Estudo descritivo do perfil de utilizador da linha Saúde 24 com análise de impacto ao nível da eficiência, equidade e empowerment em comparação com o modelo inglês NHS Direct

RESUMO - A 8 de Maio de 2008 surgiu o centro de atendimento “Linha Saúde24” (S24) no sentido de modernizar o SNS, aproximando-o do cidadão. O serviço surge baseado no modelo inglês – o NHS Direct – que pode ser encarado como um serviço de informação telefónico apoiado por enfermeiros, disponível 24h por dia, concebido para expandir os serviços púbicos de acesso à rede prestadora de cuidados com intuito de aliviar a pressão da procura na rede de urgências hospitalares e médicos de família, assim como diluir as iniquidades regionais na prestação de serviços. A S24 assenta na perspectiva de ser um ponto de contacto inicial do utente com a rede de prestação de cuidados de saúde com capacidade de orientação. O objectivo da linha está na tentativa mais eficiente no uso dos recursos disponíveis, ao mesmo tempo que delega responsabilidade no cidadão na forma como este utiliza os recursos disponíveis, com melhor racionalização financeira na área da saúde aliada a uma melhor qualidade de serviço prestada e adequada, colocando os cidadãos no mesmo patamar, diluindo as dificuldades de acesso a aqueles que necessitam na tentativa de harmonizar e racionalizar o consumo de serviços de saúde. Esta estrutura permite ao cidadão conhecer melhor o seu estado de saúde e decidir mais acertadamente quanto à decisão a tomar. Com este estudo, e com base na literatura nacional e internacional, pretende-se descrever o perfil de utilizador que acede à S24 – definir o tipo de utilizador, disposição geográfica, motivos pelo qual acede ao serviço e qual o seu destino final, fazendo comparação com o perfil do NHS Direct. Assim, e com os dados obtidos, far-se-á uma avaliação preliminar em termos do contributo da linha S24 no que concerne à sua eficiência, equidade e empowerment dado ao utilizador. --- ------------------------------ABSTRACT - Saúde 24 (S24) is a national 24-hour health line initiated in May 2008 aiming at modernizing the Portuguese NHS by bringing it closer to the citizen. Indeed, S24 be seen as an initial contact point between the patient and the healthcare network, facilitating a better a management of health care demand. The service is inspired on the UK NHS Direct – a nurse-led telephone line to provide easier and faster advice information to people about health, illness and NHS services. It is expected to provide information so that people can deal with their health problems or their families´ on their own, with the purpose of reducing demand to A&E department and out-of-hours GP services. Additionally it can contribute to a reduction in regional inequities in healthcare provision through bringing health care advice to remote areas. The purpose of S24 is to handle more efficiently the available resources by enabling responsibilities in citizens. By doing so, S24 encourages a more appropriate use of available resources, with better financial outcomes and a better quality of care. It is meant, in terms of empowerment, to help people to be in control of their health and healthcare interactions by participating in the final decision. Based on quantitative data, this study defines the S24 caller user profile in terms of type, geographical reference, reasons for calling and outcome. This analysis allows us to perform a preliminary evaluation of the S24 in terms of its contribution to efficiency, equity and empowerment. Then the S24 is compared to

An uncertainty and sensitivity analysis applied to the prioritisation of pharmaceuticals as surface water contaminants from wastewater treatment plant direct emissions

In this study, the concentration probability distributions of 82 pharmaceutical compounds detected in the effluents of 179 European wastewater treatment plants were computed and inserted into a multimedia fate model. The comparative ecotoxicological impact of the direct emission of these compounds from wastewater treatment plants on freshwater ecosystems, based on a potentially affected fraction (PAF) of species approach, was assessed to rank compounds based on priority. As many pharmaceuticals are acids or bases, the multimedia fate model accounts for regressions to estimate pH-dependent fate parameters. An uncertainty analysis was performed by means of Monte Carlo analysis, which included the uncertainty of fate and ecotoxicity model input variables, as well as the spatial variability of landscape characteristics on the European continental scale. Several pharmaceutical compounds were identified as being of greatest concern, including 7 analgesics/anti-inflammatories, 3 β-blockers, 3 psychiatric drugs, and 1 each of 6 other therapeutic classes. The fate and impact modelling relied extensively on estimated data, given that most of these compounds have little or no experimental fate or ecotoxicity data available, as well as a limited reported occurrence in effluents. The contribution of estimated model input variables to the variance of freshwater ecotoxicity impact, as well as the lack of experimental abiotic degradation data for most compounds, helped in establishing priorities for further testing. Generally, the effluent concentration and the ecotoxicity effect factor were the model input variables with the most significant effect on the uncertainty of output results.

Matrix converter as unified power flow controller: design and implementation of decoupled direct power controllers

This paper presents the design and implementation of direct power controllers for three-phase matrix converters (MC) operating as Unified Power Flow Controllers (UPFC). Theoretical principles of the decoupled linear power controllers of the MC-UPFC to minimize the cross-coupling between active and reactive power control are established. From the matrix converter based UPFC model with a modified Venturini high frequency PWM modulator, decoupled controllers for the transmission line active (P) and reactive (Q) power direct control are synthesized. Simulation results, obtained from Matlab/Simulink, are presented in order to confirm the proposed approach. Results obtained show decoupled power control, zero error tracking, and fast responses with no overshoot and no steady-state error.

GLODS: Global and Local Optimization using Direct Search

Locating and identifying points as global minimizers is, in general, a hard and time-consuming task. Difficulties increase in the impossibility of using the derivatives of the functions defining the problem. In this work, we propose a new class of methods suited for global derivative-free constrained optimization. Using direct search of directional type, the algorithm alternates between a search step, where potentially good regions are located, and a poll step where the previously located promising regions are explored. This exploitation is made through the launching of several instances of directional direct searches, one in each of the regions of interest. Differently from a simple multistart strategy, direct searches will merge when sufficiently close. The goal is to end with as many direct searches as the number of local minimizers, which would easily allow locating the global extreme value. We describe the algorithmic structure considered, present the corresponding convergence analysis and report numerical results, showing that the proposed method is competitive with currently commonly used global derivative-free optimization solvers.

Materials selection for a set of multiple parts considering manufacturing costs and weight reduction with structural isoperformance using direct multisearch optimization

Materials selection is a matter of great importance to engineering design and software tools are valuable to inform decisions in the early stages of product development. However, when a set of alternative materials is available for the different parts a product is made of, the question of what optimal material mix to choose for a group of parts is not trivial. The engineer/designer therefore goes about this in a part-by-part procedure. Optimizing each part per se can lead to a global sub-optimal solution from the product point of view. An optimization procedure to deal with products with multiple parts, each with discrete design variables, and able to determine the optimal solution assuming different objectives is therefore needed. To solve this multiobjective optimization problem, a new routine based on Direct MultiSearch (DMS) algorithm is created. Results from the Pareto front can help the designer to align his/hers materials selection for a complete set of materials with product attribute objectives, depending on the relative importance of each objective.

Multiobjective optimization of viscoelastic laminated sandwich structures using the Direct MultiSearch method

A multiobjective approach for optimization of passive damping for vibration reduction in sandwich structures is presented in this paper. Constrained optimization is conducted for maximization of modal loss factors and minimization of weight of sandwich beams and plates with elastic laminated constraining layers and a viscoelastic core, with layer thickness and material and laminate layer ply orientation angles as design variables. The problem is solved using the Direct MultiSearch (DMS) solver for derivative-free multiobjective optimization and solutions are compared with alternative ones obtained using genetic algorithms.

Optimization of cruciform specimens for biaxial fatigue loading with direct multi search

In order to correctly assess the biaxial fatigue material properties one must experimentally test different load conditions and stress levels. With the rise of new in-plane biaxial fatigue testing machines, using smaller and more efficient electrical motors, instead of the conventional hydraulic machines, it is necessary to reduce the specimen size and to ensure that the specimen geometry is appropriate for the load capacity installed. At the present time there are no standard specimen's geometries and the indications on literature how to design an efficient test specimen are insufficient. The main goal of this paper is to present the methodology on how to obtain an optimal cruciform specimen geometry, with thickness reduction in the gauge area, appropriate for fatigue crack initiation, as a function of the base material sheet thickness used to build the specimen. The geometry is optimized for maximum stress using several parameters, ensuring that in the gauge area the stress distributions on the loading directions are uniform and maximum with two limit phase shift loading conditions (delta = 0 degrees and (delta = 180 degrees). Therefore the fatigue damage will always initiate on the center of the specimen, avoiding failure outside this region. Using the Renard Series of preferred numbers for the base material sheet thickness as a reference, the reaming geometry parameters are optimized using a derivative-free methodology, called direct multi search (DMS) method. The final optimal geometry as a function of the base material sheet thickness is proposed, as a guide line for cruciform specimens design, and as a possible contribution for a future standard on in-plane biaxial fatigue tests

Group-to-group bidirectional Wi-Fi direct communication with two relay nodes

The current capabilities of mobile phones in terms of communication, processing and storage, enables its use to form autonomous networks of devices that can be used in case of collapse or inexistent support from a communication infrastructure. In this paper, we propose a network configuration of nodes that provides high-speed bidirectional device-to-device communication, with symmetrical data transfer rates, in Wi-Fi Direct multi-group scenarios, without using performance hindering broadcasts. Copyright © 2015 ICST.

An evaluation of the direct agglutination test to diagnose "Mal de Caderas" disease

Se evaluó la utilidad de la prueba de aglutinación directa (AD) para diagnosticar el Mal de Caderas. Se emplearon cuarenta y cuatro sueros provenientes de dos lotes de equinos naturalmente infectados con el Trypanosoma evansi (Lote 1 y Lote 2). La AD fue positiva (Aglutinación > 1:512) en 13 de 16 equinos (81.2%), de los que se aislaron los parásitos. En doce de estos animales (92%) se detectaron IgM anti T. evansi mediante la AD realizada con 2-mercaptoetanol (AD + 2-ME). La AD fue positiva en 17 de los 28 equinos que resultaron negativos al diagnóstico parasitológico. Un tercer lote de cinco equinos infectados con T. evansi que presentaba elevados títulos de AD, fue tratado con Suramina Sódica (Nagano1-Bayer). La AD + 2-ME evidenció en cuatro animales que, gran parte de estos anticuerpos se ubicaban en la fracción IgM. Posterior al tratamiento farmacológico y, en concordancia de la negativización de la parasitemia, la detección de la IgM anti T. evansi no fue posible, mientras que los anticuerpos IgG continuaron detectándose a los doce meses post-tratamiento en valores de 1:512, en tres animales. Cincuenta sueros de equinos de una zona libre del parásito, que se emplearon como controles, fueron negativos a la AD. Se recomienda la utilización de la AD y AD + 2-ME para el uso de rutina en el diagnóstico del Mal de Caderas de los equinos, en combinación con otros métodos parasitológicos sensibles.

Synthesis of biodiesel from wastes of food industry via direct transesterification with methanol/carbon dioxide mixtures

Dissertation presented at Faculdade de Ciências e Tecnologia from Universidade Nova de Lisboa to obtain the degree of Master in Chemical and Biochemical Engineering

Does corruption inhibit foreign direct investment?

Globalization creates new opportunities for firms to invest abroad and many economies are making active efforts to attract Foreign Direct Investment (FDI) in order to promote economic growth. Decisions to invest abroad depend on a complex set of factors, but the least corrupt countries may attract more foreign direct investment because they provide a more favorable climate for investors. In this paper we investigate the impact of corruption on FDI inflows in 73 countries, over the period 1998-2008. Our results suggest that countries where corruption is lower, the FDI inflows are greater, and so controlling corruption may be an important strategy for increase FDI inflows.

Revalorization of spent coffee residues by a direct agronomic approach

Spent coffee grounds (SCG) represent a high-volume food waste worldwide, and several reuse approaches have been attempted. Herein, a greenhouse field experiment was carried out by cultivating Batavia lettuce with 5%, 10%, 15%, 20% and 30% (v/v) espresso SCG directly composted in the soil. Healthy vegetables were obtained for all treatments, without yield loss for up to 10% SCG. A progressive increment of green color intensity with increasing SCG content was observed, corroborated by the increase of their photosynthetic pigments (chlorophylls and carotenoids). Furthermore, total ascorbic acid and tocopherols showed statistical significant increases (p < 0.001) between control and all tested groups. Marked variations of nutritionally relevant minerals, particularly potassium, phosphorous and sodium were also revealed at higher percentage treatments (20% and 30%). This approach constitutes a clean, direct, simple and cost-effective measure to produce value-added vegetables, while reducing food waste disposal.

Comparison of direct immunofluorescence, conventional cell culture and polymerase chain reaction techniques for detecting respiratory syncytial virus in nasopharyngeal aspirates from infants

A total of 316 samples of nasopharyngeal aspirate from infants up to two years of age with acute respiratory-tract illnesses were processed for detection of respiratory syncytial virus (RSV) using three different techniques: viral isolation, direct immunofluorescence, and PCR. Of the samples, 36 (11.4%) were positive for RSV, considering the three techniques. PCR was the most sensitive technique, providing positive findings in 35/316 (11.1%) of the samples, followed by direct immunofluorescence (25/316, 7.9%) and viral isolation (20/315, 6.3%) (p < 0.001). A sample was positive by immunofluorescence and negative by PCR, and 11 (31.4%) were positive only by RT-PCR. We conclude that RT-PCR is more sensitive than IF and viral isolation to detect RSV in nasopharyngeal aspirate specimens in newborn and infants.