Avaliação do sono e enfermeiros nos diferentes turnos hospitalares

This study aimed to analyze the pattern characteristics of sleep and sleep quality of nurses who worked day and night shifts. This is a study with a quantitative approach, cross-sectional, descriptive. The study was conducted at the University Hospital of Rio Grande do Norte. Data were collected in full in the period from January to September 2015, through the instruments: Pittsburgh Sleep Quality Index and Sleep Diary. Subjects were interviewed according to their work shift, day or night, during the working hours of the nursing team. After being coded and tabulated, data were analyzed using SPSS version 20.0. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, in the Opinion No. 751 567. For a description of continuous variables were used position measurements (mean and median), dispersion (standard deviation) and correlation (Spearman correlation test), to a 0.05 significance level. The socio-demographic profile of the sample showed a total of n = 104 participants, distributed in: 64 on day shift and night shift 40; wherein 90.4% are female, aged between 24-45 years, corresponding to 73% of the sample. There was the presence of statistically significant differences for the variables: employment and living habits (inpatient and outpatient sector (p = 0.003), have more than one job (p = 0.002), use cordial (p = 0.021); Sleep pattern: nap time (p = 0.003), sleep latency (p = 0.013), total sleep time (p = 0.001), how it felt to wake up (p = 0.017), quality of nighttime sleep (p = 0.001) and sleep quality (p = 0.007) compared between the day shift and the night shift. It was concluded that shift work has changed the pattern and sleep quality of nurses working day and night shifts.

Discrete-event Simulation and Optimization to Improve the Performance of a Healthcare System

Thesis (Ph.D.)--University of Washington, 2016-08

PERFIL DOS FREQUENTADORES DAS ACADEMIAS DE GINÁSTICA DE UM MUNICÍPIO DO RIO GRANDE DO SUL

Objetivo: Traçar o perfil dos frequentadores das academias de ginástica do município de Canguçu-RS. Métodos: Estudo transversal, de caráter descritivo, com 177 frequentadores de academias de diversas modalidades. Utilizou-se um questionário estruturado, contendo 76 questões para mensurar variáveis sociodemograficas, antropométricas, nutricionais e comportamentais, além de informações relacionadas às praticas nas academias. Realizouse análise descritiva dos dados, com cálculo de médias ± desvios-padrão para as variáveis contínuas e cálculo de proporções para as variáveis categóricas. Resultados: Participaram 177 frequentadores das academias na cidade de Canguçu-RS (30±12,5 anos; 70,0±12,8 kg; 1,69±0,1m). Com relação às variáveis comportamentais, a maioria nunca fumou (71,8%), não bebia exageradamente (89,9%) e era ativa no lazer (87%). No tocante às variáveis nutricionais, 66,7% tinham índice de massa corporal normal e a maioria não alcançava as recomendações de consumo diário de frutas, verduras e legumes, e não usava suplementos (69,5%). No que diz respeito às variáveis relacionadas à academia, a maioria dos respondentes frequentava há mais de 12 meses (56,5%), quatro ou mais vezes por semana (52%), à noite (52,5%), relatando que o principal motivo para ir à academia foi permanecer saudável (78%). Os praticantes afirmaram satisfação com os objetivos alcançados (60%) e praticavam a modalidade de musculação (97,2%). Conclusão: A maioria dos frequentadores das academias era do sexo masculino, jovem, ativa no lazer, praticava a modalidade de musculação e estava satisfeita com os resultados buscados nas academias. Apesar disso, são necessárias estratégias de mudança de comportamento em relação ao consumo de frutas, verduras e legumes.

STATISTICAL METHODS FOR ADVANCED ECONOMETRIC MODELS WITH APPLICATIONS TO VEHICLE HOLDING AND SPEED QUANTILES DISTRIBUTION

This dissertation proposes statistical methods to formulate, estimate and apply complex transportation models. Two main problems are part of the analyses conducted and presented in this dissertation. The first method solves an econometric problem and is concerned with the joint estimation of models that contain both discrete and continuous decision variables. The use of ordered models along with a regression is proposed and their effectiveness is evaluated with respect to unordered models. Procedure to calculate and optimize the log-likelihood functions of both discrete-continuous approaches are derived, and difficulties associated with the estimation of unordered models explained. Numerical approximation methods based on the Genz algortithm are implemented in order to solve the multidimensional integral associated with the unordered modeling structure. The problems deriving from the lack of smoothness of the probit model around the maximum of the log-likelihood function, which makes the optimization and the calculation of standard deviations very difficult, are carefully analyzed. A methodology to perform out-of-sample validation in the context of a joint model is proposed. Comprehensive numerical experiments have been conducted on both simulated and real data. In particular, the discrete-continuous models are estimated and applied to vehicle ownership and use models on data extracted from the 2009 National Household Travel Survey. The second part of this work offers a comprehensive statistical analysis of free-flow speed distribution; the method is applied to data collected on a sample of roads in Italy. A linear mixed model that includes speed quantiles in its predictors is estimated. Results show that there is no road effect in the analysis of free-flow speeds, which is particularly important for model transferability. A very general framework to predict random effects with few observations and incomplete access to model covariates is formulated and applied to predict the distribution of free-flow speed quantiles. The speed distribution of most road sections is successfully predicted; jack-knife estimates are calculated and used to explain why some sections are poorly predicted. Eventually, this work contributes to the literature in transportation modeling by proposing econometric model formulations for discrete-continuous variables, more efficient methods for the calculation of multivariate normal probabilities, and random effects models for free-flow speed estimation that takes into account the survey design. All methods are rigorously validated on both real and simulated data.

INJURIES RELATED TO COMPETITIVE AND NONCOMPETITIVE SPORTS IN ELDERLY MEN

Objective: To verify the sociodemographic profile and the frequency of musculoskeletal injuries in elderly people who practice competitive and noncompetitive sports activities in the city of Pelotas, RS. Methods: Descriptive study, including 29 male subjects, aged 65 years or older, who practiced sports modalities in a competitive and noncompetitive way, in the city of Pelotas, in 2015. Data collection was performed through the application of a questionnaire with questions addressing economic, sociodemographic, nutritional and behavioral issues, and injuries sustained in sports activities. Statistical analysis was performed by calculating measures of central tendency for continuous variables and proportions for categorical variables. Results: The current practice of competitive sports was described by 58.6% (n=17) of the subjects, and the most practiced sports were 7-a-side football (53.0%, n=9), tennis (23.5%, n=4) and swimming (23.5%, n=4). Noncompetitive sports were practiced by 44.8% (n=13), and tennis was the most popular sport played (92.3%, n=12). The frequency of injuries among individuals practicing competitive and noncompetitive sports was, respectively, 35.3% (n=6), and 38.5% (n=5). The most frequent injuries were epicondylitis (50.0%, n=3) and meniscus injuries (60.0%, n=3), and the most affected body regions were knee (27.3%, n=3), elbow (27.3%, n=3), and shoulder (18.2%, n=2). The injuries occurred during the sports activities, and the dominant side was the one affected in 63.6% (n=7). Conclusion: This study verified that the occurrence of injuries in elderly individuals who practice sports is relevant, even among those who practice them noncompetitively, with epicondylitis as the most frequent among them, whereas meniscus injuries are the most frequent among those who practice competitive sports.

Interrupted searches in the BBMCSFilter context for MINLP problems

The BBMCSFilter method was developed to solve mixed integer nonlinear programming problems. This kind of problems have integer and continuous variables and they appear very frequently in process engineering problems. The objective of this work is to analyze the performance of the method when the coordinate searches are interrupted in the context of the multistart strategy. From the numerical experiments, we observed a reduction on the number of function evaluations and on the CPU time.

Resiliência e performance: Um voo lado a lado?

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Social e das Organizações.

Communicating continuous quantum variables between different Lorentz frames

We show how to communicate Heisenberg-limited continuous (quantum) variables between Alice and Bob in the case where they occupy two inertial reference frames that differ by an unknown Lorentz boost. There are two effects that need to be overcome: the Doppler shift and the absence of synchronized clocks. Furthermore, we show how Alice and Bob can share Doppler-invariant entanglement, and we demonstrate that the protocol is robust under photon loss.

Classification of Chenopodium Genus Populations and Species Based on Continuous and Categorical Variables

2000 Mathematics Subject Classification: 62P10, 62H30

Bayesian Dependence Tests for Continuous, Binary and Mixed Continuous-Binary Variables

Tests for dependence of continuous, discrete and mixed continuous-discrete variables are ubiquitous in science. The goal of this paper is to derive Bayesian alternatives to frequentist null hypothesis significance tests for dependence. In particular, we will present three Bayesian tests for dependence of binary, continuous and mixed variables. These tests are nonparametric and based on the Dirichlet Process, which allows us to use the same prior model for all of them. Therefore, the tests are “consistent” among each other, in the sense that the probabilities that variables are dependent computed with these tests are commensurable across the different types of variables being tested. By means of simulations with artificial data, we show the effectiveness of the new tests.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Simultaneous material selection and geometry design of statically determinate trusses using continuous optimization

In this work, we explore simultaneous geometry design and material selection for statically determinate trusses by posing it as a continuous optimization problem. The underlying principles of our approach are structural optimization and Ashby’s procedure for material selection from a database. For simplicity and ease of initial implementation, only static loads are considered in this work with the intent of maximum stiffness, minimum weight/cost, and safety against failure. Safety of tensile and compression members in the truss is treated differently to prevent yield and buckling failures, respectively. Geometry variables such as lengths and orientations of members are taken to be the design variables in an assumed layout. Areas of cross-section of the members are determined to satisfy the failure constraints in each member. Along the lines of Ashby’s material indices, a new design index is derived for trusses. The design index helps in choosing the most suitable material for any geometry of the truss. Using the design index, both the design space and the material database are searched simultaneously using gradient-based optimization algorithms. The important feature of our approach is that the formulated optimization problem is continuous, although the material selection from a database is an inherently discrete problem. A few illustrative examples are included. It is observed that the method is capable of determining the optimal topology in addition to optimal geometry when the assumed layout contains more links than are necessary for optimality.

A Viscoelastic Constitutive Model with Nonlinear Evolutionary Internal Variables

Based on the internal variable theory, a viscoelastic constitutive model of a highly deformable continuous medium is proposed. A set of second rank tensorial internal state variables corresponding to Biot's strain is introduced, and a nonlinear evolution

Continuous F0 in the source-excitation generation for HMM-based TTS: Do we need voiced/unvoiced classification?

Most HMM-based TTS systems use a hard voiced/unvoiced classification to produce a discontinuous F0 signal which is used for the generation of the source-excitation. When a mixed source excitation is used, this decision can be based on two different sources of information: the state-specific MSD-prior of the F0 models, and/or the frame-specific features generated by the aperiodicity model. This paper examines the meaning of these variables in the synthesis process, their interaction, and how they affect the perceived quality of the generated speech The results of several perceptual experiments show that when using mixed excitation, subjects consistently prefer samples with very few or no false unvoiced errors, whereas a reduction in the rate of false voiced errors does not produce any perceptual improvement. This suggests that rather than using any form of hard voiced/unvoiced classification, e.g., the MSD-prior, it is better for synthesis to use a continuous F0 signal and rely on the frame-level soft voiced/unvoiced decision of the aperiodicity model. © 2011 IEEE.