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.

REXIB: Remote Experiments Interface Builder

Remote Experimentation is an educational resource that allows teachers to strengthen the practical contents of science & engineering courses. However, building up the interfaces to remote experiments is not a trivial task. Although teachers normally master the practical contents addressed by a particular remote experiment they usually lack the programming skills required to quickly build up the corresponding web interface. This paper describes the automatic generation of experiment interfaces through a web-accessible Java application. The application displays a list of existent modules and once the requested modules have been selected, it generates the code that enables the browser to display the experiment interface. The tools? main advantage is enabling non-tech teachers to create their own remote experiments.

Reappraisal of the wrong-sign HBB¯ coupling and the study of h→Zγ

It has been pointed out recently that current experiments still allow for a two Higgs doublet model where the hbb¯ coupling (kDmb/v) is negative; a sign opposite to that of the Standard Model. Due to the importance of delayed decoupling in the hH+H− coupling, h→γγ improved measurements will have a strong impact on this issue. For the same reason, measurements or even bounds on h→Zγ are potentially interesting. In this article, we revisit this problem, highlighting the crucial importance of h→VV, which can be understood with simple arguments. We show that the impacts on kD<0 models of both h→bb¯ and h→τ+τ− are very sensitive to input values for the gluon fusion production mechanism; in contrast, h→γγ and h→Zγ are not. We also inquire if the search for h→Zγ and its interplay with h→γγ will impact the sign of the hbb¯ coupling. Finally, we study these issues in the context of the flipped two Higgs doublet model.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Methods and challenges for the health impact assessment of vaccination programs in Latin America

ABSTRACT OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", and "impact" in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.

The impact of Sinogram-Affirmed Iterative Reconstruction on patient dose and image quality compared to filtered back projection: a narrative review

Objective: Summarize all relevant findings in published literature regarding the potential dose reduction related to image quality using Sinogram-Affirmed Iterative Reconstruction (SAFIRE) compared to Filtered Back Projection (FBP). Background: Computed Tomography (CT) is one of the most used radiographic modalities in clinical practice providing high spatial and contrast resolution. However it also delivers a relatively high radiation dose to the patient. Reconstructing raw-data using Iterative Reconstruction (IR) algorithms has the potential to iteratively reduce image noise while maintaining or improving image quality of low dose standard FBP reconstructions. Nevertheless, long reconstruction times made IR unpractical for clinical use until recently. Siemens Medical developed a new IR algorithm called SAFIRE, which uses up to 5 different strength levels, and poses an alternative to the conventional IR with a significant reconstruction time reduction. Methods: MEDLINE, ScienceDirect and CINAHL databases were used for gathering literature. Eleven articles were included in this review (from 2012 to July 2014). Discussion: This narrative review summarizes the results of eleven articles (using studies on both patients and phantoms) and describes SAFIRE strengths for noise reduction in low dose acquisitions while providing acceptable image quality. Conclusion: Even though the results differ slightly, the literature gathered for this review suggests that the dose in current CT protocols can be reduced at least 50% while maintaining or improving image quality. There is however a lack of literature concerning paediatric population (with increased radiation sensitivity). Further studies should also assess the impact of SAFIRE on diagnostic accuracy.

Design state exploration applied to the development of a remote lab for projectile launch experiments

This paper describes the application of Design State Exploration techniques in the development of a remote lab for projectile motion experiments. The application was enabled by the existence of two independent teams: one composed of a series of internships that started first and another with two grantees that started a few months later. The paper presents evidence on how this approach provided gains in the development process conducted by the second team that benefited from design state exploration studies performed by the first team. This particular aspect is highlighted in relation to the work already presented in the 10th Remote Engineering and Virtual Instrumentation (REV) conference.

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.

Addressing software impact in the design of remote laboratories

Remote Laboratories or WebLabs constitute a first-order didactic resource in engineering faculties. However, in many cases, they lack a proper software design, both in the client and server side, which degrades their quality and academic usefulness. This paper presents the main characteristics of a Remote Laboratory, analyzes the software technologies to implement the client and server sides in a WebLab, and correlates these technologies with the characteristics to facilitate the selection of a technology to implement a WebLab. The results obtained suggest the adoption of a Service Oriented Laboratory Architecture-based approach for the design of future Remote Laboratories so that client-agnostic Remote Laboratories and Remote Laboratory composition are enabled. The experience with the real Remote Laboratory, WebLab-Deusto, is also presented.

A flexible online apparatus for projectile launch experiments

In order to provide a more flexible learning environment in physics, the developed projectile launch apparatus enables students to determine the acceleration of gravity and the dependence of a set of parameters in the projectile movement. This apparatus is remotely operated and accessed via web, by first scheduling an access time slot. This machine has a number of configuration parameters that support different learning scenarios with different complexities.

Extraction of volatile oil from aromatic plants with supercritical carbon dioxide: experiments and modeling

An overview of the studies carried out in our laboratories on supercritical fluid extraction (SFE) of volatile oils from seven aromatic plants: pennyroyal (Mentha pulegium L.), fennel seeds (Foeniculum vulgare Mill.), coriander (Coriandrum sativum L.), savory (Satureja fruticosa Beguinot), winter savory (Satureja montana L.), cotton lavender (Santolina chamaecyparisus) and thyme (Thymus vulgaris), is presented. A flow apparatus with a 1 L extractor and two 0.27 L separators was built to perform studies at temperatures ranging from 298 to 353 K and pressures up to 30.0 MPa. The best compromise between yield and composition compared with hydrodistillation (HD) was achieved selecting the optimum experimental conditions of extraction and fractionation. The major differences between HD and SFE oils is the presence of a small percentage of cuticular waxes and the relative amount of thymoquinone, an oxygenated monoterpene with important biological properties, which is present in the oils from thyme and winter savory. On the other hand, the modeling of our data on supercritical extraction of volatile oil from pennyroyal is discussed using Sovova's models. These models have been applied successfully to the other volatile oil extractions. Furthermore, other experimental studies involving supercritical CO2 carried out in our laboratories are also mentioned.

Cultural innovation and transmission of tool use in wild chimpanzees:evidence from field experiments

Animal Cognition, V.6, pp. 213-223

The influence of the boundary conditions on low-velocity impact composite damage

The objective of this work was to study the influence of the boundary conditions on low-velocity impact behaviour of carbon-epoxy composite plates. Experimental work and numerical analysis were performed on [04,904]s laminates. The influence of different boundary conditions on the impacted plates was analysed considering rectangular and square plates. The X-radiography was used as a non-destructive technique to evaluate the internal damage caused by impact loading. A three-dimensional numerical analysis was also performed considering progressive damage modelling. The model includes three-dimensional solid elements and interface finite elements including a cohesive mixed-mode damage model, which allows simulating delamination between different oriented layers. It was verified that plate’s boundary conditions have influence on the delaminated area. Good agreement between experimental and numerical analysis for shape, orientation and size of the delamination was obtained.

The influence of sludge characteristics from fullscale MBR in membrane filterability

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia do Ambiente,perfil Sanitária

Speculative execution by using software transactional memory

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do Grau de Mestre em Engenharia Informática.