Perspectives of clinical handover processes: a multi-site survey across different health professionals

AIMS AND OBJECTIVES: To examine the perspectives of health professionals of different disciplines about clinical handover. BACKGROUND: Ineffective handovers can cause major problems relating to the lack of delivery of appropriate care. DESIGN: A prospective, cross-sectional design was conducted using a survey about clinical handover practices. METHODS: Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The sample comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Australia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover; their perceived effectiveness of clinical handover; involvement of patients and family members; health professionals' ability to confirm understanding and to clarify clinical information; role modelling behaviour of health professionals; training needs; adverse events encountered and possibilities for improvements. RESULTS: In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers. CONCLUSIONS: Complex barriers impeded the conduct of effective handovers, including insufficient opportunities for training, lack of role modelling, and lack of confidence and understanding about handover processes. RELEVANCE TO CLINICAL PRACTICE: Greater focus should be placed on creating opportunities for senior health professionals to act as role models. Sophisticated approaches should be implemented in training and education.

Financial comparisons of the artisanal fisheries in Urubupungá Complex in the middle Paraná River (Brazil)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Group size and composition of Guiana dolphins (Sotalia guianensis) (Van Bénèden, 1864) in the Paranaguá Estuarine Complex, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Guiana dolphins, Sotalia guianensis (Cetacea: Delphinidae), in the Paranaguá Estuarine Complex: insights on the use of area based on the photo-identification technique

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tuberculosis survey of free-ranging marsh deer (Blastocerus dichotomus) in Brazil

Esophageal-pharyngeal fluids from 53 free-ranging marsh deer (Blastocerus dichotomus) captured for a research program in the state of Mato Grosso do Sul, Brazil, were assayed for tuberculosis. Total DNA was extracted, amplified by polymerase chain reaction using specific primers for Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis, M. microti, and M. africanum), and observed by agarose gel electrophoresis stained with ethidium bromide. All samples were negative. This, along with necropsy and histopathology data, suggests that these animals are not shedding and probably do not have active disease.

Economic Survey of Latin America and the Caribbean 2007-2008: Macroeconomic policy and volatility

Includes bibliography

Economic Survey of Latin America and the Caribbean 2010-2011: Internacional integration and macroeconomic policy challenges amid global economic turmoil

Includes bibliography

At least two indigenous species of the Bemisia tabaci complex are present in Brazil

Bemisia tabaci is one of the most important global agricultural insect pests, being a vector of emerging plant viruses such as begomoviruses and criniviruses that cause serious problems in many countries. Although knowledge of the genetic diversity of B. tabaci populations is important for controlling this pest and understanding viral epidemics, limited information is available on this pest in Brazil. A survey was conducted in different locations of São Paulo and Mato Grosso states, and the phylogenetic relationships of B. tabaci individuals from 43 populations sampled from different hosts were analysed based on partial mitochondrial cytochrome oxidase 1 gene (mtCOI) sequences. According to the recently proposed classification of the B. tabaci complex, which employs the 3.5% mtCOI sequence divergence threshold for species demarcation, most of the specimens collected were found to belong to the Middle East-Asia Minor 1 species, which includes the invasive populations of the commonly known B biotype, within the Africa/Middle East/Asia Minor high-level group. Three specimens collected from Solanun gilo and Ipomoea sp. were grouped together and could be classified in the New World species that includes the commonly known A biotype. However, six specimens collected from Euphorbia heterophylla, Xanthium cavanillesii and Glycine maxima could not be classified into any of the 28 previously proposed species, although according to the 11% mtCOI sequence divergence threshold, they belong to the New World high-level group. These specimens were classified into a new recently proposed species named New World 2 that includes populations from Argentina. Middle East-Asia Minor 1, New World and New World 2 were differentiated by RFLP analysis of the mtCOI gene using TaqI enzyme. Taq I analysis in silico also differentiates these from Mediterranean species, thus making this method a convenient tool to determine population dynamics, especially critical for monitoring the presence of this exotic pest in Brazil. © 2012 Blackwell Verlag, GmbH.

Questionnaire and survey methodology. Saint Lucia: Survey of living condition and household budgets 2005/2006

This manual documents some of the material related to the Survey of Living Conditions and Household Budgets (SLC/HBS) conducted in Saint Lucia by the Kairi Consultants Limited and National Assessment Team between 2005 and 2006. The SLC/HBS is a sample survey which generates data on households and individuals in the country. The main objectives of this survey were (i) to collect information from households on their expenditure patterns, income and other characteristics and; (ii) to revise the 'average shopping basket' used in constructing the Consumer Price Index (CPI) for the country, and the relative weights of the items in the basket. The survey also provided valuable data for an assessment of the impact of socio-economic policies on the living conditions of the resident population in Saint Lucia. Further, data on households gathered in the survey also provide valuable inputs for the compilation of the country's National Accounts statistics relating to the household sector. This manual was developed by the Economic Commission for Latin America and the Caribbean (ECLAC) – Subregional Headquarters in the Caribbean as a supplementary document for the Caribbean Household Surveys Database (CHSD). The main components of this manual include survey methodology and the questionnaires used for data collection. The latter are included in the annex at the end of the document. All information contained therein was provided by the Statistics Department in Saint Lucia. The ECLAC Subregional Headquarters for the Caribbean is pleased to acknowledge the Saint Lucia Statistics Department for graciously consenting to the use of their surveys and metadata under the project Improving Caribbean Household Surveys. Due recognition must also be given to the Statistics and Economics Projection Division at ECLAC (Santiago) who provided guidance in the standardization of the datasets and the creation of the Caribbean Household Surveys Databank.

Word sense disambiguation via high order of learning in complex networks

Complex networks have been employed to model many real systems and as a modeling tool in a myriad of applications. In this paper, we use the framework of complex networks to the problem of supervised classification in the word disambiguation task, which consists in deriving a function from the supervised (or labeled) training data of ambiguous words. Traditional supervised data classification takes into account only topological or physical features of the input data. On the other hand, the human (animal) brain performs both low- and high-level orders of learning and it has facility to identify patterns according to the semantic meaning of the input data. In this paper, we apply a hybrid technique which encompasses both types of learning in the field of word sense disambiguation and show that the high-level order of learning can really improve the accuracy rate of the model. This evidence serves to demonstrate that the internal structures formed by the words do present patterns that, generally, cannot be correctly unveiled by only traditional techniques. Finally, we exhibit the behavior of the model for different weights of the low- and high-level classifiers by plotting decision boundaries. This study helps one to better understand the effectiveness of the model. Copyright (C) EPLA, 2012

Geochemistry and Pb-207/Pb-206 zircon ages of granitoids from the southern portion of the Tamboril-Santa Quiteria granitic-migmatitic complex, Ceara Central Domain, Borborema Province (NE Brazil)

The Tamboril-Santa Quiteria Complex is an important Neoproterozoic granitic-migmatitic unit from the Ceara Central Domain that developed from ca. 650 to 610 Ma. In general the granitoids range in composition from diorite to granite with predominance (up to 85%) of granitic to monzogranitic composition with biotite as the main mafic AFM phase. Geochemical and Pb-207/Pb-206 evaporation zircon geochronology studies were applied in a group of these abundant monzogranitic rocks from the region of Novo Oriente in the southern portion of the Ceara Central Domain. In this area the granitoids are weakly peraluminous biotite granitoids and deformed biotite granitoids of high-K calc-alkaline and ferroan composition, which we interpreted as primary magmas (segregated diatexites) derived from the partial melting of crustal material. The close temporal relation of this magmatism with local eclogitic and regional high temperature metamorphism in Ceara Central Domain point out to an orogenic setting, arguably emplaced during the collisional stage. Subordinate coeval juvenile mantle incursions are also present. This crustally derived magmatism is the primary product of the continental thickening that resulted from the collision between the rocks represented by the Amazonian-West African craton (Sao Luiz cratonic fragment) to the northwest and the Paleoproterozoic-Archean basement of the Borborema Province to the southeast along the Transbrasiliano tectonic corridor. (C) 2011 Elsevier Ltd. All rights reserved.

Symmetry insights for design of supercomputer network topologies: roots and weights lattices

We present a family of networks whose local interconnection topologies are generated by the root vectors of a semi-simple complex Lie algebra. Cartan classification theorem of those algebras ensures those families of interconnection topologies to be exhaustive. The global arrangement of the network is defined in terms of integer or half-integer weight lattices. The mesh or torus topologies that network millions of processing cores, such as those in the IBM BlueGene series, are the simplest member of that category. The symmetries of the root systems of an algebra, manifested by their Weyl group, lends great convenience for the design and analysis of hardware architecture, algorithms and programs.

Post-trial access to study medication: a Brazilian e-survey with major stakeholders in clinical research

Objectives To analyse the perspective of clinical research stakeholders concerning post-trial access to study medication. Methods Questionnaires and informed consents were sent through e-mail to 599 ethics committee (EC) members, 290 clinical investigators (HIV/AIDS and Diabetes) and 53 sponsors in Brazil. Investigators were also asked to submit the questionnaire to their research patients. Two reminders were sent to participants. Results The response rate was 21%, 20% and 45% in EC, investigators and sponsors' groups, respectively. 54 patients answered the questionnaire through their doctors. The least informative item in the consent form was how to obtain the study medication after trial. If a benefit were demonstrated in the study, 60% of research participants and 35% of EC answered that all patients should continue receiving study medication after trial; 43% of investigators believed the medication should be given to participants, and 40% to subjects who participated and benefited from treatment. For 50% of the sponsors, study medication should be assured to participants who had benefited from treatment. The majority of responders answered that medication should be provided free by sponsors; investigators and sponsors believed the medication should be kept until available in the public health sector; EC members said that the patient should keep the benefit; patients answered that benefits should be assured for life. Conclusions Due to the study limitations, the results cannot be generalised; however, the data can contribute to discussion of this complex topic through analysing the views of stakeholders in clinical research in Brazil.

Birth in Brazil: national survey into labour and birth

Background: Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. Methods: Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. Discussion: This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.

Milky Way demographics with the VVV survey I. The 84-million star colour-magnitude diagram of the Galactic bulge

Context. The Milky Way (MW) bulge is a fundamental Galactic component for understanding the formation and evolution of galaxies, in particular our own. The ESO Public Survey VISTA Variables in the Via Lactea is a deep near-IR survey mapping the Galactic bulge and southern plane. Particularly for the bulge area, VVV is covering similar to 315 deg(2). Data taken during 2010 and 2011 covered the entire bulge area in the JHKs bands. Aims. We used VVV data for the whole bulge area as a single and homogeneous data set to build for the first time a single colour-magnitude diagram (CMD) for the entire Galactic bulge. Methods. Photometric data in the JHK(s) bands were combined to produce a single and huge data set containing 173 150 467 sources in the three bands, for the similar to 315 deg(2) covered by VVV in the bulge. Selecting only the data points flagged as stellar, the total number of sources is 84 095 284. Results. We built the largest colour-magnitude diagrams published up to date, containing 173.1+ million sources for all data points, and more than 84.0 million sources accounting for the stellar sources only. The CMD has a complex shape, mostly owing to the complexity of the stellar population and the effects of extinction and reddening towards the Galactic centre. The red clump (RC) giants are seen double in magnitude at b similar to -8 degrees-10 degrees, while in the inner part (b similar to -3 degrees) they appear to be spreading in colour, or even splitting into a secondary peak. Stellar population models show the predominance of main-sequence and giant stars. The analysis of the outermost bulge area reveals a well-defined sequence of late K and M dwarfs, seen at (J - K-s) similar to 0.7-0.9 mag and K-s greater than or similar to 14 mag. Conclusions. The interpretation of the CMD yields important information about the MW bulge, showing the fingerprint of its structure and content. We report a well-defined red dwarf sequence in the outermost bulge, which is important for the planetary transit searches of VVV. The double RC in magnitude seen in the outer bulge is the signature of the X-shaped MW bulge, while the spreading of the RC in colour, and even its splitting into a secondary peak, are caused by reddening effects. The region around the Galactic centre is harder to interpret because it is strongly affected by reddening and extinction.