Avaliação da cultura de segurança do paciente na Amazônia Ocidental

Introdução: A cultura de segurança do paciente é fator contribuinte para a manutenção do bem-estar do usuário no sistema de saúde, pois por meio dela obtém-se uma sistematização organizada e de qualidade do cuidado ao paciente, prevenindo possíveis intercorrências que possam trazer danos. Objetivo: Analisar a Cultura de Segurança do Paciente (CSP) na perspectiva dos profissionais de saúde no Hospital de Referência do Alto Rio Juruá, na Amazônia Ocidental Brasileira. Método: Trata-se de um estudo transversal desenvolvido em um hospital público de médio porte em um município da Amazônia Ocidental. O questionário Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality foi aplicado em 280 profissionais, no período dezembro de 2016 a fevereiro de 2017. Foi realizada a análise descritiva dos dados e a consistência interna do instrumento. Resultados: Os resultados apontam as melhores avaliações nas dimensões de Trabalho em equipe nos âmbitos das unidades (60%) e Aprendizado organizacional (60%). Os aspectos com os piores resultados foram as dimensões de Respostas não punitivas aos erros (18%) e Frequência de eventos relatados (32%). A análise de confiabilidade interna (Alpha de Cronbach) das dimensões variou entre 0,35 a 0,90. Conclusão: A cultura do medo parece predominar nesse hospital, contudo o estudo demonstrou que há possibilidades de melhoria em todas as dimensões da CSP. Os valores do Alpha de Cronbach apresentaram semelhança com os resultados obtidos pelo processo de validação.Introduction: The safety culture of the patient is a contributing factor for the maintenance of the user’s well-being in the health system because, through it, an organized systematization and quality of patient care are obtained, preventing possible intercurrences that can cause damages. Objective: To analyze the Patient Safety Culture (PSC) from the perspective of health professionals at the Reference Hospital of the Upper Juruá River, in the Brazilian Western Amazon. Methods: This is a cross-sectional study developed in a medium-sized public hospital in a municipality in Western Amazonia. The Survey for Patient Safety Culture survey of the Agency for Healthcare Research and Quality was applied to 280 professionals from December 2016 to February 2017. Descriptive analysis of the data and the internal consistency of the instrument were performed. Results: The results indicate the best evaluations in the dimensions of Teamwork in the scopes of the units (60%) and Organizational learning (60%). The aspects with the worst results were the dimensions of non-punitive responses to errors (18%) and frequency of events reported (32%). The internal reliability (Cronbach’s Alpha) analysis of the dimensions ranged from 0.35 to 0.90. Conclusion: The "culture of fear" seems to predominate in this hospital, however, the study showed that there is scope for improvement in all dimensions of CSP. The values of Cronbach’s Alpha presented similarity to the results obtained by the validation process

Prospects for electrical performance tuning in Ca3Co4O9 materials by metallic Fe and Ni particles additions

This work further explores the possibilities for designing the high-temperature electrical performance of the thermoelectric Ca3Co4O9 phase, by a composite approach involving separate metallic iron and nickel particles additions, and by employing two different sintering schemes, capable to promote the controlled interactions between the components, encouraged by our recent promising results obtained for similar cobalt additions. Iron and nickel were chosen because of their similarities with cobalt. The maximum power factor value of around 200 µWm−1K−2 at 925 K was achieved for the composite with the nominal nickel content of 3% vol., processed via the twostep sintering cycle, which provides the highest densification from this work. The effectiveness of the proposed approach was shown to be strongly dependent on the processing conditions and added amounts of metallic particles. Although the conventional one-step approach results in Feand Ni-containing composites with the major content of the thermoelectric Ca3Co4O9 phase, their electrical performance was found to be significantly lower than for the Co-containing analogue, due to the presence of less-conducting phases and excessive porosity. In contrast, the relatively high performance of the composite with a nominal nickel content of 3% vol. processed via a two-step approach is related to the specific microstructural features from this sample, including minimal porosity and the presence of the Ca2Co2O5 phase, which partially compensate the complete decomposition of the Ca3Co4O9 matrix. The obtained results demonstrate different pathways to tailor the phase composition of Ca3Co4O9 -based materials, with a corresponding impact on the thermoelectric performance, and highlight the necessity of more controllable approaches for the phase composition tuning, including lower amounts and different morphologies of the dispersed metallic phases.publishe

Descrição da biodiversidade terrestre dos Açores

Os Açores constituem um arquipélago de nove ilhas oceânicas isoladas, onde os organismos terrestres chegaram através do vento, do mar, noutros animais e, nos tempos históricos, com a ajuda humana. Este capítulo analisa de forma detalhada aquilo que se conhece sobre a biodiversidade terrestre dos Açores. Para tal analisámos os quatro grandes grupos de organismos listados no capítulo 4: Bryophyta (musgos, antocerotas e hepáticas), Pteridophyta e Spermatophyta (fetos e fanerogâmicas), Mollusca (lesmas e caracóis) e Arthropoda (centopeias, diplópodes, crustáceos, aranhas, ácaros, insectos, etc.). O número total de espécies e/ou subespécies dos Açores pertencentes aos quatro grupos de organismos acima referidos é de cerca de 3705 (3666 espécies e 224 subespécies). No entanto, adicionando outros grupos como os vertebrados (Chordata, Vertebrata), anelídeos (Annelida), nemátodos (Nematoda) e líquenes, aquele número sobe para 4487 espécies e/ou subspecies (4443 espécies e 232 subespécies). O número total de espécies e/ou subespécies endémicas dos Açores pertencentes aos Bryophyta, Pteridophyta, Spermatophyta, Mollusca e Arthropoda totaliza as 393 (384 espécies e 44 subespécies). Os filos animais são os mais diversos em taxa endémicos (Mollusca = 49; Arthropoda = 267), com cerca de 80 % dos endemismos dos Açores. Deve ser ainda de assinalar a elevada percentagem de endemismo nos caracóis e lesmas (Mollusca) terrestres dos Açores, com cerca de 44% de endemismo. As plantas vasculares possuem 68 endemismos e os briófitos 9. Usando um estimador não paramétrico, a estimativa conservadora da riqueza de taxa endémicos terrestres de briófitos, plantas vasculares, moluscos e artrópodes rondará 530 taxa, pelo que apenas 77% dos endemismos dos Açores serão conhecidos. Em apenas alguns géneros se verificou uma taxa de especiação elevada, na sua maior parte pertencentes aos filos Mollusca e Arthropoda. A maior parte das espécies de artrópodes e moluscos endémicos são conhecidas apenas de uma ilha, enquanto que, nas plantas, uma grande fracção das espécies ocorre na maioria das ilhas. A análise das proporções das várias categorias de colonização mostra que uma grande proporção da phanerofauna de artrópodes e da flora de plantas vasculares do arquipélago é constituída por espécies introduzidas. Deste modo, as invasões por espécies exóticas constituem um problema actual e terão impactos futuros na biodiversidade dos Açores, criando um padrão de uniformização da fauna e flora. Os Açores constituem o arquipélago da Macaronésia geologicamente mais recente, estando situado mais a norte. As suas nove ilhas isoladas no meio do oceano Atlântico possuem uma grande diversidade de histórias geológicas e constituem laboratórios ecológicos e evolutivos extraordinários. Torna-se cada vez mais importante um esforço adicional nos estudos de taxonomia e ecologia de comunidades que envolvam o estudo de grupos taxonómicos mal conhecidos (fungos, líquenes, muitos grupos de artrópodes) mas também a revisão taxonómica de muitas espécies de briófitos e plantas vasculares.ABSTRACT: The Azores is a remote oceanic archipelago of nine islands where the terrestrial organisms arrived by wind, on the sea, on other animals and on historical times by human assistance. This chapter highlights what we know about Azorean terrestrial biodiversity. Four important terrestrial taxonomic groups listed in Chapter 4 are analysed in detail: Bryophyta (mosses, liverworts), Pteridophyta and Spermatophyta (ferns and phanerogamics), Mollusca (slugs and snails) and Arthropoda (millipedes, centipedes, mites, spiders, insects, etc.). Currently the total number of terrestrial species and/or subspecies of the above mentioned organisms in the Azores is estimated of about 3705 (3666 species and 224 subspecies). However, if we add other groups like vertebrates (Chordata, Vertebrata), annelids (Annelida), nematodes (Nematoda) and lichens, this number reaches 4487 species and/or subspecies (4443 species and 232 subspecies). The total number of endemic species and/or subspecies from the Azores belonging to Bryophyta, Pteridophyta, Spermatophyta, Mollusca and Arthropod is about 393 (384 species and 44 subspecies). The animals Phyla are the most diverse in endemic taxa (Mollusca = 49; Arthropoda = 267), comprising about 80% of the Azorean endemics. The percentage of endemismo within Mollusca (44%) is remarkable. Vascular plants have 68 endemic species while bryophytes have 9 endemics. Using a non-parametric estimator we obtained a conservative estimate for endemic Azorean terrestrial vascular plants, bryophytes, molluscs and arthropods around 530 taxa, which mean that only about 77% have already been described. In only some genera there was a substantial inter and intra-island speciation, most cases occurring in Mollusca and Arthropoda. Most of the endemic arthropods and molluscs are known in only one island, whereas in plants a large proportion of species occur in most islands. Na analysis of the proportions of the colonization categories in arthropods and vascular plants shows that a major proportion of the species are introduced. Therefore, invasions of alien organisms are an actual and future environmental threat in the Azores, creating a pattern of biotic homogenization that is of great contemporary concern. The Azores is the northernmost and the most recent Macaronesian archipelago. The nine islands, isolated in the middle of the Atlantic, with different geological histories, are wonderful ecological and evolutionary laboratories. An additional effort on taxonomic and community-level research implies the detailed examination of poorly studied groups (fungi, lichens, many arthropod groups), but a revision of the taxonomic status of many bryophyte and vascular plants is also deeply needed

A perspectiva arquipelágica: Açores

"[…]. Dada a inexistência de um catálogo nacional ou regional de espécies ameaçadas, e considerando que muitas das espécies endémicas dos Açores, raras e sujeitas a várias ameaças, não se encontram abrangidas por directivas e convenções internacionais, nem foram alvo de avaliação por nenhum tipo de critérios (IUCN ou outros), houve necessidade de uma definição de prioridades em termos de acções de conservação baseada numa fundamentação tanto quanto possível clara e objectiva. Nesse sentido, a lista agora apresentada permite-nos realizar uma análise de prioridades para os Açores. Com base nos mesmos critérios e pontuações já referidos em capítulos anteriores, organizou-se o Top 100 dos Açores, listagem que permitirá a prioritização de esforços e recursos (humanos, financeiros ou outros) a nível regional de forma objectiva, previamente acordada entre os intervenientes (gestores e cientistas). Pretende-se assim diminuir a subjectividade que, mais frequentemente do que é em geral admitido, está inerente à atribuição de recursos para a conservação do nosso património natural." [da Introdução

Stellar evolution and modelling stars

In this chapter I give an overall description of the structure and evolution of stars of different masses, and review the main ingredients included in state-of-the-art calculations aiming at reproducing observational features. I give particular emphasis to processes where large uncertainties still exist as they have strong impact on stellar properties derived from large compilations of tracks and isochrones, and are therefore of fundamental importance in many fields of astrophysics.Comment: Lecture presented at the IVth Azores International Advanced School in Space Sciences on "Asteroseismology and Exoplanets: Listening to the Stars and Searching for New Worlds" (arXiv:1709.00645), which took place in Horta, Azores Islands, Portugal in July 201

Macroecological patterns of species distribution, composition and richness of the Azorean terrestrial biota

We investigate the macroecological patterns of the terrestrial biota of the Azorean archipelago, namely the species-range size distributions, the distance decay of similarity, and the island species–area relationship (ISAR). We use the most recent up-to-date checklists to describe the diversity at the island level for nine groups (Lichens, Fungi, Diatoms, Bryophytes, Vascular Plants, Nematodes, Molluscs, Arthropods, Vertebrates). The particularities of the Azorean biota result in some differences to the patterns commonly found in other oceanic archipelagos. Strikingly, bryophytes, molluscs and vertebrates show a bimodal species-range size distribution, and vascular plants a right unimodal distribution due the high numbers of widespread species. Such high compositional homogeneity between islands also results in non-significant or even negative decays of similarity with distance among islands for most groups. Dispersal ability, together with other particular characteristics of each taxon, also shapes these distributions, as well as the relationships between island species richness, and area and time. Strikingly, the degree of departure of the richness of the whole archipelago from the SAR of its constituent islands largely depends on the dispersal ability of each group. Comparative studies with other oceanic archipelagos of the globe are however needed to understand the biogeographical and evolutionary processes shaping the remarkably low diversity of the Azorean biota

Stroke outcome measurements from electronic medical records : cross-sectional study on the effectiveness of neural and nonneural classifiers

Background: With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. Objective: This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. Methods: Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. Results: The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. Conclusions: Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations

Descrição da biodiversidade terrestre e marinha dos Açores

1. Os Açores são um arquipélago isolado de nove ilhas oceânicas, pertence à região biogeográfica da Macaronésia e está entre as regiões mais ricas em fungos, plantas e animais da Europa. Este capítulo destaca o que sabemos sobre os fungos, a fauna e a flora dos habitats terrestres, dulçaquícolas e marinhos dos Açores. 2. Neste capítulo, são apresentadas as estimativas do número total de espécies e subespécies conhecidas actualmente nos Açores. Todos os grupos taxonómicos terrestres mais importantes foram analisados: fungos, líquenes, diatomáceas dulçaquícolas, briófitos (musgos, hepáticas e antocerotas), plantas vasculares (licófitas, fetos, gimnospérmicas e angiospérmicas), platelmintes (vermes), nemátodos, anelídeos (minhocas), moluscos terrestres (lesmas e caracóis), artrópodes (insectos, aracnídeos, milípedes, etc.) e vertebrados (peixes de água doce, anfíbios, répteis, aves e mamíferos). A presente obra inclui também espécies do ambiente marinho, como as algas (macroalgas), a maioria dos filos de invertebrados do litoral e os vertebrados marinhos (répteis, peixes e mamíferos). As listas de espécies e subespécies (Capítulos 2-15) são baseadas nos taxa identificados numa grande variedade de publicações, tendo essa informação sido compilada por um vasto grupo de especialistas. 3. Actualmente, o número total de taxa (espécies e subespécies) terrestres nos Açores está estimado em cerca de 6164 (cerca de 6112 espécies). A inclusão de uma listagem exaustiva das espécies de aves não-nidificantes e de uma listagem preliminar de espécies de aves potencialmente nidificantes acrescenta 325 espécies e subespécies ao total das espécies açorianas. 4. O número total de espécies e subespécies endémicas terrestres dos Açores é de cerca de 452 (411 espécies). Os animais são os mais diversos em endemismos, com 331 taxa (Arthropoda = 266; Mollusca = 49; Vertebrata = 14; Nematoda = 2), compreendendo cerca de 73% dos endemismos terrestres dos Açores. A percentagem de endemismo nos Mollusca (44%) é notável. As plantas vasculares contam com 73 endemismos, os Fungi (incluindo os líquenes) têm 34 e, tanto as diatomáceas dulçaquícolas como os briófitos, incluem sete espécies endémicas. 5. Quando comparada com os arquipélagos vizinhos da Macaronésia (Madeira e Canárias), a fauna e flora terrestres dos Açores é caracterizada por uma menor taxa de endemismo, de apenas 7%, contrastando com os cerca de 20% para a Madeira e de 30% para as Canárias. 6. No que diz respeito aos organismos marinhos, são listados 1883 taxa pertencentes a 16 filos. O número total de espécies e subespécies marinhas endémicas dos Açores é de cerca de 39, a maior parte delas moluscos (29 espécies). 7. O número total de taxa terrestres e marinhos (espécies e subespécies) nos Açores, está estimado em cerca de 8047. Os organismos marinhos agora listados, perfazem cerca de 23% da biodiversidade dos Açores. 8. O número total de taxa terrestres e marinhos (espécies e subespécies) endémicos dos Açores está estimado em cerca de 491.ABSTRACT: 1. The Azores is a remote oceanic archipelago of nine islands which belongs to the Macaronesia biogeographical region and is among the richest regions concerning fungi, plant and animal diversity in Europe. This chapter highlights what we know about the Azorean terrestrial, freshwater and marine Fungi, Flora and Fauna. 2. In this chapter we summarize the current estimates of the total number of species and subspecies presently known to occur in the Azores. The most important terrestrial taxonomic groups were studied: Fungi, Lichens, Bacillariophyta (freshwater diatoms), Bryophyta sensu lato (mosses, liverworts and hornworts), vascular plants – Tracheobionta, including Lycopodiophyta (quillworts), Pteridophyta (ferns), Pinophyta (gymnosperms) and Magnoliophyta (angiosperms), Platyhelminthes (flatworms), Nematoda (roundworms), Annelida (earthworms), Terrestrial Mollusca (slugs and snails), Arthropoda (millipedes, centipedes, mites, spiders, insects, etc.) and Vertebrata (freshwater fishes, amphibians, reptiles, birds and mammals). In addition, we expand this list to the marine realm, including Algae (macroalgae), coastal invertebrates (most Phyla) and marine vertebrates (fishes, reptiles and mammals). The list of species and subspecies (Chapters 2 to 15) is based on the taxa recognized in primary published literature sources, compiled by a vast group of experts. 3. Currently the total number of terrestrial taxa (species and subspecies) in the Azores is estimated of about 6164 (about 6112 species). The inclusion of an exhaustive listing of non breeding species and a preliminary list of potentially breeding species adds 325 species and subspecies of birds to the Azorean list of species. 4. The total number of terrestrial endemic species and/or subspecies from the Azores is about 452 (411 species). Animals are the most represented in this respect, with 331 taxa (Arthropoda = 266; Mollusca = 49; Vertebrata = 14; Nematoda = 2), that is, about 73% of the Azorean terrestrial endemics. The percentage of endemism within Mollusca (44%) is remarkable. Vascular plants have 73 endemic taxa, while Fungi (including Lichens) have 34, freshwater diatoms and bryophytes have seven endemic species each. 5. Compared to the other nearest Macaronesian archipelagos (Madeira and Canaries), the Azorean terrestrial fauna and flora is characterized by a lower percentage of endemism (only 7%, which contrasts with nearly 20% for Madeira and 30% for the Canary islands). 6. Concerning the marine organisms, we listed about 1883 taxa belonging to 16 Phyla. The total number of marine endemic species and/or subspecies from the Azores is about 39, most of them being molluscs (29 species). 7. Currently, the total number of terrestrial and marine taxa (species and subspecies) in the Azores is estimated in about 8047. The marine organisms currently listed make up about 23% of the Azorean biodiversity. 8. Currently, the total number of terrestrial and marine endemic taxa (species and subspecies) in the Azores is estimated of about 491

Observation of an Excited Bc+ State

Using pp collision data corresponding to an integrated luminosity of 8.5 fb-1 recorded by the LHCb experiment at center-of-mass energies of s=7, 8, and 13 TeV, the observation of an excited Bc+ state in the Bc+π+π- invariant-mass spectrum is reported. The observed peak has a mass of 6841.2±0.6(stat)±0.1(syst)±0.8(Bc+) MeV/c2, where the last uncertainty is due to the limited knowledge of the Bc+ mass. It is consistent with expectations of the Bc∗(2S31)+ state reconstructed without the low-energy photon from the Bc∗(1S31)+→Bc+γ decay following Bc∗(2S31)+→Bc∗(1S31)+π+π-. A second state is seen with a global (local) statistical significance of 2.2σ (3.2σ) and a mass of 6872.1±1.3(stat)±0.1(syst)±0.8(Bc+) MeV/c2, and is consistent with the Bc(2S10)+ state. These mass measurements are the most precise to date