Performance evaluation of Mexico's health system at the national and subnational level, 1990-2019: an analysis of the Health Access and Quality Index.

OBJECTIVES: This study aimed to comprehensively evaluate Mexico's health system performance from 1990 to 2019 utilising the Health Access and Quality Index (HAQI) as a primary indicator. STUDY DESIGN: A retrospective ecological analysis was performed using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) study and the National Population Council (CONAPO). METHODS: HAQI values for 1990, 2000, 2010, 2015, and 2019 were examined for each state in Mexico and three age groups (young, working, and post-working). Additionally, the marginalisation index was employed to assess inequalities in the HAQI distribution across states. The concentration index of the HAQI for each year was estimated, and the efficiency of states in producing the HAQI was evaluated using a data envelopment approach. RESULTS: Through the analysis of national and subnational data, results indicated an overall improvement in healthcare access and quality during the study period. Although differences in the HAQI value related to state marginalisation decreased from 1990 to 2015, by 2019, the inequality had returned to a level comparable to 2000. Efficiency in producing health (HAQI values) exhibited substantial heterogeneity and fluctuations in the ranking order over time. States such as Nuevo León consistently performed well, while others, such as Guerrero, Chihuahua, Mexico City, and Puebla, consistently underperformed. CONCLUSIONS: The findings from this study emphasise the necessity for nuanced strategies to address healthcare disparities and enhance the overall system performance. The study provides valuable insights for ongoing discussions about the future of Mexico's healthcare system, aiming to inform evidence-based policy decisions and improve the nationwide delivery of healthcare services.

Developing environmental, social and governance (ESG) strategies on evaluation of municipal waste disposal centers: A case of Mexico.

Waste disposal systems are crucial components of environmental management, and focusing on this sector can contribute to the development of various other sectors and improve social welfare. Urban waste is no longer solely an environmental issue; it now plays a significant role in the economy, energy, and value creation, with waste disposal centers (WDCs) being a key manifestation. The purpose of this study is to measure the performance of WDCs in the state of Nuevo León, Mexico, with the aim of developing environmental, social, and governance (ESG) strategies to strengthen and prepare the WDCs for the industrial developments in this state. By identifying environmental variables and undesirable factors, the efficiency and managerial capacity of 32 WDCs were assessed. The analysis revealed that 9 out of the 32 WDCs are technically efficient, while the remaining 23 require significant improvements. Using the Data Envelopment Analysis (DEA) technique, an average efficiency score of 0.91 was found, with a standard deviation of 0.08. The managerial capacity analysis indicated that the highest-ranked WDC achieved an efficiency score of 1, whereas the lowest-ranked WDC scored 0.67. Finally, an operational map of development strategies was developed using the Interpretive Structural Modeling (ISM) and Matrix Impact Cross-Reference Multiplication Applied to a Classification (MICMAC) approach. The results indicate that four phases of development should be followed for real development and maturity of development in these WDCs, including Groundwork, Structuring, Development and Growth, and Smart Maturity.

Air quality modeling in the metropolitan area of São Paulo, Brazil: A review.

Numerous studies have used air quality models to estimate pollutant concentrations in the Metropolitan Area of São Paulo (MASP) by using different inputs and assumptions. Our objectives are to summarize these studies, compare their performance, configurations, and inputs, and recommend areas of further research. We examined 29 air quality modeling studies that focused on ozone (O3) and fine particulate matter (PM2.5) performed over the MASP, published from 2001 to 2023. The California Institute of Technology airshed model (CIT) was the most used offline model, while the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) was the most used online model. Because the main source of air pollution in the MASP is the vehicular fleet, it is commonly used as the only anthropogenic input emissions. Simulation periods were typically the end of winter and during spring, seasons with higher O3 and PM2.5 concentrations. Model performance for hourly ozone is good with half of the studies with Pearson correlation above 0.6 and root mean square error (RMSE) ranging from 7.7 to 27.1 ppb. Fewer studies modeled PM2.5 and their performance is not as good as ozone estimates. Lack of information on emission sources, pollutant measurements, and urban meteorology parameters is the main limitation to perform air quality modeling. Nevertheless, researchers have used measurement campaign data to update emission factors, estimate temporal emission profiles, and estimate volatile organic compounds (VOCs) and aerosol speciation. They also tested different emission spatial disaggregation approaches and transitioned to global meteorological reanalysis with a higher spatial resolution. Areas of research to explore are further evaluation of models' physics and chemical configurations, the impact of climate change on air quality, the use of satellite data, data assimilation techniques, and using model results in health impact studies. This work provides an overview of advancements in air quality modeling within the MASP and offers practical approaches for modeling air quality in other South American cities with limited data, particularly those heavily impacted by vehicle emissions.

Occupational health and safety management systems: a systemic approach / Sistemas de gerenciamento em saúde e segurança do trabalho: uma abordagem sistêmica

Abstract Risks are intrinsic to any human activity. Occupational Health and Safety Management Systems (OHSMSs) are mechanisms designed to mitigate risks, protect workers, and ensure productivity. This study aimed to support researchers' reflective analysis by examining scientific literature related to OHSMSs and identifying possibilities for future research with practical significance. Employing a qualitative approach, this systematic review was conducted using bibliographic procedures and action research. The intervention instrument ProKnow-C guided by a structured process from a constructivist perspective, was applied. A total of 3,130 studies were analyzed to select the bibliographic portfolio. The systemic analysis revealed that most articles neither demonstrate legitimacy nor consider companies' particularities. The paper advances theoretical knowledge of OHSMSs by assessing relevant studies in the field, identifying evolution patterns, and highlighting gaps. A research agenda is proposed to guide the development of future models. We conclude that the challenges of designing ad hoc OHSMSs and incorporating the decision-makers' knowledge throughout the process when addressed, have the potential to significantly contribute to the advancement of this field of knowledge.

Resumo Os riscos são intrínsecos a todas as atividades humanas. Os sistemas de avaliação de desempenho de saúde e segurança no trabalho (SADSSTs) são mecanismos projetados para lidar com riscos, proteger os trabalhadores e garantir produtividade. Este estudo objetivou apoiar a análise reflexiva dos pesquisadores com base na literatura científica relacionada aos SADSSTs, identificando possibilidades de pesquisas futuras de importância prática. Com abordagem qualitativa, esta revisão sistemática foi desenvolvida com a adoção de procedimentos bibliográficos e pesquisa-ação. Foi utilizado o instrumento de intervenção ProKnow-C, um processo estruturado orientado pela perspectiva construtivista. Um total de 3.130 estudos foi analisado para a seleção do portfólio bibliográfico. A análise sistêmica revelou que a maioria dos artigos não apresenta legitimidade, nem considera as particularidades das empresas. O artigo avança no conhecimento teórico dos SADSSTs avaliando os estudos relevantes na área e identificando padrões de evolução e lacunas. Propõe-se uma agenda de pesquisa para orientar o desenvolvimento de modelos futuros. Conclui-se que o desenvolvimento de um SADSST ad hoc, não genérico e concebido com o conhecimento do decisor em todo o processo, permanece sendo um desafio e tem potencial para contribuir para o avanço deste campo do conhecimento.

Reflexos do pagamento por desempenho na atuação do(a)s profissionais da Atenção Primária à Saúde, Paraíba, Brasil / Effects of pay-for-performance on the work of primary health care professionals in the state of Paraíba, Brazil / Reflejos del pago por desempeño en la actuación de los y las profesionales de la atención primaria de la salud, Paraíba, Brasil

O estudo buscou compreender a influência da estratégia do Pay for Performance (P4P), por meio do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB), na atuação do(a)s trabalhadore(a)s. Trata-se de um estudo de caso qualitativo realizado com o(a)s trabalhadore(a)s das Estratégias de Saúde da Família. A análise foi realizada mediante a técnica de construção de narrativas. Constatou-se que o P4P contribuiu para qualificação do processo de trabalho, ao mesmo tempo que estimulou competição e conflito entre as equipes, aflorando sentimentos de culpa e injustiça e, devido à precarização do trabalho, o estímulo financeiro se descaracteriza, tornando-se complemento salarial. Problemas macroestruturais afetam as condições de trabalho e a motivação do(a)s trabalhadore(a)s, de modo que modelos de incentivo financeiro, isoladamente, não são suficientes para reverter tal cenário.(AU)

This study sought to understand the influence of pay-for-performance (P4P) on worker performance using data from the National Program for Improving Primary Care Access and Quality (PMAQ-AB). We conducted a qualitative case study with professionals working in family health strategy teams. The data were analyzed using the narrative construction technique. The findings show that P4P contributed to the improvement of work processes, while at the same time stimulating competition and conflict between the teams, causing feelings of guilt and injustice. However, the original purpose of the financial incentive is defeated due to poor working terms and conditions, becoming akin to a salary supplement. Macrostructural problems affect working conditions and worker motivation, showing that financial incentive models alone are not sufficient to reverse this situation.(AU)

El estudio buscó comprender la influencia de la estrategia Pay for Performance (P4P), por medio del Programa de Mejora del Acceso y Calidad de la Atención Básica (Pmaq-AB), en la actuación de los trabajadores y las trabajadoras. Se trata de un estudio de caso, cualitativo, realizado con los trabajadores y las trabajadoras de las Estrategias de Salud de la Familia. El análisis se realizó mediante la construcción de narrativas. Se constató que el P4P contribuyó para la calificación del proceso de trabajo, al mismo tiempo que incentivó competencia y conflicto entre los equipos, haciendo aflorar los sentimientos de culpa e injusticia y, debido a la precarización del trabajo, el incentivo financiero se descaracteriza pasando a ser complemento salarial. Problemas macroestructurales afectan las condiciones de trabajo y la motivación de los trabajadores y de las trabajadoras, de modo que los modelos de incentivo económico, aisladamente, no son suficientes para revertir ese escenario.(AU)

Novel evaluation approach for molecular signature-based deconvolution methods.

The tumoral immune microenvironment (TIME) plays a key role in prognosis, therapeutic approach and pathophysiological understanding over oncological processes. Several computational immune cell-type deconvolution methods (DM), supported by diverse molecular signatures (MS), have been developed to uncover such TIME interplay from RNA-seq tumor biopsies. MS-DM pairs were benchmarked against each other by means of different metrics, such as Pearson's correlation, R2 and RMSE, but these only evaluate the linear association of the estimated proportion related to the expected one, missing the analysis of prediction-dependent bias trends and cell identification accuracy. We present a novel protocol composed of four tests allowing appropriate evaluation of the cell type identification performance and proportion prediction accuracy of molecular signature-deconvolution method pair by means of certainty and confidence cell-type identification scores (F1-score, distance to the optimal point and error rates) as well the Bland-Altman method for error-trend analysis. Our protocol was used to benchmark six state-of-the-art DMs (CIBERSORTx, DCQ, DeconRNASeq, EPIC, MIXTURE and quanTIseq) paired to five murine tissue-specific MSs, revealing a systematic overestimation of the number of different cell types across almost all methods.

A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak.

The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.

Fatores que influenciam a prática do enfermeiro na consulta de puericultura na atenção primária / Factores que influyen en la práctica del enfermero en la consulta de puericultura en la atención primaria / Factors that influence the practice of nurses in childcare consultation in primary care

Objetivo: analisar os fatores que influenciam a prática do enfermeiro na consulta de puericultura na Atenção Primária. Método: estudo transversal com 31 enfermeiros da Saúde da Família de município do Nordeste do Brasil, utilizando-se checklist com dimensões do cuidado implementadas na puericultura. Para análise dos dados, utilizou-se estatística descritiva e teste de Mann-Whitney. Resultados: as consultas realizadas por enfermeiros com tempo de conclusão da graduação e tempo de atuação de até dez anos apresentaram um cuidado voltado para as dimensões acolhimento, anamnese e avaliação da situação vacinal e suplementações. Enquanto aqueles com tempo superior a dez anos priorizaram a avaliação do crescimento e os registros no prontuário e na Caderneta da Criança. Houve associação significativa entre o sexo feminino e ter especialização com o desempenho dos profissionais. Conclusão: os fatores que influenciam a prática dos enfermeiros na puericultura acarretam importantes diferenças assistenciais, podendo comprometer a integralidade do cuidado à criança.

Objetivo: analizar los factores que influyen en la práctica del enfermero en la consulta de puericultura en la Atención Primaria. Método: estudio transversal con 31 enfermeros de la Salud de la Familia de municipio del Nordeste de Brasil, utilizándose checklist con dimensiones del cuidado implementadas en el puericultura. Para el análisis de los datos, se utilizó estadística descriptiva y prueba de Mann-Whitney. Resultados: las consultas realizadas por enfermeros con tiempo de conclusión de la graduación y tiempo de actuación de hasta diez años presentaron un cuidado volcado para las dimensiones acogida, anamnesis y evaluación de la situación vacunal y suplementaciones. Mientras que aquellos con tiempo superior a diez años priorizaron la evaluación del crecimiento y los registros en el prontuario y en la Libreta del Niño. Hubo asociación significativa entre el sexo femenino y tener especialización con el desempeño de los profesionales. Conclusión: los factores que influyen en la práctica de los enfermeros en el puericultura acarrean importantes diferencias asistenciales, pudiendo comprometer la integralidad del cuidado al niño.

Objective to analyze the factors that influence the practice of nurses in childcare consultation in Primary Care. Method: cross-sectional study with 31 Family Health nurses from a municipality in the Northeast of Brazil, using a checklist with care dimensions implemented in childcare. For data analysis, descriptive statistics and Mann-Whitney test were used. Results: the consultations performed by nurses with graduation completion time and working time of up to ten years presented a care focused on the dimensions of embracement, anamnesis and evaluation of the vaccination status and supplementation. While those with more than ten years prioritized the evaluation of growth and records in the medical record and in the Child's Handbook. There was a significant association between female gender and specialization with the performance of professionals. Conclusion: the factors that influence the practice of nurses in childcare cause important differences in care, and may compromise the completeness of child care.

Algemas manageriales: Análise da avaliação do acesso e melhoria da qualidade em saúde no Brasil

Resumo: Este trabalho indaga o caráter avaliativo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica na Atenção Primaria à Saúde no Brasil, a partir do caráter performativo deste instrumento no cenário mundial de crescente managerialização das políticas sanitárias. Objetivo: Compreender como a qualidade do acesso se define em termos práticos e quais ações são promovidas aos trabalhadores da Atenção Primaria à Saúde através da Portaria 1.645 e o Instrumento de Avaliação aplicado aos profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica. Métodos: Foi realizada uma Análise Pragmática do Discurso, com auxílio dos Softwares Atlas.ti 8 e Microsoft Excel 2010. Resultados: Os resultados revelam estândares e indicadores promovidos pelo Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica, assim como o papel ambivalente de gestores e profissionais da saúde, entre seu caráter voluntário e proativo e, revelam o desmonte do modelo de Atenção Primária à Saúde sob lógica comunitária no Brasil, em comparação à abordagem do Novo Management Público e a atuação em função de indicadores. Conclusões: O papel do Estado na garantia de direito a saúde é minimizado e dá lugar ao Novo Management Público na saúde.

Resumen: Este trabajo cuestiona el carácter evaluativo del Programa Nacional para la Mejora del Acceso y la Calidad de la Atención Primaria en la Atención Primaria de Salud en Brasil, a partir del carácter performativo de este instrumento en el escenario mundial de creciente managerialización de las políticas sanitarias. Objetivo: Comprender cómo se define la calidad del acceso en términos prácticos y qué acciones se promueven a los trabajadores de Atención Primaria de Salud a través de la Ordenanza 1.645 y el Instrumento de Evaluación aplicado a los profesionales de Núcleo Ampliado de Saúde da Família e Atenção Básica. Métodos: Se realizó un Análisis Pragmático del Discurso, con la ayuda de Softwares Atlas.ti 8 y Microsoft Excel 2010. Resultados: Los resultados revelan estándares e indicadores promovidos por el Programa Nacional para la Mejora del Acceso y la Calidad de la Atención Primaria, así como el papel ambivalente de los gerentes y profesionales de la salud, entre su carácter voluntario y proactivo y revelan el desmantelamiento del modelo de Atención Primaria de Salud bajo lógica comunitaria en Brasil, en comparación con el enfoque del Nuevo Management Público y el desempeño en función de los indicadores. Conclusiones: Se minimiza el papel del Estado en la garantía del derecho a la salud y se da paso al Nuevo Management Público en la salud.

Abstract: This paper questions the evaluative process of the National Program for Improving Access and Quality of Primary Care in Primary Health Care in Brazil, based on the performative character of this instrument in the world scenario of increasing management of health policies. Objective: To understand how the quality of access is defined in practical terms and what actions are promoted to Primary Health Care workers through Ordinance 1,645 and the Evaluation Instrument applied to Extended Centers for Family Health and Primary Care professionals. Methods: A Pragmatic Discourse Analysis was performed, with the help of Atlas.ti 8 and Microsoft Excel 2010 Software. Results: The results reveal standards and indicators promoted by the National Program for Improving Access and Quality of Primary Care, as well as the ambivalent role of managers and health professionals, between their voluntary and proactive character and reveal the dismantling of the Primary Health Care model under community logic in Brazil, compared to the New Public Management approach and the performance in function of indicators. Conclusions: The role of the State in guaranteeing the right to health is minimized and gives way to New Public Management in healthcare.

Performance-Cost Trade-Off in Auto-Scaling Mechanisms for Cloud Computing.

Cloud computing has been widely adopted over the years by practitioners and companies with a variety of requirements. With a strong economic appeal, cloud computing makes possible the idea of computing as a utility, in which computing resources can be consumed and paid for with the same convenience as electricity. One of the main characteristics of cloud as a service is elasticity supported by auto-scaling capabilities. The auto-scaling cloud mechanism allows adjusting resources to meet multiple demands dynamically. The elasticity service is best represented in critical web trading and transaction systems that must satisfy a certain service level agreement (SLA), such as maximum response time limits for different types of inbound requests. Nevertheless, existing cloud infrastructures maintained by different cloud enterprises often offer different cloud service costs for equivalent SLAs upon several factors. The factors might be contract types, VM types, auto-scaling configuration parameters, and incoming workload demand. Identifying a combination of parameters that results in SLA compliance directly in the system is often sophisticated, while the manual analysis is prone to errors due to the huge number of possibilities. This paper proposes the modeling of auto-scaling mechanisms in a typical cloud infrastructure using a stochastic Petri net (SPN) and the employment of a well-established adaptive search metaheuristic (GRASP) to discover critical trade-offs between performance and cost in cloud services.The proposed SPN models enable cloud designers to estimate the metrics of cloud services in accordance with each required SLA such as the best configuration, cost, system response time, and throughput.The auto-scaling SPN model was extensively validated with 95% confidence against a real test-bed scenario with 18.000 samples. A case-study of cloud services was used to investigate the viability of this method and to evaluate the adoptability of the proposed auto-scaling model in practice. On the other hand, the proposed optimization algorithm enables the identification of economic system configuration and parameterization to satisfy required SLA and budget constraints. The adoption of the metaheuristic GRASP approach and the modeling of auto-scaling mechanisms in this work can help search for the optimized-quality solution and operational management for cloud services in practice.

Comparação de avaliação de medidas indiretas e associação com medida subjetiva de capacidade aeróbia / Comparison of assessment of indirect measures and association with subjective measure of aerobic capacity

Este estudo teve como objetivo comparar a avaliação da resistência aeróbia avaliada pelos testes de McArdle e Conconi e associar as medidas indiretas com a percepção subjetiva por meio da Escala de Capacidade Percebida (ECP). Foram recrutados 29 participantes, 17 homens e 12 mulheres, com idades iguais ou maiores de 18 anos da região de São José, Santa Catarina. Após os recrutamentos foram analisados variáveis como sexo, idade, estatura, massa corporal, frequência cardíaca e esforço físico por meio dos testes de banco de McArdle e Conconi, além da capacidade percebida por meio da ECP. A média da pontuação da ECP foi de 9,72 (DP = 1,60). O Índice de Correlação Intraclasse entre os dois testes foi considerando excelente (r = 0,939; p < 0,001). Além disso, ambas análises apresentaram associação com a variável desfecho. No entanto, o poder explicativo da Regressão Linear, considerando como variável independente o VO2max a partir do deste de McArdle foi maior (45,3%). Assim, recomenta-se a utilização da tabela de referência deste teste para identificação do VO2máx a partir da percepção subjetiva pela ECP. Desta forma, a ECP pode ser uma ferramenta valiosa na avaliação, prescrição de exercícios e em estudos epidemiológicos por sua fácil e rápida aplicabilidade em adultos ativos fisicamente

This study aimed to compare the assessment of aerobic resistance evaluated by the McArdle and Conconi tests and to associate the indirect measures with the subjective perception through the Rating of Perceived Capacity (RPC). 29 participants were recruited, 17 men and 12 women, aged 18 years or older from the region of São José-SC. After recruitment, variables such as gender, age, height, body mass, heart rate and physical effort were analyzed using the McArdle and Conconi bench tests, in addition to the perceived capac-ity through the ECP. The mean ECP score was 9.72 (SD = 1.60). The Intraclass Correlation Index between the two tests was considered excellent (r = 0.939; p < 0.001). In addition, both analyses were associated with the outcome variable. However, the explanatory power of Linear Regression, considering VO2max as an independent variable from McArdle's, was higher (45.3%). Thus, it is recommended to use the reference table of this test to identify the VO2max from the subjective perception by the ECP. In this way, ECP can be a valuable tool in the evaluation, exercise prescription and in epidemiological studies due to its easy and quick easy applicability in physically active adults

Professional performance in the administration of medicines in pediatrics: a study cross-sectional observational / Desempenho dos profissionais na administração de medicamentos na pediatria: um estudo observacional transversal / Desempeño de profesionales en la administración de medicamentos en pediatria: un estudio observacional transversal

ABSTRACT Objectives: to evaluate Patient Safety actions carried out by nurses in the Administration of Medicines in Pediatrics. Methods: observational, cross-sectional, quantitative study carried out in 2018, with 25 nurses from a Hospital in Peru. 183 observations were made; the instrument Safety of the patient was used in the administration of medicines in Pediatrics Spanish version. The performance of the professionals was evaluated by the Positivity Index. Results: of 22 itens observed, five were adequate, five were safe, two were classified as borderline and ten as endurable among those who stand out; Bring to bed only medications prescribed for a single child and maintains an adequate record of prepared medications that will be stored. Conclusions: weaknesses were observed in the medication administration process, since only 10 itens were classified as safe or adequate, reinforcing the need for permanent education activities by the institution for nursing training.

RESUMO Objetivos: avaliar as ações Segurança do Paciente dos profissionais de enfermagem na Administração de Medicamentos na Pediatria Métodos: estudo observacional, transversal, quantitativo realizado em 2018, com 25 enfermeiras de um Hospital do Peru. 183 observações foram feitas, utilizou-se o instrumento Segurança do Paciente na administração de medicamentos em Pediatria versão em español. O desempenho dos profissionais foi avaliado pelo Índice de Positividade. Resultados: dos 22 itens observados, cinco eram adequados, cinco itens seguros, dois classificados como limítrofes e dez como toleráveis, entre os quais se destacam; Leva para a cama apenas medicamentos prescritos para uma única criança e mantém um registro adequado dos medicamentos preparados que serão armazenados. Conclusões: observamos fragilidades no processo de administração de medicamentos, visto que apenas 10 itens foram classificados como seguros ou adequados, reforçando a necessidade de ações de educação permanente por parte da instituição para a formação do enfermeiro.

RESUMEN Objetivos: evaluar acciones de Seguridad del Paciente realizadas por enfermeras en la Administración de Medicamentos en Pediatria. Métodos: estudio observacional, transversal, cuantitativo realizado el 2018, con 25 enfermeras de un Hospital en Peru. Fueron realizadas 183 observaciones, se utilizó el instrumento Seguridad del paciente en la administración de medicamentos en Pediatria versión español. El desempeño de los profesionales fue evaluado por el Índice de Positividad. Resultados: de 22 ítems observados, cinco fueron adecuados, cinco ítens seguros, dos clasificados como limíte y diez como sufribles entre los que se destacan; Lleva a la cama solo los medicamentos prescritos a un único niño y Mantiene registro adecuado de medicamentos preparados que serán almacenados. Conclusiones: se observo fragilidades en el proceso de administración de medicamentos, visto que solamente 10 ítems fueron clasificados como seguros o adecuados, reforzando la necesidad de actividades de educación permanente por la institución, para la capacitación de enfermería.

Evaluación del desempeño clínico del ensayo SUMASIGNAL VHC para la detección del ARN del virus de la hepatitis C

RESUMEN Introducción: La detección y cuantificación del genoma del virus de la hepatitis C (ARN-VHC), mediante la transcripción inversa-PCR en tiempo real (RT-qPCR), es vital para el diagnóstico y seguimiento del tratamiento antiviral de los pacientes con hepatitis C. Objetivo: Evaluar los indicadores de desempeño clínico como la especificidad, sensibilidad y reproducibilidad del ensayo SUMASIGNAL VHC, comercializado por el Centro de Inmunoensayo (Cuba), tomando como técnica de referencia la prueba Artus® HCV RG RT-qPCR. Métodos : Se empleó un panel conformado por 70 muestras de suero: 46 ARN-VHC positivas, 12 ARN-VHC negativas y 12 positivas a marcadores moleculares de otros virus. El coeficiente de correlación de Pearson (r) y la prueba de Bland-Altman, se utilizaron para comparar las cargas virales del VHC, obtenidas por las técnicas SUMASIGNAL VHC y la de referencia; las que fueron expresadas en logaritmo en base 10 (log10) UI/mL. Los valores de p< 0,05 se consideraron estadísticamente significativos. Resultados: La sensibilidad y especificidad clínica del SUMASIGNAL VHC fue 100 %; mientras que no se detectó reactividad cruzada con los otros virus evaluados. Se demostró que el ensayo en cuestión, tuvo una correlación buena (r= 0,89) y fuerte concordancia (media= -0,01 Log10 UI/mL) con la prueba de referencia (p< 0,0001). La reproducibilidad de la cuantificación del ARN-VHC en dos momentos diferentes, con la prueba SUMASIGNAL VHC mostró una correlación excelente (r= 0,97; p< 0,0001). Conclusiones: El ensayo SUMASIGNAL VHC proporciona datos válidos, reproducibles y técnicamente confiables para realizar el diagnóstico específico del VHC, incluso constituye una herramienta útil para monitorear la carga viral de este agente en el Sistema Nacional de Salud Cubano.

ABSTRACT Introduction: Detection and quantification of the hepatitis C virus genome (HCV RNA) by real time reverse transcription PCR (RT-qPCR) are vital for the diagnosis and antiviral treatment follow-up of hepatitis C patients. Objective: Evaluate the clinical performance of the SUMASIGNAL HCV assay for quantification of HCV viral load. Methods: A panel was formed with 70 serum samples: 46 HCV RNA positive, 12 HCV RNA negative and 12 positive for molecular markers of other viruses. Pearson's correlation coefficient (r) and the Bland-Altman plot were used to compare the HCV viral loads obtained by SUMASIGNAL HCV techniques with reference values, which were expressed as base 10 logarithm (log10) UI/ml. Values of p <0.05 were considered statistically significant. Results: The clinical sensitivity and specificity of SUMASIGNAL HVC were 100%, and no cross-reactivity was detected with the other viruses evaluated. The study assay exhibited a good correlation (r= 0.89) and strong concordance (mean= -0.01 Log10 UI/ml) with the reference test (p< 0.0001). Reproducibility of the HCV RNA quantification with the SUMASIGNAL HCV test at two different moments displayed an excellent correlation (r= 0.97; p< 0.0001). Conclusions: The SUMASIGNAL HVC assay provides valid, reproducible and technically reliable data for specific HCV diagnosis. It is also a useful tool to monitor the viral load of this agent in the Cuban National Health System.

A Proposal for a Data-Driven Approach to the Influence of Music on Heart Dynamics.

Electrocardiographic signals (ECG) and heart rate viability measurements (HRV) provide information in a range of specialist fields, extending to musical perception. The ECG signal records heart electrical activity, while HRV reflects the state or condition of the autonomic nervous system. HRV has been studied as a marker of diverse psychological and physical diseases including coronary heart disease, myocardial infarction, and stroke. HRV has also been used to observe the effects of medicines, the impact of exercise and the analysis of emotional responses and evaluation of effects of various quantifiable elements of sound and music on the human body. Variations in blood pressure, levels of stress or anxiety, subjective sensations and even changes in emotions constitute multiple aspects that may well-react or respond to musical stimuli. Although both ECG and HRV continue to feature extensively in research in health and perception, methodologies vary substantially. This makes it difficult to compare studies, with researchers making recommendations to improve experiment planning and the analysis and reporting of data. The present work provides a methodological framework to examine the effect of sound on ECG and HRV with the aim of associating musical structures and noise to the signals by means of artificial intelligence (AI); it first presents a way to select experimental study subjects in light of the research aims and then offers possibilities for selecting and producing suitable sound stimuli; once sounds have been selected, a guide is proposed for optimal experimental design. Finally, a framework is introduced for analysis of data and signals, based on both conventional as well as data-driven AI tools. AI is able to study big data at a single stroke, can be applied to different types of data, and is capable of generalisation and so is considered the main tool in the analysis.

Avaliação de fatores intervenientes no desempenho de estações de tratamento de água / Evaluation intervening factors in the performance of water treatment plants

RESUMO O objetivo do trabalho consistiu em avaliar a influência da sazonalidade, da eventual sobrecarga hidráulica, do porte, do custo e da idade no desempenho de estações convencionais de tratamento de água pela análise de confiabilidade como ferramenta de avaliação. Para tal, empregaram-se dados operacionais do efluente de 20 estações operadas pelo mesmo prestador referentes ao período 2009-2014. As análises estatísticas mostraram que o desempenho, em termos de turbidez do efluente, elevou-se no período de estiagem em relação ao chuvoso e nas unidades de pequeno porte avaliadas. No mesmo contexto, a quase totalidade das estações submetidas à sobrecarga hidráulica apresentou desempenho inferior. A determinação da faixa de turbidez requerida na saída da estação, pela análise de confiabilidade, mostrou-se importante ferramenta de gestão permitindo hierarquizar ações de melhorias nos sistemas. Não se verificou correlação entre o nível de confiabilidade e o custo do tratamento e a idade da estação.

ABSTRACT The objective of this work was to evaluate the influence of seasonality, possible hydraulic overload, size, cost, and age of the station in the performance of conventional water treatment stations based on reliability analysis as an evaluation tool. For this purpose, operational data of the effluent from 20 stations operated by the same provider for the 2009-2014 period were used. Statistical analyses showed that the performance was increased in the dry season compared to the rainy one and in the small units evaluated. In the same scenario, almost all the stations submitted to hydraulic overload exhibit inferior performance. The determination of turbidity range required at the exit of the station, through the reliability analysis, proved to be an important management tool, allowing to hierarchize improvement actions in the systems. In addition, there was no correlation between the level of reliability and the treatment cost and the age of the station.

ZORA all-electron double zeta basis sets for the elements from H to Xe: application in atomic and molecular property calculations.

From the segmented all-electron basis set of double zeta valence quality plus polarization functions (DZP) for the elements from H to Xe, the zeroth-order regular approximation (ZORA) is used to generate a DZP-ZORA basis set, i.e., the contraction coefficients of the DZP set are re-optimized using the minimum ZORA energy criterion. To properly describe electrons distant from the nuclei, a diffuse function is added to each atomic symmetry (s, p, d, and f). The later basis set is designated as DZP-ZORA augmented. To test the effectiveness of the basis sets developed in this work, calculations of ionization energies and mean dipole polarizabilities of some elements are performed using the ZORA-CCSD(T) method. At the same level of theory, bond lengths, dissociation energies, and harmonic vibrational frequencies of some diatoms are also reported. Comparison with experimental data and recommended values available in the literature is made. Except for polarizability, scalar relativistic effects are estimated for the other properties. The performances of the ZORA and second-order Douglas-Kroll-Hess Hamiltonians are evaluated.

Performance of sewage treatment plants and impact of effluent discharge on receiving water quality within an urbanized area.

In Brazil, wastewater treatment coverage is low. Even when treatment is carried out, many municipalities cannot achieve adequate levels of contaminant removal, and the usual practice of releasing raw or treated domestic effluent into water bodies remains. Thus, this pollution source puts pressure on water resources, compromising downstream uses of the disposal. This study has two aims: (1) to evaluate the performance of sewage treatment plants and (2) to determine the impact of discharging treated effluent on the water quality of receiving water bodies located within an urbanized area in the Velhas River basin, Minas Gerais State, Brazil. Monitoring data from raw wastewater were compared with typical ranges reported in literature, and effluent concentrations were compared between plants. The monitoring data of the receiving water bodies collected at points upstream and downstream of each disposal were statistically compared. Different performances between the systems and significant alterations in the receiving bodies resulting from the discharge of the treated effluents were found.

Avaliação de desempenho na organização de gestão do trabalho no município de São Tomé-RN / Performance assessment in the work management organization in the city of São Tomé-RN / Evaluación del desempeño en la organización de gestión del trabajo en el municipio de São Tomé-RN

Objetivo: refletir sobre a necessidade de implantação da avaliação de desempenho dos profissionais de saúde do município de São Tomé-RN. Método: Trata-se de um ensaio reflexivo, de caráter descritivo e de abordagem qualitativa. Resultados: Tem-se a necessidade de sensibilizar a gestão, na perspectiva de implantar uma avaliação de desempenho, a partir de instrumentos, tendo em vista várias necessidades tais como: perfil profissional, assiduidade, comportamento profissional, capacitações de educação continuada, viabilizar desempenho eficaz do profissional, melhorar condições de trabalho e qualidade de vida no trabalho. Conclusão: Para concretizar a implantação de avaliação de desempenho é preciso que haja um bom planejamento; realizar diagnósticos na gestão com bases nos problemas levantados, constatar problemas não é o suficiente para provocar mudanças necessárias. Faz-se imperativo, portanto, empenhar-se na construção de estratégias que possam promover mudanças no cotidiano dos serviços de saúde que possam vir a contribuir para melhoria da gestão.(AU)

Objective: to reflect on the need to implement the performance evaluation of health professionals in the municipality of São Tomé-RN. Method: This is a reflective essay, with a descriptive character and a qualitative approach. Results: There is a need to sensitize management, with a view to implementing a performance evaluation, based on instruments, in view of various needs such as: professional profile, attendance, professional behavior, continuing education skills, enabling effective performance professional, improve working conditions and quality of life at work. Conclusion: In order to implement the performance evaluation, there must be good planning; making diagnoses in management based on the problems raised, finding problems is not enough to cause necessary changes. It is imperative, therefore, to commit to the construction of strategies that can promote changes in the daily life of health services that may contribute to improve management.(AU)

Objetivo: reflexionar sobre la necesidad de implementar la evaluación del desempeño de los profesionales de la salud en el municipio de São Tomé-RN. Método: Se trata de un ensayo reflexivo, con carácter descriptivo y enfoque cualitativo. Resultados: Existe la necesidad de sensibilizar a la gestión, con miras a implementar una evaluación de desempeño, basada en instrumentos, ante diversas necesidades tales como: perfil profesional, asistencia, comportamiento profesional, capacidades de educación continua, posibilitando un desempeño efectivo profesional, mejorar las condiciones laborales y la calidad de vida en el trabajo. Conclusión: Para implementar la evaluación de desempeño, debe haber una buena planificación; haciendo diagnósticos en la gestión basados en los problemas planteados, encontrar problemas no es suficiente para provocar los cambios necesarios. Por tanto, es imperativo apostar por la construcción de estrategias que puedan promover cambios en la vida diaria de los servicios de salud que contribuyan a mejorar la gestión.(AU)

Reliability in the evaluation of international and national judges in an artistic swimming routine / Confiabilidade na avaliação de juízes internacionais e nacionais em uma rotina de nado artístico

Abstract Artistic swimming (AS) is a sport evaluated by fifteen judges in routine sessions. The athletes' goal is to achieve proficient motor patterns according to pre-established criteria. The present studied analyzed whether there is difference between the two groups of AS judges with different levels of experience. The group of the International Swimming Federation - FINA (IG) evaluates AS at national and international level and the non-FINA group (NG) evaluates AS only at national level. Twenty experienced judges were divided into groups, 10 IG judges and 10 NG judges. Thus, judges evaluated the item execution of three routines with five required elements. Cronbach's alpha coefficient showed high internal consistency in IG (a= 0.85 in T1 and 0.83 in T2). In NG, internal consistency was observed in T1 and low consistency in T2 (a= 0.82 in T1 and 0.39 in T2). Evaluation analysis between IG and NG was significant (p?0.0330) and reliability analysis (bias: -0.1266 95% agreement limit: -1.642 to 1.388) showed consistency and high degree of confidence in results. The findings suggest that the item execution of required elements showed high objectivity regarding judges with different levels of experience, IG and NG, regardless of categorization and time of practice. FINA has changed the number of judges and the number of items evaluated in routine sessions. It is suggested that the reduction of items has contributed in a positive way so that judges can focus more on evaluation itself.

Resumo Nado artístico (NA) é um esporte avaliado por quinze juízes em provas de rotinas. A meta dos atletas é a realização de padrões motores proficientes de acordo com critérios pré-estabelecidos. O presente estudo analisou se havia diferença entre os dois grupos de juízes de NA com diferentes níveis de experiência. O grupo da Federação Internacional de Natação - FINA (GI) avalia a nível nacional e internacional e o grupo não FINA (GN) avalia apenas a nível nacional. Participaram 20 juízes experientes separados em grupos, 10 juízes GI e 10 juízes GN. Assim, os juízes avaliaram o item execução de três rotinas com cinco elementos obrigatórios. O coeficiente alfa de Cronbach apresentou elevada consistência interna no GI (a= 0,85 em T1 e 0,83 em T2). No GN observou-se consistência interna em T1 e baixa em T2 (a = 0,82 em T1 e 0,39 em T2). A análise de avaliação entre GI e GN, foi significativa (p?0,0330) e análise de confiabilidade (viés: -0,1266 de limite de concordância 95%: -1,642 a 1,388) mostrando consistência e alto grau de confiança nos resultados. Os achados sugerem que o item execução dos elementos requeridos apresentou alta objetividade no que diz respeito aos juízes com diferentes níveis de experiência, GI e GN, independentemente da categorização e do tempo de prática. A FINA alterou o número de juízes e o número de itens que são avaliados nas provas de rotina. Sugere-se que a redução dos itens tenha contribuído para que os juízes se concentrassem mais na avaliação.

Numerical Study of Nanofluid Irreversibilities in a Heat Exchanger Used with an Aqueous Medium.

Heat exchangers play an important role in different industrial processes; therefore, it is important to characterize these devices to improve their efficiency by guaranteeing the efficient use of energy. In this study, we carry out a numerical analysis of flow dynamics, heat transfer, and entropy generation inside a heat exchanger; an aqueous medium used for oil extraction flows through the exchanger. Hot water flows on the shell side; nanoparticles have been added to the water in order to improve heat transfer toward the cold aqueous medium flowing on the tube side. The aqueous medium must reach a certain temperature in order to obtain its oil extraction properties. The analysis is performed for different Richardson numbers (Ri = 0.1-10), nanofluid volume fractions (φ = 0.00-0.06), and heat exchanger heights (H = 0.6-1.0). Results are presented in terms of Nusselt number, total entropy generation, Bejan number, and performance evaluation criterion. Results showed that heat exchanger performance increases with the increase in Ri when Ri > 1 and when reducing H.