Eficiência das unidades de saúde familiar na diabetes – uma abordagem por Data Envelopment Analysis

Dissertação de Mestrado, Gestão de Unidades de Saúde, Faculdade de Economia, Universidade do Algarve, 2016

Transcatheter Closure of Atrial Septal Defects in a Center With Limited Resources: Outcomes and Short Term Follow-Up

Background: Transcatheter closure of atrial septal defects (ASD) has been accepted world-wide as an alternative to surgical closure with excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD mostly in the developing world where resources are limited. Objectives: To report the outcomes and short term follow-up of transcatheter closure of ASD over a 12-year period at our institution with limited resources. Patients and Methods: This retrospective study included all patients with the diagnosis of secundum ASD and significant shunting (Qp/Qs > 1.5:1) as well as dilated right atrium and right ventricle who had transcatheter closure at Integrated Cardiovascular Center (PJT), Dr. Cipto Mangunkusumo Hospital between October 2002 and October 2014. One hundred fifty-two patients enrolled in this study were candidates for device closure. Right and left heart cardiac catheterization was performed before the procedure. All patients underwent physical examination, ECG, chest X-ray and transthoracal echocardiography (TTE) prior to device implantation. Results: A total of 152 patients with significant ASD underwent device implantation. Subjects’ age ranged from 0.63 to 69.6 years, with median 9.36 years and mean 16.30 years. They consisted of 33 (21.7%) males and 119 (78.3%) females, with mean body weight of 29.9 kg (range 8 to 75; SD 18.2). The device was successfully implanted in 150 patients where the majority of cases received the Amplatzer septal occluder (147/150; 98%) and the others received the Heart Lifetech ASD occluder (3/150, 2%), whereas two other cases were not suitable for device closure and we decided for surgical closure. The mean ASD size was 19.75 (range 14 - 25) mm. During the procedure, 5 (4.9%) patients had bradycardia and 3 (2.9%) patients had supraventricular tachycardia (SVT), all of which resolved. Conclusions: In our center with limited facilities and manpower, transcatheter closure of atrial septal defect was effective and safe as an alternative treatment to surgery. The outcome and short-term follow-up revealed excellent results, but long-term follow-up is needed.

Trajetos cênicos do grupo parafolclórico da UFRN:que dança é essa?

This paper aims at studying UFRN Parafolclórico Group, whose aesthetic formation is subjected to our analysis, specially at its two last performances, that is, Flor do Lírio (Lily Flower), 2004, and Debaixo do Barro do Chão (Under the Mud of the Ground), 2008. Three targets are envisaged here: to analyze the aesthetic ideas backing Parafolclórico Group exhibitions; to evaluate how their many folk elements interact with different artist languages in order to compose a certain choreography; and finally, to identify the aesthetic conformation placed behind the two different choreographs of the last performances, their trends and innermost features that differentiate them. In accordance with the Analysis of Contents (BARDIN, 2006), interviews have been made with the choreographers and the staff of the spectacles, resulting in elucidating answers to the understanding of their thematic axis. On the first chapter we called attention to motivating subjects as recollection, personal experiences, bibliography research, research in loco regarded as propelling forces of the creative works. Herein, folk culture is depicted as a dynamic process opening a frank dialogue with contemporary events and reinforcing their continuity. On the second chapter, we approached the aesthetic conformation and the scenic elements (costumes, light, scenario, make-up), integrating the studied spectacles and disseminating folk songs in various ways. As what concerns the subjects discourse, we have obtained support in authors like Robatto (1994); Lobo; Navas (2008); Burke (1989); Canclini (2006); Dufrenne (2005); Medeiros (2005); Pavis (2005); Silva (2005), among others. Those authors have provided us with an indispensable theoretic support which, added to the interviews, convinced us that the Parafolclórico Group s aesthetic conception tends to identify itself with the artist languages and other techniques of that Group. It also made sure that the Group s course aims at an aesthetic conception which is not limited to popular culture manifestations, like dance, but admits to play with other media in order to communicate its art. In view of this situation, we arrived to two conclusions: first: the group s interchanges emphasize the dynamic character of popular culture which, by establishing contacts with different realities, receives influences capable of extending its own continuity; second: the contemporary state of arts also improves multiple interchanges opening way, so, for many accomplishments in their field. Therefore, UFRN Parafolclórico Group inserts itself in the contemporary scenery by performing new evaluations of the popular dances as long as it puts them in contact with different technical, aesthetic, artist and culture combinations

Dynamics of Granular Crystals with Elastic-Plastic Contacts

We study the behavior of granular crystals subjected to impact loading that creates plastic deformation at the contacts between constituent particles. Granular crystals are highly periodic arrangements of spherical particles, arranged into densely packed structures resembling crystals. This special class of granular materials has been shown to have unique dynamics with suggested applications in impact protection. However, previous work has focused on very low amplitude impacts where every contact point can be described using the Hertzian contact law, valid only for purely elastic deformation. In this thesis, we extend previous investigation of the dynamics of granular crystals to significantly higher impact energies more suitable for the majority of applications. Additionally, we demonstrate new properties specific to elastic-plastic granular crystals and discuss their potential applications as well. We first develop a new contact law to describe the interaction between particles for large amplitude compression of elastic-plastic spherical particles including a formulation for strain-rate dependent plasticity. We numerically and experimentally demonstrate the applicability of this contact law to a variety of materials typically used in granular crystals. We then extend our investigation to one-dimensional chains of elastic-plastic particles, including chains of alternating dissimilar materials. We show that, using the new elastic-plastic contact law, we can predict the speed at which impact waves with plastic dissipation propagate based on the material properties of the constituent particles. Finally, we experimentally and numerically investigate the dynamics of two-dimensional and three-dimensional granular crystals with elastic-plastic contacts. We first show that the predicted wave speeds for 1D granular crystals can be extended to 2D and 3D materials. We then investigate the behavior of waves propagating across oblique interfaces of dissimilar particles. We show that the character of the refracted wave can be predicted using an analog to Snell's law for elastic-plastic granular crystals and ultimately show how it can be used to design impact guiding "lenses" for mitigation applications.

Design and Applications of a Decade-Spanning Terahertz Frequency Comb Spectrometer: Doppler-limited Rotational Spectroscopy of Methanol and Methanol-OD

This thesis details the design and applications of a terahertz (THz) frequency comb spectrometer. The spectrometer employs two offset locked Ti:Sapphire femtosecond oscillators with repetition rates of approximately 80 MHz, offset locked at 100 Hz to continuously sample a time delay of 12.5 ns at a maximum time delay resolution of 15.6 fs. These oscillators emit continuous pulse trains, allowing the generation of a THz pulse train by the master, or pump, oscillator and the sampling of this THz pulse train by the slave, or probe, oscillator via the electro-optic effect. Collecting a train of 16 consecutive THz pulses and taking the Fourier transform of this pulse train produces a decade-spanning frequency comb, from 0.25 to 2.5 THz, with a comb tooth width of 5 MHz and a comb tooth spacing of ~80 MHz. This frequency comb is suitable for Doppler-limited rotational spectroscopy of small molecules. Here, the data from 68 individual scans at slightly different pump oscillator repetition rates were combined, producing an interleaved THz frequency comb spectrum, with a maximum interval between comb teeth of 1.4 MHz, enabling THz frequency comb spectroscopy.

The accuracy of the THz frequency comb spectrometer was tested, achieving a root mean square error of 92 kHz measuring selected absorption center frequencies of water vapor at 10 mTorr, and a root mean square error of 150 kHz in measurements of a K-stack of acetonitrile. This accuracy is sufficient for fitting of measured transitions to a model Hamiltonian to generate a predicted spectrum for molecules of interest in the fields of astronomy and physical chemistry. As such, the rotational spectra of methanol and methanol-OD were acquired by the spectrometer. Absorptions from 1.3 THz to 2.0 THz were compared to JPL catalog data for methanol and the spectrometer achieved an RMS error of 402 kHz, improving to 303 kHz when excluding low signal-to-noise absorptions. This level of accuracy compares favorably with the ~100 kHz accuracy achieved by JPL frequency multiplier submillimeter spectrometers. Additionally, the relative intensity performance of the THz frequency comb spectrometer is linear across the entire decade-spanning bandwidth, making it the preferred instrument for recovering lineshapes and taking absolute intensity measurements in the THz region. The data acquired by the Terahertz Frequency Comb Spectrometer for methanol-OD is of comparable accuracy to the methanol data and may be used to refine the fit parameters for the predicted spectrum of methanol-OD.

African swine fever virus transmission cycles in Central Europe: evaluation of wild boar-soft tick contacts through detection of antibodies against Ornithodoros erraticus saliva antigen.

BACKGROUND African swine fever (ASF) is one of the most complex viral diseases affecting both domestic and wild pigs. It is caused by ASF virus (ASFV), the only DNA virus which can be efficiently transmitted by an arthropod vector, soft ticks of the genus Ornithodoros. These ticks can be part of ASFV-transmission cycles, and in Europe, O. erraticus was shown to be responsible for long-term maintenance of ASFV in Spain and Portugal. In 2014, the disease has been reintroduced into the European Union, affecting domestic pigs and, importantly, also the Eurasian wild boar population. In a first attempt to assess the risk of a tick-wild boar transmission cycle in Central Europe that would further complicate eradication of the disease, over 700 pre-existing serum samples from wild boar hunted in four representative German Federal States were investigated for the presence of antibodies directed against salivary antigen of Ornithodoros erraticus ticks using an indirect ELISA format. RESULTS Out of these samples, 16 reacted with moderate to high optical densities that could be indicative of tick bites in sampled wild boar. However, these samples did not show a spatial clustering (they were collected from distant geographical regions) and were of bad quality (hemolysis/impurities). Furthermore, all positive samples came from areas with suboptimal climate for soft ticks. For this reason, false positive reactions are likely. CONCLUSION In conclusion, the study did not provide stringent evidence for soft tick-wild boar contact in the investigated German Federal States and thus, a relevant involvement in the epidemiology of ASF in German wild boar is unlikely. This fact would facilitate the eradication of ASF in the area, although other complex relations (wild boar biology and interactions with domestic pigs) need to be considered.

Isolating the photovoltaic junction: atomic layer deposited TiO2-RuO2 alloy Schottky contacts for silicon photoanodes

We synthesized nanoscale TiO2-RuO2 alloys by atomic layer deposition (ALD) that possess a high work function and are highly conductive. As such, they function as good Schottky contacts to extract photogenerated holes from n-type silicon while simultaneously interfacing with water oxidation catalysts. The ratio of TiO2 to RuO2 can be precisely controlled by the number of ALD cycles for each precursor. Increasing the composition above 16% Ru sets the electronic conductivity and the metal work function. No significant Ohmic loss for hole transport is measured as film thickness increases from 3 to 45 nm for alloy compositions >= 16% Ru. Silicon photoanodes with a 2 nm SiO2 layer that are coated by these alloy Schottky contacts having compositions in the range of 13-46% Ru exhibit average photovoltages of 525 mV, with a maximum photovoltage of 570 mV achieved. Depositing TiO2-RuO2 alloys on nSi sets a high effective work function for the Schottky junction with the semiconductor substrate, thus generating a large photovoltage that is isolated from the properties of an overlying oxygen evolution catalyst or protection layer.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. Selection criteria: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Main results: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the service. Authors' conclusions: There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.

Airport directory : list of airport contacts

This document is a list of contacts for each airport in South Carolina, with address, company or agency affiliation, phone number, fax number, and title for each contact.

Airport directory : list of airport contacts

This document is a list of contacts for each airport in South Carolina, with address, company or agency affiliation, phone number, fax number, and title for each contact.

Limited mid-water scavenging of trawl discards

The consumption or scavenging of fish in the water column at depths from 75 to 275 m in Algarve (southern Portugal) trawl fishing grounds was evaluated. Longlines were used to suspend baits throughout the water column while electric fishing reels were used to simulate sinking discards. Eighteen species were caught, with higher catch rates near the surface than near the bottom. However, scavenging rates were generally highest near the bottom and lowest in the middle of the water column. At depths less than 100 m the majority or all the fish were scavenged throughout the water column, while at depths greater than 200 m most of the fish were untouched after periods of time greater than would be required for them to sink to the bottom. Since other studies have shown that most small fish discards are scavenged at the surface by sea birds and most of the discarded species that sink are either too large or not attractive to pelagic predators, these results suggest that mid-water scavenging of trawl discards in deep water is relatively unimportant.

Assessing mackerel scad, Decapterus macarellus, in Cape Verde: using a Bayesian approach to biomass dynamic modelling in a data-limited situation

The fisheries for mackerel scad, Decapterus macarellus, are particularly important in Cape Verde, constituting almost 40% of total catches at the peak of the fishery in 1997 and 1998 ( 3700 tonnes). Catches have been stable at a much lower level of about 2 100 tonnes in recent years. Given the importance of mackerel scad in terms of catch weight and local food security, there is an urgent need for updated assessment. Stock assessment was carried out using a Bayesian approach to biomass dynamic modelling. In order to tackle the problem of a non-informative CPUE series, the intrinsic rate of increase, r, was estimated separately, and the ratio B-0/X, initial biomass relative to carrying capacity, was assumed based on available information. The results indicated that the current level of fishing is sustainable. The probability of collapse is low, particularly in the short-term, and it is likely that biomass may increase further above B-msy, indicating a healthy stock level. It would appear that it is relatively safe to increase catches even up to 4000 tonnes. However, the marginal posterior of r was almost identical to the prior, indicating that there is relatively low information content in CPUE. This was also the case in relation to B-0/X There have been substantial increases in fishing efficiency, which have not been adequately captured by the measure used for effort (days or trips), implying that the results may be overly optimistic and should be considered preliminary. (c) 2006 Elsevier B.V. All rights reserved.

Petrofac International Limited: el mercadeo interno, una estrategia efectiva en el manejo de personal

Como futuros administrados es importante recordar que nuestra función no será únicamente crear una empresa y generar constantemente ingresos. Esto es una de tantas tareas que tiene una persona que se encamina por crear o ser parte de una empresa, sea grande o pequeña siempre existirán variables que con los años se han convertido más y más indispensables en los procesos de este recorrido. El tema principal de nuestro estudio de caso es entender el concepto del endomarketing o como muchos lo conocen marketing interno; en pocas palabras es algo que por años se ha visto su efectividad en la productividad y satisfacción de los empleados. Google es una de las multinacionales más grandes del mundo, que el ultimo reconocimiento fue por parte de uno de los ranking más influyentes “The World’s Billionaries” ocupando como el CEO de la compañía Larry Page el puesto #12 , que por años ha sabido invertir en su recurso más importante que son sus empleados. En una entrevista con la revista Fortune, Larry exclama que “es importante que la empresa sea una familia, que las personas sientan que son parte de la empresa, y que la empresa es como una familia para ellos. Cuando se trata a las personas de esa manera, se obtiene una mejor productividad”. Con este pequeño ejemplo e idea de cómo una de las marcas más influyentes en el mundo ha fortalecido su mejor recurso por años el cual le ha remunerado con el éxito que tiene hoy en día. Entonces es como el mercadeo interno o endomarketing siendo uno de los conceptos tratados en el mercadeo en general hoy en día, logrando meterse como un modelo de negocio en la mayoría de empresas que existen hoy. Este es uno de los motivos que nos motivó para desarrollar este estudio de caso que verán a continuación, el cual se basa en la investigación y análisis de variables que comprenden a la empresa Petrofac, y si bien ha sabido implementar el concepto en sus procesos diarios. El estudio de caso describe como a través de los años ha sabido implementar con éxito la herramienta de evaluación y análisis del mercado interno a los empleados que constituyen hoy en día Petrofac International Limited. Abarcaremos primero con los objetivos del estudio, seguido del inicio y crecimiento de la empresa en los últimos años, en que países tiene presencia y cuáles son sus proyectos más importantes hoy en día. El estudio de caso será implementado por un tipo de investigación descriptiva, que con la recopilación de suficiente información tanto cuantitativa como cualitativa nos ira fortaleciendo la hipótesis principal, usaremos datos estadísticos que serán recopilados de encuestas, entrevistas y focus group. Al final con el análisis y a las conclusiones que lleguemos se busca demostrar el impacto positivo que ha tenido los empleados de diferentes países y de diferentes culturas que poco a poco han influenciado a la empresa para alcanzar el éxito que ha logrado hasta ahora, y de la misma forma como la empresa ha influenciado en cada una de las vidas de estas personas sin importar el lugar en el que estén laborando, siempre la empresa busca que se sientan parte de ella. Como resultados generales, se obtienen argumentos que sustentan que la implementación del mercadeo interno le permite a la empresa generar ventajas competitivas y dinámicas, que son desarrolladas internamente para un futuro reflejarlas ante los clientes externos. El estudio permitió concluir que el mercadeo interno debe ser una estrategia de comunicación dentro de una empresa convirtiéndose de primera necesidad para la compañía, pues los beneficios que genera son cada vez más necesarios para cada área que abarca el negocio.

Protein cutoff scanning: a comparative analysis of cutoff dependent and cutoff free methods for prospecting contacts in proteins.

In this study, we carried out a comparative analysis between two classical methodologies to prospect residue contacts in proteins: the traditional cutoff dependent (CD) approach and cutoff free Delaunay tessellation (DT). In addition, two alternative coarse-grained forms to represent residues were tested: using alpha carbon (CA) and side chain geometric center (GC). A database was built, comprising three top classes: all alpha, all beta, and alpha/beta. We found that the cutoff value? at about 7.0 A emerges as an important distance parameter.? Up to 7.0 A, CD and DT properties are unified, which implies that at this distance all contacts are complete and legitimate (not occluded). We also have shown that DT has an intrinsic missing edges problem when mapping the first layer of neighbors. In proteins, it may produce systematic errors affecting mainly the contact network in beta chains with CA. The almost-Delaunay (AD) approach has been proposed to solve this DT problem. We found that even AD may not be an advantageous solution. As a consequence, in the strict range up ? to 7.0 A, the CD approach revealed to be a simpler, more complete, and reliable technique than DT or AD. Finally, we have shown that coarse-grained residue representations may introduce bias in the analysis of neighbors in cutoffs up to ? 6.8 A, with CA favoring alpha proteins and GC favoring beta proteins. This provides an additional argument pointing to ? the value of 7.0 A as an important lower bound cutoff to be used in contact analysis of proteins.

An investigation of contact transmission of methicillin-resistant staphylococcus aureus

Hand hygiene is critical in the healthcare setting and it is believed that methicillin-resistant Staphylococcus aureus (MRSA), for example, is transmitted from patient to patient largely via the hands of health professionals. A study has been carried out at a large teaching hospital to estimate how often the gloves of a healthcare worker are contaminated with MRSA after contact with a colonized patient. The effectiveness of handwashing procedures to decontaminate the health professionals' hands was also investigated, together with how well different healthcare professional groups complied with handwashing procedures. The study showed that about 17% (9–25%) of contacts between a healthcare worker and a MRSA-colonized patient results in transmission of MRSA from a patient to the gloves of a healthcare worker. Different health professional groups have different rates of compliance with infection control procedures. Non-contact staff (cleaners, food services) had the shortest handwashing times. In this study, glove use compliance rates were 75% or above in all healthcare worker groups except doctors whose compliance was only 27%.