Contributions of ergonomics to the construction of bus drivers health and excellence in public transport and at work

This article is the product of research that analyzed the work of bus drivers of a public transportation company that is considered a benchmark reference in its field of operations, in which it strives to achieve operating excellence. Within this context, the authors sought to understand how such a company has managed to maintain a policy that is capable of reconciling quality public transport while also providing working conditions compatible with the professional development, comfort and health of its workers. Ergonomic work analysis and activity analysis were the guiding elements used in this study. Initial analyses indicate that the activity of drivers includes serving a population and providing mobility for it, which depends on driving the vehicle itself and on relationships with colleagues, users, pedestrians, drivers and others.

Applying the National Institute for Clinical Excellence criteria to patients treated with the Genous (TM) Bio-engineered R stent (TM): a sub-study of the e-HEALING (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth) worldwide registry

The National Institute for Clinical Excellence (NICE) guidelines recommend the use of bare-metal stents (BMS) in non-complex lesions with a low risk of restenosis (diameter a parts per thousand yen3 mm and lesion length a parts per thousand currency sign15 mm) and the use of drug-eluting stents (DES) in more complex lesions with a high risk of restenosis (diameter < 3.0 mm or lesion length > 15 mm). However, the guidelines were created based on studies evaluating BMS and DES only. We performed an analysis of patients undergoing non-urgent percutaneous coronary intervention with the novel endothelial cell capturing stent (ECS). The ECS is coated with CD34(+) antibodies that attract circulating endothelial progenitor cells to the stent surface, thereby accelerating the endothelialization of the stented area. We analyzed all patients enrolled in the worldwide e-HEALING registry that met the NICE criteria for either low-risk or high-risk lesions and were treated with a parts per thousand yen1 ECS. The main study outcome was target vessel failure (TVF) at 12-month follow-up, defined as the composite of cardiac death or MI and target vessel revascularization (TVR). A total of 4,241 patients were assessed in the current analysis. At 12-month follow-up, TVF occurred in 7.0% of the patients with low-risk lesions and in 8.8% of the patients with high-risk lesions (p = 0.045). When evaluating the diabetic patients versus the non-diabetic patients per risk group, no significant differences were found in TVF, MI or TVR in either risk group. The ECS shows good clinical outcomes in lesions carrying either a high or a low risk of restenosis according to the NICE guidelines with comparable rates of cardiac death, myocardial infarction, and stent thrombosis. The TVF rate with ECS was slightly higher in patients with high-risk lesions, driven by higher clinically driven TLR. The risk of restenosis with ECS in patients carrying high-risk lesions needs to be carefully considered relative to other risks associated with DES. Furthermore, the presence of diabetes mellitus did not influence the incidence of TVF in either risk group.

Development and validation of a paediatric long-bone fracture classification. A prospective multicentre study in 13 European paediatric trauma centres

BACKGROUND: The aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study. METHODS: Using the sequentially developed classification system, three samples of between 30 and 185 paediatric limb fractures from a pool of 2308 fractures documented in two multicenter studies were analysed in a blinded fashion by eight orthopaedic surgeons, on a total of 5 occasions. Intra- and interobserver reliability and accuracy were calculated. RESULTS: The reliability improved with successive simplification of the classification. The final version resulted in an overall interobserver agreement of κ = 0.71 with no significant difference between experienced and less experienced raters. CONCLUSIONS: In conclusion, the evaluation of the newly proposed classification system resulted in a reliable and routinely applicable system, for which training in its proper use may further improve the reliability. It can be recommended as a useful tool for clinical practice and offers the option for developing treatment recommendations and outcome predictions in the future.

Standard procedures for adults in accredited sleep medicine centres in Europe

The present paper describes standardized procedures within clinical sleep medicine. As such, it is a continuation of the previously published European guidelines for the accreditation of sleep medicine centres and European guidelines for the certification of professionals in sleep medicine, aimed at creating standards of practice in European sleep medicine. It is also part of a broader action plan of the European Sleep Research Society, including the process of accreditation of sleep medicine centres and certification of sleep medicine experts, as well as publishing the Catalogue of Knowledge and Skills for sleep medicine experts (physicians, non-medical health care providers, nurses and technologists), which will be a basis for the development of relevant educational curricula. In the current paper, the standard operational procedures sleep medicine centres regarding the diagnostic and therapeutic management of patients evaluated at sleep medicine centres, accredited according to the European Guidelines, are based primarily on prevailing evidence-based medicine principles. In addition, parts of the standard operational procedures are based on a formalized consensus procedure applied by a group of Sleep Medicine Experts from the European National Sleep Societies. The final recommendations for standard operational procedures are categorized either as 'standard practice', 'procedure that could be useful', 'procedure that is not useful' or 'procedure with insufficient information available'. Standard operational procedures described here include both subjective and objective testing, as well as recommendations for follow-up visits and for ensuring patients' safety in sleep medicine. The overall goal of the actual standard operational procedures is to further develop excellence in the practice and quality assurance of sleep medicine in Europe.

[Implementation of a routine gradual psycho-diagnostic programme in somatic rehabilitation centres - results of a pilot study]

STUDY AIM: A pilot study was conducted to implement and evaluate a routine gradual psycho-diagnostic programme to improve diagnostics and treatment of mental disorders in somatic rehabilitation centres. First of all, implementation strategies were acquired in trainings together with psychologists and physicians. The psycho-diagnostic programme consists of a screening instrument (PHQ-9) designed to permit time-effective detection of comorbid mental disorders. Besides evaluation of the training, the aim of the study was to analyze the extent to which it is possible to implement the routine gradual psycho-diagnostic programme in practice. Additionally, it was intended to identify beneficial and obstructive conditions for implementation. METHODOLOGY: The pilot study was conducted in two orthopaedic and one cardiological rehabilitation centre. The training was evaluated directly after its completion using a questionnaire. Three months after its implementation, the introduction of the psycho-diagnostic programme was evaluated using interviews with n=11 physicians and psychologists. RESULTS: The training was rated positively by the participants . Implementation of the entire gradual psycho-diagnostic programme was possible in one centre and to some degree in the other two. Beneficial for implementation were a frank organisational climate, sufficient time resources, and physicians' biopsychosocial understanding of disease. A dismissive attitude towards psycho-diagnostics, little communication between staff members, little perceived advantage for one's own work and fear to stigmatise patients by psychiatric diagnoses were obstructive. CONCLUSION: Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.

[Role of complementary medicine in type 1 diabetes mellitus in two Swiss centres]

Insulin replacement is the only effective treatment of type 1 Diabetes mellitus (T1DM). Nevertheless, many complementary treatments are in use for T1DM. In this study we assessed by questionnaire that out of 342 patients with T1DM, 48 (14%; 13.4% adult, 18.5% paediatric; 20 male, 28 female) used complementary medicine (CM) in addition to their insulin therapy. The purpose of the use of CM was to improve general well-being, ameliorate glucose homeostasis, reduce blood glucose levels as well as insulin doses, improve physical fitness, reduce the frequency of hypoglycaemia, and control appetite. The modalities most frequently used are cinnamon, homeopathy, magnesium and special beverages (mainly teas). Thus, good collaboration between health care professionals will allow optimal patient care.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Environmental assessment of low speed policies for motor vehicle mobility in city centres

streets in local residential areas in large cities, real traffic tests for pollutant emissions and fuel consumption have been carried out in Madrid city centre. Emission concentration and car activity were simultaneously measured by a Portable Emissions Measurement System. Real life tests carried out at different times and on different days were performed with a turbo-diesel engine light vehicle equipped with an oxidizer catalyst and using different driving styles with a previously trained driver. The results show that by reducing the speed limit from 50 km h-1 to 30 km h-1, using a normal driving style, the time taken for a given trip does not increase, but fuel consumption and NOx, CO and PM emissions are clearly reduced. Therefore, the main conclusion of this work is that reducing the speed limit in some narrow streets in residential and commercial areas or in a city not only increases pedestrian safety, but also contributes to reducing the environmental impact of motor vehicles and reducing fuel consumption. In addition, there is also a reduction in the greenhouse gas emissions resulting from the combustion of the fuel.

The role of a firm's absorptive capacity and the technology transfer process in clusters: How effective are technology centres in low-tech clusters?

This paper analyses how the internal resources of small- and medium-sized enterprises determine access (learning processes) to technology centres (TCs) or industrial research institutes (innovation infrastructure) in traditional low-tech clusters. These interactions basically represent traded (market-based) transactions, which constitute important sources of knowledge in clusters. The paper addresses the role of TCs in low-tech clusters, and uses semi-structured interviews with 80 firms in a manufacturing cluster. The results point out that producer–user interactions are the most frequent; thus, the higher the sector knowledge-intensive base, the more likely the utilization of the available research infrastructure becomes. Conversely, the sectors with less knowledge-intensive structures, i.e. less absorptive capacity (AC), present weak linkages to TCs, as they frequently prefer to interact with suppliers, who act as transceivers of knowledge. Therefore, not all the firms in a cluster can fully exploit the available research infrastructure, and their AC moderates this engagement. In addition, the existence of TCs is not sufficient since the active role of a firm's search strategies to undertake interactions and conduct openness to available sources of knowledge is also needed. The study has implications for policymakers and academia.

Heterogeneous architecture for the optimization of large-scale graph processing data centres

Con el auge del Cloud Computing, las aplicaciones de proceso de datos han sufrido un incremento de demanda, y por ello ha cobrado importancia lograr m�ás eficiencia en los Centros de Proceso de datos. El objetivo de este trabajo es la obtenci�ón de herramientas que permitan analizar la viabilidad y rentabilidad de diseñar Centros de Datos especializados para procesamiento de datos, con una arquitectura, sistemas de refrigeraci�ón, etc. adaptados. Algunas aplicaciones de procesamiento de datos se benefician de las arquitecturas software, mientras que en otras puede ser m�ás eficiente un procesamiento con arquitectura hardware. Debido a que ya hay software con muy buenos resultados en el procesamiento de grafos, como el sistema XPregel, en este proyecto se realizará una arquitectura hardware en VHDL, implementando el algoritmo PageRank de Google de forma escalable. Se ha escogido este algoritmo ya que podr��á ser m�ás eficiente en arquitectura hardware, debido a sus características concretas que se indicaráan m�ás adelante. PageRank sirve para ordenar las p�áginas por su relevancia en la web, utilizando para ello la teorí��a de grafos, siendo cada página web un vértice de un grafo; y los enlaces entre páginas, las aristas del citado grafo. En este proyecto, primero se realizará un an�álisis del estado de la técnica. Se supone que la implementaci�ón en XPregel, un sistema de procesamiento de grafos, es una de las m�ás eficientes. Por ello se estudiará esta �ultima implementaci�ón. Sin embargo, debido a que Xpregel procesa, en general, algoritmos que trabajan con grafos; no tiene en cuenta ciertas caracterí��sticas del algoritmo PageRank, por lo que la implementaci�on no es �optima. Esto es debido a que en PageRank, almacenar todos los datos que manda un mismo v�értice es un gasto innecesario de memoria ya que todos los mensajes que manda un vértice son iguales entre sí e iguales a su PageRank. Se realizará el diseño en VHDL teniendo en cuenta esta caracter��ística del citado algoritmo,evitando almacenar varias veces los mensajes que son iguales. Se ha elegido implementar PageRank en VHDL porque actualmente las arquitecturas de los sistemas operativos no escalan adecuadamente. Se busca evaluar si con otra arquitectura se obtienen mejores resultados. Se realizará un diseño partiendo de cero, utilizando la memoria ROM de IPcore de Xillinx (Software de desarrollo en VHDL), generada autom�áticamente. Se considera hacer cuatro tipos de módulos para que as�� el procesamiento se pueda hacer en paralelo. Se simplificar�á la estructura de XPregel con el fin de intentar aprovechar la particularidad de PageRank mencionada, que hace que XPregel no le saque el m�aximo partido. Despu�és se escribirá el c�ódigo, realizando una estructura escalable, ya que en la computación intervienen millones de páginas web. A continuación, se sintetizar�á y se probará el código en una FPGA. El �ultimo paso será una evaluaci�ón de la implementaci�ón, y de posibles mejoras en cuanto al consumo.

Promotion of intangible heritage as a tool to strengthen revitalisation of historic centres: the case of de Monumenta Programme in the City of Porto Alegre (Rio Grande do Sul State) Brazil

The preservation of tangible cultural heritage does not guarantee effective revitalisation of urban historic areas as a whole. The legacy of our history consists not only of paintings, sculptures, architectural monuments and public spaces, but also the safeguarding of immaterial aspects of social life, such as oral traditions, rituals, practices, knowledge and craft skills. From 1999 to 2013, 26 Brazilian cities benefited from the Monumenta Programme - a national cultural policy that involved institutions, the private sector and the local community. The purpose of the programme was to stimulate economic growth and increase cultural and social development of the historic centres. Moreover, it sought to increase the number of residents in the benefited areas as defined in its agenda (IDB, 1999; MinC & Programa Monumenta, 2006). Using the Historic Centre of Porto Alegre as a case study, this paper examines how this cultural programme enables demographic change through the promotion of intangible cultural heritage, e.g. by supporting educational projects. The demographic flow was analysed using the microdata of the Populations Censuses (years 2000 and 2010) available from the Brazilian Institute of Geography and Statistics. The results showed an increase in low-income residents the areas that participated in the programme. This increase may have been motivated by a set of cultural-educational projects under the auspices of the Monumenta Programme. The retraining of artisans of Alfândega Square, the training of low-income youth for restoration work and the implementation of the "Black Route Museum in Porto Alegre" (Bicca, 2010) are just some examples of what was done to improve the local community's economy, to encourage social cohesion and to enhance the awareness of cultural diversity as a positive and essential value in society.

The exaptive excellence of spandrels as a term and prototype

In 1979, Lewontin and I borrowed the architectural term “spandrel” (using the pendentives of San Marco in Venice as an example) to designate the class of forms and spaces that arise as necessary byproducts of another decision in design, and not as adaptations for direct utility in themselves. This proposal has generated a large literature featuring two critiques: (i) the terminological claim that the spandrels of San Marco are not true spandrels at all and (ii) the conceptual claim that they are adaptations and not byproducts. The features of the San Marco pendentives that we explicitly defined as spandrel-properties—their necessary number (four) and shape (roughly triangular)—are inevitable architectural byproducts, whatever the structural attributes of the pendentives themselves. The term spandrel may be extended from its particular architectural use for two-dimensional byproducts to the generality of “spaces left over,” a definition that properly includes the San Marco pendentives. Evolutionary biology needs such an explicit term for features arising as byproducts, rather than adaptations, whatever their subsequent exaptive utility. The concept of biological spandrels—including the examples here given of masculinized genitalia in female hyenas, exaptive use of an umbilicus as a brooding chamber by snails, the shoulder hump of the giant Irish deer, and several key features of human mentality—anchors the critique of overreliance upon adaptive scenarios in evolutionary explanation. Causes of historical origin must always be separated from current utilities; their conflation has seriously hampered the evolutionary analysis of form in the history of life.