Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

A type system for access control in an object-oriented language

Trabalho apresentado no âmbito do Mestrado em Engenharia Informática, como requisito parcial para obtenção do grau de Mestre em Engenharia Informática

National Immunization Program: Computerized System as a tool for new challenges

The scope and coverage of the Brazilian Immunization Program can be compared with those in developed countries because it provides a large number of vaccines and has a considerable coverage. The increasing complexity of the program brings challenges regarding its development, high coverage levels, access equality, and safety. The Immunization Information System, with nominal data, is an innovative tool that can more accurately monitor these indicators and allows the evaluation of the impact of new vaccination strategies. The main difficulties for such a system are in its implementation process, training of professionals, mastering its use, its constant maintenance needs and ensuring the information contained remain confidential. Therefore, encouraging the development of this tool should be part of public health policies and should also be involved in the three spheres of government as well as the public and private vaccination services.

Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Dynamic network data envelopment analysis for university hospitals evaluation

ABSTRACT OBJECTIVE To develop an assessment tool to evaluate the efficiency of federal university general hospitals. METHODS Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013. RESULTS The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research. CONCLUSIONS The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.

Assessment of data-driven modeling strategies for water delivery canals

Conferência: CONTROLO’2012 - 16-18 July 2012 - Funchal

Real time mobile system for support in firefighting environments

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

People counting system using existing surveillance video camera

The Casa da Música Foundation, responsible for the management of Casa da Música do Porto building, has the need to obtain statistical data related to the number of building’s visitors. This information is a valuable tool for the elaboration of periodical reports concerning the success of this cultural institution. For this reason it was necessary to develop a system capable of returning the number of visitors for a requested period of time. This represents a complex task due to the building’s unique architectural design, characterized by very large doors and halls, and the sudden large number of people that pass through them in moments preceding and proceeding the different activities occurring in the building. To achieve the technical solution for this challenge, several image processing methods, for people detection with still cameras, were first studied. The next step was the development of a real time algorithm, using OpenCV libraries and computer vision concepts,to count individuals with the desired accuracy. This algorithm includes the scientific and technical knowledge acquired in the study of the previous methods. The themes developed in this thesis comprise the fields of background maintenance, shadow and highlight detection, and blob detection and tracking. A graphical interface was also built, to help on the development, test and tunning of the proposed system, as a complement to the work. Furthermore, tests to the system were also performed, to certify the proposed techniques against a set of limited circumstances. The results obtained revealed that the algorithm was successfully applied to count the number of people in complex environments with reliable accuracy.

Recomendações personalizadas de alunos em sistemas de hipermédia adaptativa educacional usando Data Mining

O aumento de tecnologias disponíveis na Web favoreceu o aparecimento de diversas formas de informação, recursos e serviços. Este aumento aliado à constante necessidade de formação e evolução das pessoas, quer a nível pessoal como profissional, incentivou o desenvolvimento área de sistemas de hipermédia adaptativa educacional - SHAE. Estes sistemas têm a capacidade de adaptar o ensino consoante o modelo do aluno, características pessoais, necessidades, entre outros aspetos. Os SHAE permitiram introduzir mudanças relativamente à forma de ensino, passando do ensino tradicional que se restringia apenas ao uso de livros escolares até à utilização de ferramentas informáticas que através do acesso à internet disponibilizam material didático, privilegiando o ensino individualizado. Os SHAE geram grande volume de dados, informação contida no modelo do aluno e todos os dados relativos ao processo de aprendizagem de cada aluno. Facilmente estes dados são ignorados e não se procede a uma análise cuidada que permita melhorar o conhecimento do comportamento dos alunos durante o processo de ensino, alterando a forma de aprendizagem de acordo com o aluno e favorecendo a melhoria dos resultados obtidos. O objetivo deste trabalho foi selecionar e aplicar algumas técnicas de Data Mining a um SHAE, PCMAT - Mathematics Collaborative Educational System. A aplicação destas técnicas deram origem a modelos de dados que transformaram os dados em informações úteis e compreensíveis, essenciais para a geração de novos perfis de alunos, padrões de comportamento de alunos, regras de adaptação e pedagógicas. Neste trabalho foram criados alguns modelos de dados recorrendo à técnica de Data Mining de classificação, abordando diferentes algoritmos. Os resultados obtidos permitirão definir novas regras de adaptação e padrões de comportamento dos alunos, poderá melhorar o processo de aprendizagem disponível num SHAE.

Desenho e implementação de um data warehouse para a empresa AdClick

Esta dissertação incide sobre a problemática da construção de um data warehouse para a empresa AdClick que opera na área de marketing digital. O marketing digital é um tipo de marketing que utiliza os meios de comunicação digital, com a mesma finalidade do método tradicional que se traduz na divulgação de bens, negócios e serviços e a angariação de novos clientes. Existem diversas estratégias de marketing digital tendo em vista atingir tais objetivos, destacando-se o tráfego orgânico e tráfego pago. Onde o tráfego orgânico é caracterizado pelo desenvolvimento de ações de marketing que não envolvem quaisquer custos inerentes à divulgação e/ou angariação de potenciais clientes. Por sua vez o tráfego pago manifesta-se pela necessidade de investimento em campanhas capazes de impulsionar e atrair novos clientes. Inicialmente é feita uma abordagem do estado da arte sobre business intelligence e data warehousing, e apresentadas as suas principais vantagens as empresas. Os sistemas business intelligence são necessários, porque atualmente as empresas detêm elevados volumes de dados ricos em informação, que só serão devidamente explorados fazendo uso das potencialidades destes sistemas. Nesse sentido, o primeiro passo no desenvolvimento de um sistema business intelligence é concentrar todos os dados num sistema único integrado e capaz de dar apoio na tomada de decisões. É então aqui que encontramos a construção do data warehouse como o sistema único e ideal para este tipo de requisitos. Nesta dissertação foi elaborado o levantamento das fontes de dados que irão abastecer o data warehouse e iniciada a contextualização dos processos de negócio existentes na empresa. Após este momento deu-se início à construção do data warehouse, criação das dimensões e tabelas de factos e definição dos processos de extração e carregamento dos dados para o data warehouse. Assim como a criação das diversas views. Relativamente ao impacto que esta dissertação atingiu destacam-se as diversas vantagem a nível empresarial que a empresa parceira neste trabalho retira com a implementação do data warehouse e os processos de ETL para carregamento de todas as fontes de informação. Sendo que algumas vantagens são a centralização da informação, mais flexibilidade para os gestores na forma como acedem à informação. O tratamento dos dados de forma a ser possível a extração de informação a partir dos mesmos.

Support System for Rational Use of Electric Energy

This paper presents the system developed to promote the rational use of electric energy among consumers and, thus, increase the energy efficiency. The goal is to provide energy consumers with an application that displays the energy consumption/production profiles, sets up consuming ceilings, defines automatic alerts and alarms, compares anonymously consumers with identical energy usage profiles by region and predicts, in the case of non-residential installations, the expected consumption/production values. The resulting distributed system is organized in two main blocks: front-end and back-end. The front-end includes user interface applications for Android mobile devices and Web browsers. The back-end provides data storage and processing functionalities and is installed in a cloud computing platform - the Google App Engine - which provides a standard Web service interface. This option ensures interoperability, scalability and robustness to the system.

Deep crustal structure across a young passive margin from wide-angle and reflection seismic data (The Sardinia Experiment) - I. Gulf of Lion's margin

The conjugate margins system of the Gulf of Lion and West Sardinia (GLWS) represents a unique natural laboratory for addressing fundamental questions about rifting due to its landlocked situation, its youth, its thick sedimentary layers, including prominent palaeo-marker such as the MSC event, and the amount of available data and multidisciplinary studies. The main goals of the SARDINIA experiment, were to (i) investigate the deep structure of the entire system within the two conjugate margins: the Gulf of Lion and West Sardinia, (ii) characterize the nature of the crust, and (iii) define the geometry of the basin and provide important constrains on its genesis. This paper presents the results of P-wave velocity modelling on three coincident near-vertical reflection multi-channel seismic (MCS) and wide-angle seismic profiles acquired in the Gulf of Lion, to a depth of 35 km. A companion paper [part II Afilhado et al., 2015] addresses the results of two other SARDINIA profiles located on the oriental conjugate West Sardinian margin. Forward wide-angle modelling of both data sets confirms that the margin is characterised by three distinct domains following the onshore unthinned, 33 km-thick continental crust domain: Domain I is bounded by two necking zones, where the crust thins respectively from 30 to 20 and from 20 to 7 km over a width of about 170 km; the outermost necking is imprinted by the well-known T-reflector at its crustal base; Domain II is characterised by a 7 km-thick crust with anomalous velocities ranging from 6 to 7.5 km/s; it represents the transition between the thinned continental crust (Domain I) and a very thin (only 4-5 km) "atypical" oceanic crust (Domain III). In Domain II, the hypothesis of the presence of exhumed mantle is falsified by our results: this domain may likely consist of a thin exhumed lower continental crust overlying a heterogeneous, intruded lower layer. Moreover, despite the difference in their magnetic signatures, Domains II and III present the very similar seismic velocities profiles, and we discuss the possibility of a connection between these two different domains.

Implementation of a Campus wide DGPS Data Server

Although the Navigation Satellite Timing and Ranging (NAVSTAR) Global Positioning System (GPS) is, de facto, the standard positioning system used in outdoor navigation, it does not provide, per se, all the features required to perform many outdoor navigational tasks. The accuracy of the GPS measurements is the most critical issue. The quest for higher position readings accuracy led to the development, in the late nineties, of the Differential Global Positioning System (DGPS). The differential GPS method detects the range errors of the GPS satellites received and broadcasts them. The DGPS/GPS receivers correlate the DGPS data with the GPS satellite data they are receiving, granting users increased accuracy. DGPS data is broadcasted using terrestrial radio beacons, satellites and, more recently, the Internet. Our goal is to have access, within the ISEP campus, to DGPS correction data. To achieve this objective we designed and implemented a distributed system composed of two main modules which are interconnected: a distributed application responsible for the establishment of the data link over the Internet between the remote DGPS stations and the campus, and the campus-wide DGPS data server application. The DGPS data Internet link is provided by a two-tier client/server distributed application where the server-side is connected to the DGPS station and the client-side is located at the campus. The second unit, the campus DGPS data server application, diffuses DGPS data received at the campus via the Intranet and via a wireless data link. The wireless broadcast is intended for DGPS/GPS portable receivers equipped with an air interface and the Intranet link is provided for DGPS/GPS receivers with just a RS232 DGPS data interface. While the DGPS data Internet link servers receive the DGPS data from the DGPS base stations and forward it to the DGPS data Internet link client, the DGPS data Internet link client outputs the received DGPS data to the campus DGPS data server application. The distributed system is expected to provide adequate support for accurate (sub-metric) outdoor campus navigation tasks. This paper describes in detail the overall distributed application.

Deep crustal structure across a young passive margin from wide-angle and reflection seismic data (The Sardinia Experiment) - II. Sardinia's margin

Geophysical data acquired on the conjugate margins system of the Gulf of Lion and West Sardinia (GLWS) is unique in its ability to address fundamental questions about rifting (i.e. crustal thinning, the nature of the continent-ocean transition zone, the style of rifting and subsequent evolution, and the connection between deep and surface processes). While the Gulf of Lion (GoL) was the site of several deep seismic experiments, which occurred before the SARDINIA Experiment (ESP and ECORS Experiments in 1981 and 1988 respectively), the crustal structure of the West Sardinia margin remains unknown. This paper describes the first modeling of wide-angle and near-vertical reflection multi-channel seismic (MCS) profiles crossing the West Sardinia margin, in the Mediterranean Sea. The profiles were acquired, together with the exact conjugate of the profiles crossing the GoL, during the SARDINIA experiment in December 2006 with the French R/V L'Atalante. Forward wide-angle modeling of both data sets (wide-angle and multi-channel seismic) confirms that the margin is characterized by three distinct domains following the onshore unthinned, 26 km-thick continental crust : Domain V, where the crust thins from 26 to 6 km in a width of about 75 km; Domain IV where the basement is characterized by high velocity gradients and lower crustal seismic velocities from 6.8 to 7.25 km/s, which are atypical for either crustal or upper mantle material, and Domain III composed of "atypical" oceanic crust.The structure observed on the West Sardinian margin presents a distribution of seismic velocities that is symmetrical with those observed on the Gulf of Lion's side, except for the dimension of each domain and with respect to the initiation of seafloor spreading. This result does not support the hypothesis of simple shear mechanism operating along a lithospheric detachment during the formation of the Liguro-Provencal basin.