932 resultados para Integrated care pathway


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OBJECTIVE: Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. METHODS: A cross-sectional study using WHO drug indicators was carried out in Brasília in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. RESULTS: Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). CONCLUSIONS: Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.

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OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

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This paper reports on optical filters based on a-SiC:H tandem pi'n/pin heterostructures. The spectral sensitivity is analyzed. Steady state optical bias with different wavelengths are applied from each front and back sides and the photocurrent is measured. Results show that it is possible to control the sensitivity of the device and to tune a specific wavelength range by combining radiations with complementary light penetration depths. The transfer characteristics effects due to changes in the front and back optical bias wavelength are discussed. Depending on the wavelength of the external background and irradiation side, the device acts either as a short- or a long-pass band filter or as a band-stop filter. The output waveform presents a nonlinear amplitude-dependent response to the wavelengths of the input channels.

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Combined tunable WDM converters based on SiC multilayer photonic active filters are analyzed. The operation combines the properties of active long-pass and short-pass wavelength filter sections into a capacitive active band-pass filter. The sensor element is a multilayered heterostructure produced by PE-CVD. The configuration includes two stacked SiC p-i-n structures sandwiched between two transparent contacts. Transfer function characteristics are studied both theoretically and experimentally. Results show that optical bias activated photonic device combines the demultiplexing operation with the simultaneous photodetection and self amplification of an optical signal acting the device as an integrated photonic filter in the visible range. Depending on the wavelength of the external background and irradiation side, the device acts either as a short- or a long-pass band filter or as a band-stop filter. The output waveform presents a nonlinear amplitude-dependent response to the wavelengths of the input channels. A numerical simulation and a two building-blocks active circuit are presented and give insight into the physics of the device. (c) 2013 Elsevier B.V. All rights reserved.

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TRANSCREA, Convertir la investigación y el conocimiento en innovación, propiedad intelectual e industrial. Terceira, 16 e 17 Fevereiro, 2011.

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Dissertação apresentada à Escola Superior de Educação de Lisboa para a obtenção de grau de mestre em Ciências da Educação -Especialidade Educação Especial

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Consumer awareness, pesticide and fertilizer contaminations and environmental concerns have resulted in significant demand for organically grown farm produce. Consumption of berries has become popular among health-conscious consumers due to the high levels of valuable antioxidants, such as anthocyanins and other phenolic compounds. The present study evaluated the influence that organic farming (OF) and integrated pest management (IPM) practise exert on the total phenolic content in 22 strawberry samples from four varieties. Postharvest performance of OF and IPM strawberries grown in the same area in the centre of Portugal and harvested at the same maturity stage were compared. Chemical profiles (phenolic compounds) were determined with the aid of HPLC-DAD/MS. Total phenolic content was higher for OF strawberry extracts. This study showed that the main differences in bioactive phytochemicals between organically and IPM grown strawberries concerned their anthocyanin levels. Organically grown strawberries were significantly higher in antioxidant activity than were the IPM strawberries, as measured by DPPH and FRAP assays.

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The development of high performance monolithic RF front-ends requires innovative RF circuit design to make the best of a good technology. A fully differential approach is usually preferred, due to its well-known properties. Although the differential approach must be preserved inside the chip, there are cases where the input signal is single-ended such as RF image filters and IF filters in a RF receiver. In these situations, a stage able to convert single-ended into differential signals (balun) is needed. The most cited topology, which is capable of providing high gain, consists on a differential stage with one of the two inputs grounded. Unfortunately, this solution has some drawbacks when implemented monolithically. This work presents the design and simulated results of an innovative high-performance monolithic single to differential converter, which overcomes the limitations of the circuits.The integration of the monolithic active balun circuit with an LNA on a 0.18μm CMOS process is also reported. The circuits presented here are aimed at 802.11a. Section 2 describes the balun circuit and section 3 presents its performance when it is connected to a conventional single-ended LNA. Section 4 shows the simulated performance results focused at phase/amplitude balance and noise figure. Finally, the last section draws conclusions and future work.

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Wireless local-area networks (WLANs) have been deployed as office and home communications infrastructures worldwide. The diversification of the standards, such as IEEE 802.11 series demands the design of RF front-ends. Low power consumption is one of the most important design concerns in the application of those technologies. To maintain competitive hardware costs, CMOS has been used since it is the best solution for low cost and high integration processing, allowing analog circuits to be mixed with digital ones. In the receiver chain, the low noise amplifier (LNA) is one of the most critical blocks in a transceiver design. The sensitivity is mainly determined by the LNA noise figure and gain. It interfaces with the pre-select filter and the mixer. Furthermore, since it is the first gain stage, care must be taken to provide accurate input match, low-noise figure, good linearity and a sufficient gain over a wide band of operation. Several CMOS LNAs have been reported during the last decade, showing that the most research has been done at 802.11/b and GSM standards (900-2400MHz spectrum) and more recently at 802.11/a (5GHz band). One of the more significant disadvantages of 802.11/b is that the frequency band is crowded and subject to interference from other technologies, as is 2.4GHz cordless phones and Bluetooth. As the demand for radio-frequency integrated circuits, operating at higher frequency bands, increases, the IEEE 802.11/a standard becomes a very attractive option to wireless communication system developers. This paper presents the design and implementation of a low power, low noise amplifier aimed at IEEE 802.11a for WLAN applications. It was designed to be integrated with an active balun and mixer, representing the first step toward a fully integrated monolithic WLAN receiver. All the required circuits are integrated at the same die and are powered by 1.8V supply source. Preliminary experimental results (S-parameters) are shown and promise excellent results. The LNA circuit design details are illustrated in Section 2. Spectre simulation results focused at gain, noise figure (NF) and input/output matching are presented in Section 3. Finally, conclusions and comparison with other recently reported LNAs are made in Section 4, followed by future work.

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Pesticides are among the most widely used chemicals in the world. Because of the widespread use of agricultural chemicals in food production, people are exposed to low levels of pesticide residues through their diets. Scientists do not yet have a total understanding of the health effects of these pesticide residues. This work aims to determine differences in terms of pesticide residue content in Portuguese strawberries grown using different agriculture practices. The Quick, Easy, Cheap, Effective, Rugged, and Safe sample preparation method was conducted and shown to have good performance for multiclass pesticides extraction in strawberries. The screening of 25 pesticides residue was performed by gas chromatography–tandem mass spectrometry. In quantitative validation, acceptable performances were achieved with recoveries of 70–120 and <12 % residual standard deviation for 25 pesticides. Good linearity was obtained for all the target compounds, with highly satisfactory repeatability. The limits of detection were in the range of 0.1–28 μg/kg. The method was applied to analyze strawberry samples from organic and integrated pest management (IPM) practices harvested in 2009–2010. The results showed the presence of fludioxonil, bifenthrin, mepanipyrim, tolylfluanid, cyprodinil, tetraconazole, and malathion when using IPM below the maximum residue levels.

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A pi'n/pin a-SiC:H voltage and optical bias controlled device is presented and its behavior as image and color sensor, optical amplifier and demux device is discussed. The design and the light source properties are correlated with the sensor output characteristics. Different readout techniques are used. When a low power monochromatic scanner readout the generated carriers the transducer recognizes a color pattern projected on it acting as a direct color and image sensor. Scan speeds up to 10(4) lines per second are achieved without degradation in the resolution. If the photocurrent generated by different monochromatic pulsed channels is readout directly, the information is demultiplexed. Results show that it is possible to decode the information from three simultaneous color channels without bit errors at bit rates per channel higher than 4000 bps. Finally, when triggered by light of appropriated wavelength, it can amplify or suppress the generated photocurrent working as an optical amplifier (C) 2009 Published by Elsevier Ltd.

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Background: The eukaryotic release factor 3 (eRF3) has been shown to affect both tubulin and actin cytoskeleton, suggesting a role in cytoskeleton assembly, mitotic spindle formation and chromosome segregation. Also, direct interactions between eRF3 and subunits of the cytosolic chaperonin CCT have been described. Moreover, both eRF3a and CCT subunits have been described to be up-regulated in cancer tissues. Our aim was to evaluate the hypothesis that eRF3 expression levels are correlated with the expression of genes encoding proteins involved in the tubulin folding pathways. Methods: Relative expression levels of eRF1, eRF3a/GSPT1, PFDN4, CCT2, CCT4, and TBCA genes in tumour samples relative to their adjacent normal tissues were investigated using real time-polymerase chain reaction in 20 gastric cancer patients. Results: The expression levels of eRF3a/GSPT1 were not correlated with the expression levels of the other genes studied. However, significant correlations were detected between the other genes, both within intestinal and diffuse type tumours. Conclusions: eRF3a/GSPT1 expression at the mRNA level is independent from both cell translation rates and from the expression of the genes involved in tubulin-folding pathways. The differences in the patterns of expression of the genes studied support the hypothesis of genetically independent pathways in the origin of intestinal and diffuse type gastric tumours.

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Individuals spend 80-90% of their day indoors and elderly subjects are likely to spend even a greater amount of time indoors. Thus, indoor air pollutants such as bioaerosols may exert a significant impact on this age group. The aim of this study was to characterize fungal contamination within Portuguese elderly care centers. Fungi were measured using conventional as well as molecular methods in bedrooms, living rooms, canteens, storage areas, and outdoors. Bioaerosols were evaluated before and after the microenvironments' occupancy in order to understand the role played by occupancy in fungal contamination. Fungal load results varied from 32 colony-forming units CFU m(-3) in bedrooms to 228 CFU m(-3) in storage areas. Penicillium sp. was the most frequently isolated (38.1%), followed by Aspergillus sp. (16.3%) and Chrysonilia sp. (4.2%). With respect to Aspergillus genus, three different fungal species in indoor air were detected, with A. candidus (62.5%) the most prevalent. On surfaces, 40 different fungal species were isolated and the most frequent was Penicillium sp. (22.2%), followed by Aspergillus sp. (17.3%). Real-time polymerase chain reaction did not detect the presence of A. fumigatus complex. Species from Penicillium and Aspergillus genera were the most abundant in air and surfaces. The species A. fumigatus was present in 12.5% of all indoor microenvironments assessed. The living room was the indoor microenvironment with lowest fungal concentration and the storage area was highest.

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O LSA/ISEP(Laboratório de sistemas Autónomos do Instituto Superior de Engenharia do Porto) tem vindo nos últimos anos a desenvolver sistemas robóticos inovadores para operação em ambiente marinho sendo o veículo de superfície autónomo ROAZ II um exemplo de renome internacional. Neste contexto, e tendo em vista a satisfação dos requisitos parciais conducentes à obtenção do grau de Mestre em Eng. Electrotécnica e de Computadores - Ramo de Sistemas Autónomos do ISEP, o presente trabalho visou a integração de um robô submarino operado remotamente (ROV) com o robô de superfície ROAZ II. Esta solução inovadora de operação coordenada e integrada de um ASV/ROV permite dotar o ASV de mobilidade e visão subaquática. Após a caracterização e análise de requisitos de diversos cenários operacionais foi apresentada uma arquitectura de controlo coordenado dos dois veículos baseada em manobras de controlo descritas por autómatos híbridos. Os dois veículos foram modelados e as manobras coordenadas projectadas foram validadas com um simulador em ambiente Matlab/Simulink. Foi desenvolvido um sistema de localização relativa do ROV através da fusão sensorial de um sistema INS com um sistema acústico USBL utilizando um filtro EKF. O veículo ROV (VideoRay) do LSA foi instrumentado com os sensores necessários e efectuada a integração de hardware e software com o ASV ROAZ II permitindo a operação remota. Foi realizada uma missão demonstrativa de inspecção de pilares subaquáticos em cenário real com a operação conjunta dos dois robôs.

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OBJECTIVE: To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS: Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS: There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services. CONCLUSIONS: Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.