Construção de barreiras para diminuir as falhas nas mensurações glicêmicas realizadas pela enfermagem em pacientes críticos com insulina intravenosa

Esta pesquisa tem como objeto os fatores que influenciam a mensuração glicêmica realizada pela enfermagem em pacientes que recebem insulina contínua intravenosa utilizando glicosímetros portáteis à beira leito. Vários fatores podem influenciar a mensuração glicêmica, tais como a amostra sanguínea, a calibração do aparelho, a estocagem das fitas-teste, o hematócrito dos pacientes, o uso de vasoaminas e falhas do operador. A partir da Tese de que: A identificação dos fatores que influenciam a mensuração glicêmica realizada pela enfermagem através de glicosímetros é determinante para a eficiência das barreiras de salvaguarda voltadas para a minimização de falhas na sua execução, a fim de garantir resultados glicêmicos confiáveis e, consequentemente, realizar a titulação da insulina com segurança, teve-se como objetivo geral propor ações de enfermagem que funcionem como barreiras para diminuir as falhas nas mensurações glicêmicas realizadas pela enfermagem em pacientes que recebem infusão contínua de insulina. Espera-se contribuir com ações para garantir a adequação e o controle rigoroso da insulina administrada. Estudo observacional, transversal, prospectivo com abordagem quantitativa na análise dos dados, em uma unidade intensiva cirúrgica cardiológica de um hospital público do Rio de Janeiro. As variáveis do estudo foram submetidas a tratamentos estatísticos não paramétricos e às medidas de associação. Foram investigados 42 pacientes com observação de 417 glicemias. Predominaram pacientes do sexo feminino (57,14%), média de idade de 48 (15,85) anos, sem insuficiência renal e sem tratamento dialítico (90,48%). Observou-se PAM com média de 77(10,29) mmHg, uso de vasoaminas (80,95%), PaO2 ≥ 90mmHg em 85,71% e hematócrito <35% em 71,42%. Encontrou-se uma incidência de hipoglicemia de 35,7%, sendo a população dividida em dois grupos, o primeiro (G1) com pacientes que apresentaram hipoglicemia ≤ 60mg/dl (n=15), e o segundo (G2), com pacientes sem hipoglicemia (n=27). O hematócrito baixo foi a característica clínica que apresentou maior associação com a hipoglicemia. Pacientes com esta condição apresentaram 5,60 vezes mais risco de apresentarem hipoglicemia. O uso de vasoaminas elevou 3,3 vezes o risco de hipoglicemia em pacientes com estas medicações. A realização de cirurgias de emergência, a presença de insuficiência renal com tratamento dialítico, e a elevação da PaO2 acima de 90mmHg também apresentaram associação positiva com a hipoglicemia. Das 417 mensurações observadas, predominou o uso de amostra sanguínea de origem arterial. Observou-se que em todas as etapas da técnica de mensuração houve desvio de execução, com exceção de compressão da polpa digital. Os desvios observados que mostraram associação positiva (RR>1) para pacientes com hipoglicemia foram: a falta de calibração do glicosímetro, a falta de verificação da validade/integridade da fita teste, a falta da higienização das mãos e a falta da coleta de até 1 ml de sangue. Construiu-se uma revisão da técnica de mensuração glicêmica com enfoque nos fatores que podem comprometer o resultado glicêmico levando em conta o risco de hipoglicemia. Tornou-se evidente que a compreensão apropriada dos fatores que influenciam a glicemia e a mensuração glicêmica é indispensável para o enfermeiro na obtenção de resultados glicêmicos confiáveis, e assim, evitar erros na titulação das doses de insulina administrada.

A Auditoria Interna como ferramenta de melhoria dos controles internos de uma organização: Estudo de caso em uma empresa do segmento industrial do Rio de Janeiro

A alteração no sistema de controles internos da empresa estudada teve como marco principal a mudança do foco no trabalho da auditoria interna, que começou a desempenhar suas atividades de forma estruturada e seguindo uma metodologia específica; além, de perseguir um objetivo estratégico da organização. A auditoria interna, antes do processo de certificação do sistema de controles internos exigido pela seção 404 da SOX, era apenas um instrumento de detecção de erros e compliance fiscal, que baseava seus trabalhos somente em fatos passados, com a constatação de deficiências de controles. Todavia, sem assessorar a alta a administração da empresa na resolução das deficiências, objetivando a implementação das melhorias dos controles internos. Com a necessidade de certificação da eficácia dos controles internos, a partir do ano de 2005, o foco dos trabalhos de auditoria interna foi direcionado para lograr melhorias nos métodos de controle, gestão de riscos, prevenção de fraudes e erros, nos processos operacionais, contábeis e financeiros da organização. O objetivo dessa pesquisa foi, por meio de estudo de caso único, mensurar os principais procedimentos realizados para a implantação do sistema de controles internos da empresa estudada, incluindo a metodologia adotada, o modelo escolhido, o processo de controle estabelecido, a identificação e avaliação dos principais riscos e controles, bem como a forma de seleção, avaliação e teste dos controles internos existentes. Buscou-se coletar dados preconizados pela literatura de autores renomados e analisar as diversas bibliografias, com o objetivo de comparar com a pesquisa que foi realizada nos documentos fornecidos pela empresa analisada. Este estudo levantou pontos importantes sobre o processo de gestão da empresa e da forma como se utilizou da auditoria interna como ferramenta para a melhoria de seus controles internos. Destacam-se a geração de valor empresarial que um bom ambiente de controle interno traz e os motivos que levam uma organização a implementar uma área de auditoria interna, com especial atenção ao foco de assessoramento e consultoria, alinhado as práticas internacionais de auditoria interna. Entretanto, apesar de observar melhorias na atuação da auditoria interna da organização, constata-se a necessidade de alinhamento de algumas práticas internacionais, ainda não implementadas. Descobriu-se, também, que a auditoria interna, com o devido emporwerment da alta administração, e utilizando-se das técnicas atuais e internacionais, aumentam a confiabilidade do sistema de controles internos e com isso geram valor às suas organizações. Nesta pesquisa pôde-se constatar a utilização da auditoria interna como ferramenta de gestão de recursos organizacionais, ocasionando melhorias no sistema de controles internos da empresa, e ficando constatada, por meio de auditoria executada por firma independente, a irrefutável melhoria dos controles internos da organização estudada.

Techniques for the transport and maintenance of scleractinian coral

Several small scleractinian coral colonies were collected from a remote reef and transferred [to] the Louisiana Universities Marine Center (LUMCON) for in vitro reproductive and larval studies. The species used here were Porites astreoides and Diploria strigosa. Colony size was ~20 cm in diameter. Colonies were brought to the surface by liftbag and stored in modified ice coolers. They were transported from Freeport, TX to Cocodrie, LA by truck for nearly 15 hours where field conditions were simulated in waiting aquaria. This document describes the techniques and equipment that were used, how to outfit such aquaria, proper handling techniques for coral colonies, and several eventualities that the mariculturist should be prepared for in undertaking this endeavor. It will hopefully prevent many mistakes from being made.

Architectural research and its enemies

Like the Research Assessment Exercise (RAE) that preceded it, the UK government's proposed Research Excellence Framework (REF) is a means of allocating funding in higher education to support research. As with any method for the competitive allocation of funds it creates winners and losers and inevitably generates a lot of emotion among those rewarded or penalised. More specifically, the 'winners' tend to approve of the method of allocation and the 'losers' denigrate it as biased against their activities and generally unfair. An extraordinary press campaign has been consistently waged against research assessment and its methods by those involved in architectural education, which I will track over a decade and a half. What follows will question whether this campaign demonstrates the sophistication and superior judgment of those who have gone into print, or conversely whether its mixture of misinformation and disinformation reveals not just disenchantment and prejudice, but a naivety and a depth of ignorance about the fundamentals of research that is deeply damaging to the credibility of architecture as a research-based discipline. With the recent consultation process towards a new cycle of research assessment, the REF, getting under way, I aim to draw attention to the risk of repeating past mistakes. Copyright © Cambridge University Press 2010.

An evaluation of a new product data model

Engineering companies face many challenges today such as increased competition, higher expectations from consumers and decreasing product lifecycle times. This means that product development times must be reduced to meet these challenges. Concurrent engineering, reuse of engineering knowledge and the use of advanced methods and tools are among the ways of reducing product development times. Concurrent engineering is crucial in making sure that the products are designed with all issues considered simultaneously. The reuse of engineering knowledge allows existing solutions to be reused. It can also help to avoid the mistakes made in previous designs. Computer-based tools are used to store information, automate tasks, distribute work, perform simulation and so forth. This research concerns the evaluation of tools that can be used to support the design process. These tools are evaluated in terms of the capture of information generated during the design process. This information is vital to allow the reuse of knowledge. Present CAD systems store only information on the final definition of the product such as geometry, materials and manufacturing processes. Product Data Management (PDM) systems can manage all this CAD information along with other product related information. The research includes the evaluation of two PDM systems, Windchill and Metaphase, using the design of a single-handed water tap as a case study. The two PDMs were then compared to PROSUS/DDM. PROSUS is the Process-Based Support System proposed by [Blessing 94] using the same case study. The Design Data Model is the product data model that includes PROSUS. The results look promising. PROSUS/DDM is able to capture most design information and structure and present it logically. The design process and product information is related and stored within the DDM structure. The PDMs can capture most design information, but information from early stages of design is stored only as unstructured documentation. Some problems were found with PROSUS/DDM. A proposal is made that may make it possible to resolve these problems, but this will require further research.

The hidden traps in aquaculture

New investors in aquaculture probably know that they can make mistakes as they continue to operate their farms. Whether the mistakes happen immediately or not are risks they take as long as the mistakes are manageable and can easily be corrected. But many aquaculturists who have long been in the business say that there are costly mistakes that can wipe out one's investment. This paper is based on interviews with experienced aquaculturists and some popular articles from other aquaculture newsletters (Lindberg and Pryor on ways to lose money in aquaculture, Proceedings, Sustainable Aquaculture 95) and shares some insights regarding mistakes that may be hidden to new investors but obvious to experienced aquaculturists.

Ferroelectric liquid crystal over silicon devices

Over the past 20 years, ferroelectric liquid crystal over silicon (FLCOS) devices have made a wide impact on applications as diverse as optical correlation and holographic projection. To cover the entire gamut of this technology would be difficult and long winded; hence, this paper describes the significant developments of FLCOS within the Engineering Department at the University of Cambridge.The purpose of this paper is to highlight the key issues in fabricating silicon backplane spatial light modulators (SLMs) and to indicate ways in which the technology can be fabricated using cheap, low-density production and manufacturability. Three main devices have been fabricated as part of several research programmes and are documented in this paper. The fast bitplane SLM and the reconfigurable optical switches for aerospace and telecommunications systems (ROSES) SLM will form the basis of a case study to outline the overall processes involved. There is a great deal of commonality in the fabrication processes for all three devices, which indicates their potential strength and demonstrates that these processes can be made independent of the SLMs that are being assembled. What is described is a generic process that can be applied to any silicon backplane SLM on a die-by-die basis. There are hundreds of factors that can affect the yield in a manufacturing process and the purpose of a good process design procedure is to minimise these factors. One of the most important features in designing a process is fabrication experience, as so many of the lessons in this business can only be learned this way. We are working with the advantage of knowing the mistakes already made in the flat panel display industry, but we are also faced with the fact that those mistakes took many years and many millions of dollars to make.The fabrication process developed here originates and adapts earlier processes from various groups around the world. There are also a few totally new processes that have now been adopted by others in the field. Many, such as the gluing process, are still on-going and have to be worked on more before they will fully suit 'manufacturability'. © 2012 Copyright Taylor and Francis Group, LLC.

Mapping experience in organizations: A learning process for strategic technology planning

Today's fast-paced, dynamic environments mean that for organizations to keep "ahead of the game", engineering managers need to maximize current opportunities and avoid repeating past mistakes. This article describes the development study of a collaborative strategic management tool - the Experience Scan to capture past experience and apply learning from this to present and future situations. Experience Scan workshops were held in a number of different technology organizations, developing and refining the tool until its format stabilized. From participants' feedback, the workshop-based tool was judged to be a useful and efficient mechanism for communication and knowledge management, contributing to organizational learning.

汉字阅读中的字形、字音、字义及频率效应的研究

Unlike alphabetic languages, Chinese language is ideographical writing system. Each Chinese character is single-syllable and usually has a direct meaning. So Chinese characters are a kind of valuable experimental material used for research on reading and comparisons of the reading mechanism of different language. In this paper, the normal persons and the patients with semantic dementia were respectively scheduled for two parts of experimental studies on the orthographic, phonologic, semantic and frequency effects of reading of Chinese characters. The Stroop-like character-picture interference experimental paradigm was used to investigate the orthographic, phonologic, semantic and frequency effects of Chinese characters on picture naming when they were presented with pictures to normal persons. The results indicated that the orthographic facilitation effect, phonologic facilitation effect, and semantic interference effect occurred at different SOA values. The orthographic and phonologic facilitation effects were independent. It was for the first time shown that the interaction between orthographic variable and semantic variable occurred when the high-frequency Chinese characters were read. Phonologic representation was activated quicker than semantic representation, by comparison of their SOA. Generally, it means that there is reading without meaning in Chinese character among the normal persons. The orthographic, phonologic, semantic, frequency and concrete effects of Chinese characters were further investigated among the dementia patients with DAT(dementia of Alzheimer's type disease) or CVA or both. They all have an impaired semantic memory. The results showed that patients with dementia could read the names of the pictures aloud while they could not name them or match them with a right character correctly. This is reading impairment without meaning in Chinese among the dementia patients. Meanwhile, they had a selective reading impairment and more LARC(a legitimate alternative reading of components) mistakes especially when reading low-frequency irregular, low-frequency inconsistent and abstract Chinese characters. With the patients' semantic impairment developed, their ability to read the pictures names would remain whereas their ability to read low-frequency irregular and low-frequency inconsistency Chinese characters was reduced. These results indicated that low-frequency irregular Chinese characters can be read correctly only when it is supported by their semantic information. Based on the above results of reading without meaning and of reading of low-frequency irregular Chinese characters supported by their semantic information, it is reasonable to suggest that at least two routes are involved in the process of reading Chinese characters. They are direct phonologic route and indirect semantic route; moreover, the two routes are independent.

比较型算术应用题一致性效应的实验研究

As former research shown, the error rate of consistent compare word problem (such as: Mary has 5 apples, Tom has 2 apples more than Mary, how many apples does Tom has?) is much lower than the rate of inconsistent compare word problem (such as: Mary has 5 apples, she has 2 apples more than Tom, how many apples does Tom has?). This difference of error rate is named as Consistency Effect. There are different explanations about why consistency effect happens, one of them is R.E.Mayer's opinion about two kinds of problem solving strategies. As Mayer's opinion, unsuccessful problem solvers make mistakes on inconsistent problem because they use Direct Translation Strategy, problem solvers who use Problem Model Strategy will not make such kind of mistakes. In this study, three experiments with 3~(rd) graders investigate reasons for the consistency effect. The results of experiment 1 do not support the explanation of Mayer's theory of two kinds of strategy. Experiment 2 shows that there is no relation between inconsistent problem error and Impulsivity cognitive style. Experiment 3 reveals that the working memory capacity of successful inconsistent problem solvers is significant larger than the capacity of unsuccessful solvers. It is supposed that working memory could be an important factor contributing for the consistency effect.

Repairing Learned Knowledge Using Experience

Explanation-based learning occurs when something useful is retained from an explanation, usually an account of how some particular problem can be solved given a sound theory. Many real-world explanations are not based on sound theory, however, and wrong things may be learned accidentally, as subsequent failures will likely demonstrate. In this paper, we describe ways to isolate the facts that cause failures, ways to explain why those facts cause problems, and ways to repair learning mistakes. In particular, our program learns to distinguish pails from cups after making a few mistakes.

Limitations of Non Model-Based Recognition Schemes

Different approaches to visual object recognition can be divided into two general classes: model-based vs. non model-based schemes. In this paper we establish some limitation on the class of non model-based recognition schemes. We show that every function that is invariant to viewing position of all objects is the trivial (constant) function. It follows that every consistent recognition scheme for recognizing all 3-D objects must in general be model based. The result is extended to recognition schemes that are imperfect (allowed to make mistakes) or restricted to certain classes of objects.

Análise das atitudes e comportamento dos jovens face ao consumo de refrigerantes

Dissertação de Mestrado apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências da Comunicação, especialização em Marketing e Publicidade.

Addendum to "New Notions of Reduction and Non-Semantic Proofs of β-Strong Normalization in Typed λ-Calculi"

This is an addendum to our technical report BUCS TR-94-014 of December 19, 1994. It clarifies some statements, adds information on some related research, includes a comparison with research be de Groote, and fixes two minor mistakes in a proof.

The human impacts of flower farm development in the Ethiopian Rift Valley region

The flower industry has a reputation for heavy usage of toxic chemicals and polluting the environment, enormous consumption of water, and poor working condition and low wage level in various parts of the world. It is unfortunate that this industry is adamant to change and repeating the same mistakes in Ethiopia. Because of this, - there is a growing concern among the general public and the international community about sustainability of the Ethiopian flower industry. Consequently, working conditions in the flower industry, impacts of wage income on the livelihoods of employees, coping strategies of low wage flower farm workers, impacts of flower farms on the livelihoods of local people and environmental pollution and conflict, were analysed. Both qualitative and quantitative research methods were employed. Four quantitative data sets: labour practice, employees’ income and expenditure, displaced household, and flower grower views survey were collected between 2010 and 2012. Robust regression to identify the determinants of wage levels, and Multinomial logit to identify the determinants of coping strategies of flower farm workers and displaced households were employed. The findings show the working conditions in flower farms are characterized by low wages, job insecurity and frequent violation of employees’ rights, and poor safety measures. To ensure survival of their family, land dispossessed households adopt a wide range of strategies including reduction in food consumption, sharing oxen, renting land, share cropping, and shifting staple food crops. Most experienced scarcity of water resources, lack of grazing areas, death of herds and reduced numbers of livestock due to water source pollution. Despite the Ethiopian government investment in attracting and creating conducive environment for investors, not much was accomplished when it comes to enforcing labour laws and environmental policies. Flower farm expansion in Ethiopia, as it is now, can be viewed as part of the global land and water grab and is not all inclusive and sustainable. Several recommendations are made to improve working conditions, maximize the benefits of flower industry to the society, and to the country at large.