826 resultados para Beers criteria


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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Tecnoloigia, 2016.

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Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL. Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL. Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/sludge. The performance of ASGE high- and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI, 0.17-0.55). Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

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This paper questions the current concept of quality as used in research assessment rankings and peer review, with special reference to the link often established between impact and the way this impact is measured in the form of citation counting. Taking translation studies as a case study, we will offer a two-level approach to reveal both the macro- and micro-level biases that exist in this regard. We will first review three key aspects related to the idea of the quality of publications, namely peer review, journal indexing, and journal impact factor. We will then pinpoint some of the main macro-level problems regarding current practices and criteria as applied to translation studies, such as Thomson Reuters World of Science's journal coverage, citation patterns, and publication format. Next we will provide a micro-textual and practical perspective, focusing on citation counts and suggesting a series of corrective measures to increase comparability.

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Hazardous materials are substances that, if not regulated, can pose a threat to human populations and their environmental health, safety or property when transported in commerce. About 1.5 million tons of hazardous material shipments are transported by truck in the US annually, with a steady increase of approximately 5% per year. The objective of this study was to develop a routing tool for hazardous material transport in order to facilitate reduced environmental impacts and less transportation difficulties, yet would also find paths that were still compelling for the shipping carriers as a matter of trucking cost. The study started with identification of inhalation hazard impact zones and explosion protective areas around the location of hypothetical hazardous material releases, considering different parameters (i.e., chemicals characteristics, release quantities, atmospheric condition, etc.). Results showed that depending on the quantity of release, chemical, and atmospheric stability (a function of wind speed, meteorology, sky cover, time and location of accidents, etc.) the consequence of these incidents can differ. The study was extended by selection of other evaluation criteria for further investigation because health risk as an evaluation criterion would not be the only concern in selection of routes. Transportation difficulties (i.e., road blockage and congestion) were incorporated as important factor due to their indirect impact/cost on the users of transportation networks. Trucking costs were also considered as one of the primary criteria in selection of hazardous material paths; otherwise the suggested routes would have not been convincing for the shipping companies. The last but not least criterion was proximity of public places to the routes. The approach evolved from a simple framework to a complicated and efficient GIS-based tool able to investigate transportation networks of any given study area, and capable of generating best routing options for cargos. The suggested tool uses a multi-criteria-decision-making method, which considers the priorities of the decision makers in choosing the cargo routes. Comparison of the routing options based on each criterion and also the overall suitableness of the path in regards to all the criteria (using a multi-criteria-decision-making method) showed that using similar tools as the one proposed by this study can provide decision makers insights in the area of hazardous material transport. This tool shows the probable consequences of considering each path in a very easily understandable way; in the formats of maps and tables, which makes the tradeoffs of costs and risks considerably simpler, as in some cases slightly compromising on trucking cost may drastically decrease the probable health risk and/or traffic difficulties. This will not only be rewarding to the community by making cities safer places to live, but also can be beneficial to shipping companies by allowing them to advertise as environmental friendly conveyors.

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Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.

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According to the Water Framework Directive (WFD) transitional waters should be differentiated according to type and, in some cases, divided into different water bodies. This raises a dilemma in trying to define parts of a continuum. In the sequence of WFD several indices have been proposed including the Estuarine Fish Assessment Index, which can be applied taking an estuary as a whole (EFAI - without water bodies division) or divided in water bodies (EFAI(WB)). The purpose of this work is to analyze the robustness of the Estuarine Fish Assessment Index, based on three different ways of dividing Portuguese estuaries into water bodies according to different criteria (criterion 1 - distance to the estuary mouth, criterion 2 - salinity and criterion 3 - morphology, salinity and human dimension as pressure and state). In this study we evaluated at which degree these three criteria could influence the ecological quality ratio (EQR) results, when the index was applied to water body level (EFAI(WB)). Also, for each estuary, the EQR(WB) results for each criterion of EFAI(WB) were combined and weighted according to the water bodies areas (EFAI overall weighted - EFAI(Ow)). Finally, it was compared if the results obtained for each criterion with the EFAI(OW) were similar to the results of the index application taking the estuary as a whole (EFAI without water bodies division). No significant differences were found in both cases, which indicated that this index is a robust method regarding the division of the estuaries in different water bodies, which is an important element of a fish-based multimetric tool for assessing estuarine ecological quality. However, in some cases, different ecological quality statuses were achieved when applying the EFAI(Ow) or the EFAI. This work addressed several aspects regarding the possible division of water bodies at the WFD context. (C) 2012 Elsevier Ltd. All rights reserved.

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The increasing integration of renewable energies in the electricity grid contributes considerably to achieve the European Union goals on energy and Greenhouse Gases (GHG) emissions reduction. However, it also brings problems to grid management. Large scale energy storage can provide the means for a better integration of the renewable energy sources, for balancing supply and demand, to increase energy security, to enhance a better management of the grid and also to converge towards a low carbon economy. Geological formations have the potential to store large volumes of fluids with minimal impact to environment and society. One of the ways to ensure a large scale energy storage is to use the storage capacity in geological reservoir. In fact, there are several viable technologies for underground energy storage, as well as several types of underground reservoirs that can be considered. The geological energy storage technologies considered in this research were: Underground Gas Storage (UGS), Hydrogen Storage (HS), Compressed Air Energy Storage (CAES), Underground Pumped Hydro Storage (UPHS) and Thermal Energy Storage (TES). For these different types of underground energy storage technologies there are several types of geological reservoirs that can be suitable, namely: depleted hydrocarbon reservoirs, aquifers, salt formations and caverns, engineered rock caverns and abandoned mines. Specific site screening criteria are applicable to each of these reservoir types and technologies, which determines the viability of the reservoir itself, and of the technology for any particular site. This paper presents a review of the criteria applied in the scope of the Portuguese contribution to the EU funded project ESTMAP – Energy Storage Mapping and Planning.

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Some polycyclic aromatic hydrocarbons (PAHs) are ubiquitous in air and have been implicated as carcinogenic materials. Therefore, literature is replete with studies that are focused on their occurrence and profiles in indoor and outdoor air samples. However, because the relative potency of individual PAHs vary widely, health risks associated with the presence of PAHs in a particular environment cannot be extrapolated directly from the concentrations of individual PAHs in that environment. In addition, database on the potency of PAH mixtures is currently limited. In this paper, we have utilized multi-criteria decision making methods (MCDMs) to simultaneously correlate PAH-related health risk in some microenvironments to the concentration levels, ethoxyresorufin-O-deethylase (EROD) activity induction equivalency factors and toxic equivalency factors (TEFs) of PAHs found in those microenvironments. The results showed that the relative risk associated with PAHs in different air samples depends on the index used. Nevertheless, this approach offers a promising tool that could help identify microenvironments of concern and assist the prioritisation of control strategies.

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Research and innovation in the built environment is increasingly taking on an inter-disciplinary nature. The built environment industry and professional practice have long adopted multi and inter-disciplinary practices. The application of IT in Construction is moving beyond the automation and replication of discrete mono and multi-disciplinary tasks to replicate and model the improved inter-disciplinary processes of modern design and construction practice. A major long-term research project underway at the University of Salford seeks to develop IT modelling capability to support the design of buildings and facilities that are buildable, maintainable, operable, sustainable, accessible, and have properties of acoustic, thermal and business support performance that are of a high standard. Such an IT modelling tool has been the dream of the research community for a long time. Recent advances in technology are beginning to make such a modelling tool feasible.----- Some of the key problems with its further research and development, and with its ultimate implementation, will be the challenges of multiple research and built environment stakeholders sharing a common vision, language and sense of trust. This paper explores these challenges as a set of research issues that underpin the development of appropriate technology to support realisable advances in construction process improvements.

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The construction industry is dynamic in nature. The concept of project success has remained ambiguously defined in the construction industry. Project success is almost the ultimate goal for every project. However, it means different things to different people. While some writers consider time, cost and quality as predominant criteria, others suggest that success is something more complex. The aim of this paper is to develop a framework for measuring success of construction projects. In this paper, a set of key performance indicators (KPIs), measured both objectively and subjectively are developed through a comprehensive literature review. The validity of the proposed KPIs is also tested by three case studies. Then, the limitations of the suggested KPIs are discussed. With the development of KPIs, a benchmark for measuring the performance of a construction project can be set. It also provides significant insights into developing a general and comprehensive base for further research.

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A new approach was taken to delivering a challenging "stewarship of land" unit to over 350 predominantly first year built environment students stewardship. The new approach involved incorporating environmental and planning law into the syllabus, exposing students to a wide range of statutes, selecting legal cases according to a et of criteria and revisiting the material using different modes of delivery and teaching resources. To evaluate the effectiveness of the new approach, the students were surveyed to elicit their learning experience and preferences. The survey found that most students perceived learning about environmental and planning law, including legal cases, worthwhile.----- Areas identified by the surcey for improvement included the perception by some students that: environmenatl and planning law is irrelevant to their discipline and future caree; studying law is dull and sometimes daunting; and the prescribed reading could be omitted.----- To address student perceptions, it is proposed to reorder the topics commencing with local, charismatic topics, while explanding international content and cases, to enlarge and enhance the repertoire of video clips to include sites of legal cawses and development projects, and to reformat the online weekly quizzes to promote reading of primary material.----- Overall, the approach to teaching environmental and planning law to built environment students, including the criteria for selecting legal cases, described in this paper, was found to be effective.