Análise por simulação de melhoria de processos na entrada de unidade de atenção primária de saúde

This article analyses a process redesign proposal at the entrance to a primary care unit in Rio de Janeiro city. The main redesign is the unification of queues, instead of having users redirected to a specific queue according to their primary care team. Data collected in field visits were used to build a simulation model. Impacts were analyzed regarding the average waiting time in queue, the average size of queues, and the occupation rate of the reception counters. Results indicate a drop in 89,9% of the average waiting time in queue, from 465,5 seconds to 47,2 seconds. The average size of queues was, correspondently, reduced from 0,9 users to 0,6. Also, the average occupation rate of counters was raised from 56,9% to 67,4%, raising productivity without overloading workers. Future studies could explore the consequences of relaxing restrictions on the premises of the model and the replicability of the results on similar healthcare units.Este artículo evalúa una propuesta de rediseño de proceso en la entrada de una unidad de atención primaria en la ciudad de Río de Janeiro. El rediseño principal es la unificación de las colas a cambio de direccionar los usuarios a una cola según su equipo de atención primaria. Datos colectados en visitas a la unidad se usaron para construir un modelo de simulación. Se evaluaron los impactos sobre el tiempo de espera promedio en la cola, el tamaño promedio de las colas y la tasa de ocupación de los mostradores de la recepción. Los resultados indican una reducción en 89,9% del tiempo de espera promedio en la cola, de 465,5 segundos a 47,2 segundos. Además, el tamaño promedio de las colas ha reducido, de 0,9 usuarios a 0,6. Al final, la tasa de ocupación promedio de los mostradores se elevó del 56,9% al 67,4%, aumentando la productividad sin generar sobrecarga. Estudios futuros podrían explorar las consecuencias de relajar restricciones en las premisas del modelo y la replicabilidad de los resultados en unidades de salud similares.Este artigo analisa uma proposta de redesenho de processos da porta de entrada de uma unidade de atenção primária em saúde no Município do Rio de Janeiro. O principal redesenho proposto foi a unificação das filas dos guichês, deixando de estratificar usuários de acordo com sua equipe. Dados coletados em visitas de campo foram usados para construir um modelo de simulação de eventos discretos. Foram analisados os impactos do redesenho sobre o tempo médio de espera em fila, sobre o tamanho médio da fila e sobre a taxa de ocupação dos guichês. Os resultados da simulação apontam para uma redução de 89,9% do tempo médio em fila, passando de 465,5 segundos para 47,2 segundos. Correspondentemente, o tamanho médio da fila foi reduzido de 0,9 usuários para 0,6 usuários. Ainda, houve a redução de um guichê e aumento na taxa média de utilização dos guichês, de 56,9% para 67,4%, aumentando a produtividade sem geração de sobrecarga. Estudos futuros poderão explorar o relaxamento de restrições nas premissas do modelo e a replicabilidade dos resultados em unidades de saúde semelhantes

Supplemental Information 4: Multicolor FACS analyses of cultured DC cells

This study investigated the mechanism of protein disulfide-isomerase A3 (PDIA3)-induced visceral hypersensitivity in irritable bowel syndrome (IBS). Rats were treated with saline (control), acetic acid and restraint stress (IBS model), empty vector (RNAi control) and PDIA3-RNAi vector (PDIA3-RNAi). Mesenteric lymph node DCs (MLNDCs) and splenic CD4+/CD8+ T cells were isolated for co-cultivation. Compared with control, MLNDCs co-cultured with CD4+ or CD8+ T cells showed an increased ability to promote T cell proliferation and produced more IL-4 or IL-9 secretion. Compared with the RNAi control, MLNDCs from the PDIA3 knockdown models were less effective in promoting the proliferation of CD4+/CD8+ T cells. It is concluded that PDIA3 plays an important role in the development of IBS through the DC-mediated activation of T cells, resulting in degranulation of MCs and visceral hypersensitivity

Interface of culture, insecurity and HIV and AIDS: Lessons from displaced communities in Pader District, Northern Uganda

<p>Abstract</p> <p>Background</p> <p>Northern Uganda unlike other rural regions has registered high HIV prevalence rates comparable to those of urbanized Kampala and the central region. This could be due to the linkages of culture, insecurity and HIV. We explored community perceptions of HIV and AIDS as a problem and its inter-linkage with culture and insecurity in Pader District.</p> <p>Methods</p> <p>A cross sectional qualitative study was conducted in four sub-counties of Pader District, Uganda between May and June 2008. Data for the study were collected through 12 focus group discussions (FGDs) held separately; 2 FGDs with men, 6 FGDs with women, and 4 FGDs with the youth (2 for each sex). In addition we conducted 15 key informant interviews with; 3 health workers, 4 community leaders at village and parish levels, 3 persons living with HIV and 5 district officials. Data were analysed using the content thematic approach. This process involved identification of the study themes and sub-themes following multiple reading of interview and discussion transcripts. Relevant quotations per thematic area were identified and have been used in the presentation of study findings.</p> <p>Results</p> <p>The struggles to meet the basic and survival needs by individuals and households overshadowed HIV as a major community problem. Conflict and risky sexual related cultural practices were perceived by communities as major drivers of HIV and AIDS in the district. Insecurity had led to congestion in the camps leading to moral decadence, rape and defilement, prostitution and poverty which increased vulnerability to HIV infection. The cultural drivers of HIV and AIDS were; widow inheritance, polygamy, early marriages, family expectations, silence about sex and alcoholism.</p> <p>Conclusions</p> <p>Development partners including civil society organisations, central government, district administration, religious and cultural leaders as well as other stakeholders should mainstream HIV in all community development and livelihood interventions in the post conflict Pader district to curtail the likely escalation of the HIV epidemic. A comprehensive behaviour change communication strategy is urgently needed to address the negative cultural practices. Real progress in the region lies in advocacy and negotiation to realise lasting peace.</p

Allegory and animals in Olive Schreiner’s Undine : A Queer Little Child (1929)

Written and abandoned in the 1870s, and published posthumously in 1929, Undine: A Queer Little Child has remained on the margins of Olive Schreiner (1855-1920) studies, repeatedly dismissed as a juvenile and poor antecedent to The Story of An African Farm (1883), or deemed valuable primarily for its autobiographical content. This article redresses these schematic readings by analysing how Schreiner draws on allegorical forms in order to explore aspects of her burgeoning radicalism. Focusing on one of the main allegorical thrusts of the novel, provided by the zoomorphic and anthropomorphic animal characters that descend from mythical, fairytale, and Ancient Greek philosophical origins, it investigates how the protagonist’s metaphorically significant associations with animals relate to freethinking, feminist, and anti-imperialist ideas introduced by the novel. Undine thus undermines dominant nineteenth-century models of the “primitive” human or animal as less evolutionarily developed and without political platform, which can be seen to be a liberating move when the novel is read in dialogue with Jacques Derrida’s lectures on animals, and with other recent work in postcolonial ecocriticism

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD

Interaction Between Convection and Pulsation

This article reviews our current understanding of modelling convection dynamics in stars. Several semi-analytical time-dependent convection models have been proposed for pulsating one-dimensional stellar structures with different formulations for how the convective turbulent velocity field couples with the global stellar oscillations. In this review we put emphasis on two, widely used, time-dependent convection formulations for estimating pulsation properties in one-dimensional stellar models. Applications to pulsating stars are presented with results for oscillation properties, such as the effects of convection dynamics on the oscillation frequencies, or the stability of pulsation modes, in classical pulsators and in stars supporting solar-type oscillations.Comment: Invited review article for Living Reviews in Solar Physics. 88 pages, 14 figure

Performance of CMS muon reconstruction in pp collision events at sqrt(s) = 7 TeV

The performance of muon reconstruction, identification, and triggering in CMS has been studied using 40 inverse picobarns of data collected in pp collisions at sqrt(s) = 7 TeV at the LHC in 2010. A few benchmark sets of selection criteria covering a wide range of physics analysis needs have been examined. For all considered selections, the efficiency to reconstruct and identify a muon with a transverse momentum pT larger than a few GeV is above 95% over the whole region of pseudorapidity covered by the CMS muon system, abs(eta) < 2.4, while the probability to misidentify a hadron as a muon is well below 1%. The efficiency to trigger on single muons with pT above a few GeV is higher than 90% over the full eta range, and typically substantially better. The overall momentum scale is measured to a precision of 0.2% with muons from Z decays. The transverse momentum resolution varies from 1% to 6% depending on pseudorapidity for muons with pT below 100 GeV and, using cosmic rays, it is shown to be better than 10% in the central region up to pT = 1 TeV. Observed distributions of all quantities are well reproduced by the Monte Carlo simulation.Comment: Replaced with published version. Added journal reference and DO

Performance of CMS muon reconstruction in pp collision events at sqrt(s) = 7 TeV

The performance of muon reconstruction, identification, and triggering in CMS has been studied using 40 inverse picobarns of data collected in pp collisions at sqrt(s) = 7 TeV at the LHC in 2010. A few benchmark sets of selection criteria covering a wide range of physics analysis needs have been examined. For all considered selections, the efficiency to reconstruct and identify a muon with a transverse momentum pT larger than a few GeV is above 95% over the whole region of pseudorapidity covered by the CMS muon system, abs(eta) < 2.4, while the probability to misidentify a hadron as a muon is well below 1%. The efficiency to trigger on single muons with pT above a few GeV is higher than 90% over the full eta range, and typically substantially better. The overall momentum scale is measured to a precision of 0.2% with muons from Z decays. The transverse momentum resolution varies from 1% to 6% depending on pseudorapidity for muons with pT below 100 GeV and, using cosmic rays, it is shown to be better than 10% in the central region up to pT = 1 TeV. Observed distributions of all quantities are well reproduced by the Monte Carlo simulation.Comment: Replaced with published version. Added journal reference and DO

Compressed representation of a partially defined integer function over multiple arguments

In OLAP (OnLine Analitical Processing) data are analysed in an n-dimensional cube. The cube may be represented as a partially defined function over n arguments. Considering that often the function is not defined everywhere, we ask: is there a known way of representing the function or the points in which it is defined, in a more compact manner than the trivial one

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE