostic exercise stress test results (equivocal risk) had an intermediate cardiac event rate (8%). Conclusions: This study validates use of ACPAP. The protocol eliminated missed myocardial infarction; allowed early, safe discharge of low-risk patients; and led to early identification and management of high-risk patients.

Knowledge-based system on optimum design of liquid retaining structures with genetic algorithms

This paper delineates the development of a prototype hybrid knowledge-based system for the optimum design of liquid retaining structures by coupling the blackboard architecture, an expert system shell VISUAL RULE STUDIO and genetic algorithm (GA). Through custom-built interactive graphical user interfaces under a user-friendly environment, the user is directed throughout the design process, which includes preliminary design, load specification, model generation, finite element analysis, code compliance checking, and member sizing optimization. For structural optimization, GA is applied to the minimum cost design of structural systems with discrete reinforced concrete sections. The design of a typical example of the liquid retaining structure is illustrated. The results demonstrate extraordinarily converging speed as near-optimal solutions are acquired after merely exploration of a small portion of the search space. This system can act as a consultant to assist novice designers in the design of liquid retaining structures.

A coupled knowledge-based expert system for design of liquid-retaining structures

This paper describes a coupled knowledge-based system (KBS) for the design of liquid-retaining structures, which can handle both the symbolic knowledge processing based on engineering heuristics in the preliminary synthesis stage and the extensive numerical crunching involved in the detailed analysis stage. The prototype system is developed by employing blackboard architecture and a commercial shell VISUAL RULE STUDIO. Its present scope covers design of three types of liquid-retaining structures, namely, a rectangular shape with one compartment, a rectangular shape with two compartments and a circular shape. Through custom-built interactive graphical user interfaces, the user is directed throughout the design process, which includes preliminary design, load specification, model generation, finite element analysis, code compliance checking and member sizing optimization. It is also integrated with various relational databases that provide the system with sectional properties, moment and shear coefficients and final member details. This system can act as a consultant to assist novice designers in the design of liquid-retaining structures with increase in efficiency and optimization of design output and automated record keeping. The design of a typical example of the liquid-retaining structure is also illustrated. (C) 2003 Elsevier B.V All rights reserved.

Multilayer transverse gradient coil design

In small, cylindrical gradient coils consisting of a single layer of wires, the limiting factor in achieving large magnetic field gradients is the rapid increase in coil resistance with efficiency. This behavior results from the decrease in the maximum usable wire diameter as the number of turns is increased. By adopting a multilayer design in which the coil wires are allowed to spread out into multiple layers wound at increasing radii, a more favorable scaling of resistance with efficiency is achieved, thus allowing the design of more powerful gradient coils with acceptable resistance values. By extending the theory used to design standard cylindrical gradient coils, mathematical expressions have been developed that allow the design of multilayer coils. These expressions have previously been applied to the design of a four-layer z-gradient coil. As a further development, the equations have now been modified to allow the design of multilayer transverse gradient coils. The variation in coil performance with the number of layers employed has been investigated for coils of a size suitable for use in NMR microscopy, and the effect of constructing the coil using wires or cuts in a continuous conducting surface has also been assessed. We find that at fixed resistance a small wire-wound two-layer coil offers an increase in efficiency of a factor of about 1.5 compared with a single-layer coil. In addition, a two-layer coil of 10-mm inner diameter has been designed and built. This coil had an efficiency of 0.41 Tm-1 A(-1), a resistance of 0.96 +/- 0.01 Omega, and an inductance of 22.3 +/- 0.2 muH. The coil produces a gradient that deviates from linearity by less than 5% over a central cylindrical region of interest of height and length 6.2 mm. (C) 2003 Wiley Periodicals, Inc.

Balancing the number and size of sites: An economic approach to the optimal design of cluster samples

The design of randomized controlled trials entails decisions that have economic as well as statistical implications. In particular, the choice of an individual or cluster randomization design may affect the cost of achieving the desired level of power, other things being equal. Furthermore, if cluster randomization is chosen, the researcher must decide how to balance the number of clusters, or sites, and the size of each site. This article investigates these interrelated statistical and economic issues. Its principal purpose is to elucidate the statistical and economic trade-offs to assist researchers to employ randomized controlled trials that have desired economic, as well as statistical, properties. (C) 2003 Elsevier Inc. All rights reserved.

Effect of lifter design on drying performance in rotary dryers

Lifter use in dryers improves mass transfer by increasing the amount of surface area available for transfer and also by increasing the velocity of gas over the particle surface. An even cross-sectional distribution of particles in a dryer improves the efficiency of operation by ensuring that evaporation from falling particles is taking place for the maximum fraction of the rotation period of the drier. Studies on lifter design to improve the cross-sectional particle distribution were performed on angled lifters. A single lifter was used and the mass-transfer rate examined as a function of angular lifter displacement. Analysis of the mass transfer characteristics of single lifters allowed performance comparisons and recommendations for lifter design.

Conhecimento organizacional em escolas de governo: um estudo comparado

Como reflexo de uma tend??ncia que tem ganhado import??ncia crescente nas organiza????es p??blicas, privadas e n??o governamentais do Brasil e do mundo, a tem??tica gest??o do conhecimento motivou a realiza????o desta pesquisa, cujo foco imediato ?? fornecer subs??dios para auxiliar organiza????es p??blicas como escolas de governo em seus processos de desenvolvimento de conhecimento organizacional. Este conhecimento ?? criado mediante a intera????o dos conhecimentos t??cito e expl??cito. A intera????o entre eles pode ser verificada por meio de quatro convers??es, as quais formam um ciclo do conhecimento organizacional: a socializa????o, a externaliza????o, a combina????o e a internaliza????o. O estudo em quest??o visa apresentar um conjunto de crit??rios representantes do ciclo de desenvolvimento do conhecimento organizacional e, mediante an??lise comparada entre sete escolas de governo internacionais e uma nacional, a Funda????o Escola Nacional de Administra????o P??blica (Enap), elaborar o desenho de uma estrutura organizacional que maximize o desenvolvimento do conhecimento organizacional em escolas de governo.

Federalismo e rela????es intergovernamentais: os cons??rcios p??blicos como instrumento de coopera????o federativa

Se nos estados federais os mecanismos de coopera????o e coordena????o intergovernamental j?? s??o relevantes, no caso brasileiro eles ganham centralidade ainda maior. A Constitui????o Federal de 1988 agregou complexidade ao desenho federativo brasileiro, reconhecendo o munic??pio como ente federado. Esse processo foi acompanhado por intensa descentraliza????o de pol??ticas p??blicas, pelo fortalecimento do poder local e por mecanismos pouco coordenados de rela????o vertical e horizontal entre os entes federativos. Ao mesmo tempo, a aus??ncia de pol??ticas de desenvolvimento regional acentuou as desigualdades locais e regionais observadas historicamente no pa??s. Diferentes experi??ncias de consorciamento foram levadas a cabo por munic??pios no pa??s e ainda hoje esse ?? um instrumento de larga utiliza????o. De forma diversa, as iniciativas de coopera????o entre estados s??o ainda incipientes. As limita????es institucionais e jur??dicas dos desenhos utilizados pelos munic??pios, no entanto, levaram ?? aprova????o da Emenda Constitucional n?? 19/98, que instituiu os cons??rcios p??blicos e a gest??o associada de servi??os p??blicos.

Conselhos municipais de pol??ticas p??blicas: uma an??lise explorat??ria

Os Conselhos Gestores s??o f??runs h??bridos onde se viabiliza a participa????o popular no desenho das pol??ticas p??blicas, nas negocia????es de interesses da coletividade, na elabora????o de programas e projetos sociais e na fiscaliza????o das a????es governamentais. O significado e a dimens??o dos Conselhos para a democracia participativa s??o enormes, justificando a import??ncia da realiza????o deste estudo, que se baseou na an??lise explorat??ria de 12 Conselhos locais do munic??pio mineiro de Vi??osa, com o objetivo de avaliar o desempenho dos mesmos. A avalia????o do desempenho levou em considera????o os mesmos par??metros dimensionais, tanto para a coleta de dados prim??rios quanto para a coleta secund??ria. A coleta de dados prim??rios foi realizada a partir da aplica????o de question??rios semi-estruturados aos presidentes dos Conselhos em an??lise. Utilizou-se o programa SPSS, vers??o 15.0, para an??lise estat??stica das quest??es objetivas dos question??rios e a t??cnica de an??lise de conte??do para exame das quest??es abertas. Ap??s essa etapa, realizou-se um workshop com os presidentes dos Conselhos, visando ?? obten????o de novos dados e informa????es. Os Conselhos municipais analisados apresentaram resultados pouco discrepantes entre a teoria aplicada ao tema e a sua efetiva pr??tica no campo p??blico. Contudo, a pesquisa revelou que o grau de desenvolvimento institucional dos Conselhos n??o ?? homog??neo, ou seja, h?? alguns melhores gestores que outros. A escolha independente e democr??tica dos membros n??o-governamentais dos Conselhos em Vi??osa revelou o seu grau de independ??ncia do Poder Executivo. Por??m, a capacita????o de conselheiros precisa ser implementada para evitar uma desfigura????o dos Conselhos. No que tange ?? governan??a, destacouse em Vi??osa o seu grau e formas de aplicabilidade observadas na gest??o de v??rias pol??ticas. Da mesma forma, foi observado um n??vel de governabilidade que confere legitimidade ??s pol??ticas implementadas. Por fim, verificou-se que a efetividade da accountability societal tem sido instrumentalizada pelos Conselhos no ??mbito das diversas pol??ticas setoriais. J?? os dados secund??rios da an??lise foram obtidos por meio das s??nteses dos relat??rios de fiscaliza????o de munic??pios do Estado de Minas Gerais, realizadas pela Controladoria Geral da Uni??o. Foram identificados todos os registros pertinentes aos Conselhos Gestores Municipais do Estado de Minas Gerais, no per??odo de 2003 a 2006. Verificou-se que os maiores problemas se referem aos Conselhos Municipais de Sa??de e Assist??ncia Social. Entre as in??meras falhas apontadas, destacam-se problemas graves na constitui????o e operacionaliza????o dos Conselhos, resultando na inoper??ncia desses mecanismos nos munic??pios fiscalizados. A avalia????o do desempenho dos Conselhos locais de Vi??osa possibilitou concluir que esses mecanismos apresentaram um desempenho bem satisfat??rio na gest??o e controle das pol??ticas p??blicas no munic??pio.