O impacto da aplicação de modelos de maturidade nas áreas clínicas do Sistema Nacional de Saúde

Dissertação de mestrado integrado em Engenharia Biomédica (especialização em Informática Médica)The effects of the rapid technological revolution occurring in our society are undeniable. In the health area, the quick growth of Information Technologies has had a particular and striking impact as it has led to an urgent need to improve the health care provided to the population. It is imperative that care delivery becomes an increasingly computerized process in order to facilitate not only the work of all health professionals, but the lives of all users. However, it is necessary that this phenomenon of clinical informatization is evaluated, in order to make it possible to determine the current state of health institutions, as monitored, so that a path of gradual progression can be defined and followed, and internal flows, processes and systems can be improved. In Portugal, many initiatives have been implemented, such as the National Strategy for the Health Information Ecosystem 2020, in particular the SNS Sem Papel. The objective is to improve access to the National Health System and to expedite the sharing of clinical information by eliminating paper in hospital institutions. Obstacles and resistance to change can naturally occur as these initiatives are implemented. Thus, the emergence of entities such as HIMSS Analytics, capable of creating maturity models that provide a clear and concise method, capable of helping institutions to achieve their goals, becomes crucial. Within the scope of this dissertation, two maturity models created by this entity, EMRAM and AMAM, were studied in order to understand their dynamics and scrutinize how they possibilitate the gradual improvement of the analytics of the institutions and the progressive dematerialization of their systems, flows and processes

Predicting death and morbidity in perforated peptic ulcer

Peptic ulcers are defined as defects in the gastrointestinal mucosa that extend through the muscularis mucosae. Although not being the most common complication, perforations stand out as being the complication with the highest mortality rate. To predict the probability of mortality, several scoring systems based on clinical and biochemical parameters, such as the Boey and PULP scoring system have been developed. This article explores, using data mining in the medical data available, how the scoring systems perform when trying to predict mortality and patients’ state complication. We also try to conclude, from the two scoring systems presented, which predicts better the situations described. Regarding the results, we concluded that the PULP scoring allows a better mortality prediction achieving, in this case, above 90% accuracy, however, the results may be inconclusive due to the lack of patients who died in the dataset used. Regarding the complications, we concluded that, on the other hand, the Boey system achieves better results leading to a better prediction when it comes to predicting patients’ state complication.FCT - Fundação para a Ciência e a Tecnologia (UID/CEC/00319/2013

A inclusão de estudantes surdos no Campus São Luís - Monte Castelo do IFMA: buscando compreender evasão, retenção e êxito desse público / The inclusion of deaf students in the IFMA – Campus São Luís/Monte Castelo: understanding school dropout, retention and success of this public

Como consequência de movimentos sociais e acadêmicos, o entendimento acerca de deficiência, evoluiu muito e culminou para a Declaração de Salamanca, da qual o Brasil é signatário, que consiste em importante referência internacional da Educação Especial por proclamar a educação inclusiva como princípio norteador da educação para todos, o que conceitua um modelo educacional pautado na compreensão dos direitos humanos para reconhecer e valorizar a diversidade como condição humana. Desde 2012, o Instituto Federal de Educação Ciência e Tecnologia do Maranhão (IFMA) destina 5% das vagas do processo seletivo para a Educação Profissional Técnica de Nível Médio (EPTN) para alunos com deficiência. Esta pesquisa investigou alunos surdos matriculados de 2012 a 2019 nos cursos da EPTN no IFMA – Monte Castelo, objetivando compreender a opção desses alunos pelo IFMA, campus e curso, evidenciar causas para evasão, além de identificar a intenção desses alunos pós curso técnico. A metodologia foi descritiva e analítica, dando-se abordagem quantitativa e qualitativa. Foram levantados os dados de alunos matriculados, evadidos e concluídos, além de já ter sido realizada a aplicação de questionários para essas situações. No período estudado, 50 estudantes surdos se matricularam no Campus, sendo que 15 concluíram o curso (30% no total; 39,47% do universo com tempo mínimo para conclusão), 12 evadiram (24%) e 23 permanecem matriculados (46%). As principais dificuldades apontadas por esses estudantes foram as disciplinas profissionalizantes e a comunicação com colegas e professores, o que aponta a necessidade uma atenção maior a esses estudantes durante o curso, não apenas a garantia do acesso dos mesmos à escola, mas também da Libras em todos os ambientes, assim como da formação continuada de professores e estudantes ouvintes

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Search for top squarks in the four-body decay mode with single lepton final states in proton-proton collisions at s \sqrt{s} = 13 TeV

A search for the pair production of the lightest supersymmetric partner of the top quark, the top squark (t∼1), is presented. The search targets the four-body decay of the t∼1, which is preferred when the mass difference between the top squark and the lightest supersymmetric particle is smaller than the mass of the W boson. This decay mode consists of a bottom quark, two other fermions, and the lightest neutralino (χ∼01), which is assumed to be the lightest supersymmetric particle. The data correspond to an integrated luminosity of 138 fb−1 of proton-proton collisions at a center-of-mass energy of 13 TeV collected by the CMS experiment at the CERN LHC. Events are selected using the presence of a high-momentum jet, an electron or muon with low transverse momentum, and a significant missing transverse momentum. The signal is selected based on a multivariate approach that is optimized for the difference between m(t∼1) and m(χ∼01). The contribution from leading background processes is estimated from data. No significant excess is observed above the expectation from standard model processes. The results of this search exclude top squarks at 95% confidence level for masses up to 480 and 700 GeV for m(t∼1) − m(χ∼01) = 10 and 80 GeV, respectively

A search for new physics in central exclusive production using the missing mass technique with the CMS detector and the CMS-TOTEM precision proton spectrometer

A generic search is presented for the associated production of a Z boson or a photon with an additional unspecified massive particle X, pp → pp + Z/γ + X, in proton-tagged events from proton–proton collisions at √s = 13 TeV, recorded in 2017 with the CMS detector and the CMS-TOTEM precision proton spectrometer. The missing mass spectrum is analysed in the 600–1600 GeV range and a fit is performed to search for possible deviations from the background expectation. No significant excess in data with respect to the background predictions has been observed. odelindependent upper limits on the visible production cross section of pp → pp + Z/γ + X are set

Search for a vector-like quark T′ → tH via the diphoton decay mode of the Higgs boson in proton-proton collisions at s \sqrt{s} = 13 TeV

A search for the electroweak production of a vector-like quark T′, decaying to a top quark and a Higgs boson is presented. The search is based on a sample of proton-proton collision events recorded at the LHC at = 13 TeV, corresponding to an integrated luminosity of 138 fb−1. This is the first T′ search that exploits the Higgs boson decay to a pair of photons. For narrow isospin singlet T′ states with masses up to 1.1 TeV, the excellent diphoton invariant mass resolution of 1–2% results in an increased sensitivity compared to previous searches based on the same production mechanism. The electroweak production of a T′ quark with mass up to 960 GeV is excluded at 95% confidence level, assuming a coupling strength κT = 0.25 and a relative decay width Γ/MT′ < 5%