As propriedades dielétricas dos materiais têm ganhado importância na aplicação industrial nas últimas décadas, estas propriedades fornecem informações úteis para melhorar o controle de processamento e qualidade dos produtos alimentícios e outros materiais. A espectroscopia dielétrica é amplamente utilizada para estudar a dinâmica molecular em diversos sistemas, nos quais é comum observar o fenômeno de relaxação dielétrica que tem sido associado por vários pesquisadores ao fenômeno de transição vítrea, importante na estabilidade e propriedades dos materiais. O objetivo da tese foi analisar as propriedades dielétricas de produtos alimentícios e filmes biopoliméricos, dando ênfase ao estudo da mobilidade molecular nos filmes; e ao estudo da dinâmica estrutural de alimentos e sua correlação com fatores de qualidade. O estudo foi dividido em várias etapas com objetivos específicos: A primeira consistiu na montagem e startup do equipamento adquirido para medida das propriedades dielétricas (E4980A com 16451B; E5061B com 85070E, Keysight Technologies); A segunda etapa foi dedicada à análise das propriedades dielétricas de goiabada em pasta e suco de laranja na faixa de frequência de 500-3000 MHz, em função do teor de sólidos solúveis e da temperatura visando a geração de correlações que permitiriam fazer um monitoramento durante o processo de produção; Na última etapa foi estudada a mobilidade molecular de filmes de gelatina e nanocompósitos através da análise dielétrica em função da umidade, temperatura, e teor de plastificante ou nanopartícula, na faixa de frequência de 20 Hz - 2 MHz. Análises de calorimetria diferencial de varredura (DSC) e dinâmica mecânica (DMA) foram realizadas para determinar a temperatura de transição vítrea e de relaxação mecânica nos filmes produzidos. A constante dielétrica e o fator de perda dielétrica de suco de laranja e de goiabada em pasta foram dependentes da temperatura e concentração de sólidos solúveis. A temperatura de transição vítrea (Tg) e os tempos de relaxação dielétrica de filmes de gelatina diminuíram com o aumento da concentração de glicerol e com o aumento da umidade relativa de condicionamento. A temperatura de transição vítrea nos filmes nanocompósitos diminuiu com o aumento da umidade relativa de condicionamento. Filmes com 6% de laponita e sem adição de glicerol apresentaram os maiores valores de Tg. Os tempos de relaxação aumentaram ligeiramente com o aumento na concentração de laponita. Foram gerados dados úteis para estimar as propriedades dielétricas de suco de laranja e goiabada em pasta nas principais frequências de uso comercial, 915 e 2450 MHz, através de equações matemáticas em função da temperatura e concentração de sólidos solúveis. O glicerol e especialmente a água afetaram as propriedades dielétricas dos filmes de gelatina refletidas em menores tempos de relaxação, enquanto que as interações da laponita com a gelatina reduziram ligeiramente a mobilidade molecular nos filmes nanocompósitos proporcionando tempos de relaxação maiores. Este tema fez parte do Pilar 4 do projeto CEPID (2013/07914-8) \"Food Research Center\" (FoRC). / The dielectric properties of materials have gained importance in industrial application over the last decades; these properties provide useful information to improve processing and quality control of food products and related materials. The dielectric spectroscopy is widely used to study molecular dynamics in several systems, where it is common to observe the dielectric relaxation phenomenon that has been associated by many researchers to the glass transition phenomenon, important in stability and material properties. The objective of the thesis was to analyze the dielectric properties of food products and biopolymer films, emphasizing the study of molecular mobility in films; and the study of the structural dynamics of food and its correlation with quality factors. The study was divided into several stages with specific goals: The first was the installation and startup of the equipment for measurement of dielectric properties (E4980A with 16451B; E5061B with 85070E, Keysight Technologies); The subsequent step was dedicated to the analysis of the dielectric properties of guava paste and orange juice in frequencies between 500-3000 MHz, as a function of soluble solids content and temperature in order to generate correlations which allow to make a monitoring during the production process; In the last stage, the molecular mobility of gelatin biodegradable films and nanocomposites was studied through dielectric analysis as a function of moisture content, plasticizer or nanoparticle concentration and as a function of temperature, in frequencies between 20 Hz - 2 MHz. Differential scanning calorimetry (DSC) and dynamic mechanical analysis (DMA) were performed to determine the glass transition and mechanical relaxation temperatures of the films. The dielectric constant and the dielectric loss factor of orange juice and paste guava were dependent on the temperature and soluble solids concentration. The glass transition temperature (Tg) and the dielectric relaxation times of gelatin films decreased with increasing glycerol concentration and with increasing relative humidity of conditioning. The glass transition temperature of the nanocomposite films decreased with the increase of the relative humidity of conditioning. Films with 6% of laponite and without addition of glycerol had the highest values of Tg. Relaxation times increased slightly with increasing laponite concentration. Useful data were generated to estimate the dielectric properties of orange juice and guava paste in the main commercial frequencies, 915 e 2450 MHz, through mathematical equations as a function of temperature and soluble solids content. Glycerol and especially water affected the dielectric properties of gelatin films reflected in lower relaxation times, whereas laponite and gelatin interactions reduced slightly the molecular mobility of the nanocomposite films by providing longer relaxation times. This topic was part of the Pillar 4 of CEPID project (2013 / 07914-8) \"Food Research Center\" (FoRC).

A definição de metas de qualidade no fornecimento de energia é feita atualmente através de análises comparativas entre redes semelhantes. Com isso visa-se a otimização dos recursos sem impactos nos investimentos e nas despesas de manutenção. Preceito desta metodologia é que não haja investimentos adicionais e que a qualidade melhore de modo similar à da rede usada como benchmark. Este modelo não consulta diretamente a opinião dos consumidores. Outra particularidade deste modelo é que nem sempre se pode garantir que as redes usadas como benchmark estão em uma situação de ótimo ou próxima dela. De qualquer forma este modelo deve saturar e então devem ser buscadas outras metodologias. Este trabalho apresenta as bases para o estabelecimento de metas de qualidade baseada nos custos de investimentos da concessionária e na opinião e nos custos dos consumidores. O impacto tarifário decorrente da inclusão da qualidade da energia no modelo econômico da concessionária também é analisado. Os resultados apresentados discutem as pesquisas de valoração do custo da qualidade para o consumidor, o estabelecimento de metas de qualidade e a avaliação dos investimentos da concessionária em qualidade da energia elétrica. / The definition of quality goals on the supply of electrical energy is nowadays made in Brazil through the comparison between similar networks. With that, the optimization of the resources is aimed without impacts on the investments and expenditures of maintenance. The precept of this methodology is not having any additional investments so that the quality improves in a similar way to the benchmark network. This model does not consult directly the opinion of consumers. Another particularity of this model is that the situation of the benchmark network cant always be assured to be on its optimal state or close to it. Therefore, this model is expected to saturate, and other methodologies must then be searched. This work presents the basis for the establishment of goals for quality based on the costs of the investments of the utilities and on the consumers costs and opinion. The impact on the rate that may result from the increase of the energy quality on the economical model of the utilities is also analyzed. The results presented discuss the research on valuation of quality cost for the consumer, the establishment of goals for quality and evaluation on the investments on energy quality made by the utilities.

Este trabalho apresenta a aplicação da Cromatografia Líquida de Ultra Performance acoplada à espectrometria de massas (UPLC-MS/MS) como uma técnica analítica em potencial para a determinação de contaminantes orgânicos em amostras de água para consumo humano. A técnica foi aplicada no desenvolvimento de um método analítico para a determinação de 28 praguicidas listados na Portaria 2914/11 como indicadores da qualidade de águas para o consumo humano. O método analítico apresentou limite de quantificação (LQ) (entre 0,2 e 50 g L-1, considerando todas as substâncias investigadas) capaz de monitorar as substâncias de interesse em concentrações inferiores aos limites máximos permitidos pela legislação, com taxas de recuperação superiores a 80% e coeficiente de variação (CV) menor do que 15% no nível de µg L-1. A filtração da amostra, empregando filtros de seringa de 0,22µm de diâmetro de poro, foi empregada como etapa de preparo de amostra, não sendo necessário o emprego de métodos de extração e concentração da amostra previamente à análise. O método analítico proposto foi aplicado em duas amostras de água potável coletadas na cidade de Paulínia-SP; entretanto, os praguicidas investigados não foram detectados em ambas as amostras analisadas. Adições de padrão foram realizadas sobre as amostras no nível de concentração do Valor Máximo Permitido (VMP) e três vezes o VMP pela Portaria 2914/11. Valores de recuperação entre 80 e 120% foram obtidos, demostrando a aplicabilidade e exatidão do método proposto. / This work describes the application of Ultra Performance Liquid Chromatography tandem mass spectrometry (UPLC-MS/MS) for determination of organic contaminants in drinking water. The tecnique was used for the development of an analytical method for the determination of 28 pesticides, listed in the Brazilian Administrative Rule 2914/11, these compounds are considered as quality indicators for drinking waters. The limit of quantification (LQ) of the analytical method was between 0,1 e 5 µg L-1 for all target substances, being able to quantify the target substances at concentrations lower than the maximum levels of contamination (MLC) established by the Rule, with accuracy above 80% and relative standard deviation below 15%, at g L-1 level. The filtration of the sample, using 0.22 µm syringe filters, was applied as sample preparation step. The analytical method based on UPLCMS/MS was used to analyze two drinking water samples collected in Paulínia-SP city. The target pesticides were not detected in any samples. The two samples were then enriched with analytical standards of the pesticides at the MLC and 3 times the MLC levels and analyzed by the proposed method. Recoveries ranged from 80 to 120%, showing the applicability and efficiency of the proposed analytical method.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-19T17:17:02Z No. of bitstreams: 1 YaraAndrade.pdf: 1215213 bytes, checksum: eaf7b580c9f8c4d49e455d48065297e3 (MD5) / Made available in DSpace on 2017-05-19T17:17:02Z (GMT). No. of bitstreams: 1 YaraAndrade.pdf: 1215213 bytes, checksum: eaf7b580c9f8c4d49e455d48065297e3 (MD5) Previous issue date: 2016-11-17 / Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) / The Leprosy Control Program is the principle strategy in Brazil that consolidates follow-up actions of the endemic municipalities, promoting the monitoring, prevention, and control of leprosy by means of the evaluation of health indicators, which include epidemiological and operational indicators capable of measuring the magnitude of the problem and the progress achieved in the program. Therefore, the present study aimed to assess the indicators of quality of the actions and health services of the Leprosy Control Program in the hyperendemic capital of Brazil. The research was guided by the type of descriptive evaluative study, carried out in all health care institutions which operate the Leprosy Control Program in the city of São Luiz, Maranhão. The population of the study consisted of all the new cases of leprosy reported in the year 2012, and their respective contacts. The data were collected by means of instruments using the variables contained in the SINAN reporting forms, registry and records of patients reported in 2012. The data were processed and analyzed using the Epi-Info program, version 7, and presented in the form of absolute and relative frequency tables, using the parameters established by the Ministry of Health to evaluate the actions and services provided by healthcare professionals to the individual with leprosy (operational indicators). In 2012, there were 1055 cases and 3310 contacts reported. In the reported cases, it was verified that 51.1% were male, between the ages of 21 and 45 (35.3%), Caucasian (62.6%), with a high school diploma (26%), residents in the state capital (80.6%). The program obtained satisfactory results, being classified as "Good" according to the proportion of discharges by cure (71.6%), abandonment rates (4%), and the evaluation of the degree of physical disability at the moment of the diagnosis (94.5%). The indicators classified as precarious were: the proportion of examined contacts of new cases of leprosy (32.5%) and the proportion of cured cases in the year with a degree of disability evaluated at the moment of discharge (41.2%). The predominant input mode was classified as "new case" (79.1%), and the method of detection was of the type "spontaneous demand" prevailing with 52%. The most prevalent clinical form and operational classification was dimorphic (58.8) and multibacillary (74%) respectively. Based on the above, it can be concluded that the Leprosy Control Program in the city of São Luiz has been working satisfactorily, where 3 of the 5 indicators responsible for evaluating the quality of the actions and services provided by healthcare professionals to the population were classified as "Good", according to the parameters established by the Ministry of Health, suggesting an efficiency in the quality of the follow-up and monitoring of cases until the completion of treatment. The indicators considered "precarious " can indicate that the actions are not being carried out in an effective and resolving manner, contributing to the continuation of high rates of the endemic in the city, considered as hyperendemic. / O Programa de Controle da Hanseníase é a principal estratégia no Brasil para consolidação de ações de acompanhamento dos municípios endêmicos, promovendo a vigilância, prevenção e controle da hanseníase por meio da avaliação dos indicadores de saúde, que incluem indicadores epidemiológicos e operacionais, capazes de mensurar a magnitude do problema e os progressos alcançados no programa. O presente estudo objetivou avaliar os indicadores de qualidade das ações e serviços de saúde do programa de controle da hanseníase em capital hiperendêmica no Brasil. Pesquisa avaliativo-descritiva, realizada em todas as instituições de saúde que operacionam o Programa de Controle da Hanseníase no município de São Luís - MA. A população de estudo foram todos os casos novos de hanseníase notificados no ano de 2012 e seus respectivos contatos. Os dados foram coletados por meio de um instrumento utilizando as variáveis contidas nas fichas de notificação do SINAN, livro de registro e prontuários de pacientes notificados em 2012. Utilizou-se os parâmetros estabelecidos pelo Ministério da Saúde para avaliar as ações e serviços prestados por profissionais de saúde ao indivíduo com hanseníase (indicadores operacionais). No ano de 2012 foram notificados 1.055 casos e 3.310 contatos. Nos casos notificados, verificou-se que 51,1% pertenciam ao sexo masculino, com idade entre 21 e 40 anos (35,3%), pardos (62,6%), com ensino médio completo (26,0%), residentes na capital do Estado (80,6%). O programa obteve resultados satisfatórios, sendo classificado como “Bom” quanto às taxas de abandono (3,4%) e quanto à avaliação do grau de incapacidade física no momento do diagnóstico (94,6%). Os indicadores classificados como “Precário” foram: proporção de alta por cura (42,5%) e proporção de contatos examinados de casos novos de hanseníase (29,1%). O indicador proporção de casos curados no ano com grau de incapacidade física avaliado no momento da alta foi classificado como “Regular” (82,5%). O modo de entrada predominante foi classificado como “caso novo” (79,1%) e o modo de detecção foi do tipo “demanda espontânea”, (52,0%). A forma clínica e classificação operacional mais prevalentes foram a dimorfa (58,8%) e multibacilar (74,0%), respectivamente. Conclui-se que o Programa de Controle da Hanseníase no município de São Luís não vem atuando de maneira satisfatória, visto que dois dos cinco indicadores responsáveis por avaliar a qualidade das ações e serviços prestados pelos profissionais de saúde à população foram classificados como “Precário” e um classificado como “Regular”, segundo os parâmetros estabelecidos pelo Ministério da Saúde, sugerindo uma deficiência na qualidade do acompanhamento e monitorização dos casos até a completude do tratamento. Os indicadores considerados “Precários” podem indicar que as ações não estão sendo realizados de maneira efetiva e resolutiva, contribuindo para a manutenção dos altos índices da endemia no município, até então considerado como hiperendêmico.

Diarrheal diseases are a global public health burden, killing 1.8 million people annually. Diarrhea disproportionately affects children and those in poverty. Most diarrheal cases can be prevented through safe drinking water, basic hygiene and/or sanitation measures, with drinking water interventions having the most impact on reducing diarrheal disease. A meta-evaluation was completed of studies evaluating a specific household water treatment method, the biosand water filter. Results from the meta-evaluation illustrate that biosand water filters improve drinking water quality and reduce diarrheal disease. However, there is no generally agreed upon field method for determining biosand water filter effectiveness that is useable in low-resource communities. A pilot study was conducted of potential field use indicators, including the Colilert coliform Presence/ Absence test, hydrogen sulfide, alkalinity, hardness, pH, and fluorescently-labeled latex microspheres. The study included both laboratory and field testing. The Colilert Presence/ Absence test had the highest correlation to the United States Environmental Protection Agency standard method (IDEXX Quantitrays), but more data is needed before making a recommendation. This study adds to understanding about evaluation of biosand water filters and provides preliminary data to address the need for a field use indicator for biosand water filters.

The prolonged wars in Iraq and Afghanistan have taken a toll on the United States as a whole and the United States military in particular. The primary aim of this research is to determine what impact the wars in Iraq and Afghanistan have had on the performance of military hospitals over the fiscal years 2001-2006. Specifically, what direct effect has the war in Iraq and Afghanistan had on the productivity and quality of military hospitals, and, do productivity and quality trends differ based on hospital characteristics? Since observations over multiple time periods are nested within hospitals, multilevel mixed effects regression and Poisson regression models are used to evaluate changes in productivity and quality while accounting for differences within hospitals. Using a contingency theory framework, this study fills the gap in looking at the impact of war on permanent military hospitals’ productivity and quality using nationally developed and implemented quality indicators (Agency for Healthcare Quality and Research Inpatient Quality Indicators and Patient Safety Indicators). Structural characteristics of the hospital, teaching status and branch of Armed Service influenced productivity and certain quality indicators. The structural components were not able to reliably predict differences in productivity and all quality indicators, but overseas hospitals and non-teaching hospitals were most likely to differ from major teaching hospitals. The wars in Iraq and Afghanistan, denoted by the variables for wounded discharges and deployed staff, were only partially related to the productivity of military hospitals. Only an increase in the percentage of wounded discharges was related to productivity of military hospitals, and none were related to the quality indicators. In essence, the war affected the workload and productivity of military hospitals, but it did not affect the quality provided in the hospitals, as measured by AHRQ inpatient and patient safety quality indicators. Structural characteristics account for more of the variation in quality among military hospitals than the impact of war within the timeframe studied.

Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through retrospective, longitudinal, multivariate regression analysis using 4 publicly available data sources. Background: The intention of pay-for-performance programs, including the Centers for Medicare and Medicaid HAC Reduction Program, is to improve the quality of care delivered; however, the theoretical and conceptual basis of pay-for-performance programs and their efficacy in improving care are widely debated. This study was designed to address the gap in knowledge related to the efficacy of value-based reimbursement as a means of motivating providers and organizations to improve healthcare quality. Results: Higher average daily census, disproportionate share percentage, and case mix index were associated with increased likelihood of receiving a penalty in the HAC Reduction Program. Approximately half (49%) of who did not experience a penalty at all improved their Total HAC Score. 51% of hospitals with 1 year of penalty improved their Total HAC Score; 54% of hospitals with 2 years of penalty improved their Total HAC Score; 73% of hospitals with 3 years of penalty improved their Total HAC Score. Conclusions: Despite the inability of some hospitals to meet the benchmark to avoid penalty, the vast majority of hospitals improved their performance over time. This finding holds promise for value-based reimbursement as a means for improving HAC incidence.

Doctor of Philosophy (PhD) / This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.

Thesis (M. A.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention.<p> This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008.<p> The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province.<p> The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.