Análise Envoltória de Dados na avaliação de hospitais públicos nas capitais brasileiras

OBJECTIVE: To apply the Data Envelopment Analysis (DEA) methodology for evaluating the performance of public hospitals, in terms of clinical medical admissions. METHODS: The efficiency of the hospitals was measured according to the performance of decision-making units in relation to the variables studied for each hospital, in the year 2000. Data relating to clinical medical admissions in hospitals within the public system in Brazilian state capitals and Federal District (mortality rate, mean length of stay, mean cost of stay and disease profile) were analyzed. The canonical correlation analysis technique was introduced to restrict the variation range of the variables used. The constant returns to scale model was used to generate scores that would enable assessment of the efficiency of the units. From the scores obtained, these cities were classified according to their relative performance in the variables analyzed. It was sought to correlate between the classification scores and the exogenous variables of the expenditure on primary care programs per inhabitant and the human development index for each state capital. RESULTS: In the hospitals studied, circulatory diseases were the most prevalent (23.6% of admissions), and the mortality rate was 10.3% of admissions. Among the 27 state capitals, four reached 100% efficiency (Palmas, Macapá, Teresina and Goiânia), seven were between 85 and 100%, ten were between 70 and 85% and ten had efficiency of less than 70%. CONCLUSIONS: The tool utilized was shown to be applicable for evaluating the performance of public hospitals. It revealed large variations among the Brazilian state capitals in relation to clinical medical admissions.OBJETIVO: Aplicar a metodologia de Análise Envoltória de Dados na avaliação do desempenho de hospitais públicos em termos das internações em suas clínicas médicas. MÉTODOS: A eficiência dos hospitais foi medida a partir do desempenho de unidades de decisão nas variáveis estudadas para cada hospital, no ano 2000. Foram analisados dados referentes às internações em clínica médica dos hospitais SUS das capitais estaduais do Brasil e Distrito Federal (taxas de mortalidade e tempo médio de internação, valor médio da internação e perfil de doenças). A técnica de análise de correlação canônica foi introduzida na restrição do intervalo de variação das variáveis. O modelo Constant Returns to Scale foi utilizado para gerar escores que permitissem avaliar a eficiência das unidades. A partir dos escores obtidos, os municípios foram classificados de acordo com seu desempenho relativo nas variáveis analisadas. Procurou-se correlação entre os escores de classificação com variáveis exógenas: despesas com programas de saúde básica por habitante e índice de desenvolvimento humano das capitais. RESULTADOS: Nos hospitais estudados se destacaram as doenças do aparelho circulatório (23,6% das internações); e a taxa de mortalidade foi de 10,3% das internações. Das 27 capitais, quatro alcançaram 100% de eficiência (Palmas, Macapá, Teresina e Goiânia), sete ficaram entre 85% e 100%, dez entre 70% e 85% e dez com menos de 70%. CONCLUSÕES: A ferramenta utilizada mostrou ser aplicável para a avaliação de desempenho de hospitais públicos, revelando a grande variabilidade entre as capitais brasileiras, no que se refere às internações em clínica médica

CÁLICE: SILÊNCIO OU RESISTÊNCIA?

A canção Cálice (1973) de Chico Buarque e Gilberto Gil é um dos exemplos de como o sujeito compositor utiliza as metáforas para dizer aquilo que não pode dizer. A linguagem musical sempre apresentou uma relação com o silêncio, pois este é carregado de significação. Este trabalho pretende analisar como o não-dito está associado ao silêncio, sendo trabalhado através do efeito metafórico que o sujeito compositor utiliza para disfarçar o seu dizer, ou seja, os sentidos silenciados e que geram efeitos de sentido variados no interlocutor. O trabalho utiliza como fundamentação teórica a Análise do discurso de linha francesa, tal como delineada por Pêcheux e desenvolvida, no Brasil, por Orlandi e seguidores. Ao analisarmos a canção Cálice, estamos interessados em observar o silêncio no sentido do não dito, mas que é dito camuflado através das metáforas

HPV type infection in different anogenital sites among HIV-positive Brazilian women

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Discrete moving frames on lattice varieties and lattice based multispace

In this paper, we develop the theory of the discrete moving frame in two different ways. In the first half of the paper, we consider a discrete moving frame defined on a lattice variety and the equivalence classes of global syzygies that result from the first fundamental group of the variety. In the second half, we consider the continuum limit of discrete moving frames as a local lattice coalesces to a point. To achieve a well-defined limit of discrete frames, we construct multispace, a generalization of the jet bundle that also generalizes Olver’s one dimensional construction. Using interpolation to provide coordinates, we prove that it is a manifold containing the usual jet bundle as a submanifold. We show that continuity of a multispace moving frame ensures that the discrete moving frame converges to a continuous one as lattices coalesce. The smooth frame is, at the same time, the restriction of the multispace frame to the embedded jet bundle. We prove further that the discrete invariants and syzygies approximate their smooth counterparts. In effect, a frame on multispace allows smooth frames and their discretisations to be studied simultaneously. In our last chapter we discuss two important applications, one to the discrete variational calculus, and the second to discrete integrable systems. Finally, in an appendix, we discuss a more general result concerning equicontinuous families of discretisations of moving frames, which are consistent with a smooth frame

Effectiveness of the bucco-lingual technique within a school-based supervised toothbrushing program on preventing caries: a randomized controlled trial

Abstract Background Supervised toothbrushing programs using fluoride dentifrice have reduced caries increment. However there is no information about the effectiveness of the professional cross-brushing technique within a community intervention. The aim was to assess if the bucco-lingual technique can increase the effectiveness of a school-based supervised toothbrushing program on preventing caries. Methods A randomized double-blinded controlled community intervention trial to be analyzed at an individual level was conducted in a Brazilian low-income fluoridated area. Six preschools were randomly assigned to the test and control groups and 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice supervised directly by a dental assistant, was developed four times per year. At the remaining school days the children brushed their teeth under indirect supervising of the teachers. In test group, children also underwent a professional cross-brushing on surfaces of first permanent molar rendered by a specially trained dental assistant five times per year. Enamel and dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars during 18-month follow-up. Exposure time of surfaces was calculated and incidence density ratio was estimated using Poisson regression model. Results Difference of 21.6 lesions per 1,000 children between control and test groups was observed. Among boys whose caries risk was higher compared to girls, incidence density was 50% lower in test group (p = 0.016). Conclusion Modified program was effective among the boys. It is licit to project a relevant effect in a larger period suggesting in a broader population substantial reduction of dental care needs. Trial registration ISRCTN18548869

Efficient second harmonic generation by para-nitroaniline embedded in electro-spun polymeric nanofibres

Intense well polarized second harmonic light was generated by poly(methyl methacrylate) nanofibres with embedded para-nitroaniline nanocrystals. Subwavelength diameter fibres were electro-spun using a 1.2 weight ratio of chromophore to polymer. Analysis of the generated second harmonic light indicates that the para-nitroaniline molecules, which nominally crystalize in the centrosymmetric space group, were organized into noncentrosymmetric structures leading to a second order susceptibility dominated by a single tensor element. Under the best deposition conditions, the nanofibrers display an effective nonlinear optical susceptibility approximately two orders of magnitude greater than that of potassium dihydrogen phosphate. Generalizing this approach to a broad range of organic molecules with strong individual molecular second order nonlinear responses, but which nominally form centrosymmetric organic crystals, could open a new pathway for the fabrication of efficient sub-micron sized second harmonic light generators.Hugo Goncalves thanks the Portuguese Foundation for Science and Technology (FCT) for the support under grant PD/BD/111873/2015. The equipment used to characterize the second harmonic response of the electro-spun fibres was acquired within the framework of the Portuguese National Program for Scientific Re-equipment, contract REEQ-25/FIS/2005 with funds from POCI 2010 (FEDER) and FCT. The Raman microscope was acquired through the project nSTeP Nanostructured Systems for Tailored Performance, NORTE-07-0124-FEDER-000039, ON. 2. This work was in part developed in the scope of the projects CICECO-Aveiro Institute of Materials (UID/CTM/50011/2013), financed by national funds through the Fundacao para a Ciencia e a Tecnologia/Ministerio da Educacao e Ciencia (FCT/MEC) and co-financed by FEDER under the PT2020 Partnership Agreement. The authors are grateful to A M P Botas (University of Aveiro) for help in acquiring the hyperspectral microscopy data.info:eu-repo/semantics/acceptedVersio

Atmospheric effects on extensive air showers observed with the Surface Detector of the Pierre Auger Observatory

Atmospheric parameters, such as pressure (P), temperature (T) and density, affect the development of extensive air showers initiated by energetic cosmic rays. We have studied the impact of atmospheric variations on extensive air showers by means of the surface detector of the Pierre Auger Observatory. The rate of events shows a ~10% seasonal modulation and ~2% diurnal one. We find that the observed behaviour is explained by a model including the effects associated with the variations of pressure and density. The former affects the longitudinal development of air showers while the latter influences the Moliere radius and hence the lateral distribution of the shower particles. The model is validated with full simulations of extensive air showers using atmospheric profiles measured at the site of the Pierre Auger Observatory.Comment: 24 pages, 9 figures, accepted for publication in Astroparticle Physic