954 resultados para Healthcare Systems Reforms


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Decentralised co-operative multi-agent systems are computational systems where conflicts are frequent due to the nature of the represented knowledge. Negotiation methodologies, in this case argumentation based negotiation methodologies, were developed and applied to solve unforeseeable and, therefore, unavoidable conflicts. The supporting computational model is a distributed belief revision system where argumentation plays the decisive role of revision. The distributed belief revision system detects, isolates and solves, whenever possible, the identified conflicts. The detection and isolation of the conflicts is automatically performed by the distributed consistency mechanism and the resolution of the conflict, or belief revision, is achieved via argumentation. We propose and describe two argumentation protocols intended to solve different types of identified information conflicts: context dependent and context independent conflicts. While the protocol for context dependent conflicts generates new consensual alternatives, the latter chooses to adopt the soundest, strongest argument presented. The paper shows the suitability of using argumentation as a distributed decentralised belief revision protocol to solve unavoidable conflicts.

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The ability to respond sensibly to changing and conflicting beliefs is an integral part of intelligent agency. To this end, we outline the design and implementation of a Distributed Assumption-based Truth Maintenance System (DATMS) appropriate for controlling cooperative problem solving in a dynamic real world multi-agent community. Our DATMS works on the principle of local coherence which means that different agents can have different perspectives on the same fact provided that these stances are appropriately justified. The belief revision algorithm is presented, the meta-level code needed to ensure that all system-wide queries can be uniquely answered is described, and the DATMS’ implementation in a general purpose multi-agent shell is discussed.

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Trabalho de Projeto apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria Orientação: Doutora Alcina Augusta de Sena Portugal Dias Coorientação: Doutora Amélia Cristina Ferreira Silva

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RESUMO - Introdução: As Reacções Adversas Medicamentosas (RAMs) constituem um grave problema de Saúde Pública em termos da mortalidade e morbilidade provocadas, tendo também um impacto económico considerável nos Sistemas de Saúde. Os Sistemas de Notificacão Espontânea de RAMs são considerados como o método de vigilância de medicamentos mais eficaz, sendo a sub-notificação de RAMs uma das suas maiores limitações. Em termos globais, foi estimado que apenas 6% de todas as reacções adversas são notificadas. Portugal apresenta uma taxa de notificação de RAMs relativamente baixa quando comparada com os países mais notificadores da Europa. São objectivos deste estudo: 1) caracterizar as atitudes e os comportamentos dos médicos, dos farmacêuticos e dos enfermeiros em Portugal Continental relativamente à notificação de RAMs; e 2) caracterizar a efectividade de intervenções educacionais destinadas a reduzir a sub-notificação de RAMs. Métodos: Numa primeira fase será efectuado um estudo de caso-controlo em médicos, farmacêuticos e enfermeiros de Portugal Continental, a exercer actividade no Servico Nacional de Saúde (SNS), de modo a caracterizar as suas atitudes e comportamentos relativamente à notificação de RAMs. Como casos serão considerados os Profissionais de Saúde que notificaram pelo menos uma RAM num determinado período e os controlos os Profissionais de Saúde que não notificaram qualquer RAM nesse mesmo período, sendo estes útimos seleccionados aleatoriamente. O estudo será conduzido através de um questionário de auto-resposta, em que as questões relativas às atitudes e comportamentos são baseadas nos “sete pecados mortais” de Inman. Será utilizada uma Escala Visual Analógica para registar as respostas, podendo estas ir de zero (totalmente em desacordo) até 10 (totalmente de acordo). Será utilizada uma análise de regressão logística para determinar o odds ratio ajustado (ORadj) da notificação de RAMs para uma mudança de exposição correspondente ao range interquartil para cada atitude. Numa segunda fase, será efectuado ensaio aleatorizado controlado de cluster, para caracterizar a efectividade das intervenções educacionais realizadas sobre as causas identificadas na primeira parte do trabalho, com o intuito de reduzir a sub-notificação de RAMs. Com base em informacão de 2007 foram identificados 43 clusters dispersos pelas várias Regiões de Saúde. As intervenções educacionais são compostas por uma apresentação com uma hora de duração complementada por um folheto recordatório. Serão ainda realizados dois sub-estudos, em que o V1.0, Final 28Set09 viii Sub-notificação de RAMs em Portugal – Um problema com solução ? primeiro tentará caracterizar o efeito de contaminação entre Profissionais de Saúde e o segundo pretende caracterizar a duração do efeito das intervenções educacionais. Resultados a atingir: Pretende-se, com a implementação deste projecto, aumentar o número de notificações de RAMs pelos médicos, farmacêuticos e enfermeiros em cerca de 110%, de modo a atingir-se uma taxa de notificação de aproximadamente 300 notificações por milhão de habitantes por ano (i.e., multiplicar por 2,1 o número notificações existentes). -------------------ABSTRACT - Introduction: The Adverse Drug Reactions (ADRs) are a serious Public Health problem in terms of mortality and morbidity caused, being also an economic burden for the health systems. The Spontaneous Adverse Event Reporting Systems are considered as the most effective drug surveillance methods, in which the ADR under-reporting represents one of its biggest limitations. It was estimated that only 6% of all adverse reactions are notified globally. When comparing with high ADR reporting rate countries Portugal shows a low ADR reporting rate. This study aims to: 1) characterize the physicians, pharmacists and nurses attitudes and behaviours related to ADR under-reporting; 2) characterize the educational interventions effectiveness to decrease the ADRs under-reporting. Methods: During a first phase a case-control study will be conducted in physicians, pharmacists and nurses in Continental Portugal working in the National Health System (NHS) in order to characterize their attitudes and behaviours related to ADR reporting. The Healthcare Professionals that have reported at least one ADR during a determined period will be considered as the cases and those that have not reported any ADR during the same period will be considered as the controls. The controls will be randomly selected. The study will be conducted through a self-administered questionnaire in which the questions related to the attitudes and behaviours are based in the Inmans’s “seven mortal sins”. A Visual Analogue Scale will be used to record the responses. The responses can range from 0 (totally disagree) to 10 (totally agree). Logistic regression will be used to determine the ADR reporting adjusted odds ratio (ORadj) for a change in the exposure corresponding to the interquartile range for each attitude. In the second phase of the study a cluster-randomized controlled trial will be conducted to characterize the educational interventions effectiveness focused on the first phase identified causes with the aim to decrease the ADRs under-reporting. Based in 2007’s information 43 clusters have been identified throughout the several Health Regions. The educational interventions are composed of one hour presentation complemented by an informational leaflet. Two sub-studies will be also conducted in which the first one will try to characterize the contamination effect between the Healthcare Professionals and the second to characterize the educational interventions effect duration. V1.0, Final 28Set09 x Sub-notificação de RAMs em Portugal – Um problema com solução ? Outcome: With the project implementation an increase of the ADR notifications performed by the physicians, pharmacists and nurses by 110% is aimed in order to obtain approximately 300 notifications per million habitants per year (i.e., multiply by 2,1 the existent notifications).

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The clinical content of administrative databases includes, among others, patient demographic characteristics, and codes for diagnoses and procedures. The data in these databases is standardized, clearly defined, readily available, less expensive than collected by other means, and normally covers hospitalizations in entire geographic areas. Although with some limitations, this data is often used to evaluate the quality of healthcare. Under these circumstances, the quality of the data, for instance, errors, or it completeness, is of central importance and should never be ignored. Both the minimization of data quality problems and a deep knowledge about this data (e.g., how to select a patient group) are important for users in order to trust and to correctly interpret results. In this paper we present, discuss and give some recommendations for some problems found in these administrative databases. We also present a simple tool that can be used to screen the quality of data through the use of domain specific data quality indicators. These indicators can significantly contribute to better data, to give steps towards a continuous increase of data quality and, certainly, to better informed decision-making.

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The iron(III) complexes [H(EtOH)][FeCl2(L)(2)] (1), [H(2)bipy](1/2)[FeCl2(L)(2)].DMF (2) and [FeCl2(L)(2,2'-bipy)] (3) (L = 3-amino-2-pyrazinecarboxylate; H(2)bipy = doubly protonated 4,4'-bipyridine; 2,2'-bipy = 2,2'-bipyridine, DMF = dimethylformamide) have been synthesized and fully characterized by IR, elemental and single-crystal X-ray diffraction analyses, as well as by electrochemical methods. Complexes 1 and 2 have similar mononuclear structures containing different guest molecules (protonated ethanol for 1 and doubly protonated 4,4'-bipyridine for 2) in their lattices, whereas the complex 3 has one 3-amino-2-pyrazinecarboxylate and a 2,2'-bipyridine ligand. They show a high catalytic activity for the low power (10 W) solvent-free microwave assisted peroxidative oxidation of 1-phenylethanol, leading, in the presence of TEMPO, to quantitative yields of acetophenone [TOFs up to 8.1 x 10(3) h(-1), (3)] after 1 h. Moreover, the catalysts are of easy recovery and reused, at least for four consecutive cycles, maintaining 83 % of the initial activity and concomitant rather high selectivity. 3-Amino-2-pyrazinecarboxylic acid is used to synthesize three new iron(III) complexes which act as heterogeneous catalysts for the solvent-free microwave-assisted peroxidative oxidation of 1-phenylethanol.

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he expansion of Digital Television and the convergence between conventional broadcasting and television over IP contributed to the gradual increase of the number of available channels and on demand video content. Moreover, the dissemination of the use of mobile devices like laptops, smartphones and tablets on everyday activities resulted in a shift of the traditional television viewing paradigm from the couch to everywhere, anytime from any device. Although this new scenario enables a great improvement in viewing experiences, it also brings new challenges given the overload of information that the viewer faces. Recommendation systems stand out as a possible solution to help a watcher on the selection of the content that best fits his/her preferences. This paper describes a web based system that helps the user navigating on broadcasted and online television content by implementing recommendations based on collaborative and content based filtering. The algorithms developed estimate the similarity between items and users and predict the rating that a user would assign to a particular item (television program, movie, etc.). To enable interoperability between different systems, programs characteristics (title, genre, actors, etc.) are stored according to the TV-Anytime standard. The set of recommendations produced are presented through a Web Application that allows the user to interact with the system based on the obtained recommendations.

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

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A vigilância de efeitos indesejáveis após a vacinação é complexa. Existem vários actores de confundimento que podem dar origem a associações espúrias, meramente temporais mas que podem provocar uma percepção do risco alterada e uma consequente desconfiança generalizada acerca do uso das vacinas. Com efeito as vacinas são medicamentos complexos com características únicas cuja vigilância necessita de abordagens metodológicas desenvolvidas para esse propósito. Do exposto se entende que, desde o desenvolvimento da farmacovigilância se tem procurado desenvolver novas metodologias que sejam concomitantes aos Sistemas de Notificação Espontânea que já existem. Neste trabalho propusemo-nos a desenvolver e testar um modelo de vigilância de reacções adversas a vacinas, baseado na auto-declaração pelo utente de eventos ocorridos após a vacinação e testar a capacidade de gerar sinais aplicando cálculos de desproporção a datamining. Para esse efeito foi constituída uma coorte não controlada de utentes vacinados em Centros de Saúde que foram seguidos durante quinze dias. A recolha de eventos adversos a vacinas foi efectuada pelos próprios utentes através de um diário de registo. Os dados recolhidos foram objecto de análise descritiva e análise de data-mining utilizando os cálculos Proportional Reporting Ratio e o Information Component. A metodologia utilizada permitiu gerar um corpo de evidência suficiente para a geração de sinais. Tendo sido gerados quatro sinais. No âmbito do data-mining a utilização do Information Component como método de geração de sinais parece aumentar a eficiência científica ao permitir reduzir o número de ocorrências até detecção de sinal. A informação reportada pelos utentes parece válida como indicador de sinais de reacções adversas não graves, o que permitiu o registo de eventos sem incluir o viés da avaliação da relação causal pelo notificador. Os principais eventos reportados foram eventos adversos locais (62,7%) e febre (31,4%).------------------------------------------ABSTRACT: The monitoring of undesirable effects following vaccination is complex. There are several confounding factors that can lead to merely temporal but spurious associations that can cause a change in the risk perception and a consequent generalized distrust about the safe use of vaccines. Indeed, vaccines are complex drugs with unique characteristics so that its monitoring requires specifically designed methodological approaches. From the above-cited it is understandable that since the development of Pharmacovigilance there has been a drive for the development of new methodologies that are concomitant with Spontaneous Reporting Systems already in place. We proposed to develop and test a new model for vaccine adverse reaction monitoring, based on self-report by users of events following vaccination and to test its capability to generate disproportionality signals applying quantitative methods of signal generation to data-mining. For that effect we set up an uncontrolled cohort of users vaccinated in Healthcare Centers,with a follow-up period of fifteen days. Adverse vaccine events we registered by the users themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. The methodology we used allowed for the generation of a sufficient body of evidence for signal generation. Four signals were generated. Regarding the data-mining, the use of Information Component as a method for generating disproportionality signals seems to increase scientific efficiency by reducing the number of events needed to signal detection. The information reported by users seems valid as an indicator of non serious adverse vaccine reactions, allowing for the registry of events without the bias of the evaluation of the casual relation by the reporter. The main adverse events reported were injection site reactions (62,7%) and fever (31,4%).

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In this paper we address the problem of computing multiple roots of a system of nonlinear equations through the global optimization of an appropriate merit function. The search procedure for a global minimizer of the merit function is carried out by a metaheuristic, known as harmony search, which does not require any derivative information. The multiple roots of the system are sequentially determined along several iterations of a single run, where the merit function is accordingly modified by penalty terms that aim to create repulsion areas around previously computed minimizers. A repulsion algorithm based on a multiplicative kind penalty function is proposed. Preliminary numerical experiments with a benchmark set of problems show the effectiveness of the proposed method.

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Task scheduling is one of the key mechanisms to ensure timeliness in embedded real-time systems. Such systems have often the need to execute not only application tasks but also some urgent routines (e.g. error-detection actions, consistency checkers, interrupt handlers) with minimum latency. Although fixed-priority schedulers such as Rate-Monotonic (RM) are in line with this need, they usually make a low processor utilization available to the system. Moreover, this availability usually decreases with the number of considered tasks. If dynamic-priority schedulers such as Earliest Deadline First (EDF) are applied instead, high system utilization can be guaranteed but the minimum latency for executing urgent routines may not be ensured. In this paper we describe a scheduling model according to which urgent routines are executed at the highest priority level and all other system tasks are scheduled by EDF. We show that the guaranteed processor utilization for the assumed scheduling model is at least as high as the one provided by RM for two tasks, namely 2(2√−1). Seven polynomial time tests for checking the system timeliness are derived and proved correct. The proposed tests are compared against each other and to an exact but exponential running time test.

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Dissertação de Mestrado apresentada ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria, sob orientação do Mestre Paulino Silva

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This paper focuses on a PV system linked to the electric grid by power electronic converters, identification of the five parameters modeling for photovoltaic systems and the assessment of the shading effect. Normally, the technical information for photovoltaic panels is too restricted to identify the five parameters. An undemanding heuristic method is used to find the five parameters for photovoltaic systems, requiring only the open circuit, maximum power, and short circuit data. The I- V and the P- V curves for a monocrystalline, polycrystalline and amorphous photovoltaic systems are computed from the parameters identification and validated by comparison with experimental ones. Also, the I- V and the P- V curves under the effect of partial shading are obtained from those parameters. The modeling for the converters emulates the association of a DC-DC boost with a two-level power inverter in order to follow the performance of a testing commercial inverter employed on an experimental system. © 2015 Elsevier Ltd.

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For an interval map, the poles of the Artin-Mazur zeta function provide topological invariants which are closely connected to topological entropy. It is known that for a time-periodic nonautonomous dynamical system F with period p, the p-th power [zeta(F) (z)](p) of its zeta function is meromorphic in the unit disk. Unlike in the autonomous case, where the zeta function zeta(f)(z) only has poles in the unit disk, in the p-periodic nonautonomous case [zeta(F)(z)](p) may have zeros. In this paper we introduce the concept of spectral invariants of p-periodic nonautonomous discrete dynamical systems and study the role played by the zeros of [zeta(F)(z)](p) in this context. As we will see, these zeros play an important role in the spectral classification of these systems.

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Thesis to obtain the Master Degree in Electronics and Telecommunications Engineering