Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

A Complexity Based Model for Quantifying Forensic Evidential Probabilities

An operational complexity model (OCM) is proposed to enable the complexity of both the cognitive and the computational components of a process to be determined. From the complexity of formation of a set of traces via a specified route a measure of the probability of that route can be determined. By determining the complexities of alternative routes leading to the formation of the same set of traces, the odds ratio indicating the relative plausibility of the alternative routes can be found. An illustrative application to a BitTorrent piracy case is presented, and the results obtained suggest that the OCM is capable of providing a realistic estimate of the odds ratio for two competing hypotheses. It is also demonstrated that the OCM can be straightforwardly refined to encompass a variety of circumstances.

A Resource Centric Approach For Advancing Collaboration Through Hydrologic Data And Model Sharing

HydroShare is an online, collaborative system being developed for open sharing of hydrologic data and models. The goal of HydroShare is to enable scientists to easily discover and access hydrologic data and models, retrieve them to their desktop or perform analyses in a distributed computing environment that may include grid, cloud or high performance computing model instances as necessary. Scientists may also publish outcomes (data, results or models) into HydroShare, using the system as a collaboration platform for sharing data, models and analyses. HydroShare is expanding the data sharing capability of the CUAHSI Hydrologic Information System by broadening the classes of data accommodated, creating new capability to share models and model components, and taking advantage of emerging social media functionality to enhance information about and collaboration around hydrologic data and models. One of the fundamental concepts in HydroShare is that of a Resource. All content is represented using a Resource Data Model that separates system and science metadata and has elements common to all resources as well as elements specific to the types of resources HydroShare will support. These will include different data types used in the hydrology community and models and workflows that require metadata on execution functionality. The HydroShare web interface and social media functions are being developed using the Drupal content management system. A geospatial visualization and analysis component enables searching, visualizing, and analyzing geographic datasets. The integrated Rule-Oriented Data System (iRODS) is being used to manage federated data content and perform rule-based background actions on data and model resources, including parsing to generate metadata catalog information and the execution of models and workflows. This presentation will introduce the HydroShare functionality developed to date, describe key elements of the Resource Data Model and outline the roadmap for future development.

RWater – A Cyber Enabled Tool For Hydrologic Modeling And Analysis

Existing distributed hydrologic models are complex and computationally demanding for using as a rapid-forecasting policy-decision tool, or even as a class-room educational tool. In addition, platform dependence, specific input/output data structures and non-dynamic data-interaction with pluggable software components inside the existing proprietary frameworks make these models restrictive only to the specialized user groups. RWater is a web-based hydrologic analysis and modeling framework that utilizes the commonly used R software within the HUBzero cyber infrastructure of Purdue University. RWater is designed as an integrated framework for distributed hydrologic simulation, along with subsequent parameter optimization and visualization schemes. RWater provides platform independent web-based interface, flexible data integration capacity, grid-based simulations, and user-extensibility. RWater uses RStudio to simulate hydrologic processes on raster based data obtained through conventional GIS pre-processing. The program integrates Shuffled Complex Evolution (SCE) algorithm for parameter optimization. Moreover, RWater enables users to produce different descriptive statistics and visualization of the outputs at different temporal resolutions. The applicability of RWater will be demonstrated by application on two watersheds in Indiana for multiple rainfall events.

O uso comercial da internet por micro, pequenas e médias empresas de Porto Alegre : um estudo exploratório sobre as empresas do trade point Porto Alegre

Uma grande evolução aconteceu no mundo com o surgimento da Internet. Ela causou um espantoso aumento das comunicações, que passaram a ser em tempo real e com uma abrangência mundial. Foi a democratização da informação. A Internet serve como uma grande ferramenta para as empresas, principalmente com a globalização dos mercados, fenômeno que cresce cada dia mais e atinge a todos. A globalização fez com que as organizações se tornassem globais, e a Internet funciona como um elo de ligação entre empresas, fornecedores e consumidores. Este trabalho consistiu na realização de uma pesquisa survey exploratória com o objetivo de verificar e descrever o uso potencial da Internet como ferramenta de auxílio à realização de negócios de caráter global, nas micro, pequenas e médias empresas de Porto Alegre. A amostra das empresas pesquisadas foi extraída do Trade Point Porto Alegre, por ser essa uma entidade que tem por objetivo auxiliar as empresas a realizarem operações globais. Com relação ao mercado global, o trabalho identificou que quase todas as empresas acreditam que ele tenha oportunidades de negócios. Os principais meios para entrar nesse mercado são a participação em feiras e rodadas de negócios, contato pessoal e o Trade Point. A Internet já está disseminada no meio empresarial, todas as empresas já a conhecem, e boa parte das empresas realizam operações que podem ser auxiliadas pela rede, como comunicação, promoção de produtos e acompanhamento pós-venda. Identificou-se que as microempresas são as que menos acreditam no mercado internacional, mas apontaram que a Internet pode ajudá-las em suas atividades. Já as pequenas empresas são as que atuam no mercado internacional e acreditam que a Internet possa ajudá-las em algumas atividades. Por fim, as médias empresas, também atuam no mercado internacional, principalmente com as exportações, e são as que já estão utilizando a Internet. O Trade Point se mostrou um serviço bem requisitado pelas empresas, principalmente as que atuam com o comércio internacional. As principais vantagens citadas foram a centralização de informações e a geração de novos negócios.

Early and post transition metal complexes as a single of combined components in the ethylene and isoprene polynerization

In this work is reported, in a first step, the effect of different experimental parameters and their relation with polymer properties using the homogeneous binary catalyst system composed by Ni(α-diimine)Cl2 (α-diimine = 1,4-bis(2,6-diisopropylphenyl)- acenaphthenediimine) and {TpMs*}V(Ntbu)Cl2 (TpMs* = hydridobis(3-mesitylpyrazol-1- yl)(5-mesitylpyrazol-1-yl)) activated with MAO. This complexes combination produces, in a single reactor, polyethylene blends with different and controlled properties dependent on the polymerization temperature, solvent and Nickel molar fraction (xNi). In second, the control of linear low density polyethylene (LLDPE) production was possible, using a combination of catalyst precursors {TpMs}NiCl (TpMs = hydridotris(3- mesitylpyrazol-1-yl)) and Cp2ZrCl2, activated with MAO/TMA, as Tandem catalytic system. The catalytic activities as well as the polymer properties are dependent on xNi. Polyethylene with different Mw and controlled branches is produced only with ethylene monomer. Last, the application group 3 metals catalysts based, M(allyl)2Cl(MgCl2)2.4THF (M = Nd, La and Y), in isoprene polymerization with different cocatalysts systems and experimental parameters is reported. High yields and polyisoprene with good and controlled properties were produced. The metal center, cocatalysts and the experimental parameters are determinant for the polymers properties and their control. High conversions in cis-1,4- or trans-1,4-polyisoprene were obtained and the polymer microstructure depending of cocatalyst and metal type. Combinations of Y and La precursors were effective systems for the cis/transpolyisoprene blends production, and the control of cis-trans-1,4-microstructures by Yttrium molar fraction (xY) variation was possible.

Internet - lacuna jurídica ou inferno legal

A rápida evolução da Internet, permitindo a troca de mercadorias e serviços, pode ser comparada ao período da revolução industrial. A ausência total de fronteiras na Internet suscita tanto a admiração quanto o receio. Na verdade, o crescimento da Internet baseia-se em três fatores distintos e complementares: (i) o comercial; (ii) o tecnológico; e, (iii) o jurídico. A Internet não tem um comando jurídico uniformizado e harmonizado. Daí resulta que ela se traduz num mosaico organizacional que, hoje, está permitindo o seu funcionamento. A Internet é independente, entretanto não pode subsistir sem a influência de um sistema legal. De fato, as leis nacionais de um determinado país tem vocação a se aplicar às transações comerciais celebradas via Internet, dada a inexistência de uma regulamentação única e abrangente. Contudo, a aplicação não poderá ser imediata, adaptações serão necessárias para atender aos novos modelos jurídicos utilizados na Internet. Esta pesquisa é a primeira parte de um estudo mais amplo: a influência da Internet no direito brasileiro. Por tratar-se de um primeiro estudo bibliográfico, foram examinadas as principais áreas do direito que estão sendo influenciadas pelo desenvolvimento rápido e crescente da Internet. É, portanto, a primeira etapa deste estudo a pesquisa bibliográfica, propriamente dita. Nessa etapa, foram identificadas e comparadas as posições doutrinárias tanto de países sob a influência do sistema jurídico de common law como do romano-germânico. A partir de então, na segunda etapa, foram classificados os tópicos de maior interesse para a doutrina, através de palavras-chave. Partindo assim do presente estudo, o estudo mais amplo pretenderá delinear os alicerces de uma proposta jurídica comparada, entre os sistemas de common law e romano germânico, para então examinar a influência da Internet no direito brasileiro.

A BDI-based approach for the assessment of driver's decision-making in commuter scenarios

The rapid growth of urban areas has a significant impact on traffic and transportation systems. New management policies and planning strategies are clearly necessary to cope with the more than ever limited capacity of existing road networks. The concept of Intelligent Transportation System (ITS) arises in this scenario; rather than attempting to increase road capacity by means of physical modifications to the infrastructure, the premise of ITS relies on the use of advanced communication and computer technologies to handle today’s traffic and transportation facilities. Influencing users’ behaviour patterns is a challenge that has stimulated much research in the ITS field, where human factors start gaining great importance to modelling, simulating, and assessing such an innovative approach. This work is aimed at using Multi-agent Systems (MAS) to represent the traffic and transportation systems in the light of the new performance measures brought about by ITS technologies. Agent features have good potentialities to represent those components of a system that are geographically and functionally distributed, such as most components in traffic and transportation. A BDI (beliefs, desires, and intentions) architecture is presented as an alternative to traditional models used to represent the driver behaviour within microscopic simulation allowing for an explicit representation of users’ mental states. Basic concepts of ITS and MAS are presented, as well as some application examples related to the subject. This has motivated the extension of an existing microscopic simulation framework to incorporate MAS features to enhance the representation of drivers. This way demand is generated from a population of agents as the result of their decisions on route and departure time, on a daily basis. The extended simulation model that now supports the interaction of BDI driver agents was effectively implemented, and different experiments were performed to test this approach in commuter scenarios. MAS provides a process-driven approach that fosters the easy construction of modular, robust, and scalable models, characteristics that lack in former result-driven approaches. Its abstraction premises allow for a closer association between the model and its practical implementation. Uncertainty and variability are addressed in a straightforward manner, as an easier representation of humanlike behaviours within the driver structure is provided by cognitive architectures, such as the BDI approach used in this work. This way MAS extends microscopic simulation of traffic to better address the complexity inherent in ITS technologies.

Os bancos brasileiros na internet: um estudo de caso sobre os motivadores para a sua forma de atuação neste ambiente

O objetivo deste estudo é propor um modelo de análise integrada para a forma de atuação dos bancos brasileiros no ambiente da Internet. Para tanto foi conduzido um estudo de caso único com o Banco do Brasil. A maioria das entrevistas foi realizada nas sedes administrativa e de tecnologia do banco na cidade de Brasília, DF. Foi proposto um Modelo de Análise Integrada baseado em várias teorias e estruturas da área de estudos organizacionais e sistemas de informação. Entre as descobertas da pesquisa está a constatação de que o fenômeno estudado pode ser satisfatoriamente compreendido com o emprego de todas as teorias selecionadas, comprovando a complexidade do objeto desta pesquisa. O estudo apresentou entre suas limitações o fato de ter sido um estudo de caso único, como também a impossibilidade de se realizar esta pesquisa em amplo espectro, com um número consideravelmente maior de organizações. O ineditismo e a contribuição deste estudo residem no fato de ter proposto um modelo integrado com teorias e estruturas de análise que facilitam a compreensão do fenômeno observado. Em estudos futuros o pesquisador poderia incluir a pesquisa em um número maior de instituições para enriquecer a análise.

Employing the Components of the Human Development Index to Drive Resources to Educational Policies

A new form of composition of the indicators employed to generate the United Nations Human Development Index (HDI) is presented here. This form of composition is based on the assumption that random errors affect the measurement of each indicator. This assumption allows for replacing the vector of evaluations according to each indicator by vectors of probabilities of being the best or the worst according to such attribute. The probabilistic composition of such probabilities of preference according to each indicator into probabilities of being the best or the worst according to all of them generates indices that may unveil, on one hand, performances to be followed and, on the other hand, extreme conditions that an additive composition would hide. Differences between the results of application of the diverse forms of composition are examined in the case of the HDI and in the case of the districts version of the HDI employed to compare Brazilian municipalities. It is verified that the smallest correlation between the education.

JML- Based formal development of a Java card application for managing medical appointments

Although formal methods can dramatically increase the quality of software systems, they have not widely been adopted in software industry. Many software companies have the perception that formal methods are not cost-effective cause they are plenty of mathematical symbols that are difficult for non-experts to assimilate. The Java Modelling Language (short for JML) Section 3.3 is an academic initiative towards the development of a common formal specification language for Java programs, and the implementation of tools to check program correctness. This master thesis work shows how JML based formal methods can be used to formally develop a privacy sensitive Java application. This is a smart card application for managing medical appointments. The application is named HealthCard. We follow the software development strategy introduced by João Pestana, presented in Section 3.4. Our work influenced the development of this strategy by providing hands-on insight on challenges related to development of a privacy sensitive application in Java. Pestana’s strategy is based on a three-step evolution strategy of software specifications, from informal ones, through semiformal ones, to JML formal specifications. We further prove that this strategy can be automated by implementing a tool that generates JML formal specifications from a welldefined subset of informal software specifications. Hence, our work proves that JML-based formal methods techniques are cost-effective, and that they can be made popular in software industry. Although formal methods are not popular in many software development companies, we endeavour to integrate formal methods to general software practices. We hope our work can contribute to a better acceptance of mathematical based formalisms and tools used by software engineers. The structure of this document is as follows. In Section 2, we describe the preliminaries of this thesis work. We make an introduction to the application for managing medical applications we have implemented. We also describe the technologies used in the development of the application. This section further illustrates the Java Card Remote Method Invocation communication model used in the medical application for the client and server applications. Section 3 introduces software correctness, including the design by contract and the concept of contract in JML. Section 4 presents the design structure of the application. Section 5 shows the implementation of the HealthCard. Section 6 describes how the HealthCard is verified and validated using JML formal methods tools. Section 7 includes some metrics of the HealthCard implementation and specification. Section 8 presents a short example of how a client-side of a smart card application can be implemented while respecting formal specifications. Section 9 describes a prototype tools to generate JML formal specifications from informal specifications automatically. Section 10 describes some challenges and main ideas came acrorss during the development of the HealthCard. The full formal specification and implementation of the HealthCard smart card application presented in this document can be reached at https://sourceforge.net/projects/healthcard/.

Application of multivariable control using artificial neural networks in a debutanizer distillation column

LOPES, Jose Soares Batista et al. Application of multivariable control using artificial neural networks in a debutanizer distillation column.In: INTERNATIONAL CONGRESS OF MECHANICAL ENGINEERING - COBEM, 19, 5-9 nov. 2007, Brasilia. Anais... Brasilia, 2007

Marketing de relacionamento em um provedor de internet: um estudo comparativo que considera a visão gerencial e a percepção dos clientes

The current paper aims at analyzing customer retention in Internet provider services. For this study, we sought to understand what are the client's expectations regarding the services available and compare them with management perception in relation to the use of those services. Identifying the coherence level between the two points of view, management and client, it is possible to pinpoint how service is assessed in real conditions. Then, from this point on, a new vision can be implemented on available services, and new customer service strategies aiming at best serving to their expectation and need, can be rethought. The exploratory research was utilized. It was based on case study, and quantitative and qualitative methods were used. The quantitative method was done by applying the cluster technique with six variables of control derived from the six main services, whose definition was done through qualitative survey of the internal management team. Then, an structured interview with 443 clients, from a probabilistic sample of 800 costumers. The total number of active clients of the internet provider is of 10.677. Client perception in relation to services varied, if compared with the four services that were under the managerial metric method, this comparison showed a more positive evaluation than the real use of the service. Thus, it was observed that the value of each service available for the client depends on his/her perception of it, regardless of using or not the offered service. As a result, it is possible to understand which services offered by the company under study effectively contribute to a good client-company relationship, and the upkeep of those clients

Natural fibers based composites - Technical and social issues

Brazil is the only country in South America to have an automotive supplier sector based on natural fibers. New opportunities are arising due to an increase demand by the car makers in applying natural fibers in their parts. Several crop fibers have been developed in Brazil. Among them can be listed caroa, piacava, pupunha, mutum and others of regional application. For the automotive industry, which requires large quantities with uniform quality, the alternatives are sisal (170,000 ton/yr), curaua (150 ton/yr in 2003), malva, 200 ton/yr; Brazil is the single largest producer country of sisal, and commercially, the only one in curaua. For South America, the alternatives are fique in Colombia, abaca in equator, flax in Argentina and curaua in Venezuela. It must be understood by the target countries of drugs, is that crop fiber can be an economic alternative to coca in the Andes region, therefore an instrument of land reform and drug reduction plantations. Several companies have a strong program of apply natural fibers based components in their products: Volkswagen do Brazil, DaimlerChrysler, General Motors do Brazil. Among their suppliers can be listed companies such Pematec (curaua), Toro (sisal, coir and jute), Incomer (sisal and jute), Ober (jute, curaua), Indaru (jute and sisal), Antolin (imported kenaf,) Tapetes Sao Carlos (sisal), Poematec (coir) and Art-Gore, with Woodstock'' wood and natural fibers). Figures about production and demand are discussed in the paper.

Construtivismo de marco teórico-pedagógico a grife: um estudo a partir das mensagens veiculadas na internet

This thesis is resulted of a research on propagated the social representations of constructivism in the Internet, which as had estimated basic the idea of Moscovici (1961) of that the media it has determinative paper in the popularization of the scientific theories, in formation e propagation of the social representations and in the construction of behaviors human beings. Understanding the Internet as latest space of circulation of social communications, therefore, privileged field (and still not explored) for studies of social representations, we choose this half midiático as investigative field of our research, it if it constitutes in the "great ocean of the new informational planet" (LEVY, 2000, p. 126), besides making possible the interaction with different forms of images, different individuals, different ' world ', configuring itself as important space of symbolic production e of analysis of the representational process in the world contemporary. Based in these questions, we trace as objective to analyze the circulating speech propagated on-line on the constructivism, searching to apprehend the social representations shared the respect. This objective was constructed in face of the insertion of the theory constructivist in the educational way has two decades more than, as well as of its consolidation as reference in different social contexts, mainly in midiático. The question that directed the research was: as this theory obtains to penetrate in some layers of our society, to influence the world readings e the behaviors of different people? That modifications it suffers in this trajectory and which the paper of the Internet in this process? The corpus of the research was constituted of the substances on the theory found in the Internet, in pages in Portuguese of Google, in the period of 27 of July of 2004 the 17 of August of 2004. The data they had been analyzed on the basis of the project of analysis of content elaborated for Moscovici (1961) and in the estimated theoreticians of the social communication, in special of the hypermedia. The results had disclosed that the Internet participates of determinative form in the process of popularization of the constructivism theory, not only spreading out its estimated theoretician- methodological for the domain public (diffusion), but propagating positive beliefs and images of its postulates (propagation) and using them it service of interests politicians e financiers (propaganda). The popularization of the constructivism in the Internet and social representations of this theory propagated configure one process in which the theory passes of pedagogical theoretical landmark for grief, assuming a commercial character extremely and the status of solution for problems of the education and the society, stirring up attitudes and behaviors in public, most general possible, that comes to take care of to the interests politicians e marketing. Recognizing the diversity, the permanent renewal of information and the negotiation of directions gifts in the Internet, as well as the innumerable ones forms of access to the information found by it, we consider results of the research as fruits of the inherent characteristics to this way midiático, to the time where we call the attention for relativity these results, for the plasticity of knowing them and sensible propagated on-line e for the great challenge that the hypermedia imposes to the study of communication phenomena, of the social representations and in educational quarrels and for the necessity of new research that they investigate the forms of socialization of the information and communication propitiated by hypermedia and its implications in the construction of the symbolic universes and in practical social