Estimating capacity and resource allocation in healthcare settings using business process modelling and simulation

Healthcare involves complex decision making from planning to resource management. Resources in hospitals are usually allocated by experienced managers,however, due to an inherent process complexity, decisions are surrounded by uncertainties, variabilities, and constraints. Information Systems must be robust enough to provide support to stakeholders, capable of controlling and support work flows. The present work explores the required synergy when combining business processes with discrete event simulation. The objective is to estimate performance indices and address capacity management of a surgical center as a case study.Postprin

Exercise Therapy for Fibromyalgia

Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals from the American Heart Association

Self‐care is defined as a naturalistic decision‐making process addressing both the prevention and management of chronic illness, with core elements of self‐care maintenance, self‐care monitoring, and self‐care management. In this scientific statement, we describe the importance of self‐care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self‐care behaviors such as diet and exercise, barriers to self‐care, and the effectiveness of self‐care in improving outcomes is reviewed, as is the evidence supporting various individual, family‐based, and community‐based approaches to improving self‐care. Although there are many nuances to the relationships between self‐care and outcomes, there is strong evidence that self‐care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self‐care in evidence‐based guidelines

PADRÕES DE DESMATAMENTO NOS BIOMAS AMAZÔNIA, CERRADO E PANTANAL NA BACIA HIDROGRÁFICA DO ALTO PARAGUAI, MATO GROSSO - BRASIL

The objective of this study is to analyze the spatial dynamics of vegetation cover and land use and the rate of deforestation in the Upper Paraguay River Basin, located in the Brazilian state of Mato Grosso, so that the information can contribute to the development of territorial planning strategies aimed at environmental conservation. Analyses of the dynamics of changes in vegetation cover and land use and deforestation rates were carried out through procedures carried out via geoprocessing (cutting, reclassification, resizing and quantification) of the annual mapping data (1985-2020) generated by the Annual Mapping Project of Land Cover and Use in Brazil (MapBiomas). In the investigated hydrographic unit, the Natural Vegetation Areas decreased by 19.82%, while the Agricultural Anthropogenic Areas increased by 76.74%. In the basin, the average deforestation rate was 1.57%/year, while in the Amazon, Cerrado and Pantanal biomes in the basin it was 4.09%/year, 1.58%/year and 0.75%/year, respectively. In the Pantanal, the average deforestation rate went from 0.77%/year to 0.88%/year from the initial five-year period (1986-1990) to the end (2016-2020), while in the same period there was a reduction in the Amazon (5.12%/year to 2.22%/year) and in the Cerrado (1.68%/year to 1.21%/year). It can be seen that deforestation occurs heterogeneously in the basin with greater intensity in the biomes located in the plateau region (Amazon and Cerrado), where anthropogenic areas have surpassed areas of natural vegetation. Although the average rate of deforestation is low in the Pantanal, compared to the other biomes, a recent upward trend (2016-2020) in the average was observed.El objetivo de este estudio es analizar la dinámica espacial de la cobertura vegetal y el uso del suelo y la tasa de deforestación en la Cuenca del Río Alto Paraguay, ubicada en el estado brasileño de Mato Grosso, de manera que la información pueda contribuir al desarrollo de estrategias de planificación territorial orientadas a la conservación ambiental. Los análisis de la dinámica de los cambios en la cobertura vegetal y en las tasas de uso y deforestación del suelo se realizaron a través de procedimientos realizados a través del geoprocesamiento (corte, reclasificación, redimensionamiento y cuantificación) de los datos de mapeo anual (1985-2020) generados por el Proyecto Anual de Mapeo de Cobertura y Uso del Suelo en Brasil (MapBiomas). En la unidad hidrográfica investigada, las Áreas de Vegetación Natural disminuyeron en 19.82%, mientras que las Áreas Antropogénicas Agrícolas aumentaron en 76.74%. En la cuenca, la tasa promedio de deforestación fue de 1,57%/año, mientras que en los biomas Amazonia, Cerrado y Pantanal de la cuenca fue de 4,09%/año, 1,58%/año y 0,75%/año, respectivamente. En el Pantanal, la tasa promedio de deforestación pasó de 0,77%/año a 0,88%/año desde el quinquenio inicial (1986-1990) hasta el final (2016-2020), mientras que en el mismo período hubo una reducción en la Amazonia (5,12%/año a 2,22%/año) y en el Cerrado (1,68%/año a 1,21%/año). Se puede observar que la deforestación ocurre de manera heterogénea en la cuenca, con mayor intensidad en los biomas ubicados en la región de la meseta (Amazonas y Cerrado), donde las áreas antropogénicas han superado las áreas de vegetación natural. Aunque la tasa promedio de deforestación es baja en el Pantanal, en comparación con los otros biomas, se observó una tendencia al alza reciente (2016-2020) en el promedio.O objetivo deste estudo é analisar a dinâmica espacial da cobertura vegetal e uso da terra e a taxa de desmatamento na Bacia Hidrográfica do Alto Paraguai, localizada no estado brasileiro de Mato Grosso, visando que as informações possam contribuir no desenvolvimento de estratégias de planejamento territorial voltadas à conservação ambiental. Foram realizadas análises da dinâmica de mudanças da cobertura vegetal e uso da terra e das taxas de desmatamento por meio de procedimentos efetuados via geoprocessamento (recorte, reclassificação, redimensionamento e quantificação) dos dados anuais de mapeamentos (1985-2020) gerados pelo Projeto de Mapeamento Anual da Cobertura e Uso do Solo no Brasil (MapBiomas). Na unidade hidrográfica investigada as Áreas de Vegetação Natural sofreram redução de 19,82%, ao passo que as Áreas Antrópicas Agrícolas aumentaram 76,74%. Na bacia a taxa média de desmatamento foi de 1,57%/ano, enquanto que nos biomas Amazônia, Cerrado e Pantanal na bacia foi de 4,09%/ano, 1,58%/ano e 0,75%/ano, respectivamente. No Pantanal a taxa média de desmatamento foi de 0,77%/ano para 0,88%/ano do quinquênio inicial (1986-1990) para o final (2016-2020), enquanto no mesmo período houve redução na Amazônia (5,12%/ano para 2,22%/ano) e no Cerrado (1,68%/ano para 1,21%/ano). Constata-se que na bacia o desmatamento ocorre de forma heterogênea, com maior intensidade nos biomas localizados na região de planalto (Amazônia e Cerrado), onde as áreas antrópicas superaram as áreas de vegetação natural. Embora a taxa média de desmatamento seja baixa no Pantanal, comparado aos demais biomas, foi observada uma tendência de aumento recente (2016-2020) na médi

Tétano em um canino: aspectos clínicos e terapêuticos

O tétano é uma doença grave e rara em pequenos animais, de caráter agudo e mediada pela ação da neurotoxina tetanospasmina, proveniente do bacilo Clostridium tetani. Neste relato descreve-se um caso de tétano em um canino, com ênfase em seus aspectos clínicos e terapêuticos, além da sua recuperação clínica. Foi atendido no Hospital Veterinário da Universidade de Passo Fundo, um canino, fêmea, da raça Pitbull, com cinco meses, em status epilepticus. Após a estabilização da paciente, constataram-se animal em posição de cavalete, com paralisia espástica generalizada, risus sardonicus, trismo, cauda e orelhas eretas e dificuldade em expandir o tórax. O diagnóstico presuntivo de tétano foi firmado a partir da anamnese, sinais clínicos e achados laboratoriais. O tratamento suporte estabelecido incluiu reposição hidroeletrolítica, soro antitetânico, antibioticoterapia, analgesia, fármacos miorrelaxantes e anticonvulsivantes. O manejo intensivo da paciente foi realizado com sondagem uretral e nasoesofágica, trocas de decúbito a cada duas horas e diminuição de estímulos ambientais. A fisioterapia e a acupuntura também foram utilizadas para complementar o tratamento e acelerar a recuperação. A paciente recebeu alta médica um mês após o início do tratamento, apresentando evolução satisfatória. No presente caso, o exame clínico em associação aos sinais clínicos característicos da doença, acrescidos da anamnese minuciosa foram fundamentais ao diagnóstico presuntivo de tétano. Além disso, o manejo intensivo, o tratamento medicamentoso, assim como a realização de fisioterapia e acupuntura, possibilitaram a evolução do quadro clínico à cura. Palavras-chaves: Clostridium tetani, diagnóstico; paralisia espástica; tetanospasmina; tratamento

NDVI e EVI Aplicados à Análise da Dinâmica Temporal da Cobertura Vegetal e Usos da Terra da Bacia do Córrego Padre Inácio-Mato Grosso, Brasil

O objetivo deste estudo é aplicar os índices de vegetação Normalized Difference Vegetation Index (NDVI) e Enhanced Vegetation Index (EVI) para análise da dinâmica temporal da cobertura vegetal e dos usos da terra da Bacia Hidrográfica do Córrego Padre Inácio, no Estado de Mato Grosso. O estudo é desenvolvido na perspectiva de que os dados e informações geradas contribuam para a conservação ambiental do bioma Pantanal, a qual a bacia é contribuinte hídrica. Para tal, foram gerados os dados de cobertura vegetal e dos usos da terra, para o ano de 2016; extração dos dados de NDVI e EVI para o período de 16 anos; verificação a campo para correções e validação; cálculos das curvas médias das classes para cada índice e confecção dos perfis médios. Quatro classes de cobertura vegetal e usos da terra foram identificadas na bacia: Agricultura na Região de Savana (Ac.S); Floresta Estacional Semidecidual Aluvial (Fa); Pastagem plantada na Região de Savana (Ap.S) e Savana Arborizada com Presença de Savana Florestada (Sa+Sd). A Ap.S ocupou áreas originalmente de Fa e Sa+Sd, sendo que as práticas de manejo contribuíram para a aceleração da degradação na bacia, fato evidenciado pelo baixo índice de biomassa. Atualmente a Ac.S (cana-de-açúcar, majoritariamente) tem se expandido, ocupando as áreas de Ap.S degradadas. A baixa densidade da vegetação nativa no entorno dos cursos hídricos sinaliza o descumprimento das normas do Código Florestal. Dessa maneira, é urgente a adoção de práticas de manejo conservacionistas e recuperação das Áreas de Preservação Permanentes dos cursos hídricos, caso contrário, as práticas agropecuárias desenvolvidas na bacia se tornarão inviáveis, provocando o surgimento e a intensificação de problemas ambientais

Validation of the ADAMO Care Watch for step counting in older adults

Background: Accurate measurement devices are required to objectively quantify physical activity. Wearable activity monitors, such as pedometers, may serve as affordable and feasible instruments for measuring physical activity levels in older adults during their normal activities of daily living. Currently few available accelerometer-based steps counting devices have been shown to be accurate at slow walking speeds, therefore there is still lacking appropriate devices tailored for slow speed ambulation, typical of older adults. This study aimed to assess the validity of step counting using the pedometer function of the ADAMO Care Watch, containing an embedded algorithm for measuring physical activity in older adults. Methods: Twenty older adults aged ≥ 65 years (mean ± SD, 75±7 years; range, 68–91) and 20 young adults (25±5 years, range 20–40), wore a care watch on each wrist and performed a number of randomly ordered tasks: walking at slow, normal and fast self-paced speeds; a Timed Up and Go test (TUG); a step test and ascending/descending stairs. The criterion measure was the actual number of steps observed, counted with a manual tally counter. Absolute percentage error scores, Intraclass Correlation Coefficients (ICC), and Bland–Altman plots were used to assess validity. Results: ADAMO Care Watch demonstrated high validity during slow and normal speeds (range 0.5–1.5 m/s) showing an absolute error from 1.3% to 1.9% in the older adult group and from 0.7% to 2.7% in the young adult group. The percentage error for the 30-metre walking tasks increased with faster pace in both young adult (17%) and older adult groups (6%). In the TUG test, there was less error in the steps recorded for older adults (1.3% to 2.2%) than the young adults (6.6% to 7.2%). For the total sample, the ICCs for the ADAMO Care Watch for the 30-metre walking tasks at each speed and for the TUG test were ranged between 0.931 to 0.985. Conclusion: These findings provide evidence that the ADAMO Care Watch demonstrated highly accurate measurements of the steps count in all activities, particularly walking at normal and slow speeds. Therefore, these data support the inclusion of the ADAMO Care Watch in clinical applications for measuring the number of steps taken by older adults at normal, slow walking speeds

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The Alaska Arctic Vegetation Archive (AVA-AK)

The Alaska Arctic Vegetation Archive (AVA-AK, GIVD-ID: NA-US-014) is a free, publically available database archive of vegetation-plot data from the Arctic tundra region of northern Alaska. The archive currently contains 24 datasets with 3,026 non-overlapping plots. Of these, 74% have geolocation data with 25-m or better precision. Species cover data and header data are stored in a Turboveg database. A standardized Pan Arctic Species List provides a consistent nomenclature for vascular plants, bryophytes, and lichens in the archive. A web-based online Alaska Arctic Geoecological Atlas (AGA-AK) allows viewing and downloading the species data in a variety of formats, and provides access to a wide variety of ancillary data. We conducted a preliminary cluster analysis of the first 16 datasets (1,613 plots) to examine how the spectrum of derived clusters is related to the suite of datasets, habitat types, and environmental gradients. Here, we present the contents of the archive, assess its strengths and weaknesses, and provide three supplementary files that include the data dictionary, a list of habitat types, an overview of the datasets, and details of the cluster analysis