Stellar interferometry - dectors and the atmosphere

SIGLEAvailable from British Library Document Supply Centre- DSC:D061963 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Avaliação de desempenho de serviços de saúde Evaluation of the performance of health services

A partir da literatura recente (até 1988) a respeito da avaliação de serviços de saúde em geral e do desempenho hospitalar em particular, destacam-se os diferentes aspectos conceituais e metodológicos envolvidos, começando pelas primeiras tentativas no seio do Colégio Americano de Cirurgiões, passando pela criação e evolução da Comissão Conjunta de Acreditação de Hospitais americana, até os esforços e elaborações conceituais e metodológicas mais recentes. São destacados a metodologia dos grupos diagnósticos homogêneos ("diagnosis related groups" ou "DRGs") e os indicadores de gravidade ("severity of illness"). É comentada a evolução desse incipiente campo de conhecimento e de prática no ambiente nacional. São comentadas as origens do recente interesse internacional a respeito do problema, ou seja, o aumento generalizado de custos dos serviços de saúde, crescente aumento de demandas judiciais em alguns países e ainda o acentuado incremento de complexidade dos atos em muitas especialidades. Destacam-se as fontes de informação correntemente utilizadas no processo, ou seja, a observação direta (estudos caso/controle), os prontuários médicos e os instrumentos-resumo, freqüentemente utilizados para remuneração do atendimento. Mencionam-se as profundas influências na prática de saúde que o processo de avaliação tem introduzido, particularmente a padronização de procedimentos, o estadiamento de agravos, os estudos de trajetória, os relacionados a situações traçadoras ("tracers") e a alternativa que mais tem influenciado a prática de situações complexas de saúde, que são os protocolos diagnóstico-terapêutico s já amplamente utilizados em algumas áreas como a do tratamento de câncer, inclusive no Brasil.<br>Recent literature (up to 1988) on health service assessment in general and especially on hospital service assessment is reviewed, with special attention to its conceptual and methodological aspects. The history of this process is also examined, from the first attempts by the American College of Surgeons, through the Joint Commission for Hospital Accreditation activities up to more recent efforts. The Diagnosis Related Group methodology is commented especially, as well as its more recent complement, the severity of illness inidicators. Progress made in this field is briefly examined as in the light of the Brazilian situation. The origins of the growing international concern with this field are enumerated: soaring costs of health services; the recent growth in the number of medical malpractice suits; and the sharp increase in the complexity of health services. The sources of information used in the process, such as immediate observation (case-control type studies), medical records, and summary instruments already in use for payment or financial control purposes, are commented on. Mention is made of the deep influences of the assessment process on practice as in the case of the standardization of practices and procedures, staging of the pathological processes, trajectory-type studies; the utilization of tracer situations, and, finally, the most influencial on practice of all these assessment instruments: the diagnosis and treatment protocols, already in wide use in some medical fields such as cancer treatment even in developing countries

Changes in the marine carbonate system of the western Arctic: patterns in a rescued data set

A recently recovered and compiled set of inorganic carbon data collected in the Canadian Arctic since the 1970s has revealed substantial change, as well as variability, in the carbonate system of the Beaufort Sea and Canada Basin. Whereas the role of this area as a net atmospheric carbon sink has been confirmed, high pCO2 values in the upper halocline underscore the potential for CO2 outgassing as sea ice retreats and upwelling increases. In addition, increasing total inorganic carbon and decreasing alkalinity are increasing pCO2 and decreasing CaCO3 saturation states, such that undersaturation with respect to aragonite now occurs regularly in both deep waters and the upper halocline