A New Electronic Approach for the Surgical Safety Checklist

To improve surgical safety, and to reduce the mortality and surgical complications incidence, the World Health Organization (WHO) developed the Surgical Safety Checklist (SSC). The SSC is a support of information that aids health professionals to reduce the number of complications, induction of anaesthesia, period before skin incision and period before leaving the operating room (OR). The SSC was tested in several countries of the world and their results shown that after introduction of the SSC the incidence of patient complication lowered from 11.0% to 7.0% (P<0.001), the rate of death declined from 1.5% to 0.8% (P = 0.003) and the nurses recognized that patients identity was more often con rmed (81.6% to 94.2%, P<0.01) in many institutions. Recently the SSC was also implemented in Portuguese hospitals, which led us to its study in the real clinical environment. An observational study was performed: several health professionals were observed and interviewed, to understand the functioning of the SSC in an OR, during the clinical routine. The objective of this study was to understand the current use of the SSC, and how it may be improved in terms of usability, taking advantage of the technological advancements such as mobile applications. During two days were observed 14 surgeries, only 2 surgeries met the requirements for the three phases of the SSC, as de ned by the WHO. Of the remaining 12 observed surgeries, 9 surgeries completed the last phase at the correct time. It was also observed that only in 2 surgeries all the phases of the SSC were read aloud to the team and that, in 7 surgeries, several items were read aloud and answered but no one was checking the SSC, only after the end of the phase. The observational study results disclose that several health professionals do not meet with rules of the WHO manual. This study demonstrates that it is urgent to change the mindset of health professionals, and that di erent features in the SSC may be useful to make it more easy to use. With the results of the observational study, a SSC application proposal was developed with new functionalities to improve and aid the health professional in its use. In this application the user can chose between a SSC already created to a speci c surgery or to create a new SSC, adding and adapting some questions from the WHO standard. To create a new SSC, the application is connected to an online questionnaire builder (JotForm). The choice for this online questionnaire builder went through three essential characteristics: number of types of questions, mainly checkbox, radio button and text; the possibility of to create sections inside sections and the API. In addition, in this proposal the improvements are focused in forcing the user to focus in the work ow of the SSC and to save the input timestamps and any actions made by them. Therefore, the following features was implemented to achieve that goal: display one item of the SSC at a time; display the stage where the SSC is; do not allow going back to the previous step; do not allow going forward to the next item if the current is not lled; do not allow going forward to the next item if the time it took to ll the item was too short and log any action made by the user.

The effects of mega-events on city branding: The example of Warsaw and Euro 2012

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Management Consulting Lab: Project TAP

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Assessing the efficacy of the Mental Health Gap Action Programme (mhGAP) training for non-specialized health workers in Ethiopia

RESUMO: A OMS lançou em 2008, o Programa de Acção do Gap em Saúde Mental (mhGAP) para suprir a falta de cuidados, especialmente em países de rendimento baixo e médio, para as pessoas que sofrem de perturbações mentais, neurológicas e de uso de substâncias (MNS). Um componente crucial do mhGAP é representado pelo esforço no sentido da integração da saúde mental nos cuidados de saúde primários. Na Etiópia, o mhGAP foi monitorizado durante 3 anos, graças a um projeto de demonstração implementado em clínicas selecionadas em quatro regiões do país. A fase de demonstração de mhGAP na Etiópia traduziu-se principalmente na formação de profissionais de saúde não especializados, fornecendo-lhes orientação e supervisão apoiada para a utilização de medicamentos psicotrópicos essenciais e na coordenação com o Ministério Etíope Federal da Saúde, Hospital Amanuel de Saúde Mental e as Secretarias Regionais de Saúde ( RHBs ). O presente trabalho investigou a eficácia do pacote de formação mhGAP através de uma análise das pontuações dos participantes no pré- e pós-testes. A análise estatística mostrou - com uma exceção - que a melhoria dos formandos é estatisticamente significativa, o que sugere que os conhecimentos dos participantes é melhorada na fase de pós-teste. A eficácia do pacote de formação mhGAP para profissionais de saúde não especializados é uma evidência promissora de que os mesmos podem ser treinados com sucesso para realizar um pacote básico de intervenções para a prestação de cuidados e tratamento para pessoas com perturbações mentais, neurológicas e de uso de substâncias. Este trabalho destaca, também, várias limitações não apenas inerentes ao próprio projecto de investigação tais como o número limitado de respostas que foram analisadas e a falta de dados de uma das quatro regiões onde mhGAP foi testado na Etiópia. As principais limitações decorrem de facto da abordagem global limitar as intervenções de saúde mental ao programa de formação e supervisão dos trabalhadores de cuidados de saúde primários . Este processo só será bem sucedido se, juntamente com outras intervenções - que vão desde o desenvolvimento de currículos para o desenvolvimento de uma legislação de saúde mental -, fôr incluído numa estratégia mais abrangente para a reforma da saúde mental e desafiar o status quo.-----------ABSTRACT:In 2008, WHO launched the Mental Health Gap Action Programme (mhGAP) to address the lack of care, especially in low- and middle- income countries, for people living with mental, neurological and substance use (MNS) disorders. A crucial component of mhGAP is represented by the endeavor towards integration of mental health into primary health care. In Ethiopia, mhGAP has been piloted for 3 years thanks to a demonstration project implemented in selected clinics in 4 regions of the country. The demonstration phase of mhGAP in Ethiopia has mainly translated into training of non-specialized health workers, providing them with mentorship and supportive supervision, availing essential psychotropic medications and coordinating with the Ethiopian Federal Ministry of Health, Amanuel Mental Health Hospital and the Regional Health Bureaus (RHBs). The present paper investigated the efficacy of the mhGAP training package through an analysis of the participants’ scores at pre-test and post-test. The statistical analysis showed - with one exception - that the improvement of trainees is statistically significant, therefore suggesting that the knowledge of participants is improved in the post-test phase. The efficacy of the mhGAP training package on non-specialized health workers is promising evidence that non-specialized health-care providers can be successfully trained to deliver a basic package of interventions for providing care and treatment for people with mental, neurological and substance use disorders. However, this paper also highlights several limitations, which are not only inherent to the research itself, such as the limited number of scores that was analyzed, or the lack of data from one of the four regions where mhGAP has been piloted in Ethiopia; major limitations occur in fact in the overall approach of confining mental health interventions to training and supervising primary health care workers. This process will only be successful if coupled with other interventions – ranging from curricula development to development of a mental health legislation - and if it is included in a more comprehensive strategy to reform mental health and challenge the status quo.

Cataract surgery: expectations of patients assisted during a community project in São Paulo, state of São Paulo, Brazil

OBJECTIVE: To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY: Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye) aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São Paulo, Brazil, in 1999. RESULTS: The sample was composed of 331 subjects of low socioeconomic level ranging in age from 50 to 97 years (average = 71.8 years). Expectation of total recovery from the cataract condition by means of surgery was declared by 80.0% of the respondents, with no significant differences between male and female subjects (P < 0.1723). Hope to resume manual activities was expressed by 59.8%. CONCLUSION: A predominance of expectations of resuming normal activity and achieving a better quality of life after cataract surgery were identified.

Genetic algorithm for shipping route estimation with long-range tracking data : automatic reconstruction of shipping routes based on the historical ship positions for maritime safety applications

Ship tracking systems allow Maritime Organizations that are concerned with the Safety at Sea to obtain information on the current location and route of merchant vessels. Thanks to Space technology in recent years the geographical coverage of the ship tracking platforms has increased significantly, from radar based near-shore traffic monitoring towards a worldwide picture of the maritime traffic situation. The long-range tracking systems currently in operations allow the storage of ship position data over many years: a valuable source of knowledge about the shipping routes between different ocean regions. The outcome of this Master project is a software prototype for the estimation of the most operated shipping route between any two geographical locations. The analysis is based on the historical ship positions acquired with long-range tracking systems. The proposed approach makes use of a Genetic Algorithm applied on a training set of relevant ship positions extracted from the long-term storage tracking database of the European Maritime Safety Agency (EMSA). The analysis of some representative shipping routes is presented and the quality of the results and their operational applications are assessed by a Maritime Safety expert.

Implementation of a probabilistic based framework for safety assessment of existing timber elements

The assessment of existing timber structures is often limited to information obtained from non or semi destructive testing, as mechanical testing is in many cases not possible due to its destructive nature. Therefore, the available data provides only an indirect measurement of the reference mechanical properties of timber elements, often obtained through empirical based correlations. Moreover, the data must result from the combination of different tests, as to provide a reliable source of information for a structural analysis. Even if general guidelines are available for each typology of testing, there is still a need for a global methodology allowing to combine information from different sources and infer upon that information in a decision process. In this scope, the present work presents the implementation of a probabilistic based framework for safety assessment of existing timber elements. This methodology combines information gathered in different scales and follows a probabilistic framework allowing for the structural assessment of existing timber elements with possibility of inference and updating of its mechanical properties, through Bayesian methods. The probabilistic based framework is based in four main steps: (i) scale of information; (ii) measurement data; (iii) probability assignment; and (iv) structural analysis. In this work, the proposed methodology is implemented in a case study. Data was obtained through a multi-scale experimental campaign made to old chestnut timber beams accounting correlations of non and semi-destructive tests with mechanical properties. Finally, different inference scenarios are discussed aiming at the characterization of the safety level of the elements.

Crescer com os outros: a aprendizagem cooperativa e o trabalho de grupo como estratégias fundamentais no desenvolvimento de competências sociais: o contributo do Projeto Curricular Integrado

Relatório de estágio de mestrado em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

Portuguese strengths and fragilities on safety and health practices

Despite improvements over the years, accidents continue to be a scourge in the construction sector, leading to an increase in the number of journal articles addressing the issue, in an attempt to help construction industry to increase safety performance [1]. This paper aims to, helping construction industry and particulary tunneling community, describe the Portuguese approach to most typical health and safety problems in underground excavations performed with the Sequential Excavation Method (SEM). The article will address various topics, from safety management and organizational practices, to collective and personal protection equipment, to emergency planning. nt problems in safety and health matters are similar to several other countries, the paper will expose a compilation of Portuguese best practices used to solve that problems. This enunciation of best practices describes experience from most important and recognized Project Owners and Contractors in Portugal. In a second phase it will be analysed Portuguese weaknesses, identifying preventive measures, and their comparative importance, that should be adopted in Portugal in order to reduce accidents and health diseases.

An integrated system for human action recognition from video using hidden Markov model

In this paper, we present an integrated system for real-time automatic detection of human actions from video. The proposed approach uses the boundary of humans as the main feature for recognizing actions. Background subtraction is performed using Gaussian mixture model. Then, features are extracted from silhouettes and Vector Quantization is used to map features into symbols (bag of words approach). Finally, actions are detected using the Hidden Markov Model. The proposed system was validated using a newly collected real- world dataset. The obtained results show that the system is capable of achieving robust human detection, in both indoor and outdoor environments. Moreover, promising classification results were achieved when detecting two basic human actions: walking and sitting.

Princípios para a reabilitação sustentável low cost de edifícios antigos: estudo de um quarteirão no centro da cidade do Porto

Dissertação de mestrado em Construção e Reabilitação Sustentável

Mechanical fatigue performance of PCL-chondroprogenitor constructs after cell culture under bioreactor mechanical stimulus

In tissue engineering of cartilage, polymeric scaffolds are implanted in the damaged tissue and subjected to repeated compression loading cycles. The possibility of failure due to mechanical fatigue has not been properly addressed in these scaffolds. Nevertheless, the macroporous scaffold is susceptible to failure after repeated loading-unloading cycles. This is related to inherent discontinuities in the material due to the micropore structure of the macro-pore walls that act as stress concentration points. In this work, chondrogenic precursor cells have been seeded in Poly-ε-caprolactone (PCL) scaffolds with fibrin and some were submitted to free swelling culture and others to cyclic loading in a bioreactor. After cell culture, all the samples were analyzed for fatigue behavior under repeated loading-unloading cycles. Moreover, some components of the extracellular matrix (ECM) were identified. No differences were observed between samples undergoing free swelling or bioreactor loading conditions, neither respect to matrix components nor to mechanical performance to fatigue. The ECM did not achieve the desired preponderance of collagen type II over collagen type I which is considered the main characteristic of hyaline cartilage ECM. However, prediction in PCL with ECM constructs was possible up to 600 cycles, an enhanced performance when compared to previous works. PCL after cell culture presents an improved fatigue resistance, despite the fact that the measured elastic modulus at the first cycle was similar to PCL with poly(vinyl alcohol) samples. This finding suggests that fatigue analysis in tissue engineering constructs can provide additional information missed with traditional mechanical measurements.

Polymer electrolyte based on DNA and N,N,N-trimethyl-N-(2-hydroxyethyl)ammonium bis(trifluoromethylsulfonyl)imide

Combining ionic liquids (ILs) with polymers offers the prospect of new applications, where they surpass the performance of conventional media, such as organic solvents, giving advantages in terms of improved safety and a higher operating temperature range. In this work we have investigated the morphology, thermal and electrochemical properties of polymer electrolytes prepared through the addition of con- trolled quantities of the cholinium based IL N,N,N-trimethyl-N-(2-hydroxyethyl)ammonium bis(trifluo- romethylsulfonyl)imide ([N1 1 1 2(OH)] [NTf2]) to a deoxyribonucleic acid (DNA) host network. These novel IL-based electrolytes have been analyzed aiming at applications in electrochemical devices. An optimized sample showed good thermal stability up to 155 °C and a wide electrochemical window of ~3.5 V. The highest conductivity was registered for the DNA[N1 1 1 2(OH)][NTf2] (1:1) (2.82 × 10-5 and 1.09 × 10-3 S cm-1 at 30 and 100 °C, respectively).

Association study of the Ile349val polymorphism of the gene ADH1C and alcohol dependence

OBJECTIVE: The aim of this study was to investigate the polymorphism Ile349Val of the enzyme alcohol dehydrogenase ADH1C gene among individuals with alcohol dependence syndrome (ADS) attending Alcoholics Anonymous (AA) meetings. METHODS: A total of 120 subjects residing in Rio de Janeiro city participated in this study. Subjects were divided into two groups: a group consisting of 54 individuals from the ADS group and 66 individuals that declared not having any alcohol dependence (control group). DNA was extracted from mouth epithelial cells by phenol-chloroform method and further submitted to amplification by polymerase chain reaction (PCR). RESULTS: Our results did not show differences between the genotypes of control individuals and ADS subjects. Nevertheless, we found increased rates of alcoholism in families of ADS subjects as compared to controls. CONCLUSIONS: Our results did not show any genotype difference on the ADH1C gene when control and AA genotypes are compared.

Systems biology approaches for the design of novel Saccharomyces cerevisiae winemaking strains for enhanced flavour compounds synthesis

Tese de Doutoramento em Biologia Ambiental e Molecular