Gestión de pruebas para equipos de vídeo

Desde hace ya muchos años, uno de los servicios de telecomunicaciones más demandado por los españoles ha sido la televisión de pago, complementando y ampliando la oferta de contenidos audiovisuales que habitualmente son ofrecidos de manera gratuita por la televisión analógica y recientemente por la televisión digital terrestre o TDT. Estos servicios de video, han sido tradicionalmente ofrecidos por operadores satélites, operadores de cable u otros operadores de telecomunicaciones con los que a través de una conexión de datos (ADSL, VDSL o fibra óptica), ofrecían sus contenidos a través de IP. La propia evolución y mejora de la tecnología utilizada para la emisión de contenidos sobre IP, ha permitido que a día de hoy, la televisión se conciba como un servicio Over The Top (OTT) ajeno al medio de transmisión, permitiendo a cualquier agente, distribuir sus contenidos audiovisuales de manera sencilla y a todos sus clientes en todas las partes del mundo; siendo solamente necesario disponer de una conexión a internet. De esta manera, el proyecto desarrollado va a girar en torno a la herramienta StormTest de la empresa S3Group, comprada por CENTUM Solutions (empresa especializada en ofrecer servicio de ingeniería para sistema de comunicaciones, control e inteligencia de señal) con el objetivo de satisfacer las necesidades de sus clientes y con la que en definitiva se ha contado para la realización de este proyecto. El principal objetivo de este proyecto es la definición e implementación de un banco de pruebas que permita optimizar los procesos de validación técnica, mejorando los tiempos de ejecución y concentrando la actividad de los ingenieros en tareas de mayor valor. Para la realización de este proyecto, se han fijado diversos objetivos necesarios para el desarrollo de este tipo de actividades. Los principales son los siguientes:  Análisis de la problemática actual: donde en los procesos de aceptación técnica se dedica muchas horas de trabajo para la realización de pruebas repetitivas y de poco valor las cuales se pueden automatizar por herramientas existentes en el mercado.  Búsqueda y selección de una herramienta que satisfaga las necesidades de pruebas.  Instalación en los laboratorios.  Configuración y adaptación de la herramienta a las necesidades y proyectos específicos. Con todo ello, este proyecto cubrirá los siguientes logros:  Reducir los tiempos de ejecución de las campañas de pruebas, gracias a la automatización de gran parte ellas.  Realizar medidas de calidad subjetiva y objetiva complejas, imposibles de ejecutar a través de las personas. Mejorar y automatizar los sistemas de reporte de resultados. Abstract: Many years ago, one of the telecommunications services most demanded in Spain has been pay television, complementing and extending the offer of audiovisual content which are usually offered for free by analog tv and recently by digital terrestrial televisión or TDT. These video services, have been traditionally offered by satellite operators, cable operators or other telecommunications operators that through a data connection (ADSL,VDSL or fiber optic), offered its content over IP. The evolution and improvement of the technology used for broadcasting over IP, has allowed that to date, television is conceived as a service Over The Top (OTT), not dependent on the transmission medium, allowing any agent to distribute audiovisual content in a very simple way and to all its customers in all parts of the world; being only necessary to have an decent internet connection. In this way, the project will have relation with S3Group’s StormTest tool, bought by CENTUM Solutions (company specialized in engineering services for communications, control and signal intelligence system) with the aim of satisfying the needs of its customers and which ultimately has counted for the realization of this project. The main objective of this project is the definition and implementation of a test bench that allows to optimize the processes of technical validation, improving execution times and concentrating the activities of engineers on higher value tasks. For the realization of this project, it has been defined several objectives necessary for the development of this type of activity. The most important tones are listed below:  Analysis of the current situation: where in technical acceptance processes it is dedicated many hours of work for the completion of repetitive testing and without value which can be automated by tools available on the market  Search and selection of a tool that meets the needs of testing.  Installation on the laboratories.  Configuration and customization of the tool to specific projects. With all this, this project will cover the following achievements: Reduce the execution time of the testing campaigns, thanks to the automation of many of them.  Measurements of subjective and objective quality tests, impossible to run with engineers (due to subjective perception). Improve and automate reporting of results systems

Modelo de gestión de costes medioambientales para el sector petroquímico venezolano

El crecimiento económico ha producido mejoras en el nivel de vida de la población que muchas veces tienen efectos medioambientales negativos en el largo plazo. Ante esta problemática, surge la necesidad a nivel empresarial de enmarcarse en un modelo de desarrollo sostenible que combine los objetivos de crecimiento económico con los de protección medioambiental. Esta situación puede representar altos costes para las empresas del sector petroquímico venezolano, debido al elevado riesgo de sus operaciones y al conjunto de regulaciones legales vigentes en materia medioambiental. Por lo tanto, el objetivo de la presente investigación ha sido proponer un modelo para la gestión de costes medioambientales de dicho sector fundamentado en la ecoeficiencia. Se planteó una investigación proyectiva, desde un enfoque holístico. Se utilizó un diseño de investigación univariable, transeccional contemporáneo, de fuente mixta. Univariable, porque se enfoca en la gestión de costes medioambientales como único evento a modificar. Transeccional contemporáneo, porque el evento se estudia en la actualidad y la medición de los datos se realiza en un solo momento. De fuente mixta, porque se combinó un diseño documental con un diseño de campo. Se utilizó un diseño documental para el análisis comparativo de las normativas de registro y control de costes medioambientales propuestas por organismos internacionales, mediante la aplicación de una matriz de análisis de categorías emergentes. Para el diagnóstico de la gestión de costes medioambientales en el sector petroquímico venezolano, se utilizó un diseño de campo en las empresas del sector que operan en la región zuliana. Para ello se aplicó un cuestionario con 100 ítems en escala Likert y 6 preguntas de opción múltiple. Dicho cuestionario fue validado mediante la revisión de expertos y se determinó su confiablidad a través del coeficiente alfa de Cronbach. Los resultados muestran que los principales asuntos tratados por las normativas analizadas pueden agruparse en seis temas: alcance de la contabilidad de gestión medioambiental, clasificación, tratamiento contable, asignación, informes de costes medioambientales e indicadores de gestión. Se evidenció que las guías de aplicación de la contabilidad de gestión medioambiental abordan todos los temas identificados pero no hay uniformidad en los criterios asumidos. Por el contrario, las normativas en el ámbito de la contabilidad financiera consideran principalmente los aspectos relacionados con el tratamiento contable de los costes medioambientales y su inclusión en los estados financieros. En cuanto a la gestión de costes medioambientales que realizan las empresas del sector petroquímico venezolano, se evidenció su limitación por la escasa consideración de criterios de ecoeficiencia y la poca aplicación de herramientas de contabilidad de gestión, que dificultan la determinación y el control de costes medioambientales. Tomando como base los resultados obtenidos, se diseñó el modelo de Gestión de Costes Medioambientales Ecoeficiente (GCME). Dicho modelo plantea como deben incorporarse los criterios de ecoeficiencia y las herramientas de contabilidad de gestión medioambiental para la planificación, coordinación y control en la gestión de costes medioambientales. Se plantea que estas etapas deben desarrollarse permanentemente para asegurar la mejora continua del proceso y su adaptación a los cambios tecnológicos y a las regulaciones legales. Se hace énfasis en las directrices que deben seguir las empresas del sector petroquímico venezolano para la aplicación del modelo GCME. Sin embargo, por su generalidad y adaptación a las Normas Internacionales de Contabilidad vigentes en Venezuela, dicho modelo es aplicable a diversos sectores industriales que requieran mejorar su desempeño económico-medioambiental. ABSTRACT Economic growth has led to improvements in the standard of living of the population that often have negative environmental effects over the long term. Faced with this problem, at the enterprise-level, the need to be framed in a sustainable development model that combines the goals of economic growth with environmental protection arises. This situation may represent high costs for the Venezuelan petrochemical companies due to the high risk of their operations and to all the applicable legal regulations on environmental matters. Therefore, this research aims to propose a model for the environmental costs management of these companies based on eco-efficiency. A projective research was performed from a holistic approach. An univariate, contemporary cross-sectional and mixed source research design was used. It is univariate, because it focuses on environmental costs management as the single event to change. It is contemporary cross-sectional, because the event is currently studied and the data measurement is performed in a single moment. It relies on mixed source, because it combines a documentary design with a field design. A documentary design was used for the comparative analysis of the standards of registration and control of environmental costs proposed by international organizations, by applying an analysis matrix of emerging categories. For the diagnosis of the environmental costs management in the Venezuelan petrochemical industry, a field design was applied in the companies that operate in the Zulia region. A questionnaire with 100 items on a Likert scale and 6 multiple-choice questions was used. The questionnaire was validated by peer review and internal consistency reliability was determined using Cronbach's alpha coefficient. The results show that the main issues addressed in the analyzed regulations can be grouped into six themes: scope of environmental management accounting, classification, accounting, allocation, reporting of environmental costs and performance indicators. It was evident that implementation guides of environmental management accounting address all issues identified but there is no uniformity in the assumed criteria. Meanwhile, regulations in the financial accounting field mainly consider aspects related to the accounting treatment of environmental costs and their inclusion in the financial statements. Regarding the environmental costs management performed by Venezuelan petrochemical companies, its limitations were made evident by the low status of eco-efficiency criteria and insufficient application of management accounting tools, which hinder the identification and control of environmental costs. Based on the results, the model of eco-efficient environmental costs management (EECM) was designed. This model indicates how eco-efficiency criteria and tools of environmental management accounting for planning, coordination and control in the environmental costs management should be incorporated. It argues that these stages must be continually developed to ensure a continuous process improvement and its adaptation to technological and legal regulatory changes. The guidelines which the Venezuelan petrochemical companies should follow for the EECM model application have been emphasized. However, due to its generality and adaptation to the International Accounting Standards enforced in Venezuela, this model is applicable to various industries that require an improvement of their economic and environmental performance.

Wireless communication enhancement methods for mobile robots in radiation environments

En entornos hostiles tales como aquellas instalaciones científicas donde la radiación ionizante es el principal peligro, el hecho de reducir las intervenciones humanas mediante el incremento de las operaciones robotizadas está siendo cada vez más de especial interés. CERN, la Organización Europea para la Investigación Nuclear, tiene alrededor de unos 50 km de superficie subterránea donde robots móviles controlador de forma remota podrían ayudar en su funcionamiento, por ejemplo, a la hora de llevar a cabo inspecciones remotas sobre radiación en los diferentes áreas destinados al efecto. No solo es preciso considerar que los robots deben ser capaces de recorrer largas distancias y operar durante largos periodos de tiempo, sino que deben saber desenvolverse en los correspondientes túneles subterráneos, tener en cuenta la presencia de campos electromagnéticos, radiación ionizante, etc. y finalmente, el hecho de que los robots no deben interrumpir el funcionamiento de los aceleradores. El hecho de disponer de un sistema de comunicaciones inalámbrico fiable y robusto es esencial para la correcta ejecución de las misiones que los robots deben afrontar y por supuesto, para evitar tales situaciones en las que es necesario la recuperación manual de los robots al agotarse su energía o al perder el enlace de comunicaciones. El objetivo de esta Tesis es proveer de las directrices y los medios necesarios para reducir el riesgo de fallo en la misión y maximizar las capacidades de los robots móviles inalámbricos los cuales disponen de almacenamiento finito de energía al trabajar en entornos peligrosos donde no se dispone de línea de vista directa. Para ello se proponen y muestran diferentes estrategias y métodos de comunicación inalámbrica. Teniendo esto en cuenta, se presentan a continuación los objetivos de investigación a seguir a lo largo de la Tesis: predecir la cobertura de comunicaciones antes y durante las misiones robotizadas; optimizar la capacidad de red inalámbrica de los robots móviles con respecto a su posición; y mejorar el rango operacional de esta clase de robots. Por su parte, las contribuciones a la Tesis se citan más abajo. El primer conjunto de contribuciones son métodos novedosos para predecir el consumo de energía y la autonomía en la comunicación antes y después de disponer de los robots en el entorno seleccionado. Esto es importante para proporcionar conciencia de la situación del robot y evitar fallos en la misión. El consumo de energía se predice usando una estrategia propuesta la cual usa modelos de consumo provenientes de diferentes componentes en un robot. La predicción para la cobertura de comunicaciones se desarrolla usando un nuevo filtro de RSS (Radio Signal Strength) y técnicas de estimación con la ayuda de Filtros de Kalman. El segundo conjunto de contribuciones son métodos para optimizar el rango de comunicaciones usando novedosas técnicas basadas en muestreo espacial que son robustas frente a ruidos de campos de detección y radio y que proporcionan redundancia. Se emplean métodos de diferencia central finitos para determinar los gradientes 2D RSS y se usa la movilidad del robot para optimizar el rango de comunicaciones y la capacidad de red. Este método también se valida con un caso de estudio centrado en la teleoperación háptica de robots móviles inalámbricos. La tercera contribución es un algoritmo robusto y estocástico descentralizado para la optimización de la posición al considerar múltiples robots autónomos usados principalmente para extender el rango de comunicaciones desde la estación de control al robot que está desarrollando la tarea. Todos los métodos y algoritmos propuestos se verifican y validan usando simulaciones y experimentos de campo con variedad de robots móviles disponibles en CERN. En resumen, esta Tesis ofrece métodos novedosos y demuestra su uso para: predecir RSS; optimizar la posición del robot; extender el rango de las comunicaciones inalámbricas; y mejorar las capacidades de red de los robots móviles inalámbricos para su uso en aplicaciones dentro de entornos peligrosos, que como ya se mencionó anteriormente, se destacan las instalaciones científicas con emisión de radiación ionizante. En otros términos, se ha desarrollado un conjunto de herramientas para mejorar, facilitar y hacer más seguras las misiones de los robots en entornos hostiles. Esta Tesis demuestra tanto en teoría como en práctica que los robots móviles pueden mejorar la calidad de las comunicaciones inalámbricas mediante la profundización en el estudio de su movilidad para optimizar dinámicamente sus posiciones y mantener conectividad incluso cuando no existe línea de vista. Los métodos desarrollados en la Tesis son especialmente adecuados para su fácil integración en robots móviles y pueden ser aplicados directamente en la capa de aplicación de la red inalámbrica. ABSTRACT In hostile environments such as in scientific facilities where ionising radiation is a dominant hazard, reducing human interventions by increasing robotic operations are desirable. CERN, the European Organization for Nuclear Research, has around 50 km of underground scientific facilities, where wireless mobile robots could help in the operation of the accelerator complex, e.g. in conducting remote inspections and radiation surveys in different areas. The main challenges to be considered here are not only that the robots should be able to go over long distances and operate for relatively long periods, but also the underground tunnel environment, the possible presence of electromagnetic fields, radiation effects, and the fact that the robots shall in no way interrupt the operation of the accelerators. Having a reliable and robust wireless communication system is essential for successful execution of such robotic missions and to avoid situations of manual recovery of the robots in the event that the robot runs out of energy or when the robot loses its communication link. The goal of this thesis is to provide means to reduce risk of mission failure and maximise mission capabilities of wireless mobile robots with finite energy storage capacity working in a radiation environment with non-line-of-sight (NLOS) communications by employing enhanced wireless communication methods. Towards this goal, the following research objectives are addressed in this thesis: predict the communication range before and during robotic missions; optimise and enhance wireless communication qualities of mobile robots by using robot mobility and employing multi-robot network. This thesis provides introductory information on the infrastructures where mobile robots will need to operate, the tasks to be carried out by mobile robots and the problems encountered in these environments. The reporting of research work carried out to improve wireless communication comprises an introduction to the relevant radio signal propagation theory and technology followed by explanation of the research in the following stages: An analysis of the wireless communication requirements for mobile robot for different tasks in a selection of CERN facilities; predictions of energy and communication autonomies (in terms of distance and time) to reduce risk of energy and communication related failures during missions; autonomous navigation of a mobile robot to find zone(s) of maximum radio signal strength to improve communication coverage area; and autonomous navigation of one or more mobile robots acting as mobile wireless relay (repeater) points in order to provide a tethered wireless connection to a teleoperated mobile robot carrying out inspection or radiation monitoring activities in a challenging radio environment. The specific contributions of this thesis are outlined below. The first sets of contributions are novel methods for predicting the energy autonomy and communication range(s) before and after deployment of the mobile robots in the intended environments. This is important in order to provide situational awareness and avoid mission failures. The energy consumption is predicted by using power consumption models of different components in a mobile robot. This energy prediction model will pave the way for choosing energy-efficient wireless communication strategies. The communication range prediction is performed using radio signal propagation models and applies radio signal strength (RSS) filtering and estimation techniques with the help of Kalman filters and Gaussian process models. The second set of contributions are methods to optimise the wireless communication qualities by using novel spatial sampling based techniques that are robust to sensing and radio field noises and provide redundancy features. Central finite difference (CFD) methods are employed to determine the 2-D RSS gradients and use robot mobility to optimise the communication quality and the network throughput. This method is also validated with a case study application involving superior haptic teleoperation of wireless mobile robots where an operator from a remote location can smoothly navigate a mobile robot in an environment with low-wireless signals. The third contribution is a robust stochastic position optimisation algorithm for multiple autonomous relay robots which are used for wireless tethering of radio signals and thereby to enhance the wireless communication qualities. All the proposed methods and algorithms are verified and validated using simulations and field experiments with a variety of mobile robots available at CERN. In summary, this thesis offers novel methods and demonstrates their use to predict energy autonomy and wireless communication range, optimise robots position to improve communication quality and enhance communication range and wireless network qualities of mobile robots for use in applications in hostile environmental characteristics such as scientific facilities emitting ionising radiations. In simpler terms, a set of tools are developed in this thesis for improving, easing and making safer robotic missions in hostile environments. This thesis validates both in theory and experiments that mobile robots can improve wireless communication quality by exploiting robots mobility to dynamically optimise their positions and maintain connectivity even when the (radio signal) environment possess non-line-of-sight characteristics. The methods developed in this thesis are well-suited for easier integration in mobile robots and can be applied directly at the application layer of the wireless network. The results of the proposed methods have outperformed other comparable state-of-the-art methods.

PTSD, Depression, and Substance Abuse Symptoms in Women Exposed to Intimate Partner Abuse

The present study explores relationships among several established correlates of trauma in women exposed to intimate partner abuse (IPA), including PTSD, depression, and dissociation symptoms as well as alcohol use as well as other trauma-related variables, such as social support and violence exposure. Two analysis methods were utilized: variable-oriented methods, which examine relationships between variables, and person-oriented analysis methods, which examine groupings of participants within a larger sample (N = 233). Results of the variable-oriented analyses indicated positive links among depression, PTSD, dissociation, and alcohol use in women exposed to IPA, as well as positive links between the aforementioned psychological symptoms and exposure to violence. Social support was related to decreased psychological symptoms. Person-oriented analyses indicated the presence of four unique profiles of women within the larger study sample: Profile 1 (n = 21), which was labeled High Dissociation, Low Depression/PTSD; Profile 2 (n = 150), which was labeled Low Symptoms, High Social Support, Profile 3 (n = 41); which was labeled Low Dissociation, High Depression/PTSD; and Profile 4 (n = 22), which was labeled High Symptoms, Low Social Support. This research supports previous findings about the relationships among several variables related to IPA as well as suggests the need for careful consideration of differences among women within the larger context of research, advocacy, and clinical interventions related to IPA.

Del síndrome al sinthome

Currently, the concept of symptom is based on the notion of singularity (from a base perspective, underlined by Freud, regarding the persistence of symptomatic residue). This indicates that the demise of the symptom will never be complete, since the demand drive will always persist and will not cease to search for satisfaction.Let us then, insist on this matter, on the existence of an incurable residue in the symptom (which entails a particular relationship between the subject and its own pleasure), resisting sense and interpretation. The following paper has been elaborated following a diachronic trajectory of psychoanalytic theory, which allows establishing pauses, outlining the most important shifts produced in Freudian and Lacanian elaborations, respectively. Starting from Freud‘s productions, as main fulcrum, the Lacanian approach of the symptom will be introduced to link to the proposal of the sinthome proposed by Lacan. Freud will explain symptoms through the theory of trauma; those will find themselves hinged on mnemic traces, which will make the analysis of the patient‘s produced associations a crucial activity, to comprehend the etiology of the symptoms and the development of the cure. The clinical practice of this period may be summarized as ―the unconscious is susceptible to become conscious‖, aiming to the discovery and/or decoding of the symptoms, as long as they carry meaning. All of this at the same time, will be the base of future elaborations...

Pharmacopea de la Armada (1760), un libro singular para uso de los sanitarios navales del siglo XVIII

La Pharmacopea de la Armada, obra de Leandro de Vega, publicada en 1760 para uso de médicos y cirujanos de los buques y hospitales de la marina española a lo largo del siglo XVIII, está considerada como la primera farmacopea naval española. Su autor la define con un «catálogo de medicamentos pertenecientes a las enfermedades médicas», en definitiva un nomenclátor de fórmulas para la preparación de los medicamentos de mayor utilidad para los navegantes de la época, tanto de uso interno como externo. En el presente artículo se analiza en profundidad esta obra, reconocida su relevancia de fuente primaria, situándola en su contexto histórico, detallando el contenido de sus tratados, así como dando noticia biográfica de su autor e informando de la posición profesional y misión de sus destinatarios.

Financial regulatory transparency: new data and implications for EU policy. Bruegel Policy Brief 2015/20, December 2015

International financial institutions have promoted financial regulatory transparency, or the publication by supervisors of financial industry data. Financial regulatory transparency enhances market stability and increases democratic legitimacy. • We introduce a new index of financial regulatory data transparency: the FRT Index. It measures how countries report to international financial institutions basic macroprudential data about their financial systems.The Index covers 68 high-income and emerging-market economies over 22 years (1990-2011). • We find a number of striking trends over this period. European Union members are generally more opaque than other high-income countries.This finding is especially relevant given efforts to create an EU capital markets union. • Globally, financial regulatory data transparency has increased. However, there is considerable variation. Some countries have become significantlymore transparent, while others have become much more opaque. Reporting tends to decline during financial crises. • We propose that the EU institutions take on a greater role in coordinating and possibly enforcing reporting of bank and non-bank institution data. Similar to the United States, a reporting requirement should be part of any EU general deposit insurance scheme.

Perceções dos enfermeiros sobre os erros de medicação no pré-hospitalar

Quase metade da totalidade de eventos adversos evitáveis é consequência de erros de medicação (EM), contudo, não sendo possível evitá-los completamente, estes podem ser minorados. Esta problemática em contexto pré-hospitalar (PH) tem sido pouco estudada a nível internacional e nunca foi abordada em Portugal. O objetivo deste estudo é relacionar as variáveis sociodemográficas, socioprofissionais, formação, conhecimentos e experiências com EM com a perceção dos enfermeiros que exercem no PH relativamente à frequência da ocorrência dos tipos e causas de EM, dos obstáculos ao relato de EM, dos fatores facilitadores do relato de EM e com o grau de concordância sobre divulgação de EM. Métodos: Trata-se de um estudo analítico, descritivo, transversal e correlacional. A amostra é composta por 107 enfermeiros do PH (método snowball), dos quais 56.1% são do sexo masculino. Foi aplicado um questionário eletrónico constituído por uma componente sociodemográfica, escala de conhecimentos, perceções e experiência com erros de medicação (Raimundo, 2011; Maurer, 2010; Bohomol & Ramos, 2006; Mayo & Duncan, 2004; Osborne, Blais & Hayes, 1999; Gladstone, 1995). Resultados: Dos inquiridos 60.7% apresentam fracos a razoáveis conhecimentos sobre EM; mais de 54% perceciona a sua formação académica/contínua sobre EM como sendo inexistente/insuficiente e 52.3% não recebe formação sobre farmacologia há pelo menos 6 anos; 45.8% diz ter experienciado no PH um ou mais EM sem dano para o doente e apenas 14.9% relatou um ou mais EM sem dano para o doente. Os tipos e as causas de EM identificadas ocorrem com uma frequência elevada para mais de 39% dos inquiridos. A maioria dos inquiridos (47.7%) considera que no PH existem grandes obstáculos ao relato de EM e os fatores facilitadores do relato de EM apresentados são considerados por 49.5% dos enfermeiros como altamente prováveis de facilitar o relato. 52,3% dos enfermeiros do PH discordam de uma forma global com a divulgação de EM. O sexo feminino apresenta uma perceção mais elevada da ocorrência das causas primárias de EM (MF=2.68, Dp= 0.60 vs MM=2.36, Dp=0.66) e uma perceção mais elevada dos fatores facilitadores ao relato dos EM (MF=4.40, Dp= 0.64 vs MM=4.12, Dp=0.74). Os enfermeiros que exercem exclusivamente no PH possuem uma melhor perceção da frequência de ocorrência das causas primárias de EM. Quanto maior o conhecimento dos enfermeiros sobre EM, maior é a perceção destes relativamente aos tipos de erros e maior o grau de concordância com a divulgação dos EM. Existe evidência estatisticamente significativa (p<0.05) de que os enfermeiros que experienciaram a ocorrência de pelo menos 1 erro com dano para o doente possuem melhor perceção dos tipos, causas primárias e obstáculos ao relato dos EM, assim como apresenta um maior grau de concordância com a divulgação de EM. Conclusão: A perceção dos enfermeiros sobre a frequência dos tipos e das causas de EM, assim como dos obstáculos e dos fatores facilitadores do relato de EM por parte dos enfermeiros no PH não tem, de uma forma geral, relação com as características sociodemográficas e socioprofissionais, o que demonstra a transversalidade desta problemática. Tão ou mais importante do que avaliar a dimensão e caracterizar a tipologia, causas, obstáculos e fatores facilitadores ao relato dos EM será, com base no conhecimento obtido, definir e implementar ações de gestão de risco que permitam a sua redução ou mesmo a sua supressão. PALAVRAS-CHAVE: Erros de Medicação, Perceção dos Enfermeiros, Pré- Hospitalar.

Cuidar no parto : prática de episiotomia

Enquadramento – A episiotomia é uma incisão feita no períneo para aumentar o canal vaginal com o objetivo de evitar outros traumas perineais durante o parto. No entanto, esta prática, por si só, já se considera um trauma perineal pelo corte em estruturas que podem desencadear problemas futuros. A Organização Mundial de Saúde (1996) recomenda a utilização limitada da episiotomia uma vez que não existem evidências credíveis de que a utilização generalizada ou de rotina desta prática tenha um efeito benéfico. Objetivos: Demonstrar evidência científica dos determinantes da prática de episiotomia seletiva em mulheres com parto normal/eutócico; identificar a prevalência de episiotomia; analisar os fatores (variáveis sociodemográficas, variáveis relativas ao recém-nascido, variáveis contextuais da gravidez e contextuais do parto) que influenciam na ocorrência de episiotomia. Métodos: O estudo empírico I seguiu a metodologia de revisão sistemática da literatura. Efetuou-se uma pesquisa na EBSCO, PubMed, SciELO, RCAAP de estudos publicados entre janeiro de 2008 e 23 de dezembro de 2014. Os estudos encontrados foram avaliados tendo em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatorizado e controlado de Carneiro (2008). Após avaliação crítica da qualidade, foram incluídos no corpus do estudo 4 artigos nos quais se obteve um score entre 87,5% e 95%. O estudo empírico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados: Evidência de que a episiotomia não deve ser realizada de forma rotineira, cujo uso deve restringir-se a situações clínicas específicas. A episiotomia seletiva, comparada com a episiotomia de rotina, está relacionada com um menor risco de trauma do períneo posterior, a uma menor necessidade de sutura e a menos complicações na cicatrização. Amostra constituída por 382 mulheres, na faixa etária dos 18-46 anos. Apenas, não se procedeu à episiotomia em 41,7% da amostra, apontando para a presença da episiotomia seletiva. Número significativo de mulheres com parto eutócico (80,5%), com sutura (95,0%), laceração de grau I (64,9%), dor perineal (89,1%) sujeitas a episiotomia (58,3%). A maioria dos recém-nascidos nasceram com peso normal (92,3%), com um valor expressivo de mulheres sujeitas a episiotomia (91,4%). Ainda se constatou a existência de casos, apesar de reduzidos, em que o recém-nascido nasceu macrossómico (5,4%), tendo-se recorrido igualmente a esta prática. Não há uma associação direta entre a realização de episiotomia e os scores do APGAR. Conclusão: Face a estes resultados e com base na evidência científica disponível que recomenda, desde há vários anos, que se faça um uso seletivo da episiotomia, sugere-se que os profissionais de saúde estejam mais despertos para esta realidade, de modo a que se possam anular as resistências e as barreiras de mudanças por parte dos mesmos face ao uso seletivo da episiotomia. Para promover essa mudança de comportamentos é importante não só mostrar as evidências científicas, bem como transpô-las para a prática, capacitando os profissionais de saúde, sobretudo os enfermeiros, na sua atuação. Palavras-chave: Parto Normal/eutócico; Episiotomia; Episiotomia seletiva; Episiotomia de rotina.

Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: a randomised simulation study.

BACKGROUND Resuscitation guidelines encourage the use of cardiopulmonary resuscitation (CPR) feedback devices implying better outcomes after sudden cardiac arrest. Whether effective continuous feedback could also be given verbally by a second rescuer ("human feedback") has not been investigated yet. We, therefore, compared the effect of human feedback to a CPR feedback device. METHODS In an open, prospective, randomised, controlled trial, we compared CPR performance of three groups of medical students in a two-rescuer scenario. Group "sCPR" was taught standard BLS without continuous feedback, serving as control. Group "mfCPR" was taught BLS with mechanical audio-visual feedback (HeartStart MRx with Q-CPR-Technology™). Group "hfCPR" was taught standard BLS with human feedback. Afterwards, 326 medical students performed two-rescuer BLS on a manikin for 8 min. CPR quality parameters, such as "effective compression ratio" (ECR: compressions with correct hand position, depth and complete decompression multiplied by flow-time fraction), and other compression, ventilation and time-related parameters were assessed for all groups. RESULTS ECR was comparable between the hfCPR and the mfCPR group (0.33 vs. 0.35, p = 0.435). The hfCPR group needed less time until starting chest compressions (2 vs. 8 s, p < 0.001) and showed fewer incorrect decompressions (26 vs. 33 %, p = 0.044). On the other hand, absolute hands-off time was higher in the hfCPR group (67 vs. 60 s, p = 0.021). CONCLUSIONS The quality of CPR with human feedback or by using a mechanical audio-visual feedback device was similar. Further studies should investigate whether extended human feedback training could further increase CPR quality at comparable costs for training.

The Minnesota law journal.

Vols. 2 and 3 contain meeting material of the Minnesota State Bar Association.

Regional Anesthesia in TraumaMedicine

Regional anesthesia is an established method to provide analgesia for patients in the operating room and during the postoperative phase. While regional anesthesia offers unique advantages, as shown by the recent military experience, it is not commonly utilized in the prehospital or emergency department setting. Most often, regional anesthesia techniques for traumatized patients are first utilized in the operating room for procedural anesthesia or for postoperative pain control. While infiltration or single nerve block procedures are often used by surgeons or emergency medicine physicians in the preoperative phase, more advanced techniques such as plexus block procedures or regional catheter placements are more commonly performed by anesthesiologists for surgery or postoperative pain control. These regional techniques offer advantages over intravenous anesthesia, not just in the perioperative phase but also in the acute phase of traumatized patients and during the initial transport of injured patients. Anesthesiologists have extensive experience with regional techniques and are able to introduce regional anesthesia into settings outside the operating room and in the early treatment phases of trauma patients.

A Knowledge-based System for Intelligent Support in Pharmacogenomics Evidence Assessment: Ontology-driven Evidence Representation, Retrieval, Classification and Interpretation

Thesis (Ph.D.)--University of Washington, 2016-06

No relationship between low-density lipoproteins and endothelial function in hemodialysis patients

Background: Relationships between low-density lipoprotein cholesterol and endothelial function in hemodialysis patients have yet to be investigated. Furthermore, current reporting of endothelial function data using flow-mediated dilatation has recognised limitations. The aims of the study were to determine the relationship between low-density lipoproteins and endothelial function in hemodialysis patients and to investigate the validity of determining the area under the curve for data collected during the flow-mediated dilatation technique. Methods: Brachial artery responses to reactive hyperemia (endothelial-dependent) and glyceryl trinitrate (endothelial-independent) were assessed in 19 hemodialysis patients using high-resolution ultrasound. Lipid profiles and other factors known to effect brachial artery reactivity were also measured prior to the flow-mediated dilatation technique. Results: There were no significant relationships between serum low-density lipoproteins and endothelial-dependent or -independent vasodilation using absolute change (mm), relative change (%), time to peak change (s) or area under the curve (mm(.)s). In hemodialysis patients with atherosclerosis, area under the curve analysis showed a significantly (p < 0.05) decreased endothelial-dependent response (mean +/- S.D.: 19.2 +/- 17.4) compared to non-atherosclerotic patients (42.3 +/- 28.6). However, when analysing these data using absolute change, relative change or time to peak dilatation, there were no significant differences between the two groups. Conclusions: In summary, there was no relationship between low-density lipoproteins and endothelial function in hemodialysis patients. In addition, area under the curve analysis of flow-mediated vasodilatation data may be a useful method of determining the temporal vascular response during the procedure. (c) 2004 Elsevier Ireland Ltd. All rights reserved.