Prospective independent validation of APACHE III models in an Australian tertiary adult intensive care unit

Evaluation of the performance of the APACHE III (Acute Physiology and Chronic Health Evaluation) ICU (intensive care unit) and hospital mortality models at the Princess Alexandra Hospital, Brisbane is reported. Prospective collection of demographic, diagnostic, physiological, laboratory, admission and discharge data of 5681 consecutive eligible admissions (1 January 1995 to 1 January 2000) was conducted at the Princess Alexandra Hospital, a metropolitan Australian tertiary referral medical/surgical adult ICU. ROC (receiver operating characteristic) curve areas for the APACHE III ICU mortality and hospital mortality models demonstrated excellent discrimination. Observed ICU mortality (9.1%) was significantly overestimated by the APACHE III model adjusted for hospital characteristics (10.1%), but did not significantly differ from the prediction of the generic APACHE III model (8.6%). In contrast, observed hospital mortality (14.8%) agreed well with the prediction of the APACHE III model adjusted for hospital characteristics (14.6%), but was significantly underestimated by the unadjusted APACHE III model (13.2%). Calibration curves and goodness-of-fit analysis using Hosmer-Lemeshow statistics, demonstrated that calibration was good with the unadjusted APACHE III ICU mortality model, and the APACHE III hospital mortality model adjusted for hospital characteristics. Post hoc analysis revealed a declining annual SMR (standardized mortality rate) during the study period. This trend was present in each of the non-surgical, emergency and elective surgical diagnostic groups, and the change was temporally related to increased specialist staffing levels. This study demonstrates that the APACHE III model performs well on independent assessment in an Australian hospital. Changes observed in annual SMR using such a validated model support an hypothesis of improved survival outcomes 1995-1999.

Research utilization among pediatric health professionals

The present study investigated research use and attitudes toward research among pediatric health professionals. All nurses and allied health professionals in a pediatric teaching hospital were surveyed using previously tested and published measures. Over half of the participants had some formal education in research but, for some participants, that education was many years ago. Most participants reported poor or very poor understanding of research design. Two variables were independently associated with a positive attitude towards research: (i) better understanding of how to conduct a literature search; and (ii) higher level of education. Five variables were independently associated with research use: better understanding of research design; having presented at a conference in the past two years; sense of calling to the profession; better understanding of how to conduct a literature search; and attending rounds. A small proportion of variance in both research use and a positive attitude towards research was explained by the independent predicator variables. Further research is required to identify characteristics of the workplace environment that support research use.

The morbidity of Guillain-Barré syndrome admitted to the intensive care unit

Patients with severe forms of Guillain-Barré syndrome (GBS) require intensive care. Specific treatment, catheterization, and devices may increase morbidity in the intensive care unit (ICU). To understand the spectrum of morbidity associated with ICU care, the authors studied 114 patients with GBS. Major morbidity occurred in 60% of patients. Complications were uncommon if ICU stay was less than 3 weeks. Respiratory complications such as pneumonia and tracheobronchitis occurred in half of the patients and were linked to mechanical ventilation. Systemic infection occurred in one-fifth of patients and was more frequent with increasing duration of ICU admission. Direct complications of treatment and invasive procedures occurred infrequently. Life-threatening complications such as gastrointestinal bleeding and pulmonary embolism were very uncommon. Pulmonary morbidity predominates in patients with severe GBS admitted to the ICU. Attention to management of mechanical ventilation and weaning is important to minimize this complication of GBS. Other causes of morbidity in a tertiary center ICU are uncommon.

Initial performance of pineapple and utilization of rock phosphate applied in combination with organic compounds to leaf axils

Rock phosphates have low solubility in water, but good solubility in acid. The use of organic compounds together with these phosphorus sources applied to the basal leaf axils of pineapple can increase the solubility of this phosfate source and increase the P availability to the crop. A greenhouse experiment was conducted using Araxá rock phosphate (10 g) in combination or not with solutions containing increasing concentrations of humic acids (0 to 40 mmol L-1 of carbon), with or without citric acid (0.005 mmol L-1), applied to basal leaf axils of pineapple cv. Pérola. Growth and nutritional characteristics of aerial plant parts were assessed. Growth rates of aerial parts and N, P, K, Ca and Mg contents increased curvilinearly with increasing concentration of carbon in the form of humic acids. Maximum values were found for the concentration of 9.3 mmol L-1 of carbon combined with 0.005 mmol L-1 of citric acid and natural phosphate.

Utilization of Interactive Internet in High Education

The present work reports on the practical cooperation between two Universities from Hungary and Portugal. Students from Portugal are remotely accessing an experimental facility, which is physically in Hungary. The cooperation among these Higher Education establishments allowed the development and testing of a Remote Laboratory at the BME. This paper reports on the characteristics and initial testing of the Thermocouples Rise Time Measurement System and provides information on development and students' feedback.

Outpatient health service utilization and associated factors: a population-based study

OBJECTIVE: To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. METHODS: A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. CONCLUSIONS: Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.

Real-time energy resources scheduling considering intensive wind penetration

The use of distributed energy resources, based on natural intermittent power sources, like wind generation, in power systems imposes the development of new adequate operation management and control methodologies. A short-term Energy Resource Management (ERM) methodology performed in two phases is proposed in this paper. The first one addresses the day-ahead ERM scheduling and the second one deals with the five-minute ahead ERM scheduling. The ERM scheduling is a complex optimization problem due to the high quantity of variables and constraints. In this paper the main goal is to minimize the operation costs from the point of view of a virtual power player that manages the network and the existing resources. The optimization problem is solved by a deterministic mixedinteger non-linear programming approach. A case study considering a distribution network with 33 bus, 66 distributed generation, 32 loads with demand response contracts and 7 storage units and 1000 electric vehicles has been implemented in a simulator developed in the field of the presented work, in order to validate the proposed short-term ERM methodology considering the dynamic power system behavior.

Demsi - a demand response simulator in the context of intensive use of distributed generation

Demand response can play a very relevant role in future power systems in which distributed generation can help to assure service continuity in some fault situations. This paper deals with the demand response concept and discusses its use in the context of competitive electricity markets and intensive use of distributed generation. The paper presents DemSi, a demand response simulator that allows studying demand response actions and schemes using a realistic network simulation based on PSCAD. Demand response opportunities are used in an optimized way considering flexible contracts between consumers and suppliers. A case study evidences the advantages of using flexible contracts and optimizing the available generation when there is a lack of supply.

Epidemiology of physiotherapy utilization among adults and elderly

OBJECTIVE: To analyze the prevalence of physiotherapy utilization and to explore the variables associated to its utilization. METHODS: A population-based cross-sectional study, including 3,100 subjects aged 20 years or more living in the urban area of Pelotas, southern Brazil, was carried out. The sample was selected following a multiple-stage protocol; the census tracts delimited by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics) were the primary sample units. Following descriptive and crude analyses, Poisson regression models taking the clustering of the sample into account were carried out. Data were collected through face-to-face interviews using a standardized and pre-tested questionnaire. RESULTS: The lifetime utilization of physiotherapy was 30.2%; and physiotherapy utilization in the 12 months prior to the interview was reported by 4.9%. Women, elderly subjects, and those from higher socioeconomic levels were more likely to use physiotherapy. Restricting analysis to subjects who attended physiotherapy, 66% used public health services, 25% used insurance health services and 9% had private sessions. CONCLUSIONS: This is the first population-based study on physiotherapy utilization carried out in Brazil. Utilization of physio therapy was lower than reported in both developed and developing countries. The study findings might help public health authorities to organize healthcare service in terms of this important demand.

Neonatal mortality in intensive care units of Central Brazil

OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

Energy resource management in smart grids considering an Intensive use of electric vehicles

The introduction of electricity markets and integration of Distributed Generation (DG) have been influencing the power system’s structure change. Recently, the smart grid concept has been introduced, to guarantee a more efficient operation of the power system using the advantages of this new paradigm. Basically, a smart grid is a structure that integrates different players, considering constant communication between them to improve power system operation and management. One of the players revealing a big importance in this context is the Virtual Power Player (VPP). In the transportation sector the Electric Vehicle (EV) is arising as an alternative to conventional vehicles propel by fossil fuels. The power system can benefit from this massive introduction of EVs, taking advantage on EVs’ ability to connect to the electric network to charge, and on the future expectation of EVs ability to discharge to the network using the Vehicle-to-Grid (V2G) capacity. This thesis proposes alternative strategies to control these two EV modes with the objective of enhancing the management of the power system. Moreover, power system must ensure the trips of EVs that will be connected to the electric network. The EV user specifies a certain amount of energy that will be necessary to charge, in order to ensure the distance to travel. The introduction of EVs in the power system turns the Energy Resource Management (ERM) under a smart grid environment, into a complex problem that can take several minutes or hours to reach the optimal solution. Adequate optimization techniques are required to accommodate this kind of complexity while solving the ERM problem in a reasonable execution time. This thesis presents a tool that solves the ERM considering the intensive use of EVs in the smart grid context. The objective is to obtain the minimum cost of ERM considering: the operation cost of DG, the cost of the energy acquired to external suppliers, the EV users payments and remuneration and penalty costs. This tool is directed to VPPs that manage specific network areas, where a high penetration level of EVs is expected to be connected in these areas. The ERM is solved using two methodologies: the adaptation of a deterministic technique proposed in a previous work, and the adaptation of the Simulated Annealing (SA) technique. With the purpose of improving the SA performance for this case, three heuristics are additionally proposed, taking advantage on the particularities and specificities of an ERM with these characteristics. A set of case studies are presented in this thesis, considering a 32 bus distribution network and up to 3000 EVs. The first case study solves the scheduling without considering EVs, to be used as a reference case for comparisons with the proposed approaches. The second case study evaluates the complexity of the ERM with the integration of EVs. The third case study evaluates the performance of scheduling with different control modes for EVs. These control modes, combined with the proposed SA approach and with the developed heuristics, aim at improving the quality of the ERM, while reducing drastically its execution time. The proposed control modes are: uncoordinated charging, smart charging and V2G capability. The fourth and final case study presents the ERM approach applied to consecutive days.

Estudo económico das energias renováveis: o caso português

Dissertação de Mestrado apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Empreendedorismo e Internacionalização, sob orientação de Maria Clara Dias Pinto Ribeiro