Practices of use of nasal intermittent positive pressure ventilation (NIPPV) in neonatology in northeastern Brazil

Objective: To investigate the use of nasal intermittent positive pressure ventilation (NIPPV) in level three neonatal intensive care units (NICU) in northeastern Brazil. Methods: This observational cross-sectional survey was conducted from March 2009 to January 2010 in all level three NICUs in northeastern Brazil that are registered in the Brazilian Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saude, CNES) of the Ministry of Health. Questionnaires about the use of NIPPV were sent to the NICU directors in each institution. Statistical analysis was conducted using the software Epi-Info 6.04 and double data entry. A chi-square test was used to compare variables, and the level of statistical significance was set at p <= 0.05. Results: This study identified 93 level three NICUs in northeastern Brazil registered in CNES, and 87% answered the study questionnaire. Most classified themselves as private institutions (30.7%); 98.7% used NIPPV; 92.8 % adapted mechanical ventilators for NIPPV and used short binasal prongs as the interface (94.2%). Only 17.3% of the units had a protocol for the use of NIPPV. Mean positive inspiratory pressure and positive end-expiratory pressure were 20.0 cmH(2)O (standard deviation [SD]: 4.47) and 5.0 cmH(2)O (SD: 0.84). Conclusion: NICUs in northeastern Brazil use nasal intermittent positive pressure ventilation, but indications and ventilation settings are not the same in the different institutions.

Da vigilância para prevenção de acidentes de trabalho: contribuição da ergonomia da atividade

Os acidentes são fenômenos complexos, cuja determinação situa-se na organização do trabalho, dimensão invisível aos agentes de vigilância. O objetivo deste artigo é analisar e comparar o alcance das intervenções realizadas em uma empresa frigorífica, em 1997, baseada na checagem de normas de saúde e segurança, e em 2008, quando se incorpora a ergonomia da atividade. Foi realizado estudo de caso com análise documental referente à intervenção de 1997 e análise ergonômica do trabalho adotada em 2008. Em 1997 as ações de vigilância incidiram principalmente sobre os fatores de risco visíveis. Mesmo cumprindo as exigências, a empresa continuava, em 2008, com proporção de incidência anual de 26% de acidentes, o que motivou a busca da nova abordagem. Verificou-se, em 2008, que a gênese dos acidentes era provocada por um circulo vicioso: trabalho intenso; inadequação de meios técnicos; absenteísmo e rotatividade (84% ao ano) com recrutamento de inexperientes. Esse quadro é agravado por práticas autoritárias. A ergonomia da atividade contribuiu para compreender as causas organizacionais ultrapassando os aspectos normativos da vigilância tradicional, o que indica sua importância para tornar mais efetivas as ações de vigilância para a prevenção.

Environmental management in ethanol and sugarcane plants in Brazil

There has been much discussion on the importance of Brazilian ethanol in promoting a more sustainable society. However, there is a lack of analysis of whether sugarcane plants/factories that produce this ethanol are environmentally suitable. Thus, the objective of this study was to analyse stages of environmental management at four Brazilian ethanol-producing plants, examining the management practices adopted and the factors behind this adoption. The results indicate that (1) only one of the four plants is in the environmentally proactive stage; (2) all plants are adopting operational and organisational environmental management practices; (3) all plants have problems in communicating environmental management practices; and (4) the plant with the most advanced environmental management makes intense use of communication practices and is strongly oriented towards a more environmentally aware international market. This paper is an attempt to explain the complex relationship between the evolution of environmental management, environmental practices and motivation using a framework. The implications for society, plant directors and scholars are described, as well as the study's limitations.

Elaboración de un mapa de lixiviación de nitratos mediante una metodología de acople SIG-modelo de simulación : aplicación al acuífero de La Aldea (Gran Canaria)

[ES] La contaminación difusa por nitrato constituye una de las mayores amenazas actuales para la calidad de las aguas subterráneas. De hecho, varias directivas europeas, nacionales y regionales se han legislado con el fin de minimizar el efecto de las prácticas agrarias en la contaminación de los acuíferos por nitratos. El acuífero de La Aldea (Gran Canaria, España) se ha declarado como vulnerable a la contaminación por nitrato según dichas normas. En este estudio se presenta una metodología para desarrollar el acople de un sistema de información geográfica-SIG con el modelo de simulación de nitrato GLEAMS. Esta herramienta permite calcular la cantidad de nitrato lixiviado procedente de los cultivos de tomate bajo invernadero y da la oportunidad de simular otros rangos de fertilización para minimizar el riesgo de contaminación de las aguas subterráneas. Se comprueba que la pérdida de nitrato por lixiviación en la zona a partir de dichos cultivos podía llegar a los 500 kg N/ha, casi un 62% del aportado como fertilizante mineral en un manejo tradicional. Por ello, se aconseja la aplicación de las recomendaciones de abonado incluidas en el código de buenas prácticas agrarias de Canarias o cualquier otro sistema de recomendación de abonado mineral para reducir estas pérdidas, minimizando de esta forma el riesgo de contaminación de las aguas subterráneas. ABSTRACT: Nitrate diffuse pollution is one of the main risks that affect the groundwater quality. Several european directives, national and regional guidelines have been enacted to protect the aquifers against the effect of the agricultural management practices. The “La Aldea” aquifer was declared nitrate vulnerable area following these laws. In this study a methodology was developed to link a Geographical Information System (GIS) with a nitrogen simulation model (GLEAMS) in this area. This tool allows to assess the amount of nitrate leaching that coming from the traditional nitrogen fertilization rates in greenhouses tomato crops, and gives the opportunity to simulate other fertilization rates to reduce the risk of groundwater pollution. The nitrate leaching reached to 500 kg N/ha in several zones of the study area, that represent the 62% of the nitrogen fertiliser apply in a traditional management. It was recommended the application of the Code of Good Management Practices or other recommendation system to decrease the nitrate leaching, in order to reduce the risk of groundwater pollution.

Events Management: il caso FPA Worlds 2012

Un problema comune agli Ingegneri Gestionali è quello legato alla necessità di dover sempre spiegare in cosa consista veramente il proprio campo di studi. Amici, conoscenti e parenti non dimostrano mai, infatti, familiarità con il termine. Chi scrive è costretto addirittura ad ammettere di avere una madre che, a pochi giorni dalla discussione dalla Tesi Magistrale, continui ad affermare di non aver ancora capito quale lavoro andrà poi a fare il figlio. Medicina, Giurisprudenza ed Economia sono concetti facili da comprendere; “studiare con approccio quantitativo l'organizzazione e i processi produttivi delle imprese costruendo e applicando modelli per la soluzione dei loro problemi” in effetti lo è un po’ meno. Accade così che si debbano quindi aggiungere altri termini, spiegando l’ingegneria gestionale come insieme di altre discipline: produzione, logistica, marketing, economia aziendale, risorse umane, gestione, progetti... Si dà il caso che questo insieme di altre discipline coincida in larga parte con una branca ancora più oscura ai più: l’event management. Questo lavoro di Tesi è incentrato proprio sulla gestione di un evento: gli FPA Worlds 2012, i Mondiali di Frisbee Freestyle 2012 tenutisi a Riccione dal 2 al 5 agosto. L’autore, nell’ambito del suo percorso di Tirocinio, ne è stato l’event manager, ovvero il massimo responsabile e organizzatore, andando a far confluire esperienze, conoscenze e passioni personali con la coronazione degli studi universitari. L’intero progetto lo ha coinvolto dal luglio 2010 al settembre 2012, all’interno di un’azienda riminese con cui già collaborava dal 2009. La Tesi, di carattere prettamente sperimentale, va quindi ad esporre i processi gestionali “nascosti” dietro ad un evento che ha riscosso successo di pubblico e mediatico, affiancando in ognuno dei capitoli tematici modelli teorici e risultati pratici. La vastità di conoscenze, competenze e strumenti utilizzati ha reso quest’esperienza altamente stimolante, così come le numerose sfide che si sono succedute nel difficile percorso per organizzare il miglior Mondiale di Frisbee Freestyle di sempre.

Essays on Bank Risk

This PhD Thesis is composed of three chapters, each discussing a specific type of risk that banks face. The first chapter talks about Systemic Risk and how banks get exposed to it through the Interbank Funding Market. Exposures in the said market have Systemic Risk implications because the market creates linkages, where the failure of one party can affect the others in the market. By showing that CDS Spreads, as bank risk indicators, are positively related to their Net Interbank Funding Market Exposures, this chapter establishes the above Systemic Risk Implications of Interbank Funding. Meanwhile, the second chapter discusses how banks may handle Illiquidity Risk, defined as the possibility of having sudden funding needs. Illiquidity Risk is embodied in this chapter through Loan Commitments as they oblige banks to lend to its clients, up to a certain amount of funds at any time. This chapter points out that using Securitization as funding facility, could allow the banks to manage this Illiquidity Risk. To make this case, this chapter demonstrates empirically that banks having an increase in Loan Commitments, may experience an increase in risk profile but such can be offset by an accompanying increase in Securitization Activity. Lastly, the third chapter focuses on how banks manage Credit Risk also through Securitization. Securitization has a Credit Risk management property by allowing the offloading of risk. This chapter investigates how banks use such property by looking at the effect of securitization on the banks’ loan portfolios and overall risk and returns. The findings are that securitization is positively related to loan portfolio size and the portfolio share of risky loans, which translates to higher risk and returns. Thus, this chapter points out that Credit Risk management through Securitization may be have been done towards higher risk taking for high returns.

Risk appetite e risk tolerance: strumenti di supporto agli istituti di credito per l'assunzione di rischi in tempi di crisi

Negli ultimi anni l’attenzione di legislatori e degli Organi di Vigilanza, in base alle riforme regolamentari attivate in risposta alla crisi economica, si sono focalizzate sulle pratiche di risk management delle Banche, sottolineando l’importanza dei sistemi di controllo e gestione dei rischi. Il presente lavoro nasce con l’intento di analizzare e valutare le caratteristiche salienti del processo di assunzione e gestione dei rischi nel sistema economico finanziario attuale. Numerosi e autorevoli esperti, come gli operatori del Financial Stability Board , Institute of International Finance e Senior Supervisory Group, si sono espressi sulle cause della crisi finanziaria ed hanno sollevato dubbi circa la qualità delle azioni intraprese da alcuni manager, sulle loro politiche gestionali e sulla comprensione delle reali condizioni in cui versavano le loro Banche (in termini di esposizione ai rischi, report da aggregazione dati su performance aziendali e qualità dei dati aggregati) , si è ritenuto giusto dal punto di vista teorico approfondire in particolare i temi del Risk Appetite e Risk Tolerance, novità introdotte nelle diverse direttive e normative in risposta alle citate ed ambigue politiche di gestione ed assunzione rischi. I concetti, qui introdotti, di appetito e tolleranza al rischio conducono ad una ampia sfera di riferimento che guarda alla necessità di fissare degli obiettivi di rischio e loro limiti per poter meglio controllare e valutare la stabilità economica/finanziaria e stimare gli effetti di condizioni peggiorative (reali o soltanto teoriche, come gli stress test) sulla solvibilità e profittabilità delle Banche nazionali ed internazionali. Inoltre, ad integrazione di quanto precedentemente esposto sarà illustrata una survey sulla disclosure delle principali Banche europee in relazione alle informazioni sul Risk Appetite e sul Risk Tolerance.

Effect of different management intensities on natural and human-induced carbon fluxes in a golf course in northern Italy

Turfgrasses are ubiquitous in urban landscape and their role on carbon (C) cycle is increasing important also due to the considerable footprint related to their management practices. It is crucial to understand the mechanisms driving the C assimilation potential of these terrestrial ecosystems Several approaches have been proposed to assess C dynamics: micro-meteorological methods, small-chamber enclosure system (SC), chrono-sequence approach and various models. Natural and human-induced variables influence turfgrasses C fluxes. Species composition, environmental conditions, site characteristics, former land use and agronomic management are the most important factors considered in literature driving C sequestration potential. At the same time different approaches seem to influence C budget estimates. In order to study the effect of different management intensities on turfgrass, we estimated net ecosystem exchange (NEE) through a SC approach in a hole of a golf course in the province of Verona (Italy) for one year. The SC approach presented several advantages but also limits related to the measurement frequency, timing and duration overtime, and to the methodological errors connected to the measuring system. Daily CO2 fluxes changed according to the intensity of maintenance, likely due to different inputs and disturbances affecting biogeochemical cycles, combined also to the different leaf area index (LAI). The annual cumulative NEE decreased with the increase of the intensity of management. NEE was related to the seasonality of turfgrass, following temperatures and physiological activity. Generally on the growing season CO2 fluxes towards atmosphere exceeded C sequestered. The cumulative NEE showed a system near to a steady state for C dynamics. In the final part greenhouse gases (GHGs) emissions due to fossil fuel consumption for turfgrass upkeep were estimated, pinpointing that turfgrass may result a considerable C source. The C potential of trees and shrubs needs to be considered to obtain a complete budget.

The Next 10 years in the Management of Peripheral Artery Disease: Perspectives from The 'PAD 2009' Conference

OBJECTIVES: To briefly inform on the conclusions from a conference on the next 10 years in the management of peripheral artery disease (PAD). DESIGN OF THE CONFERENCE: International participation, invited presentations and open discussion were based on the following issues: Why is PAD under-recognised? Health economic impact of PAD; funding of PAD research; changes of treatment options? Aspects on clinical trials and regulatory views; and the role of guidelines. RESULTS AND CONCLUSIONS: A relative lack of knowledge about cardiovascular risk and optimal management of PAD patients exists not only among the public, but also in parts of the health-care system. Specialists are required to act for improved information. More specific PAD research is needed for risk management and to apply the best possible evaluation of evidence for treatment strategies. Better strategies for funding are required based on, for example, public/private initiatives. The proportion of endovascular treatments is steadily increasing, more frequently based on observational studies than on randomised controlled trials. The role of guidelines is therefore important to guide the profession in the assessment of most relevant treatment.

Land use policies and practices for reducing vulnerability in rural Tajikistan

Tajikistan, with 93% of its surface area taken up by mountains and 65% of its labor force employed in agriculture, is judged to be highly vulnerable to risks, including climate change risks and food insecurity risks. The article examines a set of land use policies and practices that can be used to mitigate the vulnerability of Tajikistan’s large rural population, primarily by increasing family incomes. Empirical evidence from Tajikistan and other CIS countries suggests that families with more land and higher commercialization earn higher incomes and achieve higher well-being. The recommended policy measures that are likely to increase rural family incomes accordingly advocate expansion of smallholder farms, improvement of livestock productivity, increase of farm commercialization through improvement of farm services, and greater diversification of both income sources and the product mix. The analysis relies for supporting evidence on official statistics and recent farm surveys. Examples from local initiatives promoting sustainable land management practices and demonstrating the implementation of the proposed policy measures are presented.

Proposal on How To Conduct a Biopharmaceutical Process Failure Mode and Effect Analysis (FMEA) as a Risk Assessment Tool

With the publication of the quality guideline ICH Q9 "Quality Risk Management" by the International Conference on Harmonization, risk management has already become a standard requirement during the life cycle of a pharmaceutical product. Failure mode and effect analysis (FMEA) is a powerful risk analysis tool that has been used for decades in mechanical and electrical industries. However, the adaptation of the FMEA methodology to biopharmaceutical processes brings about some difficulties. The proposal presented here is intended to serve as a brief but nevertheless comprehensive and detailed guideline on how to conduct a biopharmaceutical process FMEA. It includes a detailed 1-to-10-scale FMEA rating table for occurrence, severity, and detectability of failures that has been especially designed for typical biopharmaceutical processes. The application for such a biopharmaceutical process FMEA is widespread. It can be useful whenever a biopharmaceutical manufacturing process is developed or scaled-up, or when it is transferred to a different manufacturing site. It may also be conducted during substantial optimization of an existing process or the development of a second-generation process. According to their resulting risk ratings, process parameters can be ranked for importance and important variables for process development, characterization, or validation can be identified. LAY ABSTRACT: Health authorities around the world ask pharmaceutical companies to manage risk during development and manufacturing of pharmaceuticals. The so-called failure mode and effect analysis (FMEA) is an established risk analysis tool that has been used for decades in mechanical and electrical industries. However, the adaptation of the FMEA methodology to pharmaceutical processes that use modern biotechnology (biopharmaceutical processes) brings about some difficulties, because those biopharmaceutical processes differ from processes in mechanical and electrical industries. The proposal presented here explains how a biopharmaceutical process FMEA can be conducted. It includes a detailed 1-to-10-scale FMEA rating table for occurrence, severity, and detectability of failures that has been especially designed for typical biopharmaceutical processes. With the help of this guideline, different details of the manufacturing process can be ranked according to their potential risks, and this can help pharmaceutical companies to identify aspects with high potential risks and to react accordingly to improve the safety of medicines.

Predicting the risk of hospital admission in older persons--validation of a brief self-administered questionnaire in three European countries

OBJECTIVES: To validate the Probability of Repeated Admission (Pra) questionnaire, a widely used self-administered tool for predicting future healthcare use in older persons, in three European healthcare systems. DESIGN: Prospective study with 1-year follow-up. SETTING: Hamburg, Germany; London, United Kingdom; Canton of Solothurn, Switzerland. PARTICIPANTS: Nine thousand seven hundred thirteen independently living community-dwelling people aged 65 and older. MEASUREMENTS: Self-administered eight-item Pra questionnaire at baseline. Self-reported number of hospital admissions and physician visits during 1 year of follow-up. RESULTS: In the combined sample, areas under the receiver operating characteristic curves (AUCs) were 0.64 (95% confidence interval (CI)=0.62-0.66) for the prediction of one or more hospital admissions and 0.68 (95% CI=0.66-0.69) for the prediction of more than six physician visits during the following year. AUCs were similar between sites. In comparison, prediction models based on a person's age and sex alone exhibited poor predictive validity (AUC risk individuals (Pra score >or= 0.5) were 2.3 times as likely (95% CI=2.1-2.6) as low-risk individuals to have a hospital admission, and 2.1 times as likely (95% CI=2.0-2.2) to have more than six physician visits. CONCLUSION: The Pra instrument exhibits good validity for predicting future health service use on a population level in different healthcare settings. Administrative data have shown similar predictive validity, but in practice, such data are often not available. The Pra is likely of high interest to governments and health insurance companies worldwide as a basis for programs aimed at health risk management in older persons.

Perceptions of water conditions and management in the Sonora River Basin, Sonora, Mexico

The effects of climate change are expected to be very severe in arid regions. The Sonora River Basin, in the northwestern state of Sonora, Mexico, is likely to be severely affected. Some of the anticipated effects include precipitation variability, intense storm events, higher overall temperatures, and less available water. In addition, population in Sonora, specifically the capital city of Hermosillo, is increasing at a 1.5% rate and current populations are near 700,000. With the reduction in water availability and an increase in population, Sonora, Mexico is expected to experience severe water resource issues in the near future. In anticipation of these changes, research is being conducted in an attempt to improve water management in the Sonora River Basin, located in the northwestern part of Sonora. This research involves participatory modeling techniques designed to increase water manager awareness of hydrological models and their use as integrative tools for water resource management. This study was conducted as preliminary research for the participatory modeling grant in order to gather useful information on the population being studied. This thesis presents research from thirty-four in-depth interviews with water managers, citizens, and agricultural producers in Sonora, Mexico. Data was collected on perceptions of water quantity and quality in the basin, thoughts on current water management practices, perceptions of climate change and its management, experience with, knowledge of, and trust in hydrological models as water management tools. Results showed that the majority of interviewees thought there was not enough water to satisfy their daily needs. Most respondents also agreed that the water available was of good quality, but that current management of water resources was ineffective. Nearly all interviewees were aware of climate change and thought it to be anthropogenic. May reported experiencing higher temperatures, precipitation changes, and higher water scarcity and attributed those fluctuations to climate change. 65% of interviewees were at least somewhat familiar with hydrological models, though only 28% had ever used them or their output. Even with model usage results being low, 100% of respondents believed hydrological models to be very useful water management tools. Understanding how water, climate change, and hydrological models are perceived by this population of people is essential to improving their water management practices in the face of climate change.

Understanding Michigan nonindustrial private forest landowners attitudes and knowledge about forest management

Approximately one-fourth of the non-industrial private forestland (NIPF) owners in the state of Michigan, who collectively own approximately 50% of the private forested land, have conducted commercial timber harvest in recent years. Previous studies indicated that NIPFs preferred to manage their forest for a sustained yield of high-quality timber, but were limited to even-aged regeneration treatments or conversion for uneven-aged silviculture due to previous cuttings. Improved knowledge about NIPF’s intentions and forest management behavior could be useful for successful implementation of sustained yield management. This study’s objective was to identify more active NIPF’s attitudes towards timber management, their forest management practices and whether their forest management behavior leads or leads not to q management for sustained yield. Active NIPF’s intentions to harvest timber for biofuels and its suitability with NIPF’s forest management behavior will be discussed. Phone interviews of 30 NIPFs who have experience with commercial timber harvests were conducted between August and October 2011. All interviews were recorded, transcribed, and analyzed for identifying NIPF’s motivations, attitudes, forest management behavior and forestry related knowledge. Interviewees, whether consciously or not, tended to manage their land for a sustained yield and they would be willing to harvest timber for biofuels facility as long as it benefits landowners management goals.

Management of acute bronchiolitis: can evidence based guidelines alter clinical practice?

BACKGROUND: Acute bronchiolitis is the most common lower respiratory tract infection in infants and there is no evidence that drug treatment alters its natural course. Despite this, most Swiss paediatricians reported in 2001 prescribing bronchodilators and inhaled corticosteroids (ICS). This situation led to the creation of national guidelines followed by a tailored implementation programme. The aim of this study was to examine if treatment practices changed after the implementation of the new guidelines. METHODS: A questionnaire on treatment of bronchiolitis was sent to all Swiss paediatricians before (2001) and after (2006) creation and implementation of national guidelines (2003-2005). Guidelines were created in collaboration with all paediatric pulmonologists and implemented carefully using a multifaceted approach. RESULTS: Questionnaires were returned by 541 paediatricians (58%) in 2001 and by 639 (54%) in 2006. While both surveys showed a wide variation in the treatment of bronchiolitis between physicians, reported drug prescription decreased significantly between the two surveys. For outpatients, general use (for all patients) of bronchodilators dropped from 60% to 23%, and general use of ICS from 34% to 6%. For inpatients, general use of bronchodilators and ICS dropped from 55% to 18% and from 26% to 6%, respectively (all p<0.001). The decrease was evident in all regions, among hospital and primary care physicians, and among general paediatricians and paediatric pulmonologists. CONCLUSIONS: National guidelines together with a tailored implementation programme can have a major impact on medical management practices in a country.