Nursing Activities Score: avaliação da carga de trabalho de enfermagem em unidade de terapia intensiva adulto

The sizing of nursing human resources is an essential management tool to meet the needs of the patients and the institution. Regarding to the Intensive Care Unit, where the most critical patients are treated and the most advanced life-support equipments are used, requiring a high number of skilled workers, the use of specific indicators to measure the workload of the team becomes necessary. The Nursing Activities Score is a validated instrument for measuring nursing workload in the Intensive Care Unit that has demonstrated effectiveness. It is a cross-sectional study with the primary objective of assessing the workload of nursing staff in an adult Intensive Care Unit through the application of the Nursing Activities Score. The study was conducted in a private hospital specialized in the treatment of patients with cancer, which is located in the city of Natal (Rio Grande do Norte – Brazil). The study was approved by the Research Ethics Committee of the hospital (Protocol number 558.799; CAAE 24966013.7.0000.5293). For data collection, a form of sociodemographic characteristics of the patients was used; the Nursing Activities Score was used to identify the workload of nursing staff; and the instrument of Perroca, which classifies patients and provides data related to the their need for nursing care, was also used. The collected data were analyzed using a statistical package. The categorical variables were described by absolute and relative frequency, while the number by median and interquartile range. Considering the inferential approach, the Spearman test, the Wald chi-square, Kruskal Wallis and Mann-Whitney test were used. The statistically significant variables were those with p values <0.05. The evaluation of the overall averages of NAS, considering the first 15 days of hospitalization, was performed by the analysis of Generalized Estimating Equations (GEE), with adjust for the variable length of hospitalization. The sample consisted of 40 patients, in the period of June to August 2014. The results showed a mean age of 62,1 years (±23,4) with a female predominance (57,5%). The most frequent type of treatment was clinical (60,0%), observing an average stay of 6,9 days (±6,5). Considering the origin, most patients (35%) came from the Surgical Center. There was a mortality rate of 27,5%. 277 measures of NAS score and Perroca were performed, and the averages of 69,8% (±24,1) and 22,7% (±4.2) were obtained, respectively. There was an association between clinical outcome and value of the Nursing Activities Score in 24 hours (p <0.001), and between the degree of dependency of patients and nursing workload (rp 0,653, p<0,001). The achieved workload of the nursing staff, in the analyzed period, was presented high, showing that hospitalized patients required a high demand for care. These findings create subsidies for sizing of staff and allocation of human resources in the sector, in order to achieve greater safety and patient satisfaction as a result of intensive care, as well as an environment conducive to quality of life for the professionals

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Gastos públicos em educação municipal: uma análise da eficiência-custo na gestão dos recursos no ensino fundamental no estado do Rio Grande do Norte

This study evaluates the cost effectiveness of municipalities in the state of Rio Grande do Norte in the execution of spending in basic education carried out in 2011, as well as analyze the determinants of the inefficiency of the same. For this, we used two methodological approaches (i) stochastic frontier cost, and (ii) analyze data envelopment (DEA), which allows to identify the efficient frontier of the municipalities analyzed non-parametrically. Results show that municipalities under review achieved low efficiency rates in the stochastic frontier cost, while the DEA method they achieved higher rates where nineteen among them reached full efficiency. The results suggest that a significant portion of the Potiguar municipalities should review its administrative practices, especially the means of allocation of resources. In regard to determining the efficiency observed distinct results by the two methods.

Contribuições em escalonamento e análise de desempenho de redes WirelessHART

Wireless Communication is a trend in the industrial environment nowadays and on this trend, we can highlight the WirelessHART technology. In this situation, it is natural the search for new improvements in the technology and such improvements can be related directly to the routing and scheduling algorithms. In the present thesis, we present a literature review about the main specific solutions for Routing and scheduling for WirelessHART. The thesis also proposes a new scheduling algorithm called Flow Scheduling that intends to improve superframe utilization and flexibility aspects. For validation purposes, we develop a simulation module for the Network Simulator 3 (NS-3) that models aspects like positioning, signal attenuation and energy consumption and provides an link individual error configuration. The module also allows the creation of the scheduling superframe using the Flow and Han Algorithms. In order to validate the new algorithms, we execute a series of comparative tests and evaluate the algorithms performance for link allocation, delay and superframe occupation. In order to validate the physical layer of the simulation module, we statically configure the routing and scheduling aspects and perform reliability and energy consumption tests using various literature topologies and error probabilities.

Contribuições em escalonamento e análise de desempenho de redes WirelessHART

Wireless Communication is a trend in the industrial environment nowadays and on this trend, we can highlight the WirelessHART technology. In this situation, it is natural the search for new improvements in the technology and such improvements can be related directly to the routing and scheduling algorithms. In the present thesis, we present a literature review about the main specific solutions for Routing and scheduling for WirelessHART. The thesis also proposes a new scheduling algorithm called Flow Scheduling that intends to improve superframe utilization and flexibility aspects. For validation purposes, we develop a simulation module for the Network Simulator 3 (NS-3) that models aspects like positioning, signal attenuation and energy consumption and provides an link individual error configuration. The module also allows the creation of the scheduling superframe using the Flow and Han Algorithms. In order to validate the new algorithms, we execute a series of comparative tests and evaluate the algorithms performance for link allocation, delay and superframe occupation. In order to validate the physical layer of the simulation module, we statically configure the routing and scheduling aspects and perform reliability and energy consumption tests using various literature topologies and error probabilities.

Controle social do espaço público: uma análise do conselho turístico pólo costa das dunas

The managing Conselho of public politics constitute one of the main experiences of democracy in Brazil contemporary representing a conquest for construction of a democratic institutionalism. The historical newness consists of the intensification and the institutionalization of the dialogue between government and society - in public and plural canals - as condition for an allocation more efficient joust and of the public resources. In this context the present study it objectified to understand from readings of the performance of represented group of bencheses the dynamics of functioning of the Tourist Conselho Pólo Costa das Dunas while space of participation and social control. The bibliographical research contemplated diverse sources in order to compile knowledge of credential authors in the quarrel of inherent subjects to the civil society and the public sphere to the construction of the citizenship to the conception formation and dynamics of the social control through Conselho of public politics. A qualitative perspective the case study was adopted as research method and for attainment of the data interviews with the members of the Conselho had been carried through beyond consultation the referring documents the dynamics of functioning of the Conselho. The profiles capacities and limitations of the members of the Conselho had been identified constitution social and dynamic organization of functioning of the Conselho and the readings of the members of the Conselho concerning the power to decide instances and participation. The results had shown that the allotment of being able in the Conselho does not occur of equal form. The functions of coordination of the activities of the Conselho are assumed by the representatives of the public agencies. Level of qualification of council members also if presents as difficulty to development of activities of Conselho since the majority of the interviewed ones disclosed unreliability and unfamiliarity when thematic specific that runs away from its organizacional reality they are boarded in the assemblies. Of this form the Conselho if presents more as half of institutional legitimation of what half of characterization of the creation of a public sphere properly said. Finally he could himself be concluded that a democratic culture inexists that inside crosses practical the institutional ones of the Conselho thus limiting the possibility to reach the effective social control of the public politics of tourism in the Rio Grande do Norte

Estratégias competitivas genéricas nas empresas comerciais varejistas de shopping centers: um estudo a partir do modelo de Porter

Os shoppingcenters são grandes instituições repletas de empresas quecompetem entre si formas de como melhor satisfazer as necessidade dosclientes. Sendo assim, cada empresa utiliza-se de estratégias com o intuito deatingir a maior parcela de compradores possíveis sem comprometer suaexistência e sua vantagem competitiva. Este estudo está baseado na teoria dasestratégias competitivas genéricas de Porter (1980; 1985) o qual estabeleceem seu modelo que todas as empresas existentes no mercado possuam pelomenos uma das três abordagens estratégicas (diferenciação, liderança emcusto e enfoque). Desta forma, este trabalho identifica de que maneira estádistribuída as estratégia competitiva nas empresas de shoppingcenters deNatal/RN. Primeiramente buscou-se levantar a relação das estratégias destasempresas com a teoria proposta por Porter (1985) e sua alocação de acordocom os agrupamentos resultantes da combinação das estratégias. Nestemomento, foram aplicados questionários com 89 gerentes de lojas de shoppingcenters que resultou após análises estatísticas em cinco agrupamentos comabordagens válidas. Em seguida foram selecionadas as empresas quepossuíam maior afinidade com cada agrupamento e que melhor representavamos resultados dispostos em cinco clustersacerca da teoria proposta e nestaamostragem foi aplicada entrevista com os gerentes. Os resultados obtidos com as entrevistas validaram a análise dos dados encontrados nosquestionários anteriormente aplicados estando em conformidade com aproposta teoria. Identificou-se também duas modalidades de empresas queutilizavam simultaneamente mais de uma estratégia competitiva (meio-termo),sendo uma dentro e outra fora do modelo proposto pelo autor. Embora omodelo das estratégias competitivas genéricas tenha sido instituído comaspectos voltados as organizações industriais, os resultados obtidos nestetrabalho validaram a aplicação desta teoria em empresas comercias deshopping centers que vem se adequando para obter resultados financeirosmais satisfatórios e melhor posicionamento em relação à concorrência

Entre o comentário e a entrevista: “A Opinião de José Sócrates” (RTP1), “A Opinião de Luís Marques Mendes” (SIC) e “Os Comentários de Marcelo Rebelo de Sousa” (TVI)

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Jornalismo.

O terciário (re) desenhando a periferia: a região administrativa norte de Natal/RN, na última década do século XX, servicializada na Av. Dr. João Medeiros Filho

The tertiary sector has been (re)defining and (re)qualifying, in an impacting way, the urban spaces in the cities, introducing new elements for the discussion of the relationship center/periphery. In Natal, as an inducing economic activity of its development, it conforms to the new needs of the capital, expanding, being materialized through several processes and spatial forms. We aim at analyzing one of those processes, which has taken its Northern Administrative Area to (re)define the design of its urban space, through the actions developed by the agents involved with the spatialization of the tertiary activities, at the same time as it redimensions its role as a periphery of Natal, contributing to the study of the recent and growing transformations of the Brazilian capitals. The studied district corresponds to 39.4% of the municipal area and, until recently, was composed by precarious reproduction spaces, unprovided of relevant economical activities. After the boom of the development of extensive housing complexes by SFH/BNH, the area, gradually stopped being a dependent area, and it imposed itself as an economically participant region, with the increase of the trade and services sectors, as well as a favorable place for the appearance of new activities. Its reflexes are noticeable in the achieved spatial configuration. As the main road to induct changes, Dr. João Medeiros Filho Avenue presents these new tendencies in the production of the intraurban space, concentrating the largest goods and services equipments of the area, through investments of the private and public sectors, which guarantee the capital allocation for the construction of a new centrality

Configurando a cidade contemporânea em Natal : os processos espaciais em Ponta Negra

This dissertation is about the spatial configuration in Natal and processes in the Ponta Negra neighborhood today. Ponta Negra has undergone a number of critical social and spatial changes due to tourism development after the 1990s. It is of special interest to consider the intensification of real estate investment after 2000, when the new airport terminal, located in the neighboring municipality of Parnamirim, was in use. Ponta Negra is the place where most tourists go to, so attracting considerable public investments. New agents of transformation have produced change in the neighborhood as well. The present study aims at analysing the spatial processes in this part of the city. Here, the spatial configuration that resulted from extended real estate investments, both public and private, in recent years, is analysed in detail. The study identifies the multually differentiated, however internally homogenous areas. The concepts of production of space, contemporanean urban development and spatial dynamics are discussed. The research is based on document analysis and field work. Results were plotted to maps and tables. A detailed analysis of the spatial processes in the Ponta Negra neighborhood is undertaken as a conclusion, considering the contemporanean global scenario

A gestão de materiais numa empresa de telecomunicações

O mercado das telecomunicações e das tecnologias da informação é caraterizado por uma elevada instabilidade e competitividade. Deste modo, a aposta na diferenciação, no estabelecimento de vantagens competitivas e na melhoria contínua são pontos fulcrais para o sucesso das empresas tecnológicas. A empresa tecnológica PT Inovação e Sistemas, S.A. apresenta a necessidade de melhorar a gestão económica e física de materiais. Neste sentido, o presente Projeto propõe a introdução de melhorias ao nível da gestão de stocks e do armazém da referida empresa, segundo a realização de análises ABC, da determinação de stocks de segurança adequados e da redefinição do layout atual. Definem-se também critérios de alocação dos materiais no espaço de armazenagem e propõe-se a introdução de um sistema de controlo e rastreabilidade de materiais. Como fruto do presente trabalho, os resultados obtidos tiveram um impacto positivo, possibilitando um aumento da produtividade e da eficiência nos processos associados à gestão de materiais da organização.

Sobre o contágio nos mercados bolsistas internacionais: evidência de nove países

Mestrado em Contabilidade e Análise Financeira

Impact of natural and/or chemical stressors on the freeze-tolerant and euryhaline enchytraeid, Enchytraeus albidus

Rapid climatic changes are taking place in Arctic, subarctic and cold temperate regions, where predictions point to an increase in freeze-thaw events, changes in precipitation, evaporation and salinity patterns. Climate change may therefore result in large impacts in ecosystem functioning and dynamics, especially in the presence of contaminants due to intense anthropogenic activities. Even though multiple stress approaches have received increasing interest in the last decades, the number of such studies is limited. In particular, knowledge on the effect of freezethaw events and salinity fluctuations on ecotoxicology of soil invertebrates is lacking, especially important when considering supralittoral species. Therefore, the aim of this thesis was to investigate the effects of low temperature and salinity fluctuations, singly and in combination with contaminants, in the freeze-tolerant and euryhaline enchytraeid Enchytraeus albidus. The assessment of population level endpoints (survival and reproduction), along with physiological and biochemical parameters such as levels of cryoprotectants, ice/water content, oxidative stress biomarkers, cellular energy allocation, and tissue concentration of chemicals (when applied), provided new and valuable knowledge on the effects of selected physical and chemical stressors in E. albidus, and allowed the understanding of adjustments in the primary response mechanisms that enable worms to maintain homeostasis and survival in harsh environments such as polar and temperate-cold regions. The presence of moderate levels of salinity significantly increased freeze-tolerance (mainly evaluated as survival, cryoprotection and ice fraction) and reproduction of E. albidus. Moreover, it contributed to the readjustments of cryoprotectant levels, restoration of antioxidant levels and changed singnificantly the effect and uptake of chemicals (copper cadmium, carbendazim and 4-nonylphenol). Temperature fluctuations (simulated as daily freeze-thaw cycles, between -2ºC and -4ºC) caused substancial negative effect on survival of worms previsouly exposed to non-lethal concentrations of 4-nonylphenol, as compared with constant freezing (-4ºC) and control temperature (2ºC). The decrease in cryoprotectants, increase in energy consumption and the highest concentration of 4-nonylphenol in the tissues have highlighted the high energy requirements and level of toxicity experienced by worms exposed to the combined effect of contaminants and freezing-thawing events. The findings reported on this thesis demonstrate that natural (physical) and chemical stressors, singly or in combination, may alter the dynamics of E. albidus, affecting not only their survival and reproduction (and consequent presence/distribution) but also their physiological and biochemical adaptations. These alterations may lead to severe consequences for the functioning of the ecosystems along the Arctic, subarctic and cold temperate regions, where they play an important role for decomposition of dead organic matter. This thesis provides a scientific basis for improving the setting of safety factors for natural soil ecosystems, and to underline the integration of similar investigations in ecotoxicology, and eventually in risk assessment of contaminants.

Relatório de Atividades 2015

Relatório de atividades do INSA relativo ao ano de 2015. Este instrumento tem dois grandes objetivos: 1) Averiguar a concretização do Plano de Ação de 2015. Nomeadamente, avalia a estratégia assumida através dos seus objetivos estratégicos, isto é, verificar o grau de realização dos programas e dos objetivos operacionais atingidos que foram propostos no QUAR e no Plano de Ação; 2) Prestar informação institucional relativamente à execução do orçamento, à alocação de recursos humanos, financeiros e técnicos, para além de demonstrar quantitativa e qualitativamente os dados das funções essenciais inerentes ao Departamentos Técnicos e Científicos.

Análise do circuito de água de refrigeração de uma unidade de regeneração de solventes

A EGEO Solventes S.A. é uma empresa com atividade na área da gestão de resíduos, focando-se na regeneração de solventes. Na unidade industrial da empresa recorre-se à destilação de misturas de solventes usados para obtenção do solvente regenerado. Esta operação exige água para o arrefecimento e condensação dos destilados das misturas de solventes, que, posteriormente, é arrefecida em torres de refrigeração instaladas na unidade. Durante o tempo de operação da unidade foram identificados problemas na condensação dos solventes limpos, obrigando a que se ligassem dois condensadores em série para assegurar a condensação do vapor produzido na destilação e à necessidade de caudais maiores de utilidade fria. Outro dos problemas identificados foi a baixa eficiência das torres de refrigeração, uma vez que a diferença de temperaturas da água à entrada e à saída do equipamento é muito baixa. Assim sendo, o objetivo principal deste trabalho é identificar as principais causas para a baixa eficiência dos equipamentos e propor alterações aos equipamentos ou soluções de melhoria do processo. Para diagnosticar estes problemas foram recolhidas amostras para determinação da composição do solvente limpo obtido e registadas as condições de operação para obtenção da mistura ECOSOLVE MET. Recorrendo a metodologias de projeto determinou-se o fator de resistência do fouling no condensador C1 e seguidamente a geometria, a alocação de correntes e a orientação do condensador mais adequadas e concluiu-se que este está sujeito a uma forte acumulação de material nas paredes e que a melhor opção seria recorrer a um permutador horizontal com condensação na carcaça, mas aumentando o número de passagens da água nos tubos. No que diz respeito à operação da torre de arrefecimento, determinou-se o caudal mínimo de ar para determinadas condições de operação e verificou-se que o caudal de ar alimentado à torre era superior ao mínimo determinado. Foram observadas diferenças quando comparadas as condições de operação experimentais com a performance da unidade usando oito enchimentos estruturados e aleatórios para os quais há dados na literatura São também apresentadas alternativas de operação e o projeto de uma torre de arrefecimento de água, sustentada numa análise económica de todo o processo. As simulações foram realizadas com recurso ao AspenPlus®.