Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

Orientador: Leandro Gustavo de Oliveira / Resumo: Introdução: A classificação de Robson tem sido utilizada para avaliação das taxas de cesáreas no mundo. Recomenda-se que cada localidade adapte a classificação original de acordo com suas necessidades. Objetivos: Analisar os casos de cesáreas realizadas na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu utilizando uma classificação baseada nos 10 grupos de Robson, modificada a partir da inclusão de subgrupos e analisar os resultados a partir das recomendações estabelecidas pela Organização Mundial da Saúde. Métodos: Foi um estudo prospectivo com pacientes admitidas para assistência ao parto, no período de 01 de junho 2018 e 31 de maio de 2019. Uma planilha foi desenhada para a coleta dos dados e a classificação dos grupos foi elaborada a partir da classificação de Robson, modificada pela inclusão de subgrupos com métodos de indução e momento da indicação da cesárea. Resultados: Foram analisados 1823 partos, sendo 810 (44%) cesáreos. Houve 35,6% de primigestas, 19,5% de uma cesárea prévia e 15,4% de prematuros. O grupo 5, com maior número, teve 435 pacientes (23,8%), seguido do grupo 3, 422 (23,1%) e do grupo 1, 316 (17,3%). O grupo 5 teve maior número de cesáreas, 305 (37,6%). O grupo 2 teve 128 (15,8%). As iterativas totalizaram 19%. Indução do trabalho de parto teve 55,0% de sucesso. Entre pacientes com comorbidades, 60,5% tiveram cesárea. Comorbidades obstétricas mais frequentes foram: pré-eclâmpsia (12,7%), diabetes gestacional (8,4%) e restrição... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Robson classification has been used to assess cesarean section rates worldwide. It is recommended that each location adapts the original classification according to their needs. Objectives: To analyze the cases of cesarean sections performed at the Maternity from the Clinics Hospital from Medical School of Botucatu using a classification based on Robson's 10 groups, modified from the inclusion of subgroups, and to analyze the results from the recommendations established by the World Health Organization. Methods: This was a prospective study with patients admitted for childbirth assistance from June 1, 2018 to May 31, 2019. A spreadsheet was designed for data collection and the classification of groups was elaborated from the classification of Robson, modified by the inclusion of subgroups with methods of induction and the moment of cesarean section indication. Results: 1,823 births were analyzed, 810 (44%) of which were cesarean. There were 35.6% of primiparous women, 19.5% of women with previous cesarean section and 15.4% of premature babies. Group 5, with the largest number, had 435 patients (23.8%), followed by group 3, 422 (23.1%) and group 1, 316 (17.3%). Group 5 had the highest number of cesarean sections, 305 (37.6%). Group 2 had 128 (15.8%). Women with two or more previous cesarean sections totaled 19%. Labor induction was 55.0% successful. Among patients with comorbidities, 60.5% had cesarean sections. Most frequent obstetric comorbidities were: pre-ecl... (Complete abstract click electronic access below) / Mestre

The main goal of this research is to investigate vulnerability of levees to future slump slides. In the first part, polarimetric synthetic aperture radar (PolSAR) imagery is used as input in an automated classification system for characterizing areas on the levee having anomalies. In addition, a set of in-situ soil data is collected to provide detailed soil properties over the study area. In-situ soil properties of different classes characterized by the classifier are analyzed to determine how similarities between different areas. The second part, a database including of 34 slump slides that occurred in the lower Mississippi River levee system over a period of two years is used. The impacts of rainfall as well as several spatial geometrical and geomorphological variables (including channel width, river sinuosity index, riverbank erosion, channel shape condition and distance to river) are analyzed and tested for significance and used for developing a logistic regression model.

Few studies have investigated cracks involving the pulp chamber walls or floor. The purpose of this study was to create a classification system for intrapulpal cracks and analyze associated clinical characteristics. Retrospective analysis included 52 teeth confirmed to have an intrapulpal crack. The classification system describes the crack based upon its location within the pulpal walls and floor. Documentation consisted of demographic, subjective and objective examination data. Chi-squared analysis tested associations with the intrapulpal crack classifications. Ninety-two percent of intrapulpal cracks run M-D, 75% involve one pulp chamber wall, and 84% terminate at the floor-wall junction or extend into an orifice without involving the pulpal floor. There was a statistically significant (P<0.05) relationship between the location of the intrapulpal crack and tooth type as well as between the classification system and bite test and transillumination. The classification system was adaptable to clinical practice and provides insight into these challenging situations.

A absorção oral de um fármaco é fundamentalmente dependente da solubilidade aquosa e da permeabilidade gastrintestinal. Estes são fatores determinantes da biodisponibilidade e, consequentemente, da eficácia clínica de um medicamento. O Sistema de Classificação Biofarmacêutica (SCB), fundamentado nas propriedades de solubilidade e permeabilidade, consolidou-se nos últimos anos como ferramenta de auxílio na predição da biodisponibilidade de fármacos e tem sido empregado no desenvolvimento de formas farmacêuticas, contendo novos fármacos ou não, bem como no registro de medicamentos genéricos. O emprego do SCB para a isenção dos estudos de biodisponibilidade relativa/bioequivalência para algumas classes de fármacos vem sendo adotado e discutido, uma vez que os ensaios de biodisponibilidade apresentam limitações técnicas, econômicas e éticas. Assim, nos últimos anos, Agências Regulatórias têm utilizado o SCB para permitir que testes de dissolução in vitro sejam usados para estabelecer bioequivalência no caso de fármacos altamente solúveis e altamente permeáveis. O presente trabalho tem como objetivos revisar e reunir a literatura relacionada ao SCB com vistas a discutir a possibilidade de isenção dos estudos de biodisponibilidade relativa / bioequivalência para os medicamentos. Com esta proposta, foram pesquisadas as bases de dados Pubmed, Medline, Legislações Brasileiras indexadas no Visalegis e Legislação Internacional. Buscou-se a literatura pertinente publicada no período entre 1980 e o primeiro semestre de 2009. Desde a introdução do SCB existe uma relutância na aplicação das bioisenções para o registro de genéricos uma vez que as indústrias farmacêuticas não querem arriscar uma rejeição à sua solicitação nos países onde esse sistema ainda não é aceito, principalmente devido à falta de harmonização da legislação global. No Brasil, o SCB não é aceito para isenção de estudos de biodisponibilidade relativa/bioequivalência, pois os dados de permeabilidade são escassos na literatura científica para a grande maioria dos fármacos e ainda não existem protocolos validados para os estudos de permeabilidade. Além disto, o país ainda não possui um sistema de registro e controle de qualidade de princípios ativos e excipientes, ou seja, até o momento, não há regulamentação técnica para registro de matérias-primas de produtos farmacêuticos e cosméticos, ao contrário do que existe nos Estados Unidos. Para uma melhor aplicabilidade do SCB nas bioisenções as seguintes questões devem ser destacadas: continuidade do suporte científico para assegurar bioisenções para fármacos da Classe III; suporte científico para as metodologias de determinação de permeabilidade, com o objetivo de determinar a classificação biofarmacêutica dos fármacos; discutir a aplicação da Classificação Biofarmacêutica na fase de pesquisa e desenvolvimento de novas moléculas. / The oral absorption of a drug is fundamentally dependent on the aqueous solubility and gastrointestinal permeability. Those are determinant factors of the bioavailability of a drug and of the clinical efficacy of a pharmaceutical product. The Biopharmaceutics Classification System (BCS) is based on the properties of solubility and permeability and has been developed as a tool to predict bioavailability of drugs. BCS has also been used in the development of new dosage forms, including new molecules or not, as well as in the registration of generic drugs. The use of BCS as a \"waiver\" of in vivo bioavailability and bioequivalence studies for some drug classes has been discussed, since bioavailability studies represent technical, economical and ethical limitations. Therefore, in the last years the Regulatory Agencies have used BCS to allow that in vitro dissolution tests be used to establish bioequivalence in the case of highly soluble and highly permeable drugs. The present study has the objective to review the literature related to BCS, focusing in the discussion of biowaivers. The research was conducted using the following databases: Pubmed, Medline, Brazilian legislation indexed in the ANVISA website (VISALEGIS) and international legislation. The research period was between 1980 and the first semester of 2009. Since the introduction of BCS there is reluctance in the application of a biowaiver because the pharmaceutical companies do not want to risk a rejection of their biowaiver request in the countries where this system has not been established yet and also due to the lack of global legislation harmonization. In Brazil the BCS is not accepted for waiving bioequivalence studies, since permeability data are not very common in the scientific literature, for the great majority of drugs. Besides, the country does not have a regulatory framework for the registration of active pharmaceutical ingredients and raw materials, as it happens in the United States. In order to give a better applicability of BCS in biowaiver requests, the following questions must be pointed out: continuity of scientific support to assure biowaivers for Class III drugs; scientific support for permeability methodologies determination; discuss the applicability of BCS in early development phase studies for new molecular entities.

Atualmente no mercado brasileiro de condomínios de galpões logísticos são ofertados empreendimentos em variados estratos de qualidade. Isto decorre do grande espectro de necessidades e demandas de uma ampla variedade de usuários interessados em ocupar Condomínios Logísticos (CL). De modo geral, os usuários desta tipologia de empreendimento procuram, além da eficiência de armazenagem, outros serviços e atributos tais como: localização privilegiada, moderna infraestrutura de sistemas prediais, forte segurança patrimonial, incentivos fiscais na região, flexibilidade no projeto para ajustar as instalações existentes a requisitos operacionais específicos, entre outros. A partir do conjunto de atributos de qualidade oferecidos aos usuários é possível enquadrar empreendimentos deste segmento em classes específicas que permitam o mercado fazer uma leitura sem viés do padrão de qualidade dos empreendimentos em oferta, a exemplo do que já é utilizado em outros segmentos de empreendimentos de Base Imobiliária no Brasil. Contudo, um sistema de classificação de CL rigoroso e isento de viés é inexistente hoje no Brasil. O mercado dispõe exclusivamente de critérios formulados pelas empresas responsáveis pela comercialização dos espaços nos empreendimentos, o que compromete a isenção da avaliação da qualidade para o usuário. Esta notória ausência de um sistema de classificação reclama a construção de critérios mais bem fundamentados e com análise do estado dos atributos, sob o ponto de vista do usuário de CLs. Portanto o objetivo desta pesquisa é desenvolver um sistema de certificação da qualidade de CL no Brasil, no qual sejam identificados e analisados os diferentes atributos que possam enquadrar um empreendimento dentro de uma classe específica, para dar suporte a uma leitura de qualidade dos empreendimentos pelo mercado. Para atingir o objetivo mencionado, foi necessário identificar os principais aspectos comuns às classificações existentes no mercado de CL através de levantamento bibliográfico e de práticas de mercado, para, em seguida, eleger uma metodologia de análise que permita avaliar os atributos que fundamentam na visão dos usuários o que configura a qualidade dos CLs. O método empregado foi o Delphi, que envolve a aplicação sucessivas de questionários a especialistas no tema, com o intuito de reconhecer a opinião prevalente acerca da qualidade de CL segundo o ponto de vista de seus usuários típicos. Deste modo, os resultados alcançados são, i) construção de uma Matriz de atributos que identifica a importância relativa dos sistemas e atributos requeridos pelos usuários de CLs, ii) construção de um sistema de classificação da qualidade de CLs para ser oferecido ao mercado. / Currently in the Brazilian Warehouses Business Park (WBP) are offered projects in varying quality strata. This follows from the broad spectrum of needs and demands of a wide variety of users interested in occupying charges (WBP). In general, users of this project typology looking beyond the storage efficiency, other services and attributes such as: prime location, modern infrastructure building systems, strong balance security, tax incentives in the region, design flexibility to adjust the facilities existing specific operational requirements, among others. From the set of quality attributes offered to users can frame projects this segment in specific classes that allow the market to do a reading without standard bias quality of the projects on offer, similar to what is already used in other segments of enterprises Base of Real Estate in Brazil. However, a strict classification system of WBP whit free bias is nonexistent today in Brazil. The market has only criteria formulated by the companies responsible for marketing the spaces in the projects, which compromises the quality assessment of the exemption for the user. This notorious absence of a classification system calls for the construction of wellfounded criteria and analysis of the state of the attributes from the point of view of WBP user. Therefore the aim of this research is to develop a quality certification system to Warehouses Business Park in Brazil, which are identified and analyzed the different attributes that can frame a project within a specific class, to support a quality reading of developments in the market . To achieve the goal mentioned, it was necessary to identify key commonalities of existing ratings in the WBP market through literature and market practices, to then elect a methodology for assessing the attributes that support the vision of users which sets the quality of WBP. The method used was Delphi, which involves the successive application of questionnaires to experts on the subject, in order to recognize the prevailing opinion about the quality of WBP from the point of view of their typical users. Thus, the results obtained are i) construction of an array of attributes that identify the relative importance of the attributes required for systems and users shed, ii) construct a quality classification system of WBP to be offered to the market.

In August 2019, Prima-Sekunda is about to be introduced, a new classification system for the classification of pulpwood during surveying to industry. This new classification system should be more time and cost effective and at the same time offer the industries commodity volume with better quality. The purpose of this study was to compare if there was any difference in the economic outcome with the new Prima-Sekunda compared to today's classification system when measuring pulpwood. Based on the 95 piles measured, it appeared that today's classification system gives somewhat better paid than Prima-Sekunda due to the prices for Prima-Sekunda which are initially set slightly lower than today's pulpwood price. The introduction of Prima-Sekunda should be price neutral, which means that the prices for Prima-Sekunda as shown in the current study must be reasonably equal to the current pulpwood price for this goal to be materialized.

Suppliers of wheat must ensure that their products have the required quality profile demanded by customers and consistently deliver that quality in order to be competitive. Australia’s wheat industry is highly exposed to such competitive threats because it relies heavily on exports. An integral component in maintaining Australia’s competitiveness has been its classification system. The first step involves the complex process of determining a genotypic quality profile of each variety – a variety classification. At harvest, subsequent steps are the use of a statutory declaration and testing of physical quality traits. Together these steps determine how deliveries of wheat are segregated. A single variety can have different classifications across the 7 classification regions of Australia. Most classification regions are divided along state borders and these are not reflective of potential environmental influences. / The manner in which Australia wheat breeding programs now tackle their task has changed since 1999. The commercially focused companies of the current era have national targets to remain viable, and are focused on costs. Other evolutions associated with the change, are the introduction of different sources of parental material, and moving to more economic composite quality testing regimes instead of the individual site by site testing used in the past. Together, these factors, particularly variety adaptability and stability of performance, have the capacity to increase variability. The likelihood of variation is further increased given that the current classification regions upon which classification decisions are made do not adequately reflect environmental effects on the expression of quality. To determine whether better divisions of the Australian wheat-belt could be identified for variety classification purposes, a substantial spatial and temporal database of historical quality results was assembled. The creation of this relational database was unique, because never before had expansive sets of independent, state-based, quality sub-sets been joined together. However, the data were unbalanced and required alternative statistical tools to be analysed. The relational database was the platform from which three phases of research were conducted. / The first research phase investigated the extent of cross over, or re-ranking of results, statistically referred to as genotype x environment interaction. The approach was to assess balanced data sets, in a manner reminiscent of the most common method identified from the literature. The results of those analyses showed that the size of genotype and environment interaction was small compared with the main effects of genotype and environment. The second phase of research focused on identifying alternative boundaries for classification purposes. Test divisions were compared with the current set of 7 classification regions for the capacity to minimise environmental variance while maintaining differences between the zones of a set. Test divisions were based on fourteen published divisions of the Australian wheat-belt. Analyses were conducting using residual maximum likelihood because of the unbalanced structure of the data. Estimates of variance components, quality trait means and standard errors were calculated. Consideration of such estimates resulted in the identification of 4 different divisions of the wheat-belt that had low environmental variance levels for important quality traits such as maximum resistance, dough development time, and water absorption. / In addition, these 4 divisions of the wheat-belt had fewer number of zones compared with the existing set of classification regions because they linked separate parts of the wheat-belt together. In order of decreasing merit, the 4 divisions of the wheat-belt represented average October maximum temperatures; agro-ecological zones reported by Williams et al. (2002); average annual rainfall; and Departments of Agriculture recommendation zones. A final phase of crosschecking was performed to assess the veracity of the 4 identified divisions. A cluster analysis supported the orientation of their boundaries and it was also observed that the use of fixed boundaries for classification purposes would not be negatively affected by seasonal variation. The 4 divisions of the wheat-belt identified in this research support the use of environmentally focused classification boundaries. In addition to improving the capacity to segregate consistent quality, the linking of geographically separate production areas of the wheat-belt reduced the number of zones and this offers process efficiencies.

The principal aim of this study was to develop a classification model in disability sports. Using disability swimming as an example, methods of participant observation, interview, survey and document analysis were undertaken in three empirical studies to develop and clarify the classification model and three elements in swimming classification- (a) the classification process, (b) classifiers and (c) the classification system. First, the swimming classification process was identified as a social process. Members in the classification process socially interacted. The detailed classification process was described, interpreted and discussed. Several features in the classification process were identified. They included interaction among social actors, routinization, rules in the process, resources used by classifiers, power relations among social actors, allocation of rewards and sanctions in the classification process, and conflicts among social actors. Second, the role of classifiers as an agent of social control in disability swimming was examined. Resources used by medical and technical classifiers in the classification process to maintain their role and social order, and the socialization of classifiers in swimming were specifically explored. In addition, the important characteristics of swimming classifiers were identified in the study. Third, classification outcomes in disability swimming were monitored to evaluate the effectiveness of the classification system. Performance and impairment approaches were used in the study. Data of performances and types of impairment of Paralympic swimmers were analysed. The results revealed that the swimming classification system was generally fair but some classes needed to be fine-tuned. In this study elements of the classification model were clarified by integration of the results of the three empirical studies and the classification literature. It is suggested that researchers may use the concepts of the classification model for further investigationin disability sportc lassificationa nd disability sport committees may apply the model to systematicallye valuatet heir own classification systems, processes and classifiers.

Orientador: Maria de Lourdes Bueno Trindade Galo / Banca: Erivaldo Antonio da Silva / Banca: Edson Eyji Sano / Resumo: Os mapeamentos da cobertura da terra apresentam o relevante papel de permitir avaliar as alterações na paisagem provocadas pela ação antrópica e fornecer importantes informações para o manejo eficiente dos recursos naturais constituindo-se, assim, em ferramentas essenciais para o planejamento regional e urbano. Entretanto, os atuais mapeamentos atendem a propósitos muito específicos e, conseqüentemente, são limitados na sua capacidade de definir a ampla variedade de tipos existentes de cobertura da terra. Nesse contexto, a proposta central desta pesquisa é desenvolver um sistema hierárquico de classificação, amplo e abrangente, partindo de um nível generalizado de definição de classes de cobertura da terra, para mapeamentos em escala regional, e especializando essas classes para ambientes urbanos. Para cada escala de mapeamento é proposta a nomenclatura das classes e os critérios usados para defini-las. Um estudo de caso é desenvolvido para testar o sistema hierárquico em dois níveis de detalhamento distintos, nas escalas regional e urbana, e são utilizadas diferentes abordagens de classificação multiespectral para extrair as informações temáticas de interesse a cada nível de aplicação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Land cover mappings present the relevant role of allowing to evaluate the changes in the landscape caused by the man's action and to supply important information for the efficient handling of the natural resources. Thus, those are essential tools for the regional and urban planning. However, current mappings are related to very specific purposes and, consequently, they are limited in their capacity to define the wide variety of existent types of land cover. In that context, the main proposal of this research is to develop a wide and including hierarchical classification system, starting from a generalized level of definition of land cover classes for mappings in regional scale and specializing those classes for urban environment. It is proposed the nomenclature of the classes and the criteria used to define them for each scale of mapping. A study case is developed to test the hierarchical system in two detailing levels, in the regional and urban scales, and different approaches of multispectral classification are used to extract the thematic information of interest to each application level... (Complete abstract click electronic access below) / Mestre