Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Vernaculares: a casa de fazenda seridoense do século XIX como exemplo de adaptação ao clima semiárido

The farm’s rural dwellings of creation from the Seridó Potiguar microregion, built in the nineteenth century, became a reference by its vernacular character, i.e. these buildings, besides having recognized relevance to the identity of the region, they are adapted to the conditions of the place in many aspects (economic, cultural, construction, physical, et.) and consist in protective spaces in relation to hostile characteristics of Seridó’s climate. Considering the above premise, the following question arises: What characteristics of the nineteenth century Seridó Potiguar’s cattle farms are crucial for them to be a protective space in relation to the semiarid climate? In order to answer the question, this research aim to identify which particularities of the Seridó’s farmhouses that contribute to adaptability in these buildings to semiarid climate, as protection environments; and contribute to the stock valuation of the architectural heritage concerned. Therefore, procedures were adopted divided into two stages. Were first identified the recurring characteristics in the studied buildings, through typological study performed from existing inventories (DINIZ, 2008; FEIJÓ, 2002; IPHAN, 2012). To define the type it worked up with the concept that merges Durand’s analytical typology that identifies the similarities and differences to classify buildings, having the character of historical survey and architectural documentation, with the definition proposed by Argan (1963) that the type is not defined a priory, but the deduction from a number of illustrative cases which have formal and functional similarity with each other. Then worked up in a sample of five different types with each other, defined by the possibility of access to the interior of the houses, proximity to other copies, good state of conservation and preservation. The contemplated farms were: Pitombeiras, Agenus e Garrotes in Acari’s town, and the municipality of Caicó, Palma and Penedo. The second stage consists of the architectural survey, photographic record, digital three-dimensional modeling (aiming to expand the existing documentation and registration) and thermal monitoring over approximately a representative day in five farmhouses, relating the thermal performance of the houses with their individual characteristics. The selected variables for analysis monitoring are based on the thermal comfort adaptive model (SPAGNOLO and DE DEAR, 2003 apud NEGREIROS, 2010). The characteristics of the houses were analyzed as meeting the passive thermal conditioning strategies recommended by NBR 15220 (ABNT, 2005), for the bioclimatic zone 7 where the municipalities of Caicó and Acari are located. The house’s analysis of the operating temperatures revealed that 90% of the times of day the environments are within the comfort range. The farmhouses, which had a higher degree of compliance with recommended bioclimatic strategies, had the best thermal performance. In environments (usually the kitchen and rooms with low ceiling heights, exposed to west radiation) which still had discomfort hours, the thermal comfort can be reached with air movement approximately 1,0 m/s.

Vernaculares: a casa de fazenda seridoense do século XIX como exemplo de adaptação ao clima semiárido

The farm’s rural dwellings of creation from the Seridó Potiguar microregion, built in the nineteenth century, became a reference by its vernacular character, i.e. these buildings, besides having recognized relevance to the identity of the region, they are adapted to the conditions of the place in many aspects (economic, cultural, construction, physical, et.) and consist in protective spaces in relation to hostile characteristics of Seridó’s climate. Considering the above premise, the following question arises: What characteristics of the nineteenth century Seridó Potiguar’s cattle farms are crucial for them to be a protective space in relation to the semiarid climate? In order to answer the question, this research aim to identify which particularities of the Seridó’s farmhouses that contribute to adaptability in these buildings to semiarid climate, as protection environments; and contribute to the stock valuation of the architectural heritage concerned. Therefore, procedures were adopted divided into two stages. Were first identified the recurring characteristics in the studied buildings, through typological study performed from existing inventories (DINIZ, 2008; FEIJÓ, 2002; IPHAN, 2012). To define the type it worked up with the concept that merges Durand’s analytical typology that identifies the similarities and differences to classify buildings, having the character of historical survey and architectural documentation, with the definition proposed by Argan (1963) that the type is not defined a priory, but the deduction from a number of illustrative cases which have formal and functional similarity with each other. Then worked up in a sample of five different types with each other, defined by the possibility of access to the interior of the houses, proximity to other copies, good state of conservation and preservation. The contemplated farms were: Pitombeiras, Agenus e Garrotes in Acari’s town, and the municipality of Caicó, Palma and Penedo. The second stage consists of the architectural survey, photographic record, digital three-dimensional modeling (aiming to expand the existing documentation and registration) and thermal monitoring over approximately a representative day in five farmhouses, relating the thermal performance of the houses with their individual characteristics. The selected variables for analysis monitoring are based on the thermal comfort adaptive model (SPAGNOLO and DE DEAR, 2003 apud NEGREIROS, 2010). The characteristics of the houses were analyzed as meeting the passive thermal conditioning strategies recommended by NBR 15220 (ABNT, 2005), for the bioclimatic zone 7 where the municipalities of Caicó and Acari are located. The house’s analysis of the operating temperatures revealed that 90% of the times of day the environments are within the comfort range. The farmhouses, which had a higher degree of compliance with recommended bioclimatic strategies, had the best thermal performance. In environments (usually the kitchen and rooms with low ceiling heights, exposed to west radiation) which still had discomfort hours, the thermal comfort can be reached with air movement approximately 1,0 m/s.

A mathematical model for the maneuvering simulation of a propelled SPAR vessel

To predict the maneuvering performance of a propelled SPAR vessel, a mathematical model was established as a path simulator. A system-based mathematical model was chosen as it offers advantages in cost and time over full Computational Fluid Dynamics (CFD) simulations. The model is intended to provide a means of optimizing the maneuvering performance of this new vessel type. In this study the hydrodynamic forces and control forces are investigated as individual components, combined in a vectorial setting, and transferred to a body-fixed basis. SPAR vessels are known to be very sensitive to large amplitude motions during maneuvers due to the relatively small hydrostatic restoring forces. Previous model tests of SPAR vessels have shown significant roll and pitch amplitudes, especially during course change maneuvers. Thus, a full 6 DOF equation of motion was employed in the current numerical model. The mathematical model employed in this study was a combination of the model introduced by the Maneuvering Modeling Group (MMG) and the Abkowitz (1964) model. The new model represents the forces applied to the ship hull, the propeller forces and the rudder forces independently, as proposed by the MMG, but uses a 6DOF equation of motion introduced by Abkowitz to describe the motion of a maneuvering ship. The mathematical model was used to simulate the trajectory and motions of the propelled SPAR vessel in 10˚/10˚, 20˚/20˚ and 30˚/30˚ standard zig-zag maneuvers, as well as turning circle tests at rudder angles of 20˚ and 30˚. The simulation results were used to determine the maneuverability parameters (e.g. advance, transfer and tactical diameter) of the vessel. The final model provides the means of predicting and assessing the performance of the vessel type and can be easily adapted to specific vessel configurations based on the generic SPAR-type vessel used in this study.

Academic Experience and Personal Abilities in Analytical Chemistry Education

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2016

Dynamical generation of a gauge symmetry in the double-exchange model

It is shown that a bosonic formulation of the double-exchange model, one of the classical models for magnetism, generates dynamically a gauge-invariant phase in a finite region of the phase diagram. We use analytical methods, Monte Carlo simulations and finite-size scaling analysis. We study the transition line between that region and the paramagnetic phase. The numerical results show that this transition line belongs to the universality class of the antiferromagnetic RP^(2) model. The fact that one can define a universality class for the antiferromagnetic RP^(2) model, different from the one of the O(N) models, is puzzling and somehow contradicts naive expectations about universality.

The difference model with guessing explains interval bias in two-alternative forced- chocice detection procedures

The standard difference model of two-alternative forced-choice (2AFC) tasks implies that performance should be the same when the target is presented in the first or the second interval. Empirical data often show “interval bias” in that percentage correct differs significantly when the signal is presented in the first or the second interval. We present an extension of the standard difference model that accounts for interval bias by incorporating an indifference zone around the null value of the decision variable. Analytical predictions are derived which reveal how interval bias may occur when data generated by the guessing model are analyzed as prescribed by the standard difference model. Parameter estimation methods and goodness-of-fit testing approaches for the guessing model are also developed and presented. A simulation study is included whose results show that the parameters of the guessing model can be estimated accurately. Finally, the guessing model is tested empirically in a 2AFC detection procedure in which guesses were explicitly recorded. The results support the guessing model and indicate that interval bias is not observed when guesses are separated out.

Perturbative discrete-time multivariate fiber channel model with finite memory

We introduce a discrete-time fibre channel model that provides an accurate analytical description of signal-signal and signal-noise interference with memory defined by the interplay of nonlinearity and dispersion. Also the conditional pdf of signal distortion, which captures non-circular complex multivariate symbol interactions, is derived providing the necessary platform for the analysis of channel statistics and capacity estimations in fibre optic links.

Molecular basis of canalization in an ascidian species complex adapted to different thermal conditions

Canalization is a result of intrinsic developmental buffering that ensures phenotypic robustness under genetic variation and environmental perturbation. As a consequence, animal phenotypes are remarkably consistent within a species under a wide range of conditions, a property that seems contradictory to evolutionary change. Study of laboratory model species has uncovered several possible canalization mechanisms, however, we still do not understand how the level of buffering is controlled in natural populations. We exploit wild populations of the marine chordate Ciona intestinalis to show that levels of buffering are maternally inherited. Comparative transcriptomics show expression levels of genes encoding canonical chaperones such as Hsp70 and Hsp90 do not correlate with buffering. However the expression of genes encoding endoplasmic reticulum (ER) chaperones does correlate. We also show that ER chaperone genes are widely conserved amongst animals. Contrary to previous beliefs that expression level of Heat Shock Proteins (HSPs) can be used as a measurement of buffering levels, we propose that ER associated chaperones comprise a cellular basis for canalization. ER chaperones have been neglected by the fields of development, evolution and ecology, but their study will enhance understanding of both our evolutionary past and the impact of global environmental change.

Molecular basis of canalization in an ascidian species complex adapted to different thermal conditions

Canalization is a result of intrinsic developmental buffering that ensures phenotypic robustness under genetic variation and environmental perturbation. As a consequence, animal phenotypes are remarkably consistent within a species under a wide range of conditions, a property that seems contradictory to evolutionary change. Study of laboratory model species has uncovered several possible canalization mechanisms, however, we still do not understand how the level of buffering is controlled in natural populations. We exploit wild populations of the marine chordate Ciona intestinalis to show that levels of buffering are maternally inherited. Comparative transcriptomics show expression levels of genes encoding canonical chaperones such as Hsp70 and Hsp90 do not correlate with buffering. However the expression of genes encoding endoplasmic reticulum (ER) chaperones does correlate. We also show that ER chaperone genes are widely conserved amongst animals. Contrary to previous beliefs that expression level of Heat Shock Proteins (HSPs) can be used as a measurement of buffering levels, we propose that ER associated chaperones comprise a cellular basis for canalization. ER chaperones have been neglected by the fields of development, evolution and ecology, but their study will enhance understanding of both our evolutionary past and the impact of global environmental change.

Origin authentication of distillers' dried grains and solubles (DDGS) - Application and comparison of different analytical strategies

In the context of products from certain regions or countries being banned because of an identified or non-identified hazard, proof of geographical origin is essential with regard to feed and food safety issues. Usually, the product labeling of an affected feed lot shows origin, and the paper documentation shows traceability. Incorrect product labeling is common in embargo situations, however, and alternative analytical strategies for controlling feed authenticity are therefore needed. In this study, distillers' dried grains and solubles (DDGS) were chosen as the product on which to base a comparison of analytical strategies aimed at identifying the most appropriate one. Various analytical techniques were investigated for their ability to authenticate DDGS, including spectroscopic and spectrometric techniques combined with multivariate data analysis, as well as proven techniques for authenticating food, such as DNA analysis and stable isotope ratio analysis. An external validation procedure (called the system challenge) was used to analyze sample sets blind and to compare analytical techniques. All the techniques were adapted so as to be applicable to the DDGS matrix. They produced positive results in determining the botanical origin of DDGS (corn vs. wheat), and several of them were able to determine the geographical origin of the DDGS in the sample set. The maintenance and extension of the databanks generated in this study through the analysis of new authentic samples from a single location are essential in order to monitor developments and processing that could affect authentication.

Franz Liszt’s Piano Sonata in B Minor: Precedents for an Analytical Evolution

Franz Liszt has all too often been discarded as the virtuosic showman, despite the fact that his several of works have often gained great praise and attracted scholarly engagement. However, one also finds striking development of formal design and tonal harmony in many of the works for his principal composition medium, the piano. This paper seeks to explore the practical application of James A. Hepokoski and Warren Darcy’s 'Sonata Theory' upon Liszt’s magnum opus for the instrument, the Sonata in B Minor.

I shall first consider the historical analyses placed upon the work that deal with structural design, as it pertains to the paradigm of Classical sonata-form. Previous research reveals two main theoretical camps; those in favour of a multi-movement analysis (with conflicting hypotheses therein) and those in favour of a single movement sonata-form. An understanding of these historical conceptions of the piece allows one to then highlight areas of conflict and offer a new solution.

Finally, I shall use Sonata Theory to survey the Sonata in B Minor’s landscape in a new light. The title ‘Sonata’ has clear generic implications, many of which are met by Liszt; 'Sonata Theory' provides a model with which to outline the compositional deformations employed by the composer and the implications of this practice. In particular, I offer new perspectives on the validity of the double-function form, insight into the rhetorical layout of a rotational discourse, and propose a nuanced analysis befitting of this striking work.

Parametric CAD model based shape optimization using adjoint functions

Adjoint methods have proven to be an efficient way of calculating the gradient of an objective function with respect to a shape parameter for optimisation, with a computational cost nearly independent of the number of the design variables [1]. The approach in this paper links the adjoint surface sensitivities (gradient of objective function with respect to the surface movement) with the parametric design velocities (movement of the surface due to a CAD parameter perturbation) in order to compute the gradient of the objective function with respect to CAD variables.
For a successful implementation of shape optimization strategies in practical industrial cases, the choice of design variables or parameterisation scheme used for the model to be optimized plays a vital role. Where the goal is to base the optimization on a CAD model the choices are to use a NURBS geometry generated from CAD modelling software, where the position of the NURBS control points are the optimisation variables [2] or to use the feature based CAD model with all of the construction history to preserve the design intent [3]. The main advantage of using the feature based model is that the optimized model produced can be directly used for the downstream applications including manufacturing and process planning.
This paper presents an approach for optimization based on the feature based CAD model, which uses CAD parameters defining the features in the model geometry as the design variables. In order to capture the CAD surface movement with respect to the change in design variable, the “Parametric Design Velocity” is calculated, which is defined as the movement of the CAD model boundary in the normal direction due to a change in the parameter value.
The approach presented here for calculating the design velocities represents an advancement in terms of capability and robustness of that described by Robinson et al. [3]. The process can be easily integrated to most industrial optimisation workflows and is immune to the topology and labelling issues highlighted by other CAD based optimisation processes. It considers every continuous (“real value”) parameter type as an optimisation variable, and it can be adapted to work with any CAD modelling software, as long as it has an API which provides access to the values of the parameters which control the model shape and allows the model geometry to be exported. To calculate the movement of the boundary the methodology employs finite differences on the shape of the 3D CAD models before and after the parameter perturbation. The implementation procedure includes calculating the geometrical movement along a normal direction between two discrete representations of the original and perturbed geometry respectively. Parametric design velocities can then be directly linked with adjoint surface sensitivities to extract the gradients to use in a gradient-based optimization algorithm.
The optimisation of a flow optimisation problem is presented, in which the power dissipation of the flow in an automotive air duct is to be reduced by changing the parameters of the CAD geometry created in CATIA V5. The flow sensitivities are computed with the continuous adjoint method for a laminar and turbulent flow [4] and are combined with the parametric design velocities to compute the cost function gradients. A line-search algorithm is then used to update the design variables and proceed further with optimisation process.

A generalized fuzzy linguistic model for predicting component concentrations in an optical gas sensing system

Motivated by environmental protection concerns, monitoring the flue gas of thermal power plant is now often mandatory due to the need to ensure that emission levels stay within safe limits. Optical based gas sensing systems are increasingly employed for this purpose, with regression techniques used to relate gas optical absorption spectra to the concentrations of specific gas components of interest (NO_x, SO₂ etc.). Accurately predicting gas concentrations from absorption spectra remains a challenging problem due to the presence of nonlinearities in the relationships and the high-dimensional and correlated nature of the spectral data. This article proposes a generalized fuzzy linguistic model (GFLM) to address this challenge. The GFLM is made up of a series of “If-Then” fuzzy rules. The absorption spectra are input variables in the rule antecedent. The rule consequent is a general nonlinear polynomial function of the absorption spectra. Model parameters are estimated using least squares and gradient descent optimization algorithms. The performance of GFLM is compared with other traditional prediction models, such as partial least squares, support vector machines, multilayer perceptron neural networks and radial basis function networks, for two real flue gas spectral datasets: one from a coal-fired power plant and one from a gas-fired power plant. The experimental results show that the generalized fuzzy linguistic model has good predictive ability, and is competitive with alternative approaches, while having the added advantage of providing an interpretable model.