Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

Interventions pour soutenir les infirmières dans l'appropriation de l'évaluation de la condition mentale des adultes avec trouble mental hospitalisés en soins physiques

Travail dirigé présenté en vue de l'obtention du grade de maîtrise en sciences infirmières, option expertise-conseil

Development of Safety Performance Functions for SafetyAnalyst Applications in Florida

In 2010, the American Association of State Highway and Transportation Officials (AASHTO) released a safety analysis software system known as SafetyAnalyst. SafetyAnalyst implements the empirical Bayes (EB) method, which requires the use of Safety Performance Functions (SPFs). The system is equipped with a set of national default SPFs, and the software calibrates the default SPFs to represent the agency’s safety performance. However, it is recommended that agencies generate agency-specific SPFs whenever possible. Many investigators support the view that the agency-specific SPFs represent the agency data better than the national default SPFs calibrated to agency data. Furthermore, it is believed that the crash trends in Florida are different from the states whose data were used to develop the national default SPFs. In this dissertation, Florida-specific SPFs were developed using the 2008 Roadway Characteristics Inventory (RCI) data and crash and traffic data from 2007-2010 for both total and fatal and injury (FI) crashes. The data were randomly divided into two sets, one for calibration (70% of the data) and another for validation (30% of the data). The negative binomial (NB) model was used to develop the Florida-specific SPFs for each of the subtypes of roadway segments, intersections and ramps, using the calibration data. Statistical goodness-of-fit tests were performed on the calibrated models, which were then validated using the validation data set. The results were compared in order to assess the transferability of the Florida-specific SPF models. The default SafetyAnalyst SPFs were calibrated to Florida data by adjusting the national default SPFs with local calibration factors. The performance of the Florida-specific SPFs and SafetyAnalyst default SPFs calibrated to Florida data were then compared using a number of methods, including visual plots and statistical goodness-of-fit tests. The plots of SPFs against the observed crash data were used to compare the prediction performance of the two models. Three goodness-of-fit tests, represented by the mean absolute deviance (MAD), the mean square prediction error (MSPE), and Freeman-Tukey R2 (R2FT), were also used for comparison in order to identify the better-fitting model. The results showed that Florida-specific SPFs yielded better prediction performance than the national default SPFs calibrated to Florida data. The performance of Florida-specific SPFs was further compared with that of the full SPFs, which include both traffic and geometric variables, in two major applications of SPFs, i.e., crash prediction and identification of high crash locations. The results showed that both SPF models yielded very similar performance in both applications. These empirical results support the use of the flow-only SPF models adopted in SafetyAnalyst, which require much less effort to develop compared to full SPFs.

Interventions pour soutenir les infirmières dans l'appropriation de l'évaluation de la condition mentale des adultes avec trouble mental hospitalisés en soins physiques

Travail dirigé présenté en vue de l'obtention du grade de maîtrise en sciences infirmières, option expertise-conseil

El ejercicio y el desempeño musical: doce semanas de actividad física mejoran la capacidad de ejecución de un instrumento musical en estudiantes de conservatorio

Con el fin de evaluar los cambios que produce un programa de actividad física en la percepción que tienen los músicos sobre su capacidad de ejecución de un instrumento musical, se realizó una intervención con un programa de actividad física basado en la técnica Pilates, durante 12 semanas, en el Conservatorio de Música de la Universidad Nacional de Colombia, con estudiantes del programa de música instrumental. Se midieron parámetros de la aptitud física (capacidad cardiorrespiratoria, fuerza, flexibilidad y composición corporal) y de la percepción de la capacidad de ejecución (fatiga muscular, nivel de esfuerzo, dolor y fluidez) antes y después de la intervención. Los resultados arrojaron cambios positivos en la aptitud física logrando un aumento significativo en la flexibilidad y resistencia de los miembros inferiores en 14 participantes (70% de la muestra), y en la percepción de la capacidad de ejecución instrumental con el retraso en la aparición de la fatiga muscular mientras se está ejecutando el instrumento (30 minutos en promedio). Esto permite a los músicos abordar un repertorio extenso con menor fatiga, minimizando el riesgo de lesión o alteraciones musculo-esqueléticas que influyan directamente en su desempeño técnico y artístico.

Uso de dexmedetomidina como tratamiento coadyuvante de síndrome de abstinencia alcohólica: revisión sistemática

El objetivo de este estudio es establecer si la dexmedetomidina (DEX) es segura y efectiva para el manejo coadyuvante de síndrome de abstinencia a alcohol (SAA) a través de la búsqueda de evidencia científica. Metodología: se realiza una revisión sistemática de literatura publicada y no publicada desde enero de 1989 hasta febrero 2016 en PubMed, Embase, Scopus, Bireme, Cochrane library y en otras bases de datos y portales. Los criterios de inclusión fueron ensayos clínicos aleatorizados y no aleatorizados, estudios cuasi-experimentales, estudios de cohorte, y estudios de casos y controles; que incluyeron pacientes mayores de 18 años hospitalizados con diagnóstico de SAA y donde se usó DEX como terapia coadyuvante. Resultados: 7 estudios, 477 pacientes, se incluyeron en el análisis final. Se encontraron dos ensayos clínicos aleatorizados, tres estudios de casos y controles y dos estudios de cohorte retrospectivo. Solo uno de los estudios fue doble ciego y utilizó placebo como comparador. Análisis y conclusiones: en los estudios experimentales se determinan que el uso de DEX como terapia coadyuvante en el manejo de SAA tiene significancia clínica y estadística para disminuir dosis de BZD en las primeras 24 horas de tratamiento; pero no demostraron tener otros beneficios clínicos. En los estudios no aleatorizados existe consenso que relaciona el uso de DEX con menores dosis de BZD de forma temprana. Recomendaciones: no se recomienda el uso de DEX en SAA de forma rutinaria. Se recomienda usar DEX solo en casos en el que exista evidencia fallo terapéutico a BZD.

Diseño y aplicación de un modelo de remuneración variable para una empresa del sector de las telecomunicaciones

Actualmente encontramos una fuerte presión en las organizaciones por adaptarse a un mundo competitivo con un descenso en las utilidades y una incertidumbre constante en su flujo de caja. Estas circunstancias obligan a las organizaciones al mejoramiento continuo buscando nuevas formas de gestionar sus procesos y sus recursos. Para las organizaciones de prestación de servicios en el sector de telecomunicaciones una de las ventajas competitivas más importantes de obtener es la productividad debido a que sus ganancias dependen directamente del número de actividades que puedan ejecutar cada empleado. El reto es hacer más con menos y con mejor calidad. Para lograrlo, la necesidad de gestionar efectivamente los recursos humanos aparece, y aquí es donde los sistemas de compensación toman un rol importante. El objetivo en este trabajo es diseñar y aplicar un modelo de remuneración variable para una empresa de prestación de servicios profesionales en el sector de las telecomunicaciones y con esto aportar al estudio de la gestión del desempeño y del talento humano en Colombia. Su realización permitió la documentación del diseño y aplicación del modelo de remuneración variable en un proyecto del sector de telecomunicaciones en Colombia. Su diseño utilizó las tendencias de programas remunerativos y teorías de gestión de desempeño para lograr un modelo integral que permita el crecimiento sostenido en el largo plazo y la motivación al recurso más importante de la organización que es el talento humano. Su aplicación permitió también la documentación de problemas y aciertos en la implementación de estos modelos.

Relación entre los riesgos percibidos por los trabajadores en minería subterránea y los accidentes de trabajo y enfermedades laborales

Introducción: La minería es considerada uno de los sectores económicos más importantes por su capacidad para generar recursos en su propio sector y en otros sectores como metalmecánica, agricultura e informática entre otros, y por su contribución al desarrollo socioeconómico sostenible de las poblaciones. Objetivo: Determinar la relación entre los riesgos percibidos por los trabajadores que laboran en minería subterránea en 3 departamentos de Colombia y los Accidentes de Trabajo (AT) y Enfermedades Laborales (EL). Materiales y Métodos: Estudio de corte transversal en 476 trabajadores de minería subterránea. Se incluyeron variables independientes (características sociodemográficas y laborales y percepción del riesgo) y variables dependientes (enfermedad laboral y accidente de trabajo), obtenidas a través de una entrevista directa aplicada por profesionales de la salud previamente capacitados. Para el análisis estadístico se utilizó la Prueba Exacta de Fisher, el Odds Ratio (OR) con el Intervalo de Confianza (IC) del 95%. Resultados: En los trabajadores de minería subterránea en los departamentos de Boyacá, Cundinamarca y Santander, se encontró relación estadística significativa entre la accidentalidad con la percepción de riesgo por iluminación (OR= 2.059, IC= 95%: 1.116, 3.798, p=0.013), percepción de riesgo por movimientos repetitivos (OR= 1.951, IC= 95%: 0.998, 3.815, p=0.034), percepción de riesgo por ruido (OR= 2.275, IC= 95%: 0.974, 5.312, p=0.039) y percepción de riesgo por manejo de cargas (OR= 1.778, IC= 95%: 0.969, 3.264, p=0.041). Conclusión: se encontró que existe una relación significativa entre la percepción de riesgo de los trabajadores de minería subterránea con accidentes de trabajo y que no existe relación entre esta percepción y las enfermedades laborales.

Quality of life in people with leg ulcer, integrative review

Objective: To identify the main changes in the daily life of people with leg ulcer and how that affects the person’s life’s quality. Methodology: We used the methodology PI [C] OD and were selected four research articles, taken from EBSCO, PubMed, and EWMA. Results: The main changes identified in the people’s daily live with leg’s ulcers are physical (pain, decreased mobility, presence of exudate, bad smell from the wound and change in the style of clothing), psychological (sleep disorders, depression, anxiety, feelings of rejection and low self-esteem), social (isolation, restriction in leisure activities, inability to perform household chores). Conclusions: The literature about person’s life’s quality with leg ulcer reported a significant impact in the daily life of that person. The care provided by nurses should be centred on the person itself, integrating all the kind of needs and the leg ulcer mustn’t be the sole focus of care.

Tratamento de sementes para manejo do percevejo-barriga-verde na cultura de soja e milho em sucessão.

RESUMO: O objetivo deste trabalho foi avaliar o efeito do tratamento de sementes com inseticidas sobre o manejo de Dichelops melacanthus e a produtividade da soja e do milho, cultivados em sucessão. O estudo foi realizado em campo, nas safras 2012/2013 (I) e 2013/2014 (II). Avaliaram-se os inseticidas imidacloprido, tiametoxam, tiodicarbe, fipronil e abamectina. Determinaram-se: a densidade populacional do percevejo, a produtividade de soja e milho, e a intensidade da injúria em milho. A densidade do percevejo permaneceu abaixo de um inseto por metro quadrado, na maior parte do ciclo da soja. Os picos populacionais foram observados nas primeiras semanas, após a emergência do milho, e atingiram 2,2 (safra I) e 6,7 (safra II) percevejos por metro quadrado. Na cultura da soja, os inseticidas não reduziram a densidade populacional do percevejo. Na cultura do milho, o imidacloprido reduziu a densidade do percevejo em 23,2% (safra I) e 38,8% (safra II), e a injúria em 61,8% (safra I) e 26,4% (safra II). O tiametoxam reduziu a densidade dos insetos em 27,8% (safra II) e a injúria em 42,7% (safra I). O tratamento de sementes com inseticidas não proporciona aumento de produtividade à soja e ao milho, portanto, não se justifica sua utilização nas condições deste estudo. ABSTRACT: The objective of this work was to evaluate the effect of seed treatment with insecticides on the management of Dichelops melacanthus on the yield of soybean and corn, grown in succession. The study was carried out in a field, in the 2012/2013 (I) and 2013/2014 (II) crop seasons. The evaluated insecticides were: imidacloprid, thiamethoxam, thiodicarb, fipronil, and abamectin. The following were determined: stink bug population density, soybean and corn yield, and corn injury. Population density remained below one stink bug per square meter, in most of the soybean cycle. Population peaks were observed in the first weeks, after corn emergence, and they reached 2.2 (crop season I) and 6.7 (crop season II) stink bugs per square meter. In the soybean crop, the insecticides did not reduce the stink bug population density. In the corn crop, imidacloprid reduced the stink bug density in 23.2% (crop season I) and 38.8% (crop season II), and injury in 61.8% (crop season I) and 26.4% (crop season II). Thiamethoxam reduced the insect population density in 27.8% (crop season II) and injury in 42.7% (crop season I). Seed treatment with insecticides does not provide increase for soybean and corn yields, therefore, their use is not justified in this study's conditions.

Recognition of human activities through eSteps insoles

Recognition of everyday human activity through mobile personal sensing technology plays a central role in the field of pervasive healthcare. The Bologna-based American company eSteps Inc. addresses the growing motor disability of the lower limbs by offering pre-, during and post-hospitalisation monitoring solutions with biomechanics and telerehabilitation protocol. It has developed a smart, customised and sustainable device to monitor motor activity, fatigue and injury risk for patients and a special app to share data with caregivers and medical specialists. The objective of this study is the development of an Artificial Intelligence model to recognize the activity performed by a person with Multiple Sclerosis or a healthy person through eSteps devices.

3D documentation and visualization of external injury findings by integration of simple photography in CT/MRI data sets (IprojeCT).

This study evaluated the feasibility of documenting patterned injury using three dimensions and true colour photography without complex 3D surface documentation methods. This method is based on a generated 3D surface model using radiologic slice images (CT) while the colour information is derived from photographs taken with commercially available cameras. The external patterned injuries were documented in 16 cases using digital photography as well as highly precise photogrammetry-supported 3D structured light scanning. The internal findings of these deceased were recorded using CT and MRI. For registration of the internal with the external data, two different types of radiographic markers were used and compared. The 3D surface model generated from CT slice images was linked with the photographs, and thereby digital true-colour 3D models of the patterned injuries could be created (Image projection onto CT/IprojeCT). In addition, these external models were merged with the models of the somatic interior. We demonstrated that 3D documentation and visualization of external injury findings by integration of digital photography in CT/MRI data sets is suitable for the 3D documentation of individual patterned injuries to a body. Nevertheless, this documentation method is not a substitution for photogrammetry and surface scanning, especially when the entire bodily surface is to be recorded in three dimensions including all external findings, and when precise data is required for comparing highly detailed injury features with the injury-inflicting tool.

Involvement of PPAR nuclear receptors in tissue injury and wound repair.

Tissue damage resulting from chemical, mechanical, and biological injury, or from interrupted blood flow and reperfusion, is often life threatening. The subsequent tissue response involves an intricate series of events including inflammation, oxidative stress, immune cell recruitment, and cell survival, proliferation, migration, and differentiation. In addition, fibrotic repair characterized by myofibroblast transdifferentiation and the deposition of ECM proteins is activated. Failure to initiate, maintain, or stop this repair program has dramatic consequences, such as cell death and associated tissue necrosis or carcinogenesis. In this sense, inflammation and oxidative stress, which are beneficial defense processes, can become harmful if they do not resolve in time. This repair program is largely based on rapid and specific changes in gene expression controlled by transcription factors that sense injury. PPARs are such factors and are activated by lipid mediators produced after wounding. Here we highlight advances in our understanding of PPAR action during tissue repair and discuss the potential for these nuclear receptors as therapeutic targets for tissue injury.

Plasmacytoid dendritic cells sense skin injury and promote wound healing through type I interferons.

Plasmacytoid dendritic cells (pDCs) are specialized type I interferon (IFN-α/β)-producing cells that express intracellular toll-like receptor (TLR) 7 and TLR9 and recognize viral nucleic acids in the context of infections. We show that pDCs also have the ability to sense host-derived nucleic acids released in common skin wounds. pDCs were found to rapidly infiltrate both murine and human skin wounds and to transiently produce type I IFNs via TLR7- and TLR9-dependent recognition of nucleic acids. This process was critical for the induction of early inflammatory responses and reepithelization of injured skin. Cathelicidin peptides, which facilitate immune recognition of released nucleic acids by promoting their access to intracellular TLR compartments, were rapidly induced in skin wounds and were sufficient but not necessary to stimulate pDC activation and type I IFN production. These data uncover a new role of pDCs in sensing tissue damage and promoting wound repair at skin surfaces.

Designing care bundle documentation to support the recognition and treatment of acute kidney injury: a route to quality improvement

The chapter describes development of care bundle documentation, through an iterative, user-centred design process, to support the recognition and treatment of acute kidney injury (AKI). The chapter details stages of user and stakeholder consultation, employed to develop a design response that was sensitive to user experience and need, culminating in simulation testing of a near final prototype. The development of supplementary awareness-raising materials, relating to the main care bundle tool is also discussed. This information design response to a complex clinical decision-making process is contrasted to other approaches to promoting AKI care. The need for different but related approaches to the working tool itself and the tool’s communication are discussed. More general recommendations are made for the development of communication tools to support complex clinical processes.