Satisfação dos utentes de uma unidade de cirurgia de ambulatório de um hospital central : contributo para melhor cuidar

Enquadramento: O carácter inovador da Cirurgia de Ambulatório reside no seu modelo organizativo específico, centrado no doente, que o envolve num circuito independente do de internamento, procurando-se ganhos em eficiência e em qualidade e obtendo-se níveis de maior humanização e satisfação dos utentes e seus familiares. Objetivos: Analisar de que forma as variáveis sociodemográficos influenciam a qualidade percebida dos utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central; verificar se existem efeitos significativos das variáveis circunstanciais na qualidade percebida dos utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central; verificar a existência de efeitos significativos das variáveis sociofamiliares na qualidade percebida nos utentes. Métodos: Estudo quantitativo, com corte transversal, descritivo e correlacional; enquadra-se num estudo descritivo analítico-correlacional porque o mesmo tem por objetivo explorar as relações entre variáveis e descrevê-las. Os dados foram colhidos junto dos utentes tendo como base escalas e questionários. A amostra é não probabilística por conveniência, constituída por 140 utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central, na maioria, do sexo masculino (60,7%), com uma idade mínima de 19 anos e uma máxima de 94 anos, ao que corresponde uma idade média de 58,01 (±19.26 anos). Foi aplicado um Questionário de caracterização sociodemográfica e sociofamiliar, incluindo-se o Questionário (Medical Outcomes Study Social Support Survey) MOS-SSS (Fachado et al., 2007) e o Questionário Service Quality (SERVQUAL) (Parasuraman et al., 1988). Resultados: Os utentes do sexo feminino manifestam mais satisfação em relação à UCA (cortesia/empatia p=0.000; compreensão do utente p=0.000; fiabilidade p=0.005; acessibilidade p=0.010; qualidade global p=0.001; os utentes idosos obtiveram valores mais elevados em quase todas as dimensões e na qualidade global (aspetos físicos p=0.006); os participantes com o ensino básico manifestaram mais satisfação (fiabilidade p<0,016); os que possuem um rendimento familiar até 1000€ apresentaram maior nível de satisfação (cortesia/empatia p=0,033); os utentes que não se deslocam em meio de transporte próprio atribuem mais qualidade à UCA (fiabilidade p=0,028); aqueles cuja residência está situada a uma distância superior a 15 km do hospital revelam índices mais elevados de qualidade (cortesia/simpatia p=0.037; compreensão do utente p=0.044; fiabilidade p=0.022; acessibilidade p=0.001; qualidade global p=0.013); os participantes cuja distância de casa ao centro de saúde é superior a 9 km revelam mais satisfação (fiabilidade p=0.038); os utentes com tempos de espera para a cirurgia entre 6-12 meses atribuem mais qualidade à UCA (cortesia/empatia p=0.000; compreensão do utente p=0.011; fiabilidade p=0.007; acessibilidade p=0.001; qualidade global p=0.001). Conclusão: A maioria dos utentes atribui qualidade à UCA, tendo em conta a cortesia/empatia, a compreensão do utente, fiabilidade, acessibilidade e aspetos físicos, pode afirmar-se que a referida Unidade adequa os serviços prestados às suas necessidades, garantindo, deste modo, a satisfação dos utentes. Palavras-chave: Cirurgia de Ambulatório; Satisfação dos utentes; Qualidade; Atendimento.

Inserção de fornecedores locais como fonte de desempenhos em custos de transação e legitimidade: estudo de caso na cadeia produtiva do petróleo e gás do Rio Grande do Norte

The inclusion of local suppliers in production chains has considerable impact on its performance, but most notably in its main actors. The results of this process may be of different kinds and can be analyzed from economic or institutional approaches. This study aimed to verify the existence of different performances of Petrobras due to the inclusion of local suppliers in the oil and gas production chain in the state of Rio Grande do Norte, from the viewpoints of transaction costs and the Institutional Theory. In order to this, were made the characterization of the PROMINP, the description of its actions and results, the mapping of its institutional context of reference, and identification of results obtained by Petrobras in terms of transaction costs and legitimacy. The theoretical framework is based on authors dealing with industrial concentration, as like Marshall, Krugman, Porter and Schmitz, from the sociological perspective of neoinstitucional theory, as like DiMaggio and Powell and Scott and Meyer, and transaction costs, as like Williamson. This is a qualitative research, with data collection done by consulting secondary fonts and semi-structured interviews with nineteen actors of three groups, namely: actors involved in actions of the program, representatives of enterprises and representative of Petrobras. To analyze the content was used the Suchman s model (1995) for categories associated with strategies of legitimation and fourteen variables associated with the three variables assets specificity, bounded rationality and opportunism (Williamson, 1995, 1989) in the case of transaction costs. The results indicate that PROMINP has achieved its objectives by encouraging the increased participation of local companies in the oil and gas production chain, reflecting in the economic development of the state. The Redepetro/RN, fostered and built upon the interaction of the participants, is presented as a solution of continuity to the participation of enterprises in the chain, after the closure of the actions of the program. PROMINP demands responses to coercive, legislative and regulatory pressures of the organizational field, whose institutional context of reference is wide. From the point of view of legitimacy, through strategies to gain cognitive legitimacy and maintaining pragmatic legitimacy, Petrobras can manipulate the environment, ensuring the compliance of the constituents to their technical and institutional demands. Enterprises, in turn, respond to the demands through compliance with technical demands, mainly through the certification of processes, and cultural changes. There aren t clear gains related to the transaction costs, however, gains in legitimacy can be seen as a cumulative capital that can serve as a competitive differential that generates economic gains. In terms of theoretical findings, it was found that, due to its explanatory power for actions that are difficult to explain only in economic terms, Institutional Theory may be used as theoretical support concurrent with other theories. TCE model has limitations in explaining the program actions. In the case, it s emphasized that Petrobras doesn t seek only economic efficiency, but has in its mission the commitment to social development.

Using interaction data for improving the offline and online evaluation of search engines

This thesis investigates how web search evaluation can be improved using historical interaction data. Modern search engines combine offline and online evaluation approaches in a sequence of steps that a tested change needs to pass through to be accepted as an improvement and subsequently deployed. We refer to such a sequence of steps as an evaluation pipeline. In this thesis, we consider the evaluation pipeline to contain three sequential steps: an offline evaluation step, an online evaluation scheduling step, and an online evaluation step. In this thesis we show that historical user interaction data can aid in improving the accuracy or efficiency of each of the steps of the web search evaluation pipeline. As a result of these improvements, the overall efficiency of the entire evaluation pipeline is increased. Firstly, we investigate how user interaction data can be used to build accurate offline evaluation methods for query auto-completion mechanisms. We propose a family of offline evaluation metrics for query auto-completion that represents the effort the user has to spend in order to submit their query. The parameters of our proposed metrics are trained against a set of user interactions recorded in the search engine’s query logs. From our experimental study, we observe that our proposed metrics are significantly more correlated with an online user satisfaction indicator than the metrics proposed in the existing literature. Hence, fewer changes will pass the offline evaluation step to be rejected after the online evaluation step. As a result, this would allow us to achieve a higher efficiency of the entire evaluation pipeline. Secondly, we state the problem of the optimised scheduling of online experiments. We tackle this problem by considering a greedy scheduler that prioritises the evaluation queue according to the predicted likelihood of success of a particular experiment. This predictor is trained on a set of online experiments, and uses a diverse set of features to represent an online experiment. Our study demonstrates that a higher number of successful experiments per unit of time can be achieved by deploying such a scheduler on the second step of the evaluation pipeline. Consequently, we argue that the efficiency of the evaluation pipeline can be increased. Next, to improve the efficiency of the online evaluation step, we propose the Generalised Team Draft interleaving framework. Generalised Team Draft considers both the interleaving policy (how often a particular combination of results is shown) and click scoring (how important each click is) as parameters in a data-driven optimisation of the interleaving sensitivity. Further, Generalised Team Draft is applicable beyond domains with a list-based representation of results, i.e. in domains with a grid-based representation, such as image search. Our study using datasets of interleaving experiments performed both in document and image search domains demonstrates that Generalised Team Draft achieves the highest sensitivity. A higher sensitivity indicates that the interleaving experiments can be deployed for a shorter period of time or use a smaller sample of users. Importantly, Generalised Team Draft optimises the interleaving parameters w.r.t. historical interaction data recorded in the interleaving experiments. Finally, we propose to apply the sequential testing methods to reduce the mean deployment time for the interleaving experiments. We adapt two sequential tests for the interleaving experimentation. We demonstrate that one can achieve a significant decrease in experiment duration by using such sequential testing methods. The highest efficiency is achieved by the sequential tests that adjust their stopping thresholds using historical interaction data recorded in diagnostic experiments. Our further experimental study demonstrates that cumulative gains in the online experimentation efficiency can be achieved by combining the interleaving sensitivity optimisation approaches, including Generalised Team Draft, and the sequential testing approaches. Overall, the central contributions of this thesis are the proposed approaches to improve the accuracy or efficiency of the steps of the evaluation pipeline: the offline evaluation frameworks for the query auto-completion, an approach for the optimised scheduling of online experiments, a general framework for the efficient online interleaving evaluation, and a sequential testing approach for the online search evaluation. The experiments in this thesis are based on massive real-life datasets obtained from Yandex, a leading commercial search engine. These experiments demonstrate the potential of the proposed approaches to improve the efficiency of the evaluation pipeline.

Governing the transition to higher levels of education and differences between achievement and school grades by gender

The author will explore the performance of boys and girls in external examinations in Slovenia at the beginning of upper secondary and tertiary education. These are critical points in students’ educational career at which he/she has to choose a school/university. Since both transitions are managed centrally by appropriate authorities, this is also a question of Educational Governance. Transitions between levels of education should, above all, assure fairness in selection procedures. At the point of transition to upper secondary schools we will explore differences between students’ achievements in various school subjects tested at the national assessment of knowledge (NA), and their school grades by gender. Since only school grades are used as admission criteria to upper secondary schools, this comparison of school grades with external and more objective measure of students’ achievement will show possible bias. In Slovenia admission to tertiary education usually consists of (externally assessed) Matura results and school grades in the last two years of upper secondary school. The author will compare the effects of both most commonly used measures of academic achievement on admission in view of gender differences. Study courses where selection procedure was actually applied will be of specific interest since they can show signs of (un)fairness. Results show signs of bias and build case for better Educational Governance. (DIPF/Orig.)

A Experiência Operacional dos Aviadores Militares Portugueses na Grande Guerra e as Implicações para a Aviação Militar Portuguesa do pós Guerra

O presente trabalho, realizado no âmbito do Curso de Promoção a Oficial Superior (CPOS), incide inicialmente em contexto da Primeira Guerra Mundial e mais especificamente, no âmbito do Corpo Expedicionário Português (CEP), sobre a participação dos pilotos portugueses integrados ao serviço da Aviação Militar Aliada no período do conflito (1914-1918). Neste contexto, procurou-se correlacionar a experiência e o conhecimento adquiridos nesta vivência, com a posterior aplicação destas mais-valias no desenvolvimento da Aviação Militar Portuguesa, no período subsequente ao conflito. Utilizada uma estratégia de investigação qualitativa, um desenho de pesquisa histórico e seguido um percurso metodológico proposto por A. Da Silva Rego, realizou-se o levantamento de informação relacionada com a organização da aviação militar francesa, por ser aquela que acolheu nas suas esquadrilhas o maior número de pilotos militares portugueses. Posteriormente, alargado o momento histórico para os anos subsequentes à Grande Guerra, pretende-se demonstrar a influência enquanto aviadores, naquilo que foram os desígnios realizados por estes homens na organização, no desenvolvimento e na formação da Aviação Portuguesa enquanto ramo independente. Abstract: The present work, carried out as part of the Higher Official Promotion Course, has an initial focus on the First World War and more specifically, within the Portuguese Expeditionary Force (CEP), on the participation of Portuguese pilots serving the allied Air Force during the First World War (1914 – 1918). In this context, we tried to correlate the experience and knowledge gained from this experience, with the subsequent implementation of those gains in the development of Portuguese Military Aviation, in the period after the conflict. Using a qualitative research strategy, a historical research design and following a methodological approach proposed by A. Da Silva Rego, we gathered the information relatted with the organization of the French Air Force, as it was the one that received most of the most Portuguese pilots in their squadrons. Further on, broadening the historical period to the subsequent years after the First World War. we intend to demonstrate the influence of Air Force pilots on what was accomplished by these men in the organization, in the establishment and development of the Portuguese Air Force as an independent branch.

Charte canadienne et droits linguistiques : frontières allégoriques et autres assertions consensuelles

La frontière entre le politique et l'intellectualisme militant est, d'ordinaire, ténue. Tout univers politico-constitutionnel est ainsi susceptible de faire les frais d'un martèlement doctrinal qui, à maints égards, relève davantage du construit que du donné. Résultante directe d'une construction parfois intéressée, le récit identitaire, à force de répétition, s'installera confortablement sur les sièges de l'imaginaire populaire. Il accèdera, au fil du temps, au statut de mythe pur et simple. Ce dernier, politiquement parlant, revêt de puissants effets aphrodisiaques. La présente thèse doctorale s'intéresse plus particulièrement aux mythes créés, depuis 1982, par un segment de la doctrine québécoise : en matière de droits linguistiques, objet principal de notre étude, Charte canadienne des droits et libertés et Cour suprême, toutes deux liguées contre le Québec, combineront leurs efforts afin d'assurer le recul du fait français dans la Belle Province. Quant aux francophones hors Québec, ceux-ci, depuis l'effritement du concept de nation canadienne-française, sont dorénavant exclus de l'équation, expurgés de l'échiquier constitutionnel. En fait, l'adoption d'un nationalisme méthodologique comme nouvelle orthodoxie politique et doctrinale rend ardue, en plusieurs sens, la conciliation de leur existence avec les paradigmes et épistémologie maintenant consacrés. Ainsi, et selon la logique du tiers exclu, une victoire francophone hors Québec signifiera, du fait d'une prétendue symétrie interprétative, un gain pour la communauté anglo-québécoise. Cette thèse vise à discuter de la teneur de diverses allégories établies et, le cas échéant, à reconsidérer la portée réelle de la Charte canadienne en matière linguistique. Il sera alors démontré que plusieurs lieux communs formulés par les milieux intellectuels québécois échouent au moins partiellement, le test de l'analyse factuelle. Celui-ci certifiera de l'exclusion, par la doxa, de toute décision judiciaire ou autre vérité empirique ne pouvant cadrer à même les paramètres, voire les prismes, de l'orthodoxie suggérée.

Engineering a Quantum Many-body Hamiltonian with Trapped Ions

While fault-tolerant quantum computation might still be years away, analog quantum simulators offer a way to leverage current quantum technologies to study classically intractable quantum systems. Cutting edge quantum simulators such as those utilizing ultracold atoms are beginning to study physics which surpass what is classically tractable. As the system sizes of these quantum simulators increase, there are also concurrent gains in the complexity and types of Hamiltonians which can be simulated. In this work, I describe advances toward the realization of an adaptable, tunable quantum simulator capable of surpassing classical computation. We simulate long-ranged Ising and XY spin models which can have global arbitrary transverse and longitudinal fields in addition to individual transverse fields using a linear chain of up to 24 Yb+ 171 ions confined in a linear rf Paul trap. Each qubit is encoded in the ground state hyperfine levels of an ion. Spin-spin interactions are engineered by the application of spin-dependent forces from laser fields, coupling spin to motion. Each spin can be read independently using state-dependent fluorescence. The results here add yet more tools to an ever growing quantum simulation toolbox. One of many challenges has been the coherent manipulation of individual qubits. By using a surprisingly large fourth-order Stark shifts in a clock-state qubit, we demonstrate an ability to individually manipulate spins and apply independent Hamiltonian terms, greatly increasing the range of quantum simulations which can be implemented. As quantum systems grow beyond the capability of classical numerics, a constant question is how to verify a quantum simulation. Here, I present measurements which may provide useful metrics for large system sizes and demonstrate them in a system of up to 24 ions during a classically intractable simulation. The observed values are consistent with extremely large entangled states, as much as ~95% of the system entangled. Finally, we use many of these techniques in order to generate a spin Hamiltonian which fails to thermalize during experimental time scales due to a meta-stable state which is often called prethermal. The observed prethermal state is a new form of prethermalization which arises due to long-range interactions and open boundary conditions, even in the thermodynamic limit. This prethermalization is observed in a system of up to 22 spins. We expect that system sizes can be extended up to 30 spins with only minor upgrades to the current apparatus. These results emphasize that as the technology improves, the techniques and tools developed here can potentially be used to perform simulations which will surpass the capability of even the most sophisticated classical techniques, enabling the study of a whole new regime of quantum many-body physics.

Na especificidade, a evidência do impacto das intervenções do enfermeiro especialista em enfermagem de reabilitação no doente com patologia respiratória crónica, no serviço de urgência

O presente estudo decorreu no serviço de urgência do Hospital do Espírito Santo de Évora – EPE, de Setembro de 2015 a Janeiro de 2016 e enquadra-se na área da prestação de cuidados especializados em enfermagem de reabilitação. É um estudo de caso, em que objeto de estudo é “A Intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação no doente com Patologia Respiratória Crónica”. A abordagem metodológica é mista pois trata-se de um caso de estudo que não é puramente qualitativo. A utilização de metodologia quantitativa com indicadores quantitativos permitirá uma melhor compreensão e visão global do caso apresentado. Trata-se de um estudo de natureza descritiva, transversal e não experimental pois tem como objetivo a recolha de dados observáveis e quantificáveis, num determinado período de tempo e não o controlo de fenómenos. População alvo: todos os utentes com Patologia Respiratória Crónica internados no Serviço de Observação no período de tempo referido anteriormente. Amostra: 4 utentes com média de idades de 78,0 anos dos quais 75% eram do sexo masculino e 25% do sexo feminino. Foram implementadas intervenções de enfermagem de reabilitação, nomeadamente, reabilitação funcional respiratória e motora, que demonstraram ser eficazes tendo-se obtido saturações periféricas de O2 de 96%, em média. Estes resultados traduzem-se em ganhos ao nível da capacidade respiratória permitindo o desenvolvimento de atividades de vida diária normais. Também foi possível a manutenção e potenciação das capacidades de mobilidade nestes utentes com uma média etária elevada e com algumas limitações físicas e/ou cognitivas o que, só por si, também traduz ganhos em saúde no que concerne à sua independência e melhoria da qualidade de vida. O Enfermeiro Especialista em Enfermagem de Reabilitação é claramente uma mais-valia no serviço de urgência pois ao colocar em prática uma dinâmica de desempenho voltado para os conhecimentos especializados adquiridos, criando ferramentas que permitam um desempenho estruturado dos cuidados, a promoção da sua continuidade, a sua avaliação e a produção de conhecimento científico baseado na evidência contribui para a redução do tempo de internamento o que se repercute na maior eficácia na Gestão de Unidades de Saúde.

Por uma moradia termicamente confortável: proposta de habitação de interesse social com ênfase no conforto térmico

This research covers the topic of social housing and its relation to thermal comfort, so applied to an architectural and urban intervention in land situated in central urban area of Macaíba/RN, Brazil. Reflecting on the role of design and use of alternative building materials in the search for better performance is one of its main goals. The hypothesis is that by changing design parameters and choice of materials, it is possible to achieve better thermal performance results. Thus, we performed computer simulations of thermal performance and natural ventilation using computational fluid dynamics or CFD (Computational Fluid Dynamics). The presentation of the thermal simulation followed the methodology proposed in the dissertation Negreiros (2010), which aims to find the percentage of the amount of hours of comfort obtained throughout the year, while data analysis was made of natural ventilation from images generated by the images extracted from the CFD. From model building designed, was fitted an analytical framework that results in a comparison between three different proposals for dwellings housing model, which is evaluated the question of the thermal performance of buildings, and also deals with the spatial variables design, construction materials and costs. It is concluded that the final report confirmed the general hypotheses set at the start of the study, it was possible to quantify the results and identify the importance of design and construction materials are equivalent, and that, if combined, lead to gains in thermal performance potential.

Curso online para a parte pral do Celpe-Bras : contribuições da avaliação de proficiência para o ensino-aprendizagem de PLE

Dissertação (mestrado)—Universidade de Brasília, Departamento de Línguas Estrangeiras e Tradução, Programa de Pós-Graduação em Linguística Aplicada, 2016.

Projectar com luz, cor e matéria

Dissertação para obtenção do grau de Mestre em Arquitectura com Especialização em Arquitectura de Interiores, apresentada na Universidade de Lisboa - Faculdade de Arquitectura.

Estudo sobre as potencialidades de compósitos à base de gesso e fibras de coco seco para aplicação na construção civil

The use of gypsum, one of the oldest building materials for the construction industry in the country has been experiencing a significant and steady growth, due to its low cost and some of its properties that confer comparative advantage over other binder materials. Its use comprises various applications including the coating of walls and the production of internal seals and linings. Moreover, the fibers are being increasingly incorporated into arrays fragile in an attempt to improve the properties of the composite by reducing the number of cracks, the opening of the same and its propagation velocity. Other properties, depending on the function of the component material or construction, among these thermal and acoustic performances, are of great importance in the context of buildings and could be improved, that is, having better performance with this embodiment. Conduct a comparative study of physico-mechanical, thermal and acoustic composite gypsum incorporating dry coconut fiber, in the form of blanket, constituted the main objective of this work. Improving the thermal and acoustic performances of precast gypsum, used for lining and internal vertical fences of buildings, was the purpose of development of these composites. To evaluate the effect of fiber content on the properties of the composites were used to manufacture the composite layer with different thicknesses. The composites were fabricated in the form of plates with dimensions of 500x500x24mm. To facilitate the comparative study of the properties were also made with material gypsum boards only. We then determined the physico-mechanical, thermal and acoustical plaster and composites. The results indicated that the composites were significant gains in relation to thermal performance and also acoustic, in certain frequency range, increasing the thickness of the blanket. Concerning other physical-mechanical properties, the results showed that although the compressive strength was lower than for the composite did not occur after a fracture catastrophic failure. The same trend was observed with regard to resistance to bending, since the composites have not suffered sudden rupture and still continued after the load supporting point of maximum load

Nonlinear evolution of harmonically forced perturbations on a wingtip vortex

Wingtip vortices are created by flying airplanes due to lift generation. The vortex interaction with the trailing aircraft has sparked researchers’ interest to develop an efficient technique to destroy these vortices. Different models have been used to describe the vortex dynamics and they all show that, under real flight conditions, the most unstable modes produce a very weak amplification. Another linear instability mechanism that can produce high energy gains in short times is due to the non-normality of the system. Recently, it has been shown that these non-normal perturbations also produce this energy growth when they are excited with harmonic forcing functions. In this study, we analyze numerically the nonlinear evolution of a spatially, pointwise and temporally forced perturbation, generated by a synthetic jet at a given radial distance from the vortex core. This type of perturbation is able to produce high energy gains in the perturbed base flow (10^3), and is also a suitable candidate for use in engineering applications. The flow field is solved for using fully nonlinear three-dimensional direct numerical simulation with a spectral multidomain penalty method model. Our novel results show that the nonlinear effects are able to produce locally small bursts of instability that reduce the intensity of the primary vortex.

Economicidade e eficiência temporal estudo de caso no Instituto Federal de Goiás

Dissertação (mestrado)—Universidade de Brasília, Faculdade UnB Planaltina, Programa de Pós-Graduação em Gestão Pública, Mestrado Profissional em Gestão Pública, 2016.

Student’s Perception on the Personal Impact of a Social Education Degree Internship

The functional profile of the social educator is based on the development of theoretical, technical and personal/relational skills, which should guide training courses organization. Assuming the shortcomings of a merely theoretical approach, besides a consistent preparation in theoretical and essential technical contents for socio-educational intervention, practice in context should be favoured as an opportunity to develop professional skills, together with a critical reflection on the functional profile. This study emerges from the need to reflect and rethink the internship, as well as how the respective supervision is developed, of the degree in social education at the School of Education of the Polytechnic Institute of Viseu, and it is based on the students’ perceptions about the impact of the internship on personal development. This is a qualitative and exploratory study, using the documentary analysis of 50 final internship reports. From the content analysis, four categories emerged referring to gains in terms of acquiring and managing knowledge, development of technical skills, personal and relational development and reinforcement of professional identity. The importance given to personal and relational development should be noted (41.4% of mentions) taking into account its relevance in constructing a professional identity. Findings on the technical skills and on the increase of profession knowledge, also by mobilising theoretical training, positively reinforce the internship model that is based on a proximity supervision approach and on a dialogical perspective of the professional learning.