Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

Avaliação do efeito de um probiótico na performance zootécnica e microbiota entérica em coelhos (Oryctolagus cuniculus) de produção

A cunicultura é uma atividade pecuária em crescente desenvolvimento e isso traduz-se em novos desafios. Durante muitos anos a criação de coelhos recorreu em demasia ao uso de antimicrobianos com o objetivo de tratar e prevenir o aparecimento de diversas doenças. Paralelamente, estes compostos foram também usados como “promotores de crescimento”, visando essencialmente uma melhoria da eficiência digestiva. Porém, o uso indiscriminado destas substâncias levantou questões de saúde pública, como a emergência de estirpes bacterianas multirresistentes e a inerente disseminação de genes de resistência, possivelmente transferíveis ao Homem através da cadeia alimentar. No presente, existe uma enorme pressão para a adoção de estratégias que possibilitem uma redução massiva na quantidade de antimicrobianos administrados a espécies pecuárias. Este trabalho visou contribuir para o estudo de uma alternativa ao uso de antimicrobianos - os probióticos – enquanto suplementos alimentares constituídos por microrganismos vivos capazes de equilibrar a microbiota intestinal do hospedeiro. Para tal, foram constituídos dois grupos de coelhos com base na alimentação: i) grupo antibiótico, com acesso a um alimento composto suplementado com antibióticos e ii) o grupo probiótico alimentado com a mesma dieta, mas sem antibióticos e inoculado com um probiótico constituído por Escherichia coli e Enterococcus spp.. Ao longo de 22 dias de estudo foram monitorizados alguns indicadores produtivos e efetuadas recolhas periódicas de fezes para estudo microbiológico. A análise dos resultados zootécnicos permitiram verificar que o uso de probióticos em detrimento de antibióticos parece promover o crescimento de coelhos, tornando-se um método mais rentável na produção cunícula. Através de genotipagem por ERIC-PCR e PFGE, pretendeu-se verificar se as estirpes estranhas ao trato gastrointestinal dos coelhos seriam capazes de coloniza-lo, permanecendo ao longo do tempo de estudo. O facto de as estirpes inoculadas no probiótico terem sido encontradas ao longo dos dias de estudo nos coelhos aos quais foram administradas, sugere que os efeitos observados na performance zootécnica estejam relacionados com as estirpes administradas no probiótico, pelo que este poderá ser um sistema viável na substituição de antibióticos na alimentação de coelhos de produção.

A high performance wireless fieldbus in industrial multimedia-related environment

This paper summarises the most important solutions that have emerged from the work carried out by our team within the framework of the EU (IST-1999-11316) project RFieldbus - High Performance Wireless Fieldbus in Industrial Multimedia-Related Environment. Within this project, Profibus was chosen as the fieldbus platform. Essentially, extensions to the current Profibus standard are being developed in order to provide Profibus with wireless, mobility and industrialmultimedia capabilities. In fact, providing these extensions means fulfilling strong requirements, namely to encompass the communication between wired (currently available) and wireless/mobile devices and to support real-time control traffic and multimedia traffic in the same network.

Via Balastrada versus via não balastrada

Trabalho Final de Mestrado para a obtenção do grau de Mestre em Engenharia Civil, na Área de Especialização de Vias de Comunicação e Transportes

A survey in Portuguese X-ray fluoroscopy equipment: dose rates and image quality

X-ray fluoroscopy is essential in both diagnosis and medical intervention, although it may contribute to significant radiation doses to patients that have to be optimised and justified. Therefore, it is crucial to the patient to be exposed to the lowest achievable dose without compromising the image quality. The purpose of this study was to perform an analysis of the quality control measurements, particularly dose rates, contrast and spatial resolution of Portuguese fluoroscopy equipment and also to provide a contribution to the establishment of reference levels for the equipment performance parameters. Measurements carried out between 2007 and 2013 on 143 fluoroscopy equipment distributed by 34 nationwide health units were analysed. The measurements suggest that image quality and dose rates of Portuguese equipment are congruent with other studies, and in general, they are as per the Portuguese law. However, there is still a possibility of improvements intending optimisation at a national level.

Self-reported hearing performance in workers exposed to solvents

OBJECTIVE: To compare hearing performance relating to the peripheral and central auditory system between solvent-exposed and non-exposed workers. METHODS: Forty-eight workers exposed to a mixture of solvents and 48 non-exposed control subjects of matched age, gender and educational level were selected to participate in the study. The evaluation procedures included: pure-tone audiometry (500 - 8,000 Hz), to investigate the peripheral auditory system; the Random Gap Detection test, to assess the central auditory system; and the Amsterdam Inventory for Auditory Disability and Handicap, to investigate subjects' self-reported hearing performance in daily-life activities. A Student t test and analyses of covariance (ANCOVA) were computed to determine possible significant differences between solvent-exposed and non-exposed subjects for the hearing level, Random Gap Detection test and Amsterdam Inventory for Auditory Disability and Handicap. Pearson correlations among the three measures were also calculated. RESULTS: Solvent-exposed subjects exhibited significantly poorer hearing thresholds for the right ear than non-exposed subjects. Also, solvent-exposed subjects exhibited poorer results for the Random Gap Detection test and self-reported poorer listening performance than non-exposed subjects. Results of the Amsterdam Inventory for Auditory Disability and Handicap were significantly correlated with the binaural average of subject pure-tone thresholds and Random Gap Detection test performance. CONCLUSIONS: Solvent exposure is associated with poorer hearing performance in daily life activities that relate to the function of the peripheral and central auditory system.

A ansiedade antes, durante e após a performance: relatório de estágio

I (Prática Pedagógica) - Neste relatório de estágio apresenta-se uma caracterização do CRP, contextualizando um pouco da sua história, o seu funcionamento e os seus objetivos pedagógicos. Caracterizam-se, também, os alunos que participaram no estágio, destacando o seu percurso académico, as suas influências e motivações musicais. Nas práticas educativas desenvolvidas apresentam-se os princípios pedagógicos, segundo o portal Ponazapino, e os métodos de ensino lecionados durante o ano letivo que tiveram em conta o processo integrado de Ensino/Aprendizagem (Teaching and Learning). Por último apresentam-se os objetivos pedagógicos propostos para cada aluno do estágio. No final efetua-se uma análise crítica da atividade docente destacando o processo ensino/aprendizagem, a sua aplicação e benefícios no desenvolvimento integral do indivíduo.

Ansiedade na performance: causas e possíveis curas

I - Este relatório pretende descrever o estágio especializado em ensino de música realizado no âmbito do mestrado em Ensino de Música na Escola Superior de Música de Lisboa. Este estágio decorreu no Instituto Gregoriano de Lisboa e no Conservatório de Música, de Dança e de Arte Dramática de Lisboa, duas escolas de ensino oficial especializado. Sendo a primeira pública e a segunda privada, estas escolas apresentam realidades muito diferentes do ponto de vista organizacional e de gestão, que resultam em situações heterogéneas e dependentes de vários factores que serão mencionados ao longo deste relatório. A análise SWOT efectuada para cada uma destas organizações descreve mais objectivamente os factores e variáveis que permitiram construir este relatório. Foram caracterizados três alunos, um de cada curso: preparatório, básico e secundário. A Maria M. é a aluna do 2º ano do curso preparatório, o Pedro R. é aluno de 3º grau do curso básico de instrumento e o Diego M. é aluno de 7º grau. Foram aprofundadas as práticas pedagógicas desenvolvidas com cada um dos alunos e os avanços e metas atingidas por cada um destes alunos. Este estágio resulta numa reflexão sobre a prática pedagógica aplicada e as suas motivações.

Attention performance among Brazilian truck drivers and its association with amphetamine use: pilot study

The aim of this article was to describe the attention functioning of twenty-two truck drivers and its relationship with amphetamine use. Those drivers who reported using amphetamines in the twelve months previous to the interview had the best performance in a test evaluating sustained attention functioning. Although amphetamine use may initially seem advantageous to the drivers, it may actually impair safe driving. The findings suggest the importance of monitoring the laws regarding amphetamine use in this country.

Hybrid wired/wireless PROFIBUS architectures: performance study based on simulation models

The problem of providing a hybrid wired/wireless communications for factory automation systems is still an open issue, notwithstanding the fact that already there are some solutions. This paper describes the role of simulation tools on the validation and performance analysis of two wireless extensions for the PROFIBUS protocol. In one of them, the Intermediate Systems, which connect wired and wireless network segments, operate as repeaters. In the other one the Intermediate Systems operate as bridge. We also describe how the analytical analysis proposed for these kinds of networks can be used for the setting of some network parameters and for the guaranteeing real-time behaviour of the system. Additionally, we also compare the bridge-based solution simulation results with the analytical results.

Services innovation and economic performance: An analysis at the firm

In this paper we estimate a model linking innovation effort and economic performance, along the lines of the Mairesse and Mohnen (2003) model. We examine this relationship in the context of services sectors instead of Research and Development intensive manufacturing sectors. Much effort has already been made to explore the innovation-performance relationship for manufacturing sectors but it is still much understudied for services, particularly for Portugal. In this paper we aim to take a step in fulfilling this gap. We use new firm level data for ten services sectors from the Second Community Innovation Survey of Portugal, to estimate the model.

Consolidating preservative-treated wood: Combined mechanical performance of boron and polymeric products in wood degraded by Coniophora puteana

When timber elements in heritage buildings are moderately degraded by fungi and assuming underlying moisture problems have been solved, two actions can be taken: i) use a biocide to stop fungal activity; ii) consolidate the degraded elements so that the timber keeps on fulfilling its structural and decorative functions. The aim of this work is to investigate the mechanical performance of maritime pine wood degraded by fungi after being treated with a biocide followed by impregnation with a polymer product. Three commercially available products were used: a boron water-based biocide, an acrylic consolidant and an epoxy-based consolidant. Treated and consolidated specimens were subjected to mechanical tests: axial compression test (NP 618), static surface hardness (ISO 3350) and bending test (NP 619). Sets of replicates were subjected to an evaporation ageing test (EN 73) after application of the products and also tested for mechanical behaviour. An increase in mechanical strength was observed for both consolidants with no significant influence from the previous use of biocide product. The specimens subjected to ageing showed a slightly better general mechanical performance.

Performance of concrete made with aggregates recycled from precasting industry waste: influence of the crushing process

The aim of this paper is to evaluate the influence of the crushing process used to obtain recycled concrete aggregates on the performance of concrete made with those aggregates. Two crushing methods were considered: primary crushing, using a jaw crusher, and primary plus secondary crushing (PSC), using a jaw crusher followed by a hammer mill. Besides natural aggregates (NA), these two processes were also used to crush three types of concrete made in laboratory (L20, L45 e L65) and three more others from the precast industry (P20, P45 e P65). The coarse natural aggregates were totally replaced by coarse recycled concrete aggregates. The recycled aggregates concrete mixes were compared with reference concrete mixes made using only NA, and the following properties related to the mechanical and durability performance were tested: compressive strength; splitting tensile strength; modulus of elasticity; carbonation resistance; chloride penetration resistance; water absorption by capillarity; water absorption by immersion; and shrinkage. The results show that the PSC process leads to better performances, especially in the durability properties. © 2014 RILEM

Automatic tunning of Okumura-Hata model on railway communications

This paper presents the Genetic Algorithms (GA) as an efficient solution for the Okumura-Hata prediction model tuning on railways communications. A method for modelling the propagation model tuning parameters was presented. The algorithm tuning and validation were based on real networks measurements carried out on four different propagation scenarios and several performance indicators were used. It was shown that the proposed GA is able to produce significant improvements over the original model. The algorithm developed is currently been used on real GSM-R network planning process for an enhanced resources usage.

Repeater vs. Bridge-based hybrid wired/wireless PROFIBUS networks: a comparative performance analysis

In the last years, several solutions have been proposed to extend PROFIBUS in order to support wired and wireless network stations in the same network. In this paper we compare two of those solutions, one in which the interconnection between wired and wireless stations is made by repeaters and another in which the interconnection is made by bridges. The comparison is both qualitative and numerical, based on simulation models of both architectures.