Impact of long-stay beds on the performance of a tertiary hospital in emergencies

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Real time fault injection using enhanced OCD -- a performance analysis

Fault injection is frequently used for the verification and validation of dependable systems. When targeting real time microprocessor based systems the process becomes significantly more complex. This paper proposes two complementary solutions to improve real time fault injection campaign execution, both in terms of performance and capabilities. The methodology is based on the use of the on-chip debug mechanisms present in modern electronic devices. The main objective is the injection of faults in microprocessor memory elements with minimum delay and intrusiveness. Different configurations were implemented and compared in terms of performance gain and logic overhead.

The effect of superplasticizers on the mechanical performance of concrete made with fine recycled concrete aggregates

It is considered that using crushed recycled concrete as aggregate for concrete production is a viable alternative to dumping and would help to conserve abiotic resources. This use has fundamentally been based on the coarse fraction because the fine fraction is likely to degrade the performance of the resulting concrete. This paper presents results from a research work undertaken at Institut Superior Tecnico (IST), Lisbon, Portugal, in which the effects of incorporating two types of superplasticizer on the mechanical performance of concrete containing fine recycled aggregate were evaluated. The purpose was to see if the addition of superplasticizer would offset the detrimental effects associated with the use of fine recycled concrete aggregate. The experimental programme is described and the results of tests for splitting tensile strength, modulus of elasticity and abrasion resistance are presented. The relative performance of concrete made with recycled aggregate was found to decrease. However, the same concrete with admixtures in general exhibited a better mechanical performance than the reference mixes without admixtures or with a less active superplasticizer. Therefore, it is argued that the mechanical performance of concrete made with fine recycled concrete aggregates can be as good as that of conventional concrete, if superplasticizers are used to reduce the water-cement ratio of the former concrete.

Anti-Corrosion performance of a new silane coating for corrosion protection of AZ31 Magnesium alloy in Hank’s solution

Mg alloys can be used as bioresorsable metallic implants. However, the high corrosion rate of magnesium alloys has limited their biomedical applications. Although Mg ions are essential to the human body, an excess may cause undesirable health effects. Therefore, surface treatments are required to enhance the corrosion resistance of magnesium parts, decreasing its rate to biocompatible levels and allowing its safe application as bioresorbable metallic implants. The application of biocompatible silane coatings is envisaged as a suitable strategy for retarding the corrosion process of magnesium alloys. In the current work, a new glycidoxypropyltrimethoxysilane (GPTMS) based coating was tested on AZ31 magnesium substrates subjected to different surface conditioning procedures before coating deposition. The surface conditioning included a short etching with hydrofluoric acid (HF) or a dc polarisation in alkaline electrolyte. The silane coated samples were immersed in Hank's solution and the protective performance of the coating was studied through electrochemical impedance spectroscopy (EIS). The EIS data was treated by new equivalent circuit models and the results revealed that the surface conditioning process plays a key role in the effectiveness of the silane coating. The HF treated samples led to the highest impedance values and delayed the coating degradation, compared to the mechanically polished samples or to those submitted to dc polarisation.

Characterization and performance analysis of a VDFLL GNSS receiver architecture

A non-coherent vector delay/frequency-locked loop architecture for GNSS receivers is proposed. Two dynamics models are considered: PV (position and velocity) and PVA (position, velocity, and acceleration). In contrast with other vector architectures, the proposed approach does not require the estimation of signals amplitudes. Only coarse estimates of the carrier-to-noise ratios are necessary.

Impact of different moodle course designs on students? Performance

This work describes the impact of different teachers’ approaches in using Moodle, for supporting their courses, at the Polytechnic of Porto - School of Engineering. The study covers five different courses, from different degrees and different years, and includes a number of Moodle resources especially supporting laboratory classes. These and other active resources are particularly analyzed in order to evaluate students’ adherence to them. One particular course includes a number of remote experiments, made available through VISIR (Virtual Instrument Systems in Reality) and directly accessible through links included in the Moodle course page. The collected data have been correlated with students’ classifications in the lab component and in the exam, each one weighting 50% of their final marks. This analysis benefited from the existence of different teachers’ approaches, which resulted in a diversity of Moodle-supported environments. Conclusions point to the existence of a positive correlation factor between the number of Moodle accesses and the final exam grade, although the quality of the resources made available by the teachers seems to be preponderant over its quantity. In addition, different students perspectives were found regarding active resources: while some seem to encourage students to participate (for instance online quiz or online reports), others, more demanding, are unable to stimulate the majority of them.

Student performance analysis under different moodle course designs

This work extends a recent comparative study covering four different courses lectured at the Polytechnic of Porto - School of Engineering, in respect to the usage of a particular Learning Management System, i.e. Moodle, and its impact on students' results. A fifth course, which includes a number of resources especially supporting laboratory classes, is now added to the analysis. This particular course includes a number of remote experiments, made available through VISIR (Virtual Instrument Systems in Reality) and directly accessible through links included in the Moodle course page. We have analyzed the students' behavior in following these links and in effectively running experiments in VISIR (and also using other lab related resources, in Moodle). This data have been correlated with students' classifications in the lab component and in the exam, each one weighting 50% of their final marks. We aimed to compare students' performance in a richly Moodle-supported environment (with lab component) and in a poorly Moodle-supported environment (with only theoretical component). This question followed from conclusions drawn in the above referred comparative study, where it was shown that even though a positive correlation factor existed between the number of Moodle accesses and the final exam grade obtained by each student, its explanation behind was not straightforward, as the quality of the resources was preponderant over its quantity.

Marx-Type solid-state bipolar modulator topologies: Performance comparison

The operation of generalized Marx-type solid-state bipolar modulators is discussed and compared with simplified Marx-derived circuits, to evaluate their capability to deal with various load conditions. A comparative analysis on the number of switches per cell, fiber optic trigger count, losses, and switch hold-off voltages has been made. A circuit topology is obtained as a compromise in terms of operating performance, trigger simplicity, and switching losses. A five-stage laboratory prototype of this circuit has been assembled using 1200 V insulated gate bipolar transistors (IGBTs) and diodes, operating with 1000 V dc input voltage and 1 kHz frequency, giving 5 kV bipolar pulses, with 2.5 mu s pulse width and 5 mu s relaxation time into resistive, capacitive, and inductive loads.

High-performance flexible hybrid field-effect transistors based on cellulose fiber paper

IEEE Electron Device Letters, VOL. 29, NO. 9,

Performance of fractional PID algorithms controlling nonlinear systems with saturation and backlash phenomena

The development of fractional-order controllers is currently one of the most promising fields of research. However, most of the work in this area addresses the case of linear systems. This paper reports on the analysis of fractional-order control of nonlinear systems. The performance of discrete fractional-order PID controllers in the presence of several nonlinearities is discussed. Some results are provided that indicate the superior robustness of such algorithms.

The impact of national cultures on international marketing strategy and subsidiary performance of portuguese SME’s

The dynamic of the international business and its multidimensional nature requires the understanding of the complexities of different contexts dictated by cultural differences between countries. The purpose of this paper is to study, in depth howsmall and medium-sized companies develop their international marketing mix strategy in their overseas subsidiaries. We use the theoretical construct of Hofstede (1980, 1991) in the dimensions of Power Distance (PD), Uncertainty Avoidance (UA), Individualism (IND), Masculinity (MASC) and Long-Term Orientation (LTO) to assess the cross cultural differences between countries and the business practices to analyze the adaptation or standardization of the international marketing mix strategy of foreign Portuguese subsidiaries. Ourstudy uses an exploratoryand qualitative methodology. We conducted semi-structured interviews in order to achieve a good understanding ofinternational marketing mix strategy of four companies from different sectors. Our results show that the national cultural differences have great influence in the marketing strategy of the subsidiary. The business practices adjustments in the subsidiary company that proved to be necessary conditions for their performance are conducted by the products augmented offerings concerning the characteristics of the product, design and brand name in order to meet the requirements and specificities of the host country of the subsidiary.

Levantamento de práticas ambientais e energéticas de PMEs em Portugal

Para qualquer empresa o seu maior objetivo passa pela produção de lucro e, atualmente, esse aspeto está diretamente relacionado com a sua capacidade de manter uma gestão que incorpore a responsabilidade social, ambiental e económica, em prol de um desenvolvimento global mais sustentável. As grandes empresas já iniciaram e continuam este processo de mudança, desenvolvendo medidas e estratégias neste sentido. Porém, apesar de representarem o grosso do tecido empresarial, as Pequenas e Médias Empresas só agora começam a dar os primeiros passos em direção a uma gestão mais ponderada ambiental e energeticamente. Com este trabalho pretende-se reunir informação relativa às Pequenas e Médias Empresas portuguesas de forma a compreender quais as principais áreas de atuação, as medidas que poderão ser implementadas e, consolidar o ponto de situação deste sector acerca dos vários temas ao nível do meio ambiente e da energia. Para tal, foram realizados levantamentos energéticos e aplicado um questionário acerca dos comportamentos e práticas ambientais. Verificou-se que apesar da grande maioria das empresas analisadas já terem ponderado a importância e as vantagens da eficiência energética, ainda são poucas as organizações que têm implementados planos, estratégias ou instrumentos para melhoria do seu desempenho ambiental e energético.

A case study on the eco-efficiency performance of a composite processing industry: evaluation and quantification of potential improvements

In this study, an attempt was made in order to measure and evaluate the eco-efficiency performance of a pultruded composite processing company. For this purpose the recommendations of World Business Council for Sustainable Development (WCSD) and the directives of ISO 14301 standard were followed and applied. The main general indicators of eco-efficiency, as well as the specific indicators, were defined and determined. With basis on indicators’ figures, the value profile, the environmental profile, and the pertinent eco-efficiency ratios were established and analyzed. In order to evaluate potential improvements on company eco-performance, new indicators values and eco-efficiency ratios were estimated taking into account the implementation of new proceedings and procedures, at both upstream and downstream of the production process, namely: i) Adoption of a new heating system for pultrusion die-tool in the manufacturing process, more effective and with minor heat losses; ii) Recycling approach, with partial waste reuse of scrap material derived from manufacturing, cutting and assembly processes of GFRP profiles. These features lead to significant improvements on the sequent assessed eco-efficiency ratios of the present case study, yielding to a more sustainable product and manufacturing process of pultruded GFRP profiles.

Optimising the energy consumption on pultrusion process

This study is based on a previous experimental work in which embedded cylindrical heaters were applied to a pultrusion machine die, and resultant energetic performance compared with that achieved with the former heating system based on planar resistances. The previous work allowed to conclude that the use of embedded resistances enhances significantly the energetic performance of pultrusion process, leading to 57% decrease of energy consumption. However, the aforementioned study was developed with basis on an existing pultrusion die, which only allowed a single relative position for the heaters. In the present work, new relative positions for the heaters were investigated in order to optimise heat distribution process and energy consumption. Finite Elements Analysis was applied as an efficient tool to identify the best relative position of the heaters into the die, taking into account the usual parameters involved in the process and the control system already tested in the previous study. The analysis was firstly developed based on eight cylindrical heaters located in four different location plans. In a second phase, in order to refine the results, a new approach was adopted using sixteen heaters with the same total power. Final results allow to conclude that the correct positioning of the heaters can contribute to about 10% of energy consumption reduction, decreasing the production costs and leading to a better eco-efficiency of pultrusion process.