Um sistema de classificação de risco para serviços hospitalares de urgências e emergências pediátricas: CLARIPED.

Esta pesquisa refere-se ao desenvolvimento de um novo sistema triagem ou classificação de risco para os serviços de urgências e emergências pediátricas e ao estudo de validade e confiabilidade deste instrumento. O primeiro tópico trata de conceitos e fundamentos relacionados à triagem e evidencia a complexidade do tema em vários aspectos. O segundo tópico apresenta as justificativas para o desenvolvimento de um novo sistema de classificação de risco para o contexto de saúde brasileiro, diante das inadequações de se adotar sistemas idealizados em países com desenvolvimento econômico, social e cultural diversos. O terceiro tópico apresenta os objetivos da pesquisa: rever o estado da arte em relação à validade e confiabilidade de sistemas de triagem em crianças, descrever o desenvolvimento de um sistema brasileiro de classificação de risco para urgências e emergências pediátricas e estudar a validade e confiabilidade do novo instrumento. O quarto tópico é uma revisão sistemática da literatura sobre a validade e confiabilidade dos sistemas de triagem utilizados na população pediátrica. Localizaram-se estudos sobre sete sistemas de triagem desenvolvidos no Canadá, Reino Unido, EUA, Austrália, Escandinávia e África do Sul. Constatou-se a dificuldade de se comparar o desempenho de diferentes instrumentos, devido à heterogeneidade dos desfechos, das populações e dos contextos de saúde estudados. O quinto tópico descreve o processo de desenvolvimento de um instrumento brasileiro de classificação de risco em pediatria, CLARIPED, a partir do consenso entre especialistas e pré-testes. Justificou-se a escolha da Escala Sul Africana de Triagem como referência, pela sua simplicidade e objetividade e pela semelhança socioeconômica e demográfica entre os dois países. Introduziram-se várias modificações, mantendo-se a mesma logística do processo de triagem em duas etapas: aferição de parâmetros fisiológicos e verificação da presença de discriminadores de urgência. O sexto tópico se refere ao estudo prospectivo de validade e confiabilidade do CLARIPED no setor de emergência pediátrica de um hospital terciário brasileiro, no período de abril a julho de 2013. Uma boa validade de construto convergente foi confirmada pela associação entre os níveis de urgência atribuídos pelo CLARIPED e os desfechos evolutivos utilizados como proxies de urgência (utilização de recursos, hospitalização, admissão na sala de observação e tempo de permanência no setor de emergência). A comparação entre o CLARIPED e o padrão de referência mostrou boa sensibilidade de 0,89 (IC95%=0,78-0,95) e especificidade de 0,98 (IC95%=0,97-0,99) para diagnosticar elevada urgência. A confiabilidade interobservadores, resultou num kappa ponderado quadrático substancial de 0,75 (IC95%: 0,74-0,79). O sétimo e último tópico tece considerações finais sobre dois aspectos: a insuficiência de evidências científicas sobre os sistemas de triagem na população pediátrica e a oportunidade e relevância de se desenvolver um sistema brasileiro de classificação de risco para urgências e emergências pediátricas, válido e confiável, com possibilidades de adoção em âmbito nacional.

Farmer-scientist research partnerships for integrated agriculture-aquaculture

A realistic alternative to traditional technology development and transfer has been utilized by the International Center for Living Aquatic Resources Management (ICLARM) to integrate pond fish culture into low-input farming systems in Malawi. Resource mapping was used to assess farm resources and constraints and introduce the concept of integrated resource management (IRM), the synergistic movement of resources between and among farm and household enterprises. Farmer-led IRM research projects are conducted on-farm and monitored by researchers through direct observation and on-station simulation of constraints and management practices. Technology-adoption rates by farmers involved in a pilot activity was 65% compared to 0% by farmers exposed only to top-down extension approaches. Within two years of adoption, every participating farmer had transferred the technology to an average of four other farmers without the involvement of the extension services.

Aquaculture and food security, poverty alleviation and nutrition in Ghana: Case study prepared for the Aquaculture for Food Security, Poverty Alleviation and Nutrition project

This study provides an overview of the aquaculture sector in Ghana. It assesses the actual and potential contribution of aquaculture to poverty reduction and food security, and identifies enabling conditions for and drivers of the development of Ghana’s aquaculture sector. The study uses data collected from a variety of primary and secondary sources, including key informant interviews with actors within the aquaculture sector and relevant secondary literature.

Aquatic agricultural systems in Cambodia: national situation analysis

The objective of the current report produced for the CGIAR Research Program on Aquatic Agricultural Systems (AAS) is to provide basic information on key constraints driving poverty and vulnerability in aquatic agricultural systems in the Tonle Sap region in Cambodia. Six objectives and corresponding research themes are included in the program: sustainable increases in productivity; equitable access to markets; resilience and adaptive capacity; empowering policies and institutions; reduced gender disparity; and expanded benefits for the resource-poor. In this report, the authors review the main aquatic agricultural systems (status, specific policies and strategies, interventions, challenges, and options), then review the main drivers of change. This leads to an identification of plans and strategies important to AAS, with a particular focus on perspectives, gaps and opportunities in national policies, community engagement, increased benefits, adaptive capacity, and gender. This review, of potential interest to decision makers and all development partners, leads to conclusions and recommendations aimed at policymakers and institutional as well as private investors in development.

Evaluating holonic control systems: A case study

in the last 10 years many designs and trial implementations of holonic manufacturing systems have been reported in the literature. Few of these have resulted in any industrial take up of the approach and part of this lack of adoption might be attributed to a shortage of evaluations of the resulting designs and implementations and their comparison with more conventional approaches. This paper proposes a simple approach for evaluating the effectiveness of a holonic system design, with particular focus on the ability of the system to support reconfiguration (in the face of change). A case study relating to a laboratory assembly system is provided to demonstrate the evaluation approach. Copyright © 2005 IFAC.

Model development & application for inland navigational canals

Several agencies in the United Kingdom have interest in the water quality of old navigational canals that have fallen into disuse after the decline of commercial canal transportation. The interested agencies desired a model to predict the water quantity and quality of inland navigational canals in order to evaluate management options to address the issues in the natural streams to which they discharge. Inland navigational canals have unique drivers of their hydrology and water quality compared to either natural streams, irrigation canals, or larger navigational canals connected to seas or oceans. Water in an inland canal is typically sourced from a reservoir and artificially pumped to a summit reach; its movement downhill is controlled by the activity of boats and overflow weirs. Stagnant impoundments between locks, which might normally be expected to result in a decrease in the concentration of sediment-associated pollutants, actually have surprisingly high levels of sediment due to boat traffic. Algal growth in the stagnant reach can be high. This paper describes a canal model developed to simulate hydrology and water quality in inland navigational canals. This model was successfully applied to the Kennet and Avon Canal to predict hydrology, sediment generation and transport, and algal growth and transport. The model is responsive to external influences such as sunlight, temperature, nutrient concentrations, boat traffic, and runoff from the contributing catchment area.

Future-proofed energy design for dwellings: Case studies from England and application to the Code for Sustainable Homes

This paper investigates 'future-proofing' as an unexplored yet all-important aspect in the design of low-energy dwellings. It refers particularly to adopting lifecycle thinking and accommodating risks and uncertainties in the selection of fabric energy efficiency measures and low or zero-carbon technologies. Based on a conceptual framework for future-proofed design, the paper first presents results from the analysis of two 'best practice' housing developments in England; i.e., North West Cambridge in Cambridge and West Carclaze and Baal in St. Austell, Cornwall. Second, it examines the 'Energy and CO2 Emissions' part of the Code for Sustainable Homes to reveal which design criteria and assessment methods can be practically integrated into this established building certification scheme so that it can become more dynamic and future-oriented.Practical application: Future-proofed construction is promoted implicitly within the increasingly stringent building regulations; however, there is no comprehensive method to readily incorporate futures thinking into the energy design of buildings. This study has a three-fold objective of relevance to the building industry:Illuminating the two key categories of long-term impacts in buildings, which are often erroneously treated interchangeably:- The environmental impact of buildings due to their long lifecycles.- The environment's impacts on buildings due to risks and uncertainties affecting the energy consumption by at least 2050. This refers to social, technological, economic, environmental and regulatory (predictable or unknown) trends and drivers of change, such as climate uncertainty, home-working, technology readiness etc.Encouraging future-proofing from an early planning stage to reduce the likelihood of a prematurely obsolete building design.Enhancing established building energy assessment methods (certification, modelling or audit tools) by integrating a set of future-oriented criteria into their methodologies. © 2012 The Chartered Institution of Building Services Engineers.

Designing climate change mitigation plans that add up.

Mitigation plans to combat climate change depend on the combined implementation of many abatement options, but the options interact. Published anthropogenic emissions inventories are disaggregated by gas, sector, country, or final energy form. This allows the assessment of novel energy supply options, but is insufficient for understanding how options for efficiency and demand reduction interact. A consistent framework for understanding the drivers of emissions is therefore developed, with a set of seven complete inventories reflecting all technical options for mitigation connected through lossless allocation matrices. The required data set is compiled and calculated from a wide range of industry, government, and academic reports. The framework is used to create a global Sankey diagram to relate human demand for services to anthropogenic emissions. The application of this framework is demonstrated through a prediction of per-capita emissions based on service demand in different countries, and through an example showing how the "technical potentials" of a set of separate mitigation options should be combined.

Human interfaces to structured documents

This research investigates some of the reasons for the reported difficulties experienced by writers when using editing software designed for structured documents. The overall objective was to determine if there are aspects of the software interfaces which militate against optimal document construction by writers who are not computer experts, and to suggest possible remedies. Studies were undertaken to explore the nature and extent of the difficulties, and to identify which components of the software interfaces are involved. A model of a revised user interface was tested, and some possible adaptations to the interface are proposed which may help overcome the difficulties. The methodology comprised: 1. identification and description of the nature of a ‘structured document’ and what distinguishes it from other types of document used on computers; 2. isolation of the requirements of users of such documents, and the construction a set of personas which describe them; 3. evaluation of other work on the interaction between humans and computers, specifically in software for creating and editing structured documents; 4. estimation of the levels of adoption of the available software for editing structured documents and the reactions of existing users to it, with specific reference to difficulties encountered in using it; 5. examination of the software and identification of any mismatches between the expectations of users and the facilities provided by the software; 6. assessment of any physical or psychological factors in the reported difficulties experienced, and to determine what (if any) changes to the software might affect these. The conclusions are that seven of the twelve modifications tested could contribute to an improvement in usability, effectiveness, and efficiency when writing structured text (new document selection; adding new sections and new lists; identifying key information typographically; the creation of cross-references and bibliographic references; and the inclusion of parts of other documents). The remaining five were seen as more applicable to editing existing material than authoring new text (adding new elements; splitting and joining elements [before and after]; and moving block text).

Interaction strengths and net effects in food web models

Understanding how dynamic ecological communities respond to anthropogenic drivers of change such as habitat loss and fragmentation, climate change and the introduction of alien species requires that there is a theoretical framework able to predict community dynamics. At present there is a lack of empirical data that can be used to inform and test predictive models, which means that much of our knowledge regarding the response of ecological communities to perturbations is obtained from theoretical analyses and simulations. This thesis is composed of two strands of research: an empirical experiment conducted to inform the scaling of intraspecific and interspecific interaction strengths in a three species food chain and a series of theoretical analyses on the changes to equilibrium biomass abundances following press perturbations. The empirical experiment is a consequence of the difficulties faced when parameterising the intraspecific interaction strengths in a Lotka-Volterra model. A modification of the dynamic index is used alongside the original dynamic index to estimate intraspecific interactions and interspecific interaction strengths in a three species food. The theoretical analyses focused on the effect of press perturbations to focal species on the equilibrium biomass densities of all species in the community; these perturbations allow for the quantification of a species total net effect. It was found that there is a strong and consistent positive relationship between a species body size and its total net effect for a set of 97 synthetic food webs and also for the Ythan Estuary and Tuesday Lake food webs (empirically described food webs). It is shown that ecological constraints (due to allometric scaling) on the magnitude of entries in the community matrix cause the patterns observed in the inverse community matrix and thus explain the relationship between a species body mass and its total net effect in a community.

Community Vulnerability to Malaria in Madre de Dios, Peru

Construction of a highway and artisanal gold mining have contributed to population and land use changes within the department of Madre de Dios, Peru. Such changes are expected to alter malaria rates due to impacts on vector habitat and human exposure. Vulnerability, as defined by the possibility of bereavement of a physical good or abstract state, is useful for understanding which communities are most likely to be adversely impacted by hazards such as malaria. A model defining susceptibility (SUS) and lack of resilience (LOR) was used to create an index of vulnerability to malaria for 40 communities in Madre de Dios. Indicators of SUS and LOR were developed from household and community data and combined into a final vulnerability index score. Vulnerability scores ranged between 0.13 and 0.31 with a mean of 0.21. Communities were grouped according to standard deviations from the mean. The most vulnerable communities (>1.5 standard deviations from mean) were located in the southern portion of the study area. When the dimension scores were compared for all communities, scores were generally higher in the susceptibility dimension than in the lack of resilience dimension. Examination of the indicator scores of individual communities revealed that drivers of vulnerability vary across the department. Therefore, targeted interventions addressing specific aspects of vulnerability may be useful. Finally, a predicted vulnerability surface was created for a 10 km buffer surrounding the Interoceanic Highway in Madre de Dios.

Huntingtin is required for normal excitatory synapse development in cortical and striatal circuits.

Huntington's disease (HD) is a neurodegenerative disease caused by the expansion of a poly-glutamine (poly-Q) stretch in the huntingtin (Htt) protein. Gain-of-function effects of mutant Htt have been extensively investigated as the major driver of neurodegeneration in HD. However, loss-of-function effects of poly-Q mutations recently emerged as potential drivers of disease pathophysiology. Early synaptic problems in the excitatory cortical and striatal connections have been reported in HD, but the role of Htt protein in synaptic connectivity was unknown. Therefore, we investigated the role of Htt in synaptic connectivity in vivo by conditionally silencing Htt in the developing mouse cortex. When cortical Htt function was silenced, cortical and striatal excitatory synapses formed and matured at an accelerated pace through postnatal day 21 (P21). This exuberant synaptic connectivity was lost over time in the cortex, resulting in the deterioration of synapses by 5 weeks. Synaptic decline in the cortex was accompanied with layer- and region-specific reactive gliosis without cell loss. To determine whether the disease-causing poly-Q mutation in Htt affects synapse development, we next investigated the synaptic connectivity in a full-length knock-in mouse model of HD, the zQ175 mouse. Similar to the cortical conditional knock-outs, we found excessive excitatory synapse formation and maturation in the cortices of P21 zQ175, which was lost by 5 weeks. Together, our findings reveal that cortical Htt is required for the correct establishment of cortical and striatal excitatory circuits, and this function of Htt is lost when the mutant Htt is present.

Studies on Understanding Individual Willingness to Disclose Genetic Information to Public and Private Stakeholders

While technologies for genetic sequencing have increased the promise of personalized medicine, they simultaneously pose threats to personal privacy. The public’s desire to protect itself from unauthorized access to information may limit the uses of this valuable resource. To date, there is limited understanding about the public’s attitudes toward the regulation and sharing of such information. We sought to understand the drivers of individuals’ decisions to disclose genetic information to a third party in a setting where disclosure potentially creates both private and social benefits, but also carries the risk of potential misuse of private information. We conducted two separate but related studies. First, we administered surveys to college students and parents, to determine individual attitudes toward and inter-generational influences on the disclosure decision. Second, we conducted a game-theory based experiment that assessed how participants’ decisions to disclose genetic information are influenced by societal and health factors. Key survey findings indicate that concerns about genetic information privacy negatively impact the likelihood of disclosure while the perceived benefits of disclosure and trust in the institution receiving the information have a positive influence. The experiment results also show that the risk of discrimination negatively affects the likelihood of disclosure, while the positive impact that disclosure has on the probability of finding a cure and the presence of a monetary incentive to disclose, increase the likelihood. We also study the determinants of individuals’ decision to be informed of findings about their health, and how information about health status is used for financial decisions.

Water privatisation

The article examines the expansion of private water companies since 1989 the withdrawal from developing countries from 2003 onwards, and the economic impact of privatisation. The analysis is set in the context of the historical development of water services in the north and the south, showing that the role of private water companies since the start of the 20th century has been historically limited and exceptional. The impact of water privatisation is considered in relation to the issues of investment, prices, and efficiency, drawing on empirical evidence from the north and developing countries in Asia, Africa and Latin America. Particular attention is given to France and the UK, where private water companies, for different reasons, are most established. The evidence from both north and south shows systematic underinvestment, monopoly pricing, regulatory gaming, and no significant efficiency differences between public and private sector operators. In conclusion, the article identifies institutional policies including fiscal constraints and lending conditionalities as key drivers of privatisation, and questions whether these can sustain privatisation in the water sector where historical experience indicates it is an inappropriate solution.

Policy packages as potential routes to urban road pricing in the UK

This paper focuses on urban road pricing as a demand management policy that is often regarded as radical and generally unacceptable. Road pricing often gets delayed or abandoned due to low acceptability. This may be due to the fact that complex interactions and drivers of change affect road transport management and require cooperation within implementation networks. The implementation network is a group of people (referred to as partners and actors) who co-ordinate the introduction of policy tools. The drivers of change include any internal or external influences that have an effect on the time, place, or ‘shape’ of the policy measures being introduced. Demand management measures that focus on 'sustainable transport' usually address a limited set of objectives and are often implemented alone i.e. are not necessarily combined with other policy measures. When combined with other measures, it is not always clear whether the multiple interactions between policy tools and implementation networks have been sufficiently considered. Examples of ongoing implementation of policy package in the UK are the support of road pricing initiatives combined with public transport improvements by the Transport Innovation Fund. The objectives of the paper are twofold. First, we present a review of the UK urban road pricing situation. Second, we contrast the emerging issues against six key implementation factors. The analysis of three existing UK road pricing examples - London, Edinburgh and Durham – shows the importance of combining policy tools. Furthermore, through the above examples and theoretical arguments, we emphasise the additional need of creating and maintaining strong networks when implementing policy packages.