Mortalidade feminina por hipertensão: análise por causas múltiplas

INTRODUÇÃO: A prevalência da hipertensão arterial vem crescendo no país, constituindo-se em um problema de saúde pública por sua magnitude e dificuldades no controle. OBJETIVO: Avaliar a qualidade dos dados sobre hipertensão como causa de morte e verificar o ganho de informação na mortalidade por hipertensão arterial de mulheres de 10 a 49 anos, por meio da metodologia de análise por causas múltiplas de morte. MATERIAL E MÉTODOS: Foi constituída uma base de dados com 7.332 óbitos ocorridos no primeiro semestre de 2002 pertencentes ao "Estudo da Morbi-Mortalidade de Mulheres de 10 a 49 anos". A metodologia RAMOS (Reproductive Age Mortality Survey) foi aplicada em todas as capitais de Estados brasileiros e Distrito Federal. Com as informações adicionais, foi preenchida uma nova declaração de óbito - DO-NOVA. Foram analisados dois conjuntos de dados (DO-ORIGINAL - antes da investigação - e DO-NOVA - após resgate das informações. Foram realizadas comparações segundo causas básicas e múltiplas por fontes dos dados (DO-O, DO-N). RESULTADOS E CONCLUSÃO: A DO-ORIGINAL apresentou algumas falhas quantitativas e qualitativas. Concluiu-se que a análise por causas múltiplas enriquece a informação, com base nas DO. São necessárias ações contínuas para um melhor preenchimento da DO, pelos médicos, e deve haver mais estudos que adotem a metodologia de causas múltiplas.

Segurança do doente em cuidados de saúde primários : aplicação do Diagrama de Ishikawa à análise de incidentes

RESUMO - A segurança do doente constitui um dos grandes desafios dos cuidados de saúde do séc. XXI e é um componente essencial da qualidade em saúde. Os Cuidados de Saúde Primários representam o primeiro nível de contacto dos indivíduos, da família e da comunidade com o sistema de saúde. O objectivo deste trabalho foi aplicar o Diagrama de Ishikawa no estudo dos incidentes ocorridos numa unidade de Cuidados de Saúde Primários – Unidade de Saúde Familiar Marginal. A análise das causas dos incidentes relatados (n=379) mostrou que os factores associados à „tarefa‟ foram os mais frequentes (n=196) e os factores associados ao doente foram os menos frequentes (n=22). A análise de correlações mostrou uma associação positiva entre os factores da tarefa e os factores da equipa e entre os factores da tarefa e os factores da comunicação (p<0.05). Esta análise mostrou ainda, uma associação negativa entre os factores das condições de trabalho e os factores da organização (p<0.05). As medidas de discriminação aplicadas aos resultados da análise de correlação múltipla, mostraram que os factores da comunicação, os factores individuais, as condições de trabalho e o contexto institucional foram as principais associações encontradas. A análise qualitativa de oito incidentes, permitiu reflectir sobre medidas de melhoria. Este estudo aponta para a utilidade da aplicação do Diagrama de Ishikawa no apuramento das causas sistémicas mais prováveis de um incidente, e na identificação de necessidades de atuação na gestão de risco dentro das organizações. Será, no entanto, necessário testar este instrumento em outras unidades de cuidados de Saúde Primários.

The Rise of democracy in Europe and the fight against mass poverty in Latin America: the implications for marxist thought of some recent mainstream papers

Recently a number of mainstream papers have treated the rise of democracy in 19th century Europe and its instability in Latin America in an eminently Marxist fashion. This paper sets out their implications for Marxist thought. With respect to Europe, Marx's emphasis on political action backed by the threat of violence is vindicated but his justification for socialism is not. With respect to Latin America, the unequal distribution of wealth is the cause of political instability that is, in turn, the root cause of mass poverty. In addition it is possible to explain some of the paradoxical characteristics of neo-liberalism and to make a weak argument for socialism in spite of its rejection in Europe.

Construction and Evaluation of Submerged Vanes for Stream Control, HR-274, 1988

The objective of this study was to determine the practicality and effectiveness of using submerged vanes ("Iowa Vanes") to control bank erosion in a bend of East Nishnabotna River, Iowa. The vane system was constructed during the summer of 1985. It functions by eliminating, or reducing, the centrifugally induced helical motion of the flow in the bend, which is the root cause of bank undermining. The system was monitored over a 2-year period, from September 1985 to October 1987. Two surveys were conducted in the spring of 1986 in which data were taken of depths and velocities throughout the bend and of water-surface slope. The movement of the bank was determined from aerial photos and from repeated measurements of the vane-to-bank distance. The bankfull scour depths and velocities along the bank have been reduced significantly; and the movement of the bank has been stopped or considerably reduced. The improvements were obtained without changing the energy slope of the channel. Areas of design improvements were identified.

Estudi comparatiu: errors de les infermeres en la preparació i l'administració de la medicació segons dos sistemes de distribució

Introducció: Els errors de medicació són definits com qualsevol incident prevenible que pot causar dany al pacient o donar lloc a una utilització inapropiada dels medicaments, quan aquests estan sota el control dels professionals sanitaris o del pacient. Els errors en la preparació i l’administració de medicació són els més comuns de l’àrea hospitalària i, tot i la llarga cadena per la qual passa el fàrmac, el professional d’infermeria és el últim responsable de l’acció, tenint així, un paper molt important en la seguretat del pacient. Les infermeres dediquen el 40% del temps de la seva jornada laboral en tasques relacionades amb la medicació. Objectiu: Determinar si les infermeres produeixen més errors si treballen amb sistemes de distribució de medicació de stock o en sistemes de distribució unidosis de medicació. Metodologia: Estudi quantitatiu, observacional i descriptiu, on la notificació d’errors (o oportunitats d’error) realitzats per la infermera, en les fases de preparació i administració de medicació, es farà mitjançant un qüestionari autoelaborat. Els elements a identificar seran: el tipus d’error, les causes que poden haver--‐lo produït, la seva potencial gravetat i qui l’ha pogut evitar; així com el tipus de professional que l’ha produït. Altres dades rellevants són: el medicament implicat junt amb la dosis i la via d’administració i el sistema de distribució utilitzat. Mostreig i mostra: El mostreig serà no probabilístic i per conveniència. S’escolliran aquelles infermeres que l’investigador consideri amb les característiques necessàries per participar en l’estudi, així que la mostra estarà formada per les infermeres les quals treballen a la unitat 40 de l’Hospital del Mar i utilitzen un sistema de distribució de medicació de dosis unitàries i les infermeres que treballen a urgències (concretament a l’àrea de nivell dos) de l’Hospital del Mar les quals treballen amb un sistema de distribució de medicació de stock.

Field Instrumentation, Testing, and Long-Term Monitoring of High-Mast Lighting Towers in the State of Iowa, TR-518, 2006

As a result of the collapse of a 140 foot high-mast lighting tower in Sioux City, Iowa in November of 2003, a thorough investigation into the behavior and design of these tall, yet relatively flexible structures was undertaken. Extensive work regarding the root cause of this failure was carried out by Robert Dexter of The University of Minnesota. Furthermore, a statewide inspection of all the high-mast towers in Iowa revealed fatigue cracks and loose anchor bolts on other existing structures. The current study was proposed to examine the static and dynamic behavior of a variety of towers in the State of Iowa utilizing field testing, specifically long-term monitoring and load testing. This report presents the results and conclusions from this project. The field work for this project was divided into two phases. Phase 1 of the project was conducted in October 2004 and focused on the dynamic properties of ten different towers in Clear Lake, Ames, and Des Moines, Iowa. Of those ten, two were also instrumented to obtain stress distributions at various details and were included in a 12 month long-term monitoring study. Phase 2 of this investigation was conducted in May of 2005, in Sioux City, Iowa, and focused on determining the static and dynamic behavior of a tower similar to the one that collapsed in November 2003. Identical tests were performed on a similar tower which was retrofitted with a more substantial replacement bottom section in order to assess the effect of the retrofit. A third tower with different details was dynamically load tested to determine its dynamic characteristics, similar to the Phase 1 testing. Based on the dynamic load tests, the modal frequencies of the towers fall within the same range. Also, the damping ratios are significantly lower in the higher modes than the values suggested in the AASHTO and CAN/CSA specifications. The comparatively higher damping ratios in the first mode may be due to aerodynamic damping. These low damping ratios in combination with poor fatigue details contribute to the accumulation of a large number of damage-causing cycles. As predicted, the stresses in the original Sioux City tower are much greater than the stresses in the retrofitted towers at Sioux City. Additionally, it was found that poor installation practices which often lead to loose anchor bolts and out-of-level leveling nuts can cause high localized stresses in the towers, which can accelerate fatigue damage.

Service Management for Service Desk

Palvelunhallinnan kehittäminen Service Desk ympäristöön johtaa parempaan työnkulun hallintaan. Service Deskin päätehtävänä on toimia ainoana yhteyspisteenä asiakkaalta tietohallinto-osastolle. Jokainen yhteydenottopitää kirjata ja se pitäisi olla jäljitettävissä. Tapahtumien eli insidenttien kirjaaminen tapahtuu pääasiassa Service Desk -funktiossa, joka omistaa niistä jokaisen. Tapahtumien hallintaprosessin tehtävänä on etsiä loppukäyttäjän tai IT-infrastruktuurin monitorointityökalun ilmoittamalle insidentille mahdollisimman nopea ratkaisu. Insidentit saattavat johtaa ongelmiin, jotka käsitellään erillisessä prosessissa. Ongelmien hallintaprosessi yrittää etsiä vikatilanteen pohjimmaisen syyn. Kun pohjimmaisin syy on löytynyt, prosessi lähettää muutospyynnön muutosten hallintaprosessille. Jotta päästään mahdollisimman hyvään tehokkuuteen, pitää määrittää asiakasrajapinta sekä mittarit. ITIL-malli tarjoaa prosessit IT-palvelunhallinnan kehittämiselle. Kansainvälisesti tunnettuna 'de factO' standardina sitä voidaan soveltaa globaaleissa yrityksissä. Tässä työssä keskitytään erään lääkkeiden jakelussa toimivan yrityksen tietohallinto-osaston Help Deskin nykytilan määrittämiseen. Työssä myös kuvataan tietohallinto-osaston tavoitetila, jossa keskitytään Service Deskin IT palvelunhallinnan kehittämiseen. Muut prosessit ja mittarit on kuvattu niiltä osin, jotka tulee huomioida Service Deskin seuraamisen ja ohjaamisen kannalta.

Curving simulation and stability of a creep-controlled wheelset for high speed rail-vehicles

Higher travel speeds of rail vehicles will be possible by developing sophisticated top performance bogies having creep-controlled wheelsets. In this case the torque transmission between the right and the left wheel is realized by an actively controlled creep coupling. To investigate hunting stability and curving capability the linear equations of motion are written in state space notation. Simulation results are obtained with realistic system parameters from industry and various controller gains. The advantage of the „creep-controlled wheelset" is discussed by comparison the simulation results with the dynamic behaviour of the special cases „solid-axle wheelset" and „loose wheelset" (independent rotation of the wheels). The stability is also investigated with a root-locus analysis.

Utilization of Statistical Methods for Management in the Forest Industry

The strongest wish of the customer concerning chemical pulp features is consistent, uniform quality. Variation may be controlled and reduced by using statistical methods. However, studies addressing the application and benefits of statistical methods in forest product sector are scarce. Thus, the customer wish is the root cause of the motivation behind this dissertation. The research problem addressed by this dissertation is that companies in the chemical forest product sector require new knowledge for improving their utilization of statistical methods. To gain this new knowledge, the research problem is studied from five complementary viewpoints – challenges and success factors, organizational learning, problem solving, economic benefit, and statistical methods as management tools. The five research questions generated on the basis of these viewpoints are answered in four research papers, which are case studies based on empirical data collection. This research as a whole complements the literature dealing with the use of statistical methods in the forest products industry. Practical examples of the application of statistical process control, case-based reasoning, the cross-industry standard process for data mining, and performance measurement methods in the context of chemical forest products manufacturing are brought to the public knowledge of the scientific community. The benefit of the application of these methods is estimated or demonstrated. The purpose of this dissertation is to find pragmatic ideas for companies in the chemical forest product sector in order for them to improve their utilization of statistical methods. The main practical implications of this doctoral dissertation can be summarized in four points: 1. It is beneficial to reduce variation in chemical forest product manufacturing processes 2. Statistical tools can be used to reduce this variation 3. Problem-solving in chemical forest product manufacturing processes can be intensified through the use of statistical methods 4. There are certain success factors and challenges that need to be addressed when implementing statistical methods

Kosteuden vaikutus tehotransistorin estojännitteeseen

Tämän työn tavoitteena on vastata hypoteesiin jonka mukaan kosteus aiheuttaisi IGBT:n estojännitteen aleneman ja siitä seuraavan taajuusmuuttajan vikaantumisen. Työssä tarkastellaan erään ABB Drivesin käyttämän IGBT-moduulin estojännitteen käyttäytymistä kosteudelle altistamisen jälkeen. Työn teoriaosuudessa kerrotaan taajuusmuuttajasta sekä IGBT:n rakenteesta ja käyttäytymisestä erilaisissa tilanteissa. Estojännitettä tutkitaan käyräseuraajan avulla, kun IGBT on altistettu kosteudelle. Tutkimuksessa toteutettiin yhteensä kolme erilaista olosuhdesimulaatiota. Tutkittavissa IGBT-moduuleissa havaittiin vähäistä estojännitteen alenemaa sekä vuotovirran kasvua. Estojännitteen aleneman todetti-in olevan riittämätön vikaannuttaakseen taajuusmuuttajan. Estojännite säilyi korkeampana kuin valmistajan datalehdessä ilmoittama maksimiarvo. Tutkimuksen johtopäätöksenä on ettei kosteus ole aiheuttanut taajuusmuuttajan vikaantumista. Työn lopussa esitellään tapoja joilla taajuusmuuttajan kokemia olosuhteita voitaisiin seurata jatkossa tarkemmin.

Ethanol Production From Spent Substrate Of Pleurotus Eous

Spent substrate, the residual material of mushroom cultivation, causes disposal problems for cultivators. Currently the spent substrate of different mushrooms is used mainly for composting. Edible mushrooms of Pleurotus sp. can grow on a wide range of lignocellulosic substrates. In the present study, Pleurotus eous was grown on paddy straw and the spent substrate was used for the production of ethanol. Lignocellulosic biomass cannot be saccharified by enzymes to high yield of ethanol without pretreatment. The root cause for the recalcitrance of lignocellulosic biomass such as paddy straw is the presence of lignin and hemicelluloses on the surface of cellulose. They form a barrier and prevent cellulase from accessing the cellulose in the substrate. In the untreated paddy straw, the amount of hemicelluloses and lignin (in % dry weight) were 20.30 and 20.34 respectively and the total reducing sugar was estimated to be 5.40 mg/g. Extracellular xylanase and ligninases of P. eous could reduce the amount of hemicelluloses and lignin to 16 and 11(% dry weight) respectively, by 21st day of cultivation. Growth of mushroom brought a seven fold increase in the total reducing sugar yield (39.20 mg/g) and six fold increase in the production of ethanol (6.48 g/L) after 48hrs of fermentation, when compared to untreated paddy straw

Factors affecting farmers’ decisions on utilization of rice straw compost in Northeastern Thailand

Rice straw is used in Northeastern Thailand as an alternative to organic fertilizer for crop production. This enables farmers to reduce the use of chemical fertilizers which leads to a decrease in production costs. In spite of the beneficial effects in agricultural production, rice straw compost cannot be produced in large amounts because the burning of rice straws is a common farming practice. The decisions of farmers who use rice straw compost have been investigated by interviewing 120 households belonging to the members of an organic fertilizer user group using a household questionnaire. The study was conducted to evaluate the factors that affect the use of rice straw compost in Khon Kaen Province in Northeastern Thailand. Results of the logit model showed that the farmers’ education, number of rice straw compost trainings in which the farmer participated, lack of knowledge about technology, insufficient labour and difficulty in making rice straw compost had a significant impact on the farmer’s decision to use rice straw compost. Difficulty in making rice straw compost appeared to be the root cause because the procedure of making rice straw compost is complex and labour intensive. Repeated trainings thus, will have a positive and significant influence on farmers’ adoption of the technology. Training provides more knowledge and will presumably change the perception of the farmers towards new technologies and the awareness of positive effects of rice straw compost utilization.

Caracterización de los accidentes de trabajo en los funcionarios de una clínica de tercer nivel de la ciudad de Bogotá 2010 a 2013.

Objetivo: Caracterizar la accidentalidad laboral en una clínica de tercer nivel de la ciudad de Bogotá, en el periodo 2010 a 2013. Materiales y Métodos: Se realizó un estudio de tipo corte transversal, utilizando una base de datos de accidentalidad en los trabajadores vinculados directamente con la institución. Resultados: Durante el periodo estudiado se generaron 191 accidentes, 57 casos en el año 2013, el personal de enfermería fue el grupo con mayor porcentaje de accidentes (70.2 %). El sitio donde ocurrieron con mayor frecuencia los accidentes fueron las áreas asistenciales (49.2 %). Al analizar los datos de los accidentes de riesgo biológico se encontró que el pinchazo es el más común (84.7%), seguido de las heridas abiertas y lesiones superficiales (77.2%). Las partes del cuerpo más frecuentemente lesionadas fueron extremidades superiores, siendo la mano la zona más afectada (60.2%); además identifica al paciente fuente del accidente en el 71.8% de los casos y no se logra determinar en un alto porcentaje, si el trabajador afectado usa elementos de protección personal al momento del evento (82.1%). Conclusiones Los accidentes de trabajo con exposición a riesgo biológico son frecuentes en los trabajadores del área asistencial, en especial en el personal de enfermería, dadas las características propias de sus tareas diarias y el cumplimiento de las mismas. El pinchazo fue causa más común, y la parte del cuerpo más frecuentemente afectada fueron las extremidades superiores, específicamente las manos. Dado que los accidentes laborales a riesgo biológico tienen el potencial de general consecuencias nocivas para la salud es esencial establecer estrategias tendientes a minimizar su frecuencia y severidad, por lo que se recomienda revisar e implementar nuevas tecnologías para la reducción de accidentes con elementos corto punzantes, aumentar la sensibilización de los trabajadores con respecto al uso de los elementos de protección personal y revisar la metodología utilizada para la investigación de accidentes laborales.

Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study

Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.

Towards (more) integrity in academia: transcending neo-liberal assumption of research and knowledge creation and the “rules” supressing academic freedom

European researchers across heterogeneous disciplines voice concerns and argue for new paths towards a brighter future regarding scientific and knowledge creation and communication. Recently, in biological and natural sciences concerns have been expressed that major threats are intentionally ignored. These threats are challenging Europe’s future sustainability towards creating knowledge that effectively deals with emerging social, environmental, health, and economic problems of a planetary scope. Within social science circles however, the root cause regarding the above challenges, have been linked with macro level forces of neo-liberal ways of valuing and relevant rules in academia and beyond which we take for granted. These concerns raised by heterogeneous scholars in natural and the applied social sciences concern the ethics of today’s research and academic integrity. Applying Bourdieu’s sociology may not allow an optimistic lens if change is possible. Rather than attributing the replication of neo-liberal habitus in intentional agent and institutional choices, Bourdieu’s work raises the importance of thoughtlessly internalised habits in human and social action. Accordingly, most action within a given paradigm (in this case, neo-liberalism) is understood as habituated, i.e. unconsciously reproducing external social fields, even ill-defined ways of valuing. This essay analyses these and how they may help critically analyse the current habitus surrounding research and knowledge production, evaluation, and communication and related aspects of academic freedom. Although it is acknowledged that transformation is not easy, the essay presents arguments and recent theory paths to suggest that change nevertheless may be a realistic hope once certain action logics are encouraged.