Identificación de los síntomas de daño o merma de capacidad resistente en estructuras en zonas sísmicas

Los sismos afectan a las estructuras en función de su intensidad. Normalmente se espera de las estructuras daños irreparables por motivos de ductilidad en los sismos nominales o de diseño, para protección de las personas y sus bienes. No obstante, las estructuras en zonas sísmicas sufren terremotos de baja o media intensidad de manera continuada y éstos pueden afectar a la capacidad resistente residual de las mismas, es por eso que en el presente trabajo se plantea lo siguiente: a) Identificar cuál es la estrategia o nivel de protección, que consideran las diferentes Normativas y Reglamentos frente a sismos de baja o mediana intensidad, puesto que durante la vida útil de una estructura, esta puede verse afectada por sismos de intensidad baja o moderada, los cuales también provocan daños; es por ello que es de mucha importancia conocer y estudiar el aporte, estrategias y demás parámetros que consideran las Normas, esto mediante la técnica de revisión de documentación o Literatura. b) Identificar la manera con que un terremoto de baja o media intensidad afecta a la capacidad resistente de las estructuras, sus señales, sus síntomas de daño, etc. Esto a través de tres técnicas de Investigación : Revisión en Literatura, Tormenta de ideas con un grupo de expertos en el tema, y mediante la Técnica Delphi; para finalmente aplicar una método de refinamiento para elaborar un listado y un mapa de síntomas esperables en las estructuras, consecuencia de eventos sísmicos de baja o mediana intensidad. Los cuales se podrían controlar con sistemas inteligentes y así monitorizar las construcciones para prever su comportamiento futuro. Earthquakes affect structures depending on its intensity. Normally it expected of the irreparable damage structures. It due to ductility in nominal earthquakes to protect people and property. Structures in seismic areas suffer earthquakes of low to medium intensity continually, and it may affect the residual resistant ability, therefore posed in this investigation is the following: (a) Identifying what is the strategy or level of protection, which consider different guidelines and regulations against earthquakes of low to medium intensity. Since during the service life of a structure may be affected by low or moderate intensity earthquakes, which also cause damage. For this reason it is very important also to meet and study the contribution, strategies and other parameters considered by the Guidelines by reviewing the documentation or literature technique. b) Identifying the way an earthquake of low to medium intensity affects the resistant ability of structures, their signs, their symptoms of injury, etc. Through three research techniques: review of documentation or literature, brainstorming technique with a group of experts, and using the Delphi technique. Finally applying a method of refining to produce a list and a map of symptoms expected in structures, consequence of low to medium intensity earthquakes. It could be controlled with intelligent systems and thus to monitor structures to predict its future behavior

Contribuições de experiências de estágio em CAPS III para a formação interdisciplinar em Saúde Mental na perspectiva da Reforma Psiquiátrica

Introdução: A formação dos profissionais da área da saúde é fundamental para a transformação das práticas de cuidado e consolidação dos princípios e diretrizes do Sistema Único de Saúde (SUS). Sendo um desafio do SUS, esta questão também está presente no campo da Saúde Mental e é necessária para a consolidação da Reforma Psiquiátrica e construção e fortalecimento da Rede de Atenção Psicossocial. Proposição: Investigar e refletir sobre as experiências dos estudantes que realizaram estágio no Centro de Atenção Psicossocial (CAPS) III Itaim Bibi entre 2009 e 2014, no tocante à formação profissional em Saúde Mental na perspectiva da Reforma Psiquiátrica. Materiais e Métodos: Estudo qualitativo, com construção dos dados a partir da leitura de relatórios dos estudantes e de questionários com perguntas referentes à experiência dos estágios, que foram apresentadas aos participantes conforme orientações do método Delphi. As questões abordaram: motivos; expectativas; forma e qualidade de participação nas atividades; temas e estudos; trabalho em equipe; situações vivenciadas; influência na atuação profissional; apresentação do estágio e sugestões de alterações. As informações foram trabalhadas por meio de Análise de Conteúdo Temática. Resultados: Dos 52 convidados, 28 participaram da primeira rodada (53,85%), sendo: 14 terapeutas ocupacionais, 9 enfermeiros, 3 psicólogos e 2 estudantes de Serviço Social. O segundo questionário foi composto por afirmativas presentes nas respostas recebidas para que os participantes as avaliassem conforme grau de concordância da escala Likert. Nesta fase foram recebidas 26 respostas. Conclusões: Apesar das dificuldades vivenciadas, avaliou-se que a maior parte das experiências dos estágios foi positiva e possibilitou aprendizagens significativas sobre o modelo de atenção psicossocial, o funcionamento e dinâmica da instituição, o trabalho em equipe interdisciplinar e as produções de convivência, principalmente aos sujeitos que realizaram estágios com maior carga horária. Identificaram como importantes aprendizados as experiências de acompanhamento individual e grupal dos usuários, a construção de Projeto Terapêutico Singular e de redes, o trabalho territorial e intersetorial. A participação em reuniões, supervisões clínico-institucionais, multiprofissionais e em oficinas de reflexão com as docentes das Universidades foi considerada importante para a formação. O aprendizado de manejo de situações de crise e de conflitos e de técnicas de contenção foi considerado superficial. Identificou-se que modelo de gestão e o trabalho da equipe influenciam no desenvolvimento de autonomia e protagonismo dos estagiários. O fortalecimento da integração ensino-serviço-comunidade é necessário e a flexibilização das propostas instituídas poderia facilitar a construção conjunta dos planos de estágios. Como produtos desta pesquisa foram elaboradas propostas de modificações para melhor organização dos estágios no CAPS e para a integração ensino-serviço e de Plano de Estágio Supervisionado em Terapia Ocupacional para os estágios extracurriculares. Realizou-se também uma Revisão Integrativa das publicações científicas brasileiras sobre a formação de estudantes de graduação em Saúde Mental na perspectiva da Reforma Psiquiátrica. Por fim, compreendeu-se que as experiências ressoam nas práticas profissionais dos graduados de modo positivo. Os participantes que não atuam neste campo, disseram levar consigo a experiência do trabalho em equipe e de formas éticas e humanizadas de cuidado.

Percepción de las enfermeras de atención especializada sobre la prescripción enfermera

El objetivo de esta investigación fue determinar la percepción que sobre el concepto de “prescripción enfermera” tienen los profesionales enfermeros de atención especializada. Para ello se realizó un abordaje cualitativo mediante técnica Delphi, con la participación de 20 profesionales enfermeros que constituyeron el grupo de expertos. El período de estudio estuvo comprendido entre diciembre de 2008 y febrero de 2009 y se desarrolló en un hospital de tercer nivel de la Comunidad de Madrid. Se identificaron 17 actividades que fueron entendidas por el grupo de expertos como prescripción enfermera, siendo éstas agrupadas con arreglo a tres categorías: prescripción independiente, colaborativa y basándose en un protocolo. El grupo de expertos consideró que dichas actividades pueden ser desarrolladas mediante dos perfiles competenciales enfermeros: el perfil administrativo y el facultativo.

Establishing a zone where technology innovation is supported

Learning technologies are now a ubiquitous force in the higher education sector however we continue to pursue more inventive ways to use them for teaching and learning. Many teaching academics that seek to be innovative do not have access to a supportive technology innovation zone. The aim of this study was to investigate the articulated staff development needs of academics involved in a faculty based technology innovation project and create the conditions that would cultivate innovation. The study sought to find out how academics perceived they might best be assisted through their technology innovation process so that participants’ needs were incorporated into planning. A questionnaire was used to elicit background information about the academics’ experience, skills and self diagnosed skill deficits in this context. Participants were also requested to provide information about how they thought they would best acquire the skills given their time and other resource constraints. A modified Delphi Technique was utilised to achieve some consensus on what academics required to support technology innovation. Complemented by an enabling and empowering team based approach, the academics were provided with an innovation zone to achieve significant goals for the project.

Analysis of organisational climate to improve the adequacy of primary health care in the State of Kuwait

This study covers two areas of contribution to the knowledge, firstly it tried to investigate rigourously the relationships of a number of factors believed that they may affect the climate perception, classified into three types to arrive to prove a hypothesis of the important role that qualification and personal factors play in shaping the climate perception, this is in contrast with situational factors. Secondly, the study tries to recluster the items of a wide-range applied scale for the measurement of climate named HAY in order to overcome the cross-cultural differences between the Kuwaiti and the American society, and to achieve a modified dimensions of climate for a civil service organisation in Kuwait. Furthermore, the study attempts to carry out a diagnostic test for the climate of the Ministry of Public Health in Kuwait, aiming to diagnose the perceived characteristics of the MoPH organisation, and suggests a number of areas to be given attention if an improvement is to be introduced. The study used extensively the statistical and the computer facilities to make the analysis more representing the field data, on the other hand this study is characterised by the very highly responsive rate of the main survey which would affect the findings reliability. Three main field studies are included, the first one was to conduct the main questionnaire where the second was to measure the "should be" climate by the experts of MoPH using the DELPHI technique, and the third was to conduct an extensive meeting with the very top management team in MoPH. Results of the first stage were subject to CLUSTER analysis for the reconstruction of the HAY tool, whereas comparative analysis was carried on between the results of the second and third stages on one side, the first from the other.

Questionnaire Construction

Questionnaires used in survey research can elicit excellent data for analysis for any part of the industry. The author discusses how to design questions, construct the survey, and watch for errors in conducting the re- search so that the results secured advance scientific inquiry.

Construção e validação de instrumento de coleta de dados do casal grávido no âmbito da atenção básica

The research aimed to construct and validate a data collection instrument of pregnant couple as part of primary care. It was considered hypothesis that level of agreement from 70% among participants to validate the expert panel. The document has been based on the Theory of Human Needs by Horta and adjusted by Garcia and Cubas. It is a study of methodological type developed in four stages: identification of empirical indicators to pregnant women through an integrative literature review; evaluation of empirical indicators and their relation to human needs by focus group; structuring of the second version of instrument by categorization of indicators and appearance and content validation of the third version of instrument by judges, by use of Delphi technique. The collection of data was the first stage in months from August to October 2014 in the Journal of Midwifery and Women's Health and Scopus, PubMed, Lilacs, CINAHL, Cochrane databases. The remaining steps were carried out from November 2014 to February 2015. For the focus group was counted with participation of six experts through two meetings. As for the judges, it was obtained a population of 63 and final sample of 51 judges divided into 46 basic health units of Municipal City Health Natal/RN, Brazil. The study was approved by the Research Ethics Committee of Universidade Federal do Rio Grande do Norte, under Protocol number 876.200. For data analysis of the first stage it was used descriptive statistics and results are presented in tables and charts. At that stage were identified 162 empirical indicators and, when they were related to human needs, 64 by them were on psycobiological, 97 on psychosocial and one (1) on psychospiritual needs. Regarding the second and third stages, data were treated by process of categorizing and analyzing the Content Validity Index. The indicators obtained a 100% validation index. In appearance and content validation phase of instrument non-validated items were excluded and other items obtained index above 70%. Furthermore, it obtained 99% content validity index in the second version and 95.7% in the third version of the instrument as a whole and, therefore, validated tool. This instrument contains Health Institution, pregnant woman and her partner identification data, information on the human needs of the pregnant and items pertaining to systematize the collection of pregnant couple data during prenatal care. By the conclusion of the study, nurse shall have an instrument to collect the data of pregnant couple in primary care innovative by considering psychobiological, psychosocial and psychospiritual pregnant needs and insert health and sociodemographic data of pregnant partner in the context of pregnancy. Also, the document will serve as a tool for teaching and research in obstetrical nursing.

EULAR Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy and Menopause in Patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Considering climate change in the development of marine protected areas

Marine ecosystems are facing a diverse range of threats, including climate change, prompting international efforts to safeguard marine biodiversity through the use of spatial management measures. Marine Protected Areas (MPAs) have been implemented as a conservation tool throughout the world, but their usefulness and effectiveness is strongly related to climate change. However, few MPA programmes have directly considered climate change in the design, management or monitoring of an MPA network. Under international obligations, EU, UK and national targets, Scotland has developed an MPA network that aims to protect marine biodiversity and contribute to the vision of a clean, healthy and productive marine environment. This is the first study to critically analyse the Scottish MPA process and highlight areas which may be improved upon in further iterations of the network in the context of climate change. Initially, a critical review of the Scottish MPA process considered how ecological principles for MPA network design were incorporated into the process, how stakeholder perceptions were considered and crucially what consideration was given to the influence of climate change on the eventual effectiveness of the network. The results indicated that to make a meaningful contribution to marine biodiversity protection for Europe the Scottish MPA network should: i) fully adopt best practice ecological principles ii) ensure effective protection and iii) explicitly consider climate change in the management, monitoring and future iterations of the network. However, this review also highlighted the difficulties of incorporating considerations of climate change into an already complex process. A series of international case studies from British Columbia, Canada; central California, USA; the Great Barrier Reef, Australia and the Hauraki Gulf, New Zealand, were then conducted to investigate perceptions of how climate change has been considered in the design, implementation, management and monitoring of MPAs. The key lessons from this study included: i) strictly protected marine reserves are considered essential for climate change resilience and will be necessary as scientific reference sites to understand climate change effects ii) adaptive management of MPA networks is important but hard to implement iii) strictly protected reserves managed as ecosystems are the best option for an uncertain future. This work provides new insights into the policy and practical challenges MPA managers face under climate change scenarios. Based on the Scottish and international studies, the need to facilitate clear communication between academics, policy makers and stakeholders was recognised in order to progress MPA policy delivery and to ensure decisions were jointly formed and acceptable. A Delphi technique was used to develop a series of recommendations for considering climate change in Scotland’s MPA process. The Delphi participant panel was selected for their knowledge of the Scottish MPA process and included stakeholders, policy makers and academics with expertise in MPA research. The results from the first round of the Delphi technique suggested that differing views of success would likely influence opinions regarding required management of MPAs, and in turn, the data requirements to support management action decisions. The second round of the Delphi technique explored this further and indicated that there was a fundamental dichotomy in panellists’ views of a successful MPA network depending upon whether they believed the MPAs should be strictly protected or allow for sustainable use. A third, focus group round of the Delphi Technique developed a feature-based management scenario matrix to aid in deciding upon management actions in light of changes occurring in the MPA network. This thesis highlights that if the Scottish MPA network is to fulfil objectives of conservation and restoration, the implications of climate change for the design, management and monitoring of the network must be considered. In particular, there needs to be a greater focus on: i) incorporating ecological principles that directly address climate change ii) effective protection that builds resilience of the marine and linked social environment iii) developing a focused, strong and adaptable monitoring framework iv) ensuring mechanisms for adaptive management.

Proposta de uma matriz de decisão em energia hidrelétrica com o uso do método multicritério, para formulação de políticas públicas no estado do Paraná

Brazil is internationally acknowledged for its renewable sources, most notably, hydroelectric power plant projects which correspond to 65% of electricity production supply to the National Interconnected System. The main question behind this research is: what are the weights and the relative importance of the variables which have influence on the decision making process for the expansion of hydroelectric generation projects in Parana? The main objective is to propose a multi-criteria decision procedure, in association with water sources options that take into consideration the weight and relative importance of the alternatives having influence on the decision by enterprises in the generation of electricity in the state of Paraná. As far as the approach to the problem is concerned, this research can be classified as having mixed methodologies, applying Content Analysis, Delphi technique and the Analytic Hierarchy Process. Following Delphi methodology, a group of 21 was selected for data collection, all of those linked to Paranaense hydroelectricity market. And the main result was the construction of a decision tree in which it was possible to identify the importance and relative weight of the elements associated with the four dimensions of energy. In environmental dimension, the highest relative weight was placed on the loading capacity of Parana system; the economic dimension, the amortization of investment; in social dimension, the generation of direct work places and in institutional dimension, the availability of suitable sources of financing. Policy makers and business managers make their decisions based on specific criteria related to the organization segment, market information, economic and political behavior among other indicators that guide them in dealing with the typical tradeoffs of projects in hydropower area. The results obtained in the decision tree show that the economic bias is still the main factor in making investment decisions. However, environmental impacts on the State loading capacity, income generation, providing opportunities for direct as well as indirect jobs. And at an institutional level, the absence of funding sources show that the perception of experts is focused on other issues beyond the logic behind development per se. The order of priority of variables in this study indicates that in the current environment of uncertainty in the Brazilian economy as many variables must be analyzed and compared in order to optimize the scarce resources available to expand local development in relation to Paranaense water matrix.

Quality of implementation in an evidence-based family prevention program: the Family Competence Program

Family prevention programs need to be evidence-based in order to guarantee the success of their implementation. The Family Competence Program (FCP), a Spanish cultural adaptation of the Strengthening Families Program (SFP), has developed different measures and processes to gauge the quality of the implementation. This article is dedicated specifically to two of these measures: the evaluation of the facilitators and the assessment of the family engagement techniques. For evaluating the facilitators, a Delphi technique with experts and professionals is undertaken. For assessing the family techniques, both self-evaluation of trainers and evaluation by families are used. Finding underpin that, in the case of facilitators, is important that, after to skills and experience, they need to understand the theory of change of the program. In the case of family engagement techniques, more detailed, comprehensive talks, discussions and group activities lead to better family engagement outcomes.

Evaluación de los contenidos de información de medicamentos en un grupo de agencias reguladoras de medicamentos

OBJETIVO: Evaluar las diferencias de información publicada por el Invima y otras Autoridades Reguladoras de Medicamentos en relación a un grupo de variables seleccionadas y analizar las diferencias aplicando estrategias de visualización de datos. METODOLOGÍA: Estudio descriptivo de corte transversal, en el cual se comparan las diferencias en la información de medicamentos publicada en las agencias reguladoras de medicamentos. Para la definición de los criterios de comparación, más relevantes se utilizó la técnica Delphi como metodología de consenso. Las visualizaciones fueron desarrolladas en Roassal, en el entorno de programación de Grafoscopio/Pharo. RESULTADOS Y CONCLUSIONES: De 24 variables en las que hubo acuerdo de considerarlas importantes y claves por el panel de expertos; el 96% se identificaron en la Aemps, MHRA e Infarmed; el 92% en Anmat, TGA, Anvisa, Health Canada y FDA; el 80% en Anamed. El grupo de agencias en las que se identificó una menor cantidad de información publicada fueron Cofepris, Invima, Dirección Nacional de Farmacias y Drogas de Panamá, Digemid, Arcsa y el Ministerio de Salud pública de Uruguay en las que se identificó el 67%, 58%, 46%, 46%, 38% y 4%, respectivamente. Las ausencias comunes de información en el grupo de agencias con menor cantidad de información se presentó en las variables relacionadas con usos fuera de indicación (off-label), gestión del riesgo, efectos adversos, restricciones especiales, precauciones y advertencias, prospecto, almacenamiento y resumen de las características del producto, es decir que mayor la limitación se presenta en la información relacionada con prescripción y uso.

Indicateurs sécurité en obstétrique : une étude Delphi [Patient safety indicators for obstetrics: a Delphi based study]

OBJECTIVE: Clinical indicators are increasingly used to assess safety of patient care. In obstetrics, only a few indicators have been validated to date and none is used across specialties. The purpose of this study was to identify and assess for face and content validity a group of safety indicators that could be used by anaesthetists, obstetricians and neonatologists involved in labour and delivery units. MATERIALS AND METHODS: We first conducted a systematic review of the literature to identify potential measures. Indicators were then validated by a panel of 30 experts representing all specialties working in labour and delivery units. We used the Delphi method, an iterative questionnaire-based consensus seeking technique. Experts determined on a 7-point Likert scale (1=most representative/7=less representative) the soundness of each indicator as a measure of safety and their possible association with errors and complications caused by medical management. RESULTS: We identified 44 potential clinical indicators from the literature. Following the Delphi process, 13 indicators were considered as highly representative of safety during obstetrical care (mean score</=2.3). Experts ranked 6 of these indicators as being strongly associated to potential errors and complications. CONCLUSIONS: We identified and validated for face and content, a group of six clinical indicators to measure potentially preventable iatrogenic complications in labour and delivery units.

Fracture Of Distal Humerus: Mipo Technique With Visualization Of The Radial Nerve.

To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function. Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection. This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series.

In Vitro Effects Of Hydrogen Peroxide Combined With Different Activators For The In-office Bleaching Technique On Enamel.

Abstract Objective. The aim of this study was to evaluate the alteration of human enamel bleached with high concentrations of hydrogen peroxide associated with different activators. Materials and methods. Fifty enamel/dentin blocks (4 × 4 mm) were obtained from human third molars and randomized divided according to the bleaching procedure (n = 10): G1 = 35% hydrogen peroxide (HP - Whiteness HP Maxx); G2 = HP + Halogen lamp (HL); G3 = HP + 7% sodium bicarbonate (SB); G4 = HP + 20% sodium hydroxide (SH); and G5 = 38% hydrogen peroxide (OXB - Opalescence Xtra Boost). The bleaching treatments were performed in three sessions with a 7-day interval between them. The enamel content, before (baseline) and after bleaching, was determined using an FT-Raman spectrometer and was based on the concentration of phosphate, carbonate, and organic matrix. Statistical analysis was performed using two-way ANOVA for repeated measures and Tukey's test. Results. The results showed no significant differences between time of analysis (p = 0.5175) for most treatments and peak areas analyzed; and among bleaching treatments (p = 0.4184). The comparisons during and after bleaching revealed a significant difference in the HP group for the peak areas of carbonate and organic matrix, and for the organic matrix in OXB and HP+SH groups. Tukey's analysis determined that the difference, peak areas, and the interaction among treatment, time and peak was statistically significant (p < 0.05). Conclusion. The association of activators with hydrogen peroxide was effective in the alteration of enamel, mainly with regards to the organic matrix.