CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The study looked to characterize a proposal for the nursing diagnosis of âRisk of Decreased Cardiac Outputâ, based on the judgement of 25 specialists. It was carried out in the period of September of 2007 to April of 2008, in two methodological stages: a) Elaboration of the proposal of the nursing diagnosis of Risk of Decreased Cardiac Output, according to NANDA, and the operational definition for each risk factor; b) Validation of the concept, of the risk factors and the operational definitions. For so, it was used the Diagnostic Content Validation model proposed by Fehring and the Delphi technique. All the specialists were selected based on Fehringâs criteria. Data was collected at two moments, from questionnaires. The quantitative analysis disposed of the calculation of the weighted mean of the value attributed by specialist to each risk factor, being: 1 (it does not cause vulnerability) = 0; 2 (it causes very little vulnerability) = 0,25; 3 (it causes moderate vulnerability) = 0,5; 4 (it causes very much vulnerability) = 0,75; and 5 (it completely causes vulnerability) = 1. Based on this calculation, the risk factors with score below the established cutoff point of 0,6 were discarded. For the evaluation of the items related to the operational definition (Clarity, Adequacy to the risk factor and Adequacy to the remaining proposed terms) the values were tabulated (+1, 0 and -1) and the mean calculated, in order to check the level of agreement/disagreement between the specialists. There was still calculated the Index of Content Validity, which indicates the confidence of the application of the diagnosis in practice. It was considered the explanation of the objectives to the participants, their declared consent in allowing the collection and supplying the solicited data, their freedom to refuse or give up from participating in any phase of the research process without prejudice of any kind to them, to ask for clarification as well as their right to anonymity. As result, was obtained the understanding that the label proposed is representative of a nursing diagnosis, to which the concept corresponded, in adequacy to the structure used by NANDA: âTo be in risk of developing a level of health characterized by insufficient quantity of blood pumped each minute by the heart to fulfill the physical metabolic demandsâ. Were considered representative risk factor for this phenomenon (≥ 0,6), according to the specialists judgement: myocardial dysfunction (0,887), blood loss (0,875), intrapericardial pressure increase (0,825), condition that causes alteration in the rhythm and/or electric cardiac driving (0,812), defective volume of liquids (0,725), plasma loss (0,712), ineffective tissular perfusion (0,712), electrolytic unbalance (0,7), acid-base unbalance (0,697), valve alteration (0,65), major surgery (0,65) and general deep anaesthesia/spinal anaesthesia (0,625), obtaining a Index of Content Validity of 0,739. With this proposal, it was provided the characterization of this phenomenon, as a form to orientate the process of clinical judgement, making possible a preventive act, as a way to avoid the development of the real entity and of his complications. However, because of the peculiarity of this study and the relevance of its finds, itâs essential the replication of the 10 risk factors (22%) that were located between the cutoff points of 0,5 and 0,59, as well as new submissions of the data to the specialists to obtain the consensus, and the realization of a study of clinical validation, in order to obtain evidences about the incident of this phenomenon in nursesâ practice / O estudo buscou caracterizar proposta para o diagnÃstico de enfermagem Risco para DÃbito CardÃaco diminuÃdo, com base no juÃzo de 25 especialistas. Foi realizado no perÃodo de setembro de 2007 a abril de 2008, em duas etapas metodolÃgicas: a) ElaboraÃÃo da proposta do diagnÃstico de enfermagem Risco para DÃbito CardÃaco diminuÃdo, de acordo com a NANDA, e da definiÃÃo operacional para cada fator de risco; b) ValidaÃÃo do construto, dos fatores de risco e das definiÃÃes operacionais. Para tanto, utilizou o modelo de ValidaÃÃo de ConteÃdo DiagnÃstico de Fehring e a tÃcnica Delphi. Todos os especialistas foram selecionados com base nos critÃrios de Fehring. Os dados foram coletados em dois momentos, por meio de questionÃrio. Jà a anÃlise quantitativa empregou a mÃdia ponderada do valor atribuÃdo por especialista a cada fator de risco, sendo: 1 (nÃo causador de vulnerabilidade) = 0; 2 (pouco causador de vulnerabilidade) = 0,25; 3 (moderadamente causador de vulnerabilidade) = 0,5; 4 (muito causador de vulnerabilidade) = 0,75; e 5 (totalmente causador de vulnerabilidade) = 1. Com base nesse cÃlculo, descartaram-se os fatores de risco com escore abaixo do ponto de corte estabelecido de 0,6. Para a avaliaÃÃo dos itens relacionados à definiÃÃo operacional (Clareza, AdequaÃÃo ao fator de risco e AdequaÃÃo aos demais termos propostos) seus valores foram tabulados (+1, 0 e -1) e a mÃdia calculada, com vistas a verificar o nÃvel de concordÃncia/discordÃncia entre os especialistas. Calculou-se ainda o Ãndice de Validade de ConteÃdo, o qual indica a confianÃa da aplicaÃÃo do diagnÃstico na prÃtica. Considerou-se o esclarecimento dos objetivos e da metodologia aos participantes, o consentimento declarado destes em permitir a coleta e fornecer os dados solicitados, a sua liberdade para recusar ou desistir de participar em qualquer fase do processo de pesquisa sem prejuÃzo de qualquer natureza à sua pessoa, assim como para solicitar esclarecimentos e o seu direito ao anonimato. Como resultado, obteve-se a compreensÃo do rÃtulo proposto como representativo de um diagnÃstico de enfermagem, para o qual prevaleceu o construto: âEstar em risco de desenvolver um estado de saÃde caracterizado por quantidade insuficiente de sangue bombeado pelo coraÃÃo a cada minuto para atender Ãs demandas metabÃlicas corporaisâ. Foram considerados fatores de risco representativos deste fenÃmeno (≥ 0,6), segundo o juÃzo dos especialistas: disfunÃÃo miocÃrdica (0,887), perda sangÃÃnea (0,875), aumento da pressÃo intrapericÃrdica (0,825), condiÃÃo que causa alteraÃÃo no ritmo e/ou conduÃÃo elÃtrica cardÃaca (0,812), Volume de LÃquidos deficiente (0,725), perda plasmÃtica (0,712), PerfusÃo Tissular ineficaz (0,712), desequilÃbrio eletrolÃtico (0,7), desequilÃbrio acidobÃsico (0,697), alteraÃÃo valvar (0,65), grandes cirurgias (0,65) e anestesia geral profunda/ anestesia espinhal (0,625), obtendo-se um Ãndice de Validade de ConteÃdo de 0,739. Com esta proposta, propiciou-se a caracterizaÃÃo deste fenÃmeno, como forma de orientar o processo de julgamento clÃnico, possibilitando uma atuaÃÃo de cunho preventivo, de modo a evitar o desenvolvimento da entidade real e das suas complicaÃÃes. No entanto, em virtude da sua singularidade e da relevÃncia dos seus achados, à imprescindÃvel a replicaÃÃo dos 10 fatores de risco (22%) situados entre os pontos de corte de 0,5 e 0,59, assim como novas submissÃes dos dados aos especialistas para a obtenÃÃo do consenso e a realizaÃÃo de estudo de validaÃÃo clÃnica, a fim de obter evidÃncias acerca da ocorrÃncia desse fenÃmeno na prÃtica dos enfermeiros

A computer visual-input system was built for the purpose of studying the classification of leukocytes. It consisted of an image dissector camera interfaced directly to a D.E.C. PDP-9 computer; a display of the image field was also provided, using a monitoring scope. The design and hardware arrangement of the system is briefly described, while detailed diagrams of the logic networks are shown in Appendix II. Photomicrographs of neutrophils were used as a pattern set, in a study of the computer classification of cell age and lobularity. Clustering of feature vectors was noted in a two-dimensional measurement space showing that metamyelocyte, banded and segmented cells can be distinguished. A square contour-trace of the neutrophil nuclei was performed and an area operator pre-processed the shape of a nucleus into a curvature function. Peaks in this curvature function, a measure of lobularity, as well as the ratio of the perimeter to square root of nuclear area, a measure of the irregularity in the nuclear boundary, were used as orientation and size-independent features. The area operator was found to be unsuitable for extracting curvature from leukocyte images. In cases of extreme nuclear curvature and nuclear filamentation, the basic formulations of the operator were violated giving an erroneous measure of curvature. The general form of the frequency spectrum of the video signal from the image dissector camera was derived. The signal bandwidth requirements and the camera resolution were found experimentally. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate

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<p> Two basic assumptions of the H. A. Wood Land Use Classification for the American Tropics are examined. </p> <p> First, the nature of the relationship between the level of technology, climatic characteristics, economic output, and labour requirements is examined for individual crops using data acquired from the Ecuadorian government. </p> <p> Second, the author examines the extent to which it is possible to separate, and accurately identify, the Wood Land Use Systems on aerial photographs. Photographs were interpreted from both the Sierra and coastal regions of Ecuador and later field checked by the author with the aid of the Ministerio de Agricultura. </p> <p> Through analysis, certain assumptions of the classification have been verified, and some modifications have been suggested. </p> / Thesis / Master of Arts (MA)

Budgetary restraints have forced a re-evaluation of expenditures for health care. regardless of the methods of delivery and financing. Efficiency in resource allocation implies production of an optimal output mix at minimum opportunity cost. Inefficiencies in resource allocation will result in higher costs. It is often argued that the fee-for-service reimbursement method, in particular, provides incentives for over-servicing, with elective surgery receiving most attention since international and intranational variations were out of line with variations in morbidity. Although the initial concern of physicians was with the clinical risks of unnecessary surgery. concern with the rising costs of providing health care has turned attention to financial factors as possible explanations of the variations in elective surgical procedures. The physician plays a key role in the allocation of resources in the health care sector. It is, therefore, likely that the aggregate output mix of different services will be responsive to the differential relative benefit rates received by physicians, with a bias in favour of the more expensive procedures and the consequent higher costs for the system as a whole. The physician's key role is emphasized in this study with the emphasis on supplier incentives and the inherent multiproduct nature of health care output. Economic theory predicts a movement along the production possibility frontier in output space in response to relative price changes. Econometric estimation of multiproduct production relations has been facilitated by the application of duality theory and the development of flexible functional forms. Duality theory establishes that the parameters of the production function can be represented equally well by the corresponding dual profit or cost function. Flexible functional forms for the profit function permit derivation of supply equations with relative prices as independent variables. Four elective surgical procedures were selected in order to estimate the aggregate substitution in production by physicians. With pooled cross-section and time series data for Canada for the period 1973 to 1981, the supply equations were estimated as a system, using the SURE estimation technique. Supply elasticities for price changes and changes in the key fixed factors were calculated. While emphasis was on the price response, the functional form incorporated the constraints imposed by the availability of hospital beds and surgical specialists. Evidence was found in support of the view that physicians allocate their time partly in response to changes in the prices of elective procedures relative to other procedures. With global budget constraints imposed on hospital expenditures, the four procedures, being elective, might possibly be given lower priority. Also, the estimated coefficients for the lagged dependent variables suggest that an inertia model of adjustment applies. Although incentives may exist in the fee structure to substitute toward the more expensive procedures, the results suggest that, at least for the period of the study. substitution was not on the basis of price alone. and that resource constraints. as proxied jointly by the number of hospital beds and surgical specialists, play a greater role in determining aggregate output. / Thesis / Doctor of Philosophy (PhD)

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