Selection of Top 10 Quality Indicators for Nutrition Therapy

Background: The identification of useful quality indicators for nutrition therapy (QINTs) is of great interest and a challenge. This study attempted to identify the 10 QINTs that best suit the practice of quality control in nutrition therapy (NT) by evaluating the opinion of experts in NT with the use of psychometric techniques and statistical tools. Methods: Thirty-six QINTs available for clinical application in Brazil were assessed in 2 distinct phases. In phase 1, 26 nutrition experts ranked QINTs by scoring 4 attributes (utility, simplicity, objectivity, low cost) to assess each QINT on a 5-point Likert scale. The top 10 QINTs were identified from the 10 best scores obtained, and the reliability of expert opinion for each indicator was assessed by Cronbach's alpha. In phase 2, experts provided feedback regarding the selected top 10 QINTs by answering 2 closed questions. Results: The top 10 QINTs, in descending order, are the frequency of nutrition screening of hospitalized patients, diarrhea, involuntary withdrawal of enteral feeding tubes, feeding tube obstruction, fasting longer than 24 hours, glycemic dysfunction, estimated energy expenditure and protein needs, central venous catheter infection, compliance of NT indication, and frequency of application of subjective global assessment. Opinions were consistent among the interviewed experts. During feedback, 96% of experts were satisfied with the top 10 QINTs, and 100% had considered them in accordance with their previous opinion. Conclusion: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. 2012;27:261-267)

IFN-gamma Plays a Unique Role in Protection against Low Virulent Trypanosoma cruzi Strain

Background: T. cruzi strains have been divided into six discrete typing units (DTUs) according to their genetic background. These groups are designated T. cruzi I to VI. In this context, amastigotes from G strain (T. cruzi I) are highly infective in vitro and show no parasitemia in vivo. Here we aimed to understand why amastigotes from G strain are highly infective in vitro and do not contribute for a patent in vivo infection. Methodology/Principal Findings: Our in vitro studies demonstrated the first evidence that IFN-gamma would be associated to the low virulence of G strain in vivo. After intraperitoneal amastigotes inoculation in wild-type and knockout mice for TNF-alpha, Nod2, Myd88, iNOS, IL-12p40, IL-18, CD4, CD8 and IFN-gamma we found that the latter is crucial for controlling infection by G strain amastigotes. Conclusions/Significance: Our results showed that amastigotes from G strain are highly infective in vitro but did not contribute for a patent infection in vivo due to its susceptibility to IFN-gamma production by host immune cells. These data are useful to understand the mechanisms underlying the contrasting behavior of different T. cruzi groups for in vitro and in vivo infection.

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators The objective of this study is to propose a generic program for the management of urban canine populations with suggestion of performance indicators. The following international guidelines on canine population management were revised and consolidated: World Health Organization, World Organisation for Animal Health, World Society for the Protection of Animals, International Companion Animal Management Coalition, and the Food and Agriculture Organization. Management programs should cover: situation diagnosis, including estimates of population size; social participation with involvement of various sectors in the planning and execution of strategies; educational actions to promote humane values, animal welfare, community health, and responsible ownership (through purchase or adoption); environmental and waste management to eliminate sources of food and shelter; registration and identification of animals; animal health care, reproductive control; prevention and control of zoonoses; control of animal commerce; management of animal behavior and adequate solutions for abandoned animals; and laws regulating responsible ownership, prevention of abandonment and zoonoses. To monitor these actions, four groups of indicators are suggested: animal population indicators, human/animal interaction indicators, public service indicators, and zoonosis indicators. The management of stray canine populations requires political, sanitary, ethologic, ecologic, and humanitarian strategies that are socially acceptable and environmentally sustainable. Such measures must also include the control of zoonoses such as rabies and leishmaniasis, considering the concept of "one health," which benefits both the animals and people in the community.

"Evaluating the model of classification and valuation of disabilities used in Brazil and defining the elaboration and adoption of a unique model for all the country": Brazilian Interministerial Workgroup Task

The President of Brazil established an Interministerial Work Group in order to “evaluate the model of classification and valuation of disabilities used in Brazil and to define the elaboration and adoption of a unique model for all the country”. Eight Ministries and/or Secretaries participated in the discussion over a period of 10 months, concluding that a proposed model should be based on the United Nations Convention on the Rights of Person with Disabilities, the International Classification of Functioning, Disability and Health, and the ‘support theory’, and organizing a list of recommendations and necessary actions for a Classification, Evaluation and Certification Network with national coverage.

Material embodiment and energy flows as efficiency indicators of soybean (Glycine max) production in Brazil

As the requirement for agriculture to be environmentally suitable there is a necessity to adopt indicators and methodologies approaching sustainability. In Brazil, biodiesel addition into diesel is mandatory and soybean oil is its main source. The material embodiment determines the convergence of inputs into the crop. Moreover, the material flows are necessary for any environmental analysis. This study evaluated distinct production scenarios, and also conventional versus GMO crops, through the material embodiment and energy analysis. GMO crops demanded less indirectly applied inputs. The energy balance showed linearity with yield, whereas for EROI, the increases in input and yield were not affected.

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

Introduction The development of postextubation wallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI). Methods We conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay. Results After we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes. Conclusions Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

Los SIG aplicados a la organización de la información marina. Experiencias en el proyecto MEDINA (Marine Ecosystem Dynamics and Indicators for North Africa)

[ES] Los Sistemas de Información Geográfica (SIG) juegan un papel primordial en cualquier proyecto que use de algún modo datos georreferenciados. El proyecto FP7 MEDINA (Marine ecosystem dynamics and indicators for north Africa) no es una excepción, donde trabajamos con indicadores provenientes de diferentes países e instituciones. Una de las labores que se ha llevado a cabo es la armonización de dicha información y la puesta en común mediante las posibilidades que ofrecen los SIG y herramientas afines. Hablaremos de la capacidad de los SIG, especialmente en sus soluciones libres, para poder organizar, gestionar y analizar la información geográfica.

Automatic (data-based) learning of expressive indicators for machine failure detection : a proposal

Máster Universitario en Sistemas Inteligentes y Aplicaciones Numéricas en Ingeniería (SIANI)

Ottimizzazione di un Sistema di Key Performance Indicators per la Divisione Engineering aziendale. Il caso INTERTABA S.p.A.

Il seguente elaborato è la diretta conseguenza di un periodo di stage, pari a cinque mesi, svolto presso l’azienda INTERTABA S.p.A., a Zola Predosa (BO). Il Dipartimento presso cui è stato svolto il tirocinio è l’Engineering. In particolare è stata compiuta un’analisi dei KPIs presenti e sono state proposte delle azioni migliorative. Il lavoro si è sviluppato in tre fasi. Nella prima fase è stata fatta un’analisi dei KPIs attuali per ciascuna funzione appartenente all’Engineering: Engineering Support, Project Engineering, Plant & Utilities Maintenance, Technical Warehouse e General Services. Nella seconda fase sono state descritte, per ciascuna funzione, alcune proposte migliorative per i KPIs presenti. Infine, per alcune funzioni, sono state proposte alcune iniziative in merito all’implementazione di nuovi KPIs.

Sustainability indicators for environmental management and decision making

The general objective of this research is to explore theories and methodologies of sustainability indicators, environmental management and decision making disciplines with the operational purpose of producing scientific, robust and relevant information for supporting system understanding and decision making in real case studies. Several tools have been applied in order to increase the understanding of socio-ecological systems as well as providing relevant information on the choice between alternatives. These tools have always been applied having in mind the complexity of the issues and the uncertainty tied to the partial knowledge of the systems under study. Two case studies with specific application to performances measurement (environmental performances in the case of the K8 approach and sustainable development performances in the case of the EU Sustainable Development Strategy) and a case study about the selection of sustainable development indicators amongst Municipalities in Scotland, are discussed in the first part of the work. In the second part of the work, the common denominator among subjects consists in the application of spatial indices and indicators to address operational problems in land use management within the territory of the Ravenna province (Italy). The main conclusion of the thesis is that a ‘perfect’ methodological approach which always produces the best results in assessing sustainability performances does not exist. Rather, there is a pool of correct approaches answering different evaluation questions, to be used when methodologies fit the purpose of the analysis. For this reason, methodological limits and conceptual assumptions as well as consistency and transparency of the assessment, become the key factors for assessing the quality of the analysis.

Sviluppo e validazione di indicatori di qualità dell’assistenza nell’ambito della salute mentale in Emilia-Romagna

In Italia, il processo di de-istituzionalizzazione e di implementazione di modelli di assistenza per la salute mentale sono caratterizzati da carenza di valutazione. In particolare, non sono state intraprese iniziative per monitorare le attività relative all’assistenza dei pazienti con disturbi psichiatrici. Pertanto, l’obiettivo della tesi è effettuare una valutazione comparativa dei percorsi di cura nell’ambito della salute mentale nei Dipartimenti di Salute Mentale e Dipendenze Patologiche della regione Emilia-Romagna utilizzando indicatori ottenuti dai flussi amministrativi correnti.. I dati necessari alla costruzione degli indicatori sono stati ottenuti attraverso un data linkage dei flussi amministrativi correnti regionali delle schede di dimissione ospedaliera, delle attività territoriali dei Centri di Salute Mentale e delle prescrizioni farmaceutiche, con riferimento all’anno 2010. Gli indicatori sono stati predisposti per tutti i pazienti con diagnosi principale psichiatrica e poi suddivisi per categoria diagnostica in base al ICD9-CM. . Il set di indicatori esaminato comprende i tassi di prevalenza trattata e di incidenza dei disturbi mentali, i tassi di ospedalizzazione, la ri-ospedalizzazione a 7 e 30 giorni dalla dimissione dai reparti psichiatrici, la continuità assistenziale ospedale-territorio, l’adesione ai trattamenti ed il consumo e appropriatezza prescrittiva di farmaci. Sono state rilevate alcune problematiche nella ricostruzione della continuità assistenziale ospedale-territorio ed alcuni limiti degli indicatori relativi alle prescrizioni dei farmaci. Il calcolo degli indicatori basato sui flussi amministrativi correnti si presenta fattibile, pur con i limiti legati alla qualità, completezza ed accuratezza dei dati presenti. L’implementazione di questi indicatori su larga scala (regionale e nazionale) e su base regolare può essere una opportunità per impostare un sistema di sorveglianza, monitoraggio e valutazione dell’assistenza psichiatrica nei DSM.

Chemical, biochemical and microbiological indicators to assess soil quality in temperate agro-ecosystems

Soil is a critically important component of the earth’s biosphere. Developing agricultural production systems able to conserve soil quality is essential to guarantee the current and future capacity of soil to provide goods and services. This study investigates the potential of microbial and biochemical parameters to be used as early and sensitive soil quality indicators. Their ability to differentiate plots under contrasting fertilization regimes is evaluated based also on their sensitivity to seasonal fluctuations of environmental conditions and on their relationship with soil chemical parameters. Further, the study addresses some of the critical methodological aspects of microplate-based fluorimetric enzyme assays, in order to optimize assay conditions and evaluate their suitability to be used as a toll to asses soil quality. The study was based on a long-term field experiment established in 1966 in the Po valley (Italy). The soil was cropped with maize (Z. mays L.) and winter wheat (T. aestivum L.) and received no organic fertilization, crop residue or manure, in combination with increasing levels of mineral N fertilizer. The soil microbiota responded to manure amendment increasing it biomass and activity and changing its community composition. Crop residue effect was much more limited. Mineral N fertilization stimulated crop residue mineralization, shifted microbial community composition and influenced N and P cycling enzyme activities. Seasonal fluctuations of environmental factors affected the soil microbiota. However microbial and biochemical parameters seasonality did not hamper the identification of fertilization-induced effects. Soil microbial community abundance, function and composition appeared to be strongly related to soil organic matter content and composition, confirming the close link existing between these soil quality indicators. Microplate-based fluorimetric enzyme assays showed potential to be used as fast and throughput toll to asses soil quality, but required proper optimization of the assay conditions for a precise estimation of enzymes maximum potential activity.

Physical land degradation and loss of soil fertility: soil structural stability and bio-physical indicators

This study investigates the changes in soil fertility due to the different aggregate breakdown mechanisms and it analyses their relationships in different soil-plant systems, using physical aggregates behavior and organic matter (OM) changes as indicators. Three case studies were investigated: i) an organic agricultural soil, where a combined method, aimed to couple aggregate stability to nutrients loss, were tested; ii) a soil biosequence, where OM chemical characterisation and fractionation of aggregates on the basis of their physical behaviour were coupled and iii) a soils sequence in different phytoclimatic conditions, where isotopic C signature of separated aggregates was analysed. In agricultural soils the proposed combined method allows to identify that the severity of aggregate breakdown affected the quantity of nutrients lost more than nutrients availability, and that P, K and Mg were the most susceptible elements to water abrasion, while C and N were mainly susceptible to wetting. In the studied Chestnut-Douglas fir biosequence, OM chemical properties affected the relative importance of OM direct and indirect mechanisms (i.e., organic and organic-metallic cements, respectively) involved in aggregate stability and nutrient losses: under Douglas fir, high presence of carboxylate groups enhanced OM-metal interactions and stabilised aggregates; whereas under Chestnut, OM directly acted and fresh, more C-rich OM was preserved. OM direct mechanism seemed to be more efficient in C preservation in aggregates. The 13C natural abundance approach showed that, according to phytoclimatic conditions, stable macroaggregates can form both around partially decomposed OM and by organic-mineral interactions. In topsoils, aggregate resistance enhanced 13C-rich OM preservation, but in subsoils C preservation was due to other mechanisms, likely OM-mineral interactions. The proposed combined approach seems to be useful in the understanding of C and nutrients fate relates to water stresses, and in future research it could provide new insights into the complexity of soil biophysical processes.