Avaliação de Programas de Controle de Infecção relacionada a Assistência à Saúde de Hospitais

RESUMO Objetivo Avaliar os Programas de Controle de Infecção em hospitais do Paraná, considerando como hipótese desempenho geral mínimo de 75%. Método Estudo transversal de avaliação processual, por meio de instrumento previamente validado, composto por quatro indicadores que avaliam a estrutura técnico-operacional (PCET), as diretrizes operacionais (PCDO), o sistema de vigilância epidemiológica (PCVE) e as atividades de controle e prevenção (PCCP). O estudo foi realizado de 2013 a 2014 em 50 hospitais por amostra de acesso. Resultados A conformidade geral obtida foi 71,0% (23,88dp), sendo indicador PCET 79,4% (18,9dp); PCVE 76,0% (30,5dp); PCDO 65,5% (26,9dp); e PCCP 63,2%/ (39,5dp). Houve significância estatística para melhor desempenho dos PCIRAS a realização de auditorias internas (p=0,0099), certificação de qualidade (p=0,01949), enfermeiro exclusivo (p<0,0001), profissionais médicos contratados ou concursados (p=0,0005), maior carga horária de dedicação exclusiva dos médicos, 4 horas (p=0,001), maior tempo de experiência de médicos (p=0,0028) e enfermeiros (p=0,0094). Conclusão A conformidade geral desses programas não alcançou a hipótese inicialmente formulada, devido aos indicadores PCDO e PCCP. Desse modo, é possível considerar que os programas apresentavam adequação mínima para sua operacionalização e para realizar a vigilância epidemiológica de IRAS, mas estavam prejudicados quanto à insuficiência quantitativa e qualitativa de diretrizes operacionais (PCDO) e de ações para o controle e prevenção dessas infecções (PCCP).

Determinants of linear judgment: A meta-analysis of lens model studies

The mathematical representation of Brunswik s lens model has been usedextensively to study human judgment and provides a unique opportunity to conduct ameta-analysis of studies that covers roughly five decades. Specifically, we analyzestatistics of the lens model equation (Tucker, 1964) associated with 259 different taskenvironments obtained from 78 papers. In short, we find on average fairly high levelsof judgmental achievement and note that people can achieve similar levels of cognitiveperformance in both noisy and predictable environments. Although overall performancevaries little between laboratory and field studies, both differ in terms of components ofperformance and types of environments (numbers of cues and redundancy). An analysisof learning studies reveals that the most effective form of feedback is information aboutthe task. We also analyze empirically when bootstrapping is more likely to occur. Weconclude by indicating shortcomings of the kinds of studies conducted to date, limitationsin the lens model methodology, and possibilities for future research.

Fusion of data sets in multivariate linear regression with errors-in-variables

We consider the application of normal theory methods to the estimation and testing of a general type of multivariate regressionmodels with errors--in--variables, in the case where various data setsare merged into a single analysis and the observable variables deviatepossibly from normality. The various samples to be merged can differ on the set of observable variables available. We show that there is a convenient way to parameterize the model so that, despite the possiblenon--normality of the data, normal--theory methods yield correct inferencesfor the parameters of interest and for the goodness--of--fit test. Thetheory described encompasses both the functional and structural modelcases, and can be implemented using standard software for structuralequations models, such as LISREL, EQS, LISCOMP, among others. An illustration with Monte Carlo data is presented.

Equivalence of piecewise-linear approximation and Lagrangian relaxation for network revenue management

The network revenue management (RM) problem arises in airline, hotel, media,and other industries where the sale products use multiple resources. It can be formulatedas a stochastic dynamic program but the dynamic program is computationallyintractable because of an exponentially large state space, and a number of heuristicshave been proposed to approximate it. Notable amongst these -both for their revenueperformance, as well as their theoretically sound basis- are approximate dynamic programmingmethods that approximate the value function by basis functions (both affinefunctions as well as piecewise-linear functions have been proposed for network RM)and decomposition methods that relax the constraints of the dynamic program to solvesimpler dynamic programs (such as the Lagrangian relaxation methods). In this paperwe show that these two seemingly distinct approaches coincide for the network RMdynamic program, i.e., the piecewise-linear approximation method and the Lagrangianrelaxation method are one and the same.

A new compact linear programming formulation for choice network revenue management

The choice network revenue management model incorporates customer purchase behavioras a function of the offered products, and is the appropriate model for airline and hotel networkrevenue management, dynamic sales of bundles, and dynamic assortment optimization.The optimization problem is a stochastic dynamic program and is intractable. A certainty-equivalencerelaxation of the dynamic program, called the choice deterministic linear program(CDLP) is usually used to generate dyamic controls. Recently, a compact linear programmingformulation of this linear program was given for the multi-segment multinomial-logit (MNL)model of customer choice with non-overlapping consideration sets. Our objective is to obtaina tighter bound than this formulation while retaining the appealing properties of a compactlinear programming representation. To this end, it is natural to consider the affine relaxationof the dynamic program. We first show that the affine relaxation is NP-complete even for asingle-segment MNL model. Nevertheless, by analyzing the affine relaxation we derive a newcompact linear program that approximates the dynamic programming value function betterthan CDLP, provably between the CDLP value and the affine relaxation, and often comingclose to the latter in our numerical experiments. When the segment consideration sets overlap,we show that some strong equalities called product cuts developed for the CDLP remain validfor our new formulation. Finally we perform extensive numerical comparisons on the variousbounds to evaluate their performance.

Asymptotic robustness in multi-sample analysis of multivariate linear relations

Standard methods for the analysis of linear latent variable models oftenrely on the assumption that the vector of observed variables is normallydistributed. This normality assumption (NA) plays a crucial role inassessingoptimality of estimates, in computing standard errors, and in designinganasymptotic chi-square goodness-of-fit test. The asymptotic validity of NAinferences when the data deviates from normality has been calledasymptoticrobustness. In the present paper we extend previous work on asymptoticrobustnessto a general context of multi-sample analysis of linear latent variablemodels,with a latent component of the model allowed to be fixed across(hypothetical)sample replications, and with the asymptotic covariance matrix of thesamplemoments not necessarily finite. We will show that, under certainconditions,the matrix $\Gamma$ of asymptotic variances of the analyzed samplemomentscan be substituted by a matrix $\Omega$ that is a function only of thecross-product moments of the observed variables. The main advantage of thisis thatinferences based on $\Omega$ are readily available in standard softwareforcovariance structure analysis, and do not require to compute samplefourth-order moments. An illustration with simulated data in the context ofregressionwith errors in variables will be presented.

Controle integrado de espécies de Simulium (Diptera, Simuliidae) por Bacillus thuringiensis e manejos mecânicos no riacho e nos vertedouros de tanques de piscicultura, Almirante Tamandaré, Paraná, Brasil

No Riacho dos Padres na Chácara Evíssima, numa microempresa de agronegócio com criação de peixes e animais domésticos, área de lazer e salão de eventos, localizada na Região Metropolitana de Curitiba, os simulídeos em grande proliferação causaram sério impacto com as picadas a tal ponto que dificultaram o convívio habitual. De janeiro a agosto de 2002, coletou-se 24.021 pupas por meio das quais foram identificadas as espécies: Simulium inaequale, Simulium perflavum, Simulium pertinax com 85,98% e Simulium orbitale, Simulium subnigrum, Simulium distinctum e Simulium incrustatum com somente 14,02% de freqüência. O combate a estas populações iniciado em 28 de fevereiro terminou em 08 de agosto de 2002. O controle integrado consistiu na aplicação de biopesticida Bacillus thuringiensis var. israelensis (Bti) e em manejos mecânicos não só removendo os imaturos (ovos, larvas e pupas) por meio de escovação de vertedouros, mas também pela retirada de substratos naturais e antrópicos do leito. A densidade larvária média inicial, antes da aplicação de Bti no leito do riacho (75 m) e no último vertedouro, verificada em substratos antrópicos fitilhos (área 13.500 cm²), foi de 6,7 e 11,5 larvas/cm², respectivamente. Nestes habitats, o controle integrado com Bti de 1,77 a 2,09 mg/litro do ingrediente ativo, suplementado com manejos mecânicos, monitorado em substratos fitilhos (área 20.250 cm²), resultou em redução larvar de 72,61% a 99,97% e de 74,91% a 99,45%, respectivamente, nas vazões de 0,39 a 0,45 e de 0,38 a 0,43 m³/min. No primeiro vertedouro (área 5.110 cm²), porém, só com manejos mecânicos, atingiu-se a redução larvária de 53,81% a 99,59%. O controle efetuado reduziu as picadas hematófagas ao nível esperado, surtindo o efeito positivo almejado.

Finite sample nonparametric tests for linear regressions

We introduce several exact nonparametric tests for finite sample multivariatelinear regressions, and compare their powers. This fills an important gap inthe literature where the only known nonparametric tests are either asymptotic,or assume one covariate only.

Solving non-linear stochastic models by parameterizing expectations: An application to asset pricing with production

A new algorithm called the parameterized expectations approach(PEA) for solving dynamic stochastic models under rational expectationsis developed and its advantages and disadvantages are discussed. Thisalgorithm can, in principle, approximate the true equilibrium arbitrarilywell. Also, this algorithm works from the Euler equations, so that theequilibrium does not have to be cast in the form of a planner's problem.Monte--Carlo integration and the absence of grids on the state variables,cause the computation costs not to go up exponentially when the numberof state variables or the exogenous shocks in the economy increase. \\As an application we analyze an asset pricing model with endogenousproduction. We analyze its implications for time dependence of volatilityof stock returns and the term structure of interest rates. We argue thatthis model can generate hump--shaped term structures.

Fate of linear and supercoiled multinucleosomic templates during transcription.

Electron microscopy was used to monitor the fate of reconstituted nucleosome cores during in vitro transcription of long linear and supercoiled multinucleosomic templates by the prokaryotic T7 RNA polymerase and the eukaryotic RNA polymerase II. Transcription by T7 RNA polymerase disrupted the nucleosomal configuration in the transcribed region, while nucleosomes were preserved upstream of the transcription initiation site and in front of the polymerase. Nucleosome disruption was independent of the topology of the template, linear or supercoiled, and of the presence or absence of nucleosome positioning sequences in the transcribed region. In contrast, the nucleosomal configuration was preserved during transcription from the vitellogenin B1 promoter with RNA polymerase II in a rat liver total nuclear extract. However, the persistence of nucleosomes on the template was not RNA polymerase II-specific, but was dependent on another activity present in the nuclear extract. This was demonstrated by addition of the extract to the T7 RNA polymerase transcription reaction, which resulted in retention of the nucleosomal configuration. This nuclear activity, also found in HeLa cell nuclei, is heat sensitive and could not be substituted by nucleoplasmin, chromatin assembly factor (CAF-I) or a combination thereof. Altogether, these results identify a novel nuclear activity, called herein transcription-dependent chromatin stabilizing activity I or TCSA-I, which may be involved in a nucleosome transfer mechanism during transcription.

Seleção de Trichogramma spp., para o controle de Ecdytolopha aurantiana, com base na biologia e exigências térmicas

O objetivo deste trabalho foi avaliar o potencial de utilização de Trichogramma atopovirilia Oatman & Platner, 1983 e T. pretiosum Riley, 1879 como agentes de controle de Ecdytolopha aurantiana (Lima, 1927) (Lepidoptera: Tortricidae), importante praga da citricultura paulista. Foram realizados estudos de biologia em diferentes temperaturas, exigências térmicas e capacidade de parasitismo, visando fornecer subsídios a programas de controle biológico com estes parasitóides. A razão sexual não foi afetada pelas temperaturas estudadas (18, 20, 22, 25, 28, 30 e 32ºC), porém, a longevidade de fêmeas das duas espécies foi maior a 22 e 25ºC. Para a porcentagem de emergência e longevidade de fêmeas, a temperatura que tendeu a ser mais adequada foi a de 25ºC. A duração do período ovo-adulto para as duas espécies foi inversamente relacionada com o aumento da temperatura, sendo as exigências térmicas dessas espécies muito próximas, em torno de 108 GD. O hospedeiro natural, E. aurantiana, ou o alternativo, Anagasta kuehniella (Zeller, 1879) (Lepidoptera, Pyralidae), não afetaram o número de ovos parasitados por fêmea de Trichogramma. Porém, a porcentagem de parasitismo e o número de adultos emergidos por ovo, quando provenientes de ovos de E. aurantiana, foram maiores do que os criados sobre ovos de A. kuehniella. A porcentagem de emergência foi, no entanto, maior quando os parasitóides foram provenientes de ovos de A. kuehniella. As duas espécies de Trichogramma estudadas poderão ser testadas em campo para controle do bicho-furão-dos-citros, havendo uma indicação de que as exigências térmicas também podem servir como um bom parâmetro para seleção de espécies e/ou linhagens de Trichogramma, aliadas ao estudo de capacidade de parasitismo.