A gestão dos resíduos hospitalares e o papel da autoridade de saúde : caso do concelho da Amad

RESUMO O Problema. A natureza, diversidade e perigosidade dos resíduos hospitalares (RH) exige procedimentos específicos na sua gestão. A sua produção depende do número de unidades de prestação de cuidados de saúde (upcs), tipo de cuidados prestados, número de doentes observados, práticas dos profissionais e dos órgãos de gestão das upcs, inovação tecnológica, entre outros. A gestão integrada de RH tem evoluído qualitativamente nos últimos anos. Existe uma carência de informação sobre os quantitativos de RH produzidos nas upcs e na prestação de cuidados domiciliários, em Portugal. Por outro lado, os Serviços de Saúde Pública, abrangendo o poder de Autoridade de Saúde, intervêm na gestão do risco para a saúde e o ambiente associado à produção de RH, necessitando de indicadores para a sua monitorização. O quadro legal de um país nesta matéria estabelece a estratégia de gestão destes resíduos, a qual é condicionada pela classificação e definição de RH por si adoptadas. Objectivos e Metodologias. O presente estudo pretende: quantificar a produção de RH resultantes da prestação de cuidados de saúde, em seres humanos e animais nas upcs, do sistema público e privado, desenvolvendo um estudo longitudinal, onde se quantifica esta produção nos Hospitais, Centros de Saúde, Clínicas Médicas e Dentárias, Lares para Idosos, Postos Médicos de Empresas, Centros de Hemodiálise e Clínicas Veterinárias do Concelho da Amadora, e se compara esta produção em dois anos consecutivos; analisar as consequências do exercício do poder de Autoridade de Saúde na gestão integrada de RH pelas upcs; quantificar a produção média de RH, por acto prestado, nos cuidados domiciliários e, com um estudo analítico transversal, relacionar essa produção média com as características dos doentes e dos tratamentos efectuados; proceder à análise comparativa das definições e classificações de RH em países da União Europeia, através de um estudo de revisão da legislação nesta matéria em quatro países, incluindo Portugal. Resultados e Conclusões. Obtém-se a produção média de RH, por Grupos I+II, III e IV: nos Hospitais, por cama.dia, considerando a taxa de ocupação; por consulta, nos Centros de Saúde, Clínicas Médicas e Dentárias e Postos Médicos de Empresas; por cama.ano, nos Lares para Idosos, considerando a sua taxa de ocupação; e por ano, nas Clínicas de Hemodiálise e Veterinárias. Verifica-se que a actuação da Autoridade de Saúde, produz nas upcs uma diferença estatisticamente significativa no aumento das contratualizações destas com os operadores de tratamento de RH. Quantifica-se o peso médio de resíduos dos Grupos III e IV produzido por acto prestado nos tratamentos domiciliários e relaciona-se esta variável dependente com as características dos doentes e dos tratamentos efectuados. Comparam-se os distintos critérios utilizados na elaboração das definições e classificações destes resíduos inscritas na legislação da Alemanha, Reino Unido, Espanha e Portugal. Recomendações. Apresentam-se linhas de investigação futura e propõe-se uma reflexão sobre eventuais alterações de aspectos específicos no quadro legal português e nos planos de gestão integrada de RH, em Portugal. ABSTRACT The problem: The nature, diversity and hazardousness of hospital wastes (HW) requires specific procedures in its management. Its production depends on the number and patterns of healthcare services, number of patients, professional and administration practices and technologic innovations, among others. Integrated management of HW has been developping, in the scope of quality, for the past few years. There is a lack of information about the amount of HW produced in healthcare units and in the domiciliary visits, in Portugal. On the other hand, the Public Health Services, embracing the Health Authority’s power, play a very important role in managing the risk of HW production to public and environmental health. They need to use some indicators in its monitorization. In a country, rules and regulations define hospital waste management policies, which are confined by the addopted classification and definition of HW. Goals and Methods: This research study aims to quantify the production of HW as a result of healthcare services in human beings and animals, public service and private one. Through a longitudinal study, this production is quantified in Hospitals, Health Centers, Medical and Dental Clinics, Residential Centers for old people, Companies Medical Centers and Veterinary and Haemodyalisis Clinics in Amadora’s Council, comparing this production in two consecutive years. This study also focus the consequences of the Health Authority’s role in the healthcare services integrated management of HW. The middle production of HW in the domiciliary treatments is also quantified and, with a transversal analytic study, its association with patients and treatments’ characteristics is enhanced. Finally, the definitions and classifications in the European Union Countries are compared through a study that revises this matter’s legislation in four countries, including Portugal. Results and Conclusions: We get the middle production of Groups I+II, III and IV: HW: in Hospitals, by bed.day, bearing the occupation rate; by consultation, in Health Centers, Medical and Dental Clinics and Companies Medical Centers; by bed.year in Residential Centers for old people, considering their occupation rate; by year, in Veterinary and Haemodyalisis Clinics. We verify that the Health Authority’s role produces a significative statistical difference in the rise of the contracts between healthcare services and HW operators. We quantify the Groups III and IV’s wastes middle weight, produced by each medical treatment in domiciliary visits and relate this dependent variable with patients and treatments’ characteristics. We compare the different criteria used in the making of definitions and classifications of these wastes registered in German, United Kingdom, Spain and Portugal’s laws. Recommendations: Lines of further investigation are explaned. We also tender a reflexion about potential changes in rules, in regulations and in the integrated plans for managing hospital wastes in Portugal. RÉSUMÉ Le Problème. La gestion des déchets d'activités hospitalières (DAH) et de soins de santé (DSS) exige des procédures spécifiques en raison de leur nature, diversité et dangerosité. Leur production dépend, parmi d’autres, du nombre d’unités de soins de santé (USS), du type de soins administrés, du nombre de malades observés, des pratiques des professionnels et des organes de gestion des USS, de l’innovation technologique. La gestion intégrée des DAH et des DSS subit une évolution qualitative dans les dernières années. Il existe un déficit d’information sur les quantitatifs de DAH et de DSS provenant des USS et de la prestation de soins domiciliaires, au Portugal. D’autre part les Services de Santé Publique, y compris le pouvoir de l’Autorité de Santé, qui interviennent dans la gestion du risque pour la santé et pour l’environnement associé à la production de DAH et de DSS, ont besoin d’indicateurs pour leur surveillance. Dans cette matière le cadre légal établit la stratégie de gestion de ces déchets, laquelle est conditionnée par la classification et par la définition des DAH et des DSS adoptées par le pays. Objectifs et Méthodologie. Cet étude prétend: quantifier la production de DAH et de DSS provenant de la prestation de soins de santé, en êtres humains et animaux dans les USS du système public et privé. À travers un étude longitudinal, on quantifie cette production dans les Hôpitaux, Centres de Santé, Cliniques Médicales et Dentaires, Maisons de Repos pour personnes âgées, Cabinets Médicaux d’ Entreprises, Centres d’Hémodialyse et Cliniques Vétérinaires du municipe d’ Amadora, en comparant cette production en deux ans consécutifs; analyser les conséquences de l’exercice du pouvoir de l’Autorité de Santé dans la gestion intégrée des DAH et des DSS par les USS; quantifier la production moyenne de DAH et de DSS dans la prestation de soins domiciliaires et, avec un étude analytique transversal, rapporter cette production moyenne avec les caractéristiques des malades et des soins administrés; procéder à l’ analyse comparative des définitions et classifications des DAH et des DSS dans des pays de l’Union Européenne, à travers un étude de révision de la législation relative à cette matière dans quatre pays, Portugal y compris. Résultats et Conclusions. On obtient la production moyenne de DAH et des DSS, par Classes I+II, III et IV: dans les hôpitaux, par lit.jour, en considérant le taux d’occupation; par consultation, dans les Centres de Santé, Cliniques Médicales et Dentaires et Cabinets Médicaux d’ Entreprises par lit.an dans les Maisons de Repos pour personnes âgées en considérant le taux d’occupation; et par an, dans les Cliniques d’Hémodialyse et Vétérinaires. On constate que l’actuation de l’Autorité de Santé produit dans les USS une différence statistiquement significative dans l’accroissement de leurs contractualisations avec les opérateurs de traitement de DAH et de DSS. On quantifie le poids moyen des déchets des Classes III et IV produit par acte de prestation de soins à domicile et on rapporte cette variable dépendante avec les caractéristiques des malades et des soins administrés. On compare les différents critères utilisés dans l’élaboration des définitions et des classifications de ces déchets inscrites dans la légis

Clinical classification versus semiquantification with adapted reference values for 123I-FP-CIT SPECT in a nuclear medicine department

Semi quantification (SQ) in DaTScan® studies is broadly used in clinic daily basis, however there is a suspicious about its discriminative capability, and concordance with the diagnostic classification performed by the physician. Aim: Evaluate the discriminate capability of an adapted database and reference's values of healthy controls for the Dopamine Transporters (DAT) with 123I–FP-IT named DBRV adapted to Nuclear Medicine Department's protocol and population of Infanta Cristina's Hospital, and its concordance with the physician classification.

Unsupervised automatic music genre classification

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

Classification Performance of Multilayer Perceptrons with Different Risk Functionals

In the present paper we assess the performance of information-theoretic inspired risks functionals in multilayer perceptrons with reference to the two most popular ones, Mean Square Error and Cross-Entropy. The information-theoretic inspired risks, recently proposed, are: HS and HR2 are, respectively, the Shannon and quadratic Rényi entropies of the error; ZED is a risk reflecting the error density at zero errors; EXP is a generalized exponential risk, able to mimic a wide variety of risk functionals, including the information-thoeretic ones. The experiments were carried out with multilayer perceptrons on 35 public real-world datasets. All experiments were performed according to the same protocol. The statistical tests applied to the experimental results showed that the ubiquitous mean square error was the less interesting risk functional to be used by multilayer perceptrons. Namely, mean square error never achieved a significantly better classification performance than competing risks. Cross-entropy and EXP were the risks found by several tests to be significantly better than their competitors. Counts of significantly better and worse risks have also shown the usefulness of HS and HR2 for some datasets.

Automatic cymbal classification

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

Partial classification of Lorenz knots: Syllable permutations of torus knots words

We define families of aperiodic words associated to Lorenz knots that arise naturally as syllable permutations of symbolic words corresponding to torus knots. An algorithm to construct symbolic words of satellite Lorenz knots is defined. We prove, subject to the validity of a previous conjecture, that Lorenz knots coded by some of these families of words are hyperbolic, by showing that they are neither satellites nor torus knots and making use of Thurston's theorem. Infinite families of hyperbolic Lorenz knots are generated in this way, to our knowledge, for the first time. The techniques used can be generalized to study other families of Lorenz knots.

Text classification using compression-based dissimilarity measures

Arguably, the most difficult task in text classification is to choose an appropriate set of features that allows machine learning algorithms to provide accurate classification. Most state-of-the-art techniques for this task involve careful feature engineering and a pre-processing stage, which may be too expensive in the emerging context of massive collections of electronic texts. In this paper, we propose efficient methods for text classification based on information-theoretic dissimilarity measures, which are used to define dissimilarity-based representations. These methods dispense with any feature design or engineering, by mapping texts into a feature space using universal dissimilarity measures; in this space, classical classifiers (e.g. nearest neighbor or support vector machines) can then be used. The reported experimental evaluation of the proposed methods, on sentiment polarity analysis and authorship attribution problems, reveals that it approximates, sometimes even outperforms previous state-of-the-art techniques, despite being much simpler, in the sense that they do not require any text pre-processing or feature engineering.

Multi-scale vegetation classification using earth observation data of the Sundarban mangrove forest, Bangladesh.

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies.

On the Sensor Classification Scheme of Robotic Manipulators

This paper analyzes the signals captured during impacts and vibrations of a mechanical manipulator. The Fourier Transform of eighteen different signals are calculated and approximated by trendlines based on a power law formula. A sensor classification scheme based on the frequency spectrum behavior is presented.

Towards a classification scheme for musical sounds

Signal Processing: Algorithms, Architectures, Arrangements, and Applications (SPA), 2013

Impact of RIFLE Classification in Liver Transplantation

Acute renal failure (ARF) is common after orthotopic liver transplantation (OLT). The aim of this study was to evaluate the prognostic value of RIFLE classification in the development of CKD, hemodialysis requirement, and mortality. Patients were categorized as risk (R), injury (I) or failure (F) according to renal function at day 1, 7 and 21. Final renal function was classified according to K/DIGO guidelines. We studied 708 OLT recipients, transplanted between September 1992 and March 2007; mean age 44 +/- 12.6 yr, mean follow-up 3.6 yr (28.8% > or = 5 yr). Renal dysfunction before OLT was known in 21.6%. According to the RIFLE classification, ARF occurred in 33.2%: 16.8% were R class, 8.5% I class and 7.9% F class. CKD developed in 45.6%, with stages 4 or 5d in 11.3%. Mortality for R, I and F classes were, respectively, 10.9%, 13.3% and 39.3%. Severity of ARF correlated with development of CKD: stage 3 was associated with all classes of ARF, stages 4 and 5d only with severe ARF. Hemodialysis requirement (23%) and mortality were only correlated with the most severe form of ARF (F class). In conclusion, RIFLE classification is a useful tool to stratify the severity of early ARF providing a prognostic indicator for the risk of CKD occurrence and death.

An automatic voice pleasantness classification system based on prosodic and acoustic patterns of voice preference

In the last few years the number of systems and devices that use voice based interaction has grown significantly. For a continued use of these systems the interface must be reliable and pleasant in order to provide an optimal user experience. However there are currently very few studies that try to evaluate how good is a voice when the application is a speech based interface. In this paper we present a new automatic voice pleasantness classification system based on prosodic and acoustic patterns of voice preference. Our study is based on a multi-language database composed by female voices. In the objective performance evaluation the system achieved a 7.3% error rate.

Classification of varieties of pasteurella pestis strains isolated in the interior of the state of Pernambuco-Brazil

Studies were made on the biochemical behavior of 100 strains of P.pestis isolated in Northeastern Brazil with regard to production of nitrous acid, reduction of nitrates to nitrltes, and aciáification of glycerol. Results showed that 98 strains can be classified as "orientalis variety", while the remaining two could not be included in any of the existing "varieties".

Unsupervised classification of remote sensing images combining Self Organizing Maps and segmentation techniques

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.