O objetivo geral do estudo foi analisar o controle da tuberculose em penitenciarias. Método: estudo misto sequencial explanatório. Na etapa 1, abordagem quantitativa, o cenário condiz às unidades prisionais paulistas e, a etapa 2, abordagem qualitativa, condiz com a penitenciária de Iperó. A etapa 1 foi um estudo descritivo utilizando dados dos casos de presos notificados com tuberculose no período 20102016, oriundos de fonte secundária TBweb, gerando um Banco de Dados do qual foram realizadas analises descritivas e de frequências simples no software SPSS 20.0 da IBM, e no Statistica 13.0 da Statsoft; a análise de tendência temporal foi realizada no software Stata/SE 14.0 considerando o método de auto regressão de Prais-Winsten. Na etapa 2 os dados foram produzidos por meio de entrevistas individuais, semi-dirigidas utilizando um roteiro, com oito profissionais de saúde selecionados por amostragem com propósito, e que executassem as ações para o manejo da tuberculose na penitenciária, há mais de seis meses. As entrevistas foram áudio-gravadas. Para a análise dos dados se utilizou os procedimentos da Teoria Fundamentada Construtivista. Estudo aprovado pelos Comitês de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo e pela Secretaria de Administração penitenciária do estado de São Paulo. Os resultados sinalizaram que 16.640 casos de tuberculose foram notificados no período, a grande maioria do sexo masculino. Eram casos novos 79% do total. Os casos eram majoritariamente pulmonares (95,8%), sendo 67,8% bacilíferos. Apresentaram tendências crescentes os que faziam uso de álcool e drogas. Foram descobertos por Demanda Ambulatorial 51,4% dos casos e 31,2% por Busca Ativa. Abandono e óbito não-tuberculose apresentaram tendências decrescentes. Os profissionais de saúde percebem que para controlar a doença devem \"Fazer bem meu trabalho\", sendo esta a categoria principal, a ser abordada em outras duas categorias: 1) Descobrir a doença: perceber aos presos que padecem e os sinais e sintomas daqueles que não querem ser descobertos; além de indagar na manifestação dos sintomas que relatam os presos a fim de verificar a presença ou não da doença; 2) Implicar-se no tratamento da doença: se esforçam para a cura do enfermo, os orientam a cumprir todo o tratamento, mesmo que isso também implique persuadi-lo e/ou intimidá-lo. Se considera que devido à presença significativa da forma pulmonar, faz-se premência de um ciclo de estratégias de detecção da enfermidade, assim como maior atenção a realização e finalização do tratamento. Mesmo que as diretrizes estejam bem estabelecidas nem sempre é possível operacionaliza-las. Apesar de dificuldades enfrentadas no processo de atenção, os profissionais de saúde não poupam esforços para o manejo da tuberculose / The overall objective of the study was to analyze the control of tuberculosis in penitentiaries. Method: explanatory sequential mixed study. In step 1, a quantitative approach, the scenario corresponds to the prison units of São Paulo, and step 2, a qualitative approach, corresponds to the Iperó penitentiary. Step 1 was a descriptive study using data regarding the cases of prisoners notified with tuberculosis in the period 2010-2016, collected from the secondary source TBweb. Descriptive analyzes were performed in SPSS 20.0 software, Statistica 13.0 from Statsoft and time trend analysis was performed on the Stata / SE 14.0 software considering the PraisWinsten self-regression method. In step 2, data were generated by semi-directed interviews to eight health professionals selected who performed the actions for the management of tuberculosis in the penitentiary for more than six months. The interviews were audio-taped. For data analysis, procedures of the Constructivist Grounded Theory were used. This study was approved by the Research Ethics Committees of the Ribeirão Preto College of Nursing - University of São Paulo and the Secretariat of Penitentiary Administration of the state of São Paulo. The results indicated that 16,640 cases of tuberculosis were reported in the period, which vast majority of males. The new cases represented 79% of the total. The cases were mostly pulmonary (95.8%), 67.8% of which were bacilliferous. The alcohol and drugs\' use showed increased trends. Ambulatory Demand was responsible for the diagnosis of 51.4% of cases and Active Case Finding for 31.2%. Treatment default and nontuberculosis death presented decreasing trends. Health professionals perceive that in order to control the disease, they must \"Do my job well\", which was the main category, that was divided into two others: 1) Discovering the disease: perceiving the prisoners who get ill and the signs and symptoms of those who they do not want to be discovered; moreover, have to investigating the manifestation of the symptoms reported by the prisoners in order to verify the presence or not of the disease; 2) Involvement in the treatment of the disease: they put effort to cure the ill prisoner, give them orientation in order to complete all the treatment, even if this also involves persuading them and / or to coerced them. It is considered that due to the significant presence of the pulmonary form, a cycle of strategies of detection of the disease is made urgent, as well as greater attention the accomplishment and finalization of the treatment. Even if the guidelines are well established, it is not always possible to operationalize. Despite the difficulties faced in the care process, the health professionals do not spare efforts for the management of tuberculosis

In this dissertation, I combined a scenario-based, standard-response optimization model with a stochastic simulation model to improve the efficiency of the deployment of initial attack firefighting resources on wildland fires in California and the Republic of Korea. The optimization model minimizes the expected number of fires that do not receive a standard response���defined as the number of resources by type that must arrive at the fire within a specified time limit���subject to budget and station capacity constraints and uncertainty about the daily number and location of fires. The simulation model produces a set of fire scenarios in which a combination of fire count, fire locations, fire ignition times, and fire behavior occur. Compared with the current deployment, the deployment obtained with optimization shifts resources from the planning unit with the highest fire load to the planning unit with the highest standard response requirements. Resource deployments that result from relaxing constraints on station capacity achieve greater containment success by encouraging consolidation of resources into stations with high dispatch frequency, thus increasing the probability of resource availability on high fire count days. I extended the standard response framework to examine how a policy priority influences the optimal spatial allocation and performance of initial attack resources. I found that the policy goal of a fire manager changes the optimal spatial allocation of initial attack firefighting resources on a heterogeneous landscape, especially, for the socio-economic value of a potential fire location. Furthermore, I investigated the tradeoff between the number of firefighting resources and the level of fire ignition prevention efforts mitigating the probability of human-made fires in the Republic of Korea where most fires are caused by human activities. I found that fire ignition prevention is as cost-effective as initial attack resources given the current budget in the Republic of Korea on reducing the expected number of fires not receiving the standard response. From the comparison of the California and Republic of Korea cases, I can identify "rules of thumb" to be followed when allocating IA resources in particular ecological and policy settings. / Graduation date: 2013

The overall aim of this research was to explore why some hospitals are more successful than others at reducing the acquisition rates of multidrug-resistant organisms. Using a socio-ecological perspective on health systems adapted from works in ecological restoration, ecosystems management, and healthcare, a participatory comparative case study design was employed. The study was collaboratively conducted on a surgical unit at a Netherlands hospital with very low rates of multidrug-resistant organisms and a surgical unit in a Canadian hospital with higher rates of these pathogens. The cases were selected on the basis that they were both academic health sciences centres of similar size in publicly funded systems; yet, they reported differing rates of MDRO infections. Research methods included a total of six unit observations, nine practitioner-led photo walkabouts of the units (n=13), six photo elicitation focus groups with practitioners (n=26), and the review of relevant policies and procedures and related infection prevention and control data. Common findings across both cases include the perceived importance of engaged leadership, the presence of environmental design issues, a lack of antibiotic prescribing restrictions, and the frequent use of workarounds that may be problematic for infection prevention and control. Disparate findings between cases include differences in ratios of hospital beds per capita, bed occupancy rates, staffing practices, equipment cleaning processes, bed cleaning systems (centralized versus manual) and the presence, in one hospital, of an active grass roots Hygiene in Practice group engaging practitioners in several ongoing activities to promote infection prevention and control. There is a lack of comparable findings between the two cases on hand hygiene audit protocols, surveillance strategies, reporting of acquisition rates, and the nature and extent of high risk populations for community-acquired methicillin-resistant Staphylococcus aureus in the two hospitals catchment areas. The findings and methodological challenges identified in this study suggest that case selection in future comparative infection prevention and control case studies should be based on an expanded list of criteria. These criteria should include comparable audits, surveillance, and reporting practices and comparable demographic and other relevant data, such as data on the agricultural practices within and demographic attributes of vulnerable populations within the hospital catchment areas.

Introduction: HIV is a serious problem in Namibia, 13.1% of the adult population is HIV-positive or is a carrier of AIDS. This is one of the highest numbers in the world. HIV is passed from mother to child during pregnancy, during labour or through breast milk. 18.8 % of the pregnant mothers in Namibia who is in contact with the maternity welfare have HIV. Aim: The aim of the study was to describe nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding. Method: Eight nurses working with PMTCT of HIV were interviewed in Namibia. The interviews were transcribed and a content analysis was made. 18 sub-categories and seven categories were found. Findings: It is important that nurses provide individual counseling, are supportive and motivate the mothers. Poverty is an obstacle for the mothers, stigmatization occurs and cultural differences can have influence on the mothers. It is also important that nurses are updated in counseling and PMTCT. Conclusion: Nurses should provide mothers with the correct information in a pedagogical way. Nurses need to be aware of obstacles for the mothers and their families to be able to meet their different demands. Men are not involved in PMTCT-counseling and nurses think that partner involvement would benefit PMTCT of HIV.

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

No description available.

Light and noise in the neonatal intensive care unit (NICU) may be stressful to infants who are born preterm. The goals of this research were twofold: a) to evaluate the physiological stability (heart rate, heart rate variability, and oxygen saturation) of 28 to 32 gestational age preterm infants while wearing eye goggles and earmuffs for a 4-hour period, and b) to evaluate their pain response (heart rate and heart rate variability) during a painful procedure (heel lance) following the 4-hour period that they had worn the eye goggles and earmuffs. Preterm infants were recruited from four university-affiliated teaching hospitals in the Montreal region that have a level III NICU. A cross-over trial allowed the evaluation of physiological stability in a sample of 54 infants, and a randomized controlled trial with 44 infants was used to evaluate pain response. For the crossover trial, preterm infants were randomized in one of the following sequences: intervention - control or control - intervention. In the RCT, the first randomized study period (A or 8) of the cross-over trial determined whether preterm infants were or were not wearing eye goggles and earmuffs prior to a heel lance procedure. Data were collected using the Somte™ device allowing the continuous recording of outcome measures and infants were videotaped during the study periods for evaluation of potentially confounding variables. Results of the RM~ ANOVA revealed that infants were more physiologically unstable while wearing the eye goggles and earmuffs. This was shown by signs of stress, such as a significantly higher maximum heart rate and a significantly lower high frequency power (heart rate variability), during the intervention period compared with the control period. [...] / La lumière et le bruit dans l’unité néonatale peuvent être particulièrement stressants pour les prématurés. Les buts de cette étude étaient d’évaluer chez des prématurés de 28 à 32 semaines d’âge gestationnel: a) leur stabilité physiologique (rythme cardiaque, variabilité du rythme cardiaque et saturation d’oxygène) lorsqu’ils portent des lunettes et des couvre-oreilles pendant une période de 4 heures, et b) leur réponse à la douleur lors d’une prise de sang au talon (rythme cardiaque et variabilité du rythme cardiaque) après la période de 4 heures où ils ont porté les lunettes et les couvre-oreilles. Les prématurés ont été recrutés dans quatre centres hospitaliers de la région de Montréal qui possèdent une unité néonatale de soins intensifs. La stabilité physiologique a été évaluée à l’aide d’un plan croisé avec un échantillon de 54 prématurés alors que la réponse à la douleur a été évaluée à l’aide d’un essai clinique randomisé avec un nombre de 44. Pour le plan croisé, les prématurés ont été randomisés dans l’une des séquences suivantes : intervention - contrôle ou contrôle - intervention et pour l’essai clinique randomisé, la première période de la randomisation réalisée pour le plan croisé (A ou B) a déterminé si les prématurés portaient ou non les lunettes et les couvre-oreilles avant la prise de sang au talon. Les données ont été collectées à l’aide d’un appareiilage (Somté™) qui permettait un monitorage continu des variables dépendantes et des enregistrements vidéo des prématurés ont été réalisés pour l’évaluation de variables potentiellement confondantes.

No description available.

<p>Dental plaque is the most important etiological factor of periodontal diseases. Mechanical plaque control is the most effective way in preventing periodontal diseases. Chemical plaque control methods (such as mouthrinses) have been recommended to be used because of some drawbacks in the mechanical methods in some areas of the dentition (such as interproximal areas). But are these mouthrinses really effective in those areas? The aim of this study was to compare the effectiveness of Essential Oils mouthrinse (Listerine) on plaque formation in interproximal areas with Chlorhexidine and Sterile water.</p>

Massive short distance spotting has been suspected of increasing the forward rate of spread of bushfires since McArthur (1967) attributed a three-fold increase in rate of spread to short distance spotting at a fire in Daylesford. However, research into spotting has generally focussed on the prediction of long distance spotting, perhaps because of its more obvious effects on suppression of bushfires. The amount of spotting that a fire generates and the distance that spotfires start from the main fire is dependent on the amount and type of bark fuel present, as this is the primary source of embers. / Existing models of fire behaviour have proposed only one model that allows spotting to influence the forward rate of spread of the main fire - the formation of pseudo fire fronts. This thesis proposes two new inl1uence mechanisms; pre-frontal burnout and the "indraught effect". Three hypotheses have been formed to test these three influence mechanisms. / As it is difficult, costly and dangerous to use high intensity fires for experimental purposes, a fire simulation model (SAROS) was developed to run on a personal computer. The SAROS model is based on the McArthur fire behaviour model (1967), with the addition of mechanisms that allow spotting to affect the forward rate of spread of the main fire. SAROS has been tested against data from fires where spotting was thought to have significantly increased the forward rate of spread, and is shown to be a reasonable model of fire behaviour. / Further experiments were carried out to test the sensitivity of the model to the input variables and the impact of each of the variables in the model on changes in forward rate of spread due to spotting. The SAROS model shows that it is possible for massive short distance spotting to increase the forward rate of spread by over 300% of the McArthur predicted rate of spread. However under the conditions where McArthur reported spotting increasing the rate of spread by a factor of three, the SAROS model accounts fbI' only around two thirds of that increase.