Orientador: Priscila Gava Mazzola / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T22:31:21Z (GMT). No. of bitstreams: 1 Rodrigues_AlineTeotonio_M.pdf: 1894224 bytes, checksum: 1ec6d1c2a9f9406db0a14f9f6c410ed6 (MD5) Previous issue date: 2013 / Resumo: A incidência de interações medicamentosas em prescrições de unidades de terapia intensiva (UTI) é conhecidamente superior ao número de interações observado em outros setores hospitalares. O nível de complexidade tecnológica desta unidade, o elevado número de medicamentos a que os pacientes estão expostos e as dificuldades inerentes aos cuidados críticos são fatores que evidenciam a necessidade de elaborada avaliação da farmacoterapia utilizada em medicina intensiva. A atuação do farmacêutico clínico, composta entre outros fatores, pelo rastreamento e detecção de interações medicamentosas potenciais teóricas (IMPT), pode ser vista como uma colaboração importante para a qualidade do serviço e mais uma contribuição para a segurança no uso dos medicamentos em UTI. Este estudo baseia-se na avaliação de uma amostragem de prescrições médicas de UTI e tem por objetivo avaliar a incidência de IMPT em prescrições feitas na Unidade de Terapia Intensiva (UTI) de um hospital da rede pública de saúde (Hospital de Clínicas - UNICAMP), quantificá-las e classificá-las quanto ao seu grau de severidade, traçando com isso um perfil das IMPT presentes nas prescrições deste setor. No período de janeiro a dezembro de 2011 foram avaliadas prescrições de 369 pacientes, todos maiores de 18 anos, média de idade de 57,03 ± 14,62, internados por mais de 24 horas na UTI adulto. Foram prescritos no período avaliado 205 diferentes tipos de medicamentos, média de 13,04 ± 4,26 por prescrição. Entre as prescrições avaliadas 89% apresentaram interações medicamentosas potenciais teóricas, obtendo-se uma média por prescrição de 5,00 ± 5,06. Os 405 tipos de IMPT observadas nas prescrições foram classificadas, utilizando a base de dados Micromedex®, destacando-se a prevalência das IMPT moderadas e graves, presentes em 74% e 67% das prescrições, respectivamente. Além dos dados relativos ao perfil farmacoterapêutico da UTI em estudo, foi observada ainda na pesquisa correlação estatisticamente significativa entre as IMPT e tempo de internação em UTI dos pacientes e o número de medicamentos prescritos. Os resultados encontrados contribuem para o delineamento do perfil de risco relativo às IMPT em terapia intensiva, demonstrando que há uma elevada incidência de interações medicamentosas potenciais moderadas em prescrições de UTI. Ressalta-se com ele a necessidade de atuação do farmacêutico clínico nesta área, a fim de contribuir com a equipe multidisciplinar na redução de riscos provenientes da terapia medicamentosa / Abstract: The incidence of drug interactions in prescriptions of intensive care units (ICU) is known to exceed the number of interactions than the observed in other hospital settings. The level of technological complexity of this unit, the elevated number of drugs to which patients are exposed and the difficulties inherent in critical care are factors that highlight the need for elaborated evaluation of pharmacotherapy used in intensive care medicine. The role of the clinical pharmacist, composed among other factors, by tracking and detection of theoretical potential drug interactions (TPDI), can be seen as an important contribution to the quality of service and as another security barrier to the use of medication in the ICU. This study is based on the evaluation of a sample of medical prescriptions of ICU and aims to assess the existence of theoretical potential drug interactions in prescriptions made in the Intensive Care Unit (ICU) of a public health hospital (Clinic Hospital - UNICAMP), to quantify and classify them as to their degree of severity, tracing with it a profile of present TPDI in this setting. From January to December 2011, prescriptions of 369 patients were evaluated, all over 18 years old, mean age of 57.03 ± 14.62, hospitalized for more than 24 hours in adult ICU. Two hundred five different types of drugs were prescribed in the study period, average of 13.04 ± 4.26 per prescription. Among the evaluated prescriptions, 89% presented theoretical potential drug interactions, resulting in an average of 5.00 ± 5.06 per prescription. The 405 types of observed TPDI in the prescriptions were classified using database Micromedex ®, highlighting the prevalence of moderate and severe TPDI present in 74% and 67% of prescriptions, respectively. In addition to the data on pharmacotherapeutic profile of ICU under study, it was observed in the survey statistically significant correlation between TPDI and duration of hospital stay in the ICU and the number of prescription drugs. The results contribute to design the relative risk profile of TPDI in intensive care, showing that there is a high incidence of moderate potential drug interactions in prescriptions of ICU. The results emphasized the need for performance of the clinical pharmacist in this area, in order to contribute to the multidisciplinary team to reduce risks from drug therapy / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Orientador: Priscila Maria Stolses Bergamo Francisco / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T03:11:40Z (GMT). No. of bitstreams: 1 Oliveira_MarceloAntunes_M.pdf: 1564901 bytes, checksum: f7e3ecf4821c06b1c5f43ec0e9968920 (MD5) Previous issue date: 2012 / Resumo: O padrão de utilização de medicamentos, bem como a automedicação, têm sido amplamente investigados em estudos epidemiológicos nacionais e internacionais. Considerando-se o acelerado envelhecimento populacional e a demanda por informações locais para o planejamento e a gestão em saúde, o objetivo do presente estudo foi contribuir para a investigação de fatores associados à automedicação em idosos, identificando os principais fármacos consumidos por esta população sem a prescrição de um profissional habilitado. Trata-se de um estudo transversal de base populacional realizado a partir de registros de indivíduos com 60 anos ou mais, disponíveis na amostra do Inquérito de Saúde no município de Campinas (ISACamp) realizado em 2008-2009. Dos 1.515 idosos que responderam questões sobre medicamentos, 80,4% referiram uso de ao menos um medicamento nos três dias anteriores à pesquisa. Desses, 91,1% relataram consumo exclusivo de medicamentos prescritos e o restante (8,9%), uso simultâneo de prescritos e não prescritos. Após ajuste, idade > 80 anos, hipertensão arterial, presença de doenças crônicas, procura por serviços de saúde, realização de consultas odontológicas e filiação a plano médico de saúde estiveram associadas negativamente, e renda familiar per capita, positivamente à automedicação. Os fármacos sem prescrição mais consumidos foram dipirona, ácido acetilsalicílico (AAS), diclofenaco, Ginkgo biloba, paracetamol e medicamentos homeopáticos. Principalmente entre idosos, a assistência farmacêutica deve ser priorizada para evitar o uso incorreto de medicamentos e garantir o acesso aos fármacos necessários para a prevenção de agravos, tratamento e cura das doenças / Abstract: The pattern of drug use and self-medication, have been widely investigated in national and international epidemiological studies. Considering the rapid population aging and the demand for local information for planning and management in health, the objective of this study was to contribute to the investigation of factors associated with self-medication in older adults, identifying the main drugs consumed by this population without a prescription a qualified professional. A cross-sectional population-based study with clustered two-stage sampling was conducted from records of individuals aged 60 years or more, available in the sample of Health Survey in Campinas (ISACamp - 2008/2009). Of the 1,515 elderly studied, 80.4% reported using at least one drug duringthe three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age > 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs for prevention, treatment and cure of diseases / Mestrado / Mestre em Saude Coletiva

Materials management is an integrative approach to control the flow of production materials. It has been successfully practiced by numerous manufacturing firms to decrease materials cost and improve the employment of scarce resources. The need for better utilization of resources is also prevalent in service sector industries. This dissertation focused on the public utilities industry and its practices in the materials management area. Major emphasis of this research was to (1) define the state-of-the-art of materials management within the gas and electric utilities in Texas, (2) determine its impact on the corporate structure, and (3) identify opportunities for materials management in the future of the Texas utilities industry.

This research sought to identify the determinants of nonuse and high use of physician services and assess whether or not patterns of nonuse and high use changed over time. The population of interest was a group of elderly unmarried women who participated in the Longitudinal Retirement History Survey from 1969 to 1979. Andersen and Newman's (2) health care services utilization model served as the conceptual framework for this research. Of specific interest was the relationship between age strata and health care behavior. Age proved to be a stratifying variable within the health care delivery system. Over the ten year survey period, the health care behavior of preretirement and postretirement nonusers and high users differed significantly. A decline in nonuse was also associated with the transition years. This finding could be attributed to the "near poor" becoming eligible for Medicare. In any event, these data show that utilization of physician services is likely to increase among some unmarried women in their middle 60's.

The blue shark (Prionace glauca) is among the most abundant and widely distributed of all oceanic elasmobranchs. Millions of blue sharks are caught annually worldwide in pelagic long line fisheries, and it accounts for the largest component of auctioned fin weight in the international shark fin trade. There is growing concern about the depletion of its populations worldwide and impacts of such large scale removal of an apex predator on oceanic ecosystem stability. The fragmentary nature of life history information available for blue sharks, including on its detailed movement and migratory behavior, continues to limit management efforts that require such data for stock assessment and sustainable catch modeling. To assist in obtaining a better understanding of blue shark movement behavior in the western north Atlantic, I used satellite telemetry to investigate the detailed habitat utilization and movements of sharks during the summer months when the sharks form aggregations on the continental shelf off the Northeast United States, and during their fall , pelagic migrations. Thirty-one (26 male, 5 female) blue sharks were tagged with pop-up archival satellite transmitters. The transmitters reported data from a total of 1,656 combined days, yielding 74,163 depth recordings and 74,125 temperature recordings. Tracked sharks exhibited two distinct movement patterns: During the summer months, the sharks remained within a restricted geographical area south of Nantucket Island and spent nearly 80% of their time in the uppermost part of the water column in <20 m depth (mean depth of 8 m). During fall months (October and November) the sharks made fairly directed offshore and southerly movements, with several sharks associating with waters east of Bermuda. During their pelagic migrations, the sharks demonstrated markedly different water column utilization behavior. They occupied much greater depths (127 m mean depth) and exhibited a clear diel depth pattern, occupying deeper water during the day and shallower water at night, not observed on the shelf. The longest duration track was that of an immature female for nine months. The greatest distance traveled was by a mature male that moved from Martha's Vineyard, MA to waters near Puerto Rico (a linear distance > 4,000 km). There was some indication that the different demographic groups (mature males, immature males, and immature females) may display different movement behavior, especially during their pelagic migrations. This study provides the first detailed information on habitat utilization and movement patterns of blue sharks in the Western North Atlantic, and points to the need for further investigation of movement behavior by different demographic segments of the population.

Great barracuda Sphyraena barracuda is a large predatory teleost found circumglobally, other than the Eastern Pacific Ocean. The species is commonly caught by both recreational and commercial fishermen as bycatch while targeting other, more economically or recreationally valuable fishes. This species also exhibits an ontogenetic shift in habitat, with juveniles inhabiting mangrove and seagrass habitats, while adults live near offshore reefs and associated structure. This thesis consists of two separate studies of S. barracuda: 1) feeding ecology along an ontogenetic gradient and 2) habitat utilization of as derived through electronic tagging. The first chapter of this thesis describes the feeding ecology of great barracuda in South Florida, with an emphasis on the determination of when the ontogenetic shift in diet occurs between habitats and individual fish sizes. Specimens were collected primarily by seine net and hook-and-line fishing. The specimens were then dissected with the stomach contents examined. This study found that the ontogenetic diet shift in great barracuda begins around the second year, and that juveniles and adults are opportunistic predators with a wide diversity of teleost and crustacean prey items within the selected habitat. The second chapter of this thesis describes the habitat utilization and vertical movements of two great barracuda off of South Florida interpreted from data acquired from pop-up satellite archival tags (PSATs). This study found that large (>100 cm) great barracuda are capable of travelling hundreds of kilometers over a period of days to weeks. The results show that large great barracuda can tolerate temperatures ranging from 17.8° C to 31.3° C, and are capable of diving to depths greater than 175 m. It was also found that there was a significant difference in time spent at depth, with greater depths being inhabited more frequently at night.

In a passive radio-frequency identification (RFID) system the reader communicates with the tags using the EPC Global UHF Class 1 Generation 2 (EPC Gen-2) protocol with dynamic framed slotted ALOHA. Due to the unique challenges presented by a low-power, random link, the channel efficiency of even the most modern passive RFID system is less than 40%. Hence, a variety of methods have been proposed to estimate the number of tags in the environment and set the optimal frame size. Some of the algorithms in the literature even claim system efficiency beyond 90%. However, these algorithms require fundamental changes to the underlying protocol framework which makes them ineligible to be used with the current hardware running on the EPC Gen-2 platform and this infrastructure change of the existing industry will cost billions of dollars. Though numerous types of tag estimation algorithms have been proposed in the literature, none had their performance analyzed thoroughly when incorporated with the industry standard EPC Gen-2. In this study, we focus on some of the algorithms which can be utilized on today’s current hardware with minimal modifications. EPC Gen-2 already provides a dynamic platform in adjusting frame sizes based on subsequent knowledge of collision slots in a given frame. We choose some of the popular probabilistic tag estimation algorithms in the literature such as Dynamic Frame Slotted ALOHA (DFSA) – I, and DFSA – II, and rule based algorithms such as two conditional tag estimation (2CTE) method and incorporate them with EPC Gen-2 using different strategies to see if they can significantly improve channel efficiency and dynamicity. The results from each algorithm are also evaluated and compared with the performance of pure EPC Gen-2. It is important to note that while integrating these algorithms with EPC Gen-2 to modify the frame size, the protocol is not altered in any substantial way. We also kept the maximum system efficiency for any MAC layer protocol using DFSA as the upper bound to have an impartial comparison between the algorithms. Finally, we present a novel and comprehensive analysis of the probabilistic tag estimation algorithms (DFSA-I & DFSA-II) in terms of their statistically significant correlations between channel efficiency, algorithm estimation accuracy and algorithm utilization rate as the existing literature only look at channel efficiency with no auxiliary analysis. In this study, we use a scalable and flexible simulation framework and created a light-weight, verifiable Gen-2 simulation tool to measure these performance parameters as it is very difficult, if not impossible, to calculate system performance analytically. This framework can easily be used to test and compare more algorithms in the literature with Gen-2 and other DFSA based approaches.

Abstract Over the past half a decade, new forms of knowledge sharing, collaboration and online participation have emerged. As a result, a new generation of IT tools are being used for the creation and exchange knowledge. This dissertation uses a knowledge management framework known as the 7C model and applies a multi-method approach to deepen the understanding on how new knowledge emerges with these tools. As the benefits of knowledge are realized when it is applied, this dissertation places special emphasis also on the usability of the knowledge. The results indicate that the knowledge creation sub-processes of comprehension and conceptualization need more scientific attention. In addition, the results suggest that comprehension can be supported by helping users to reflect and by utilizing guideline information. Supporting deeper interaction and improved linking with the existing content, allowing users to stay in a state of flow, and using decision aids can help in comprehension. Conceptualization can be supported through knowledge rationale, metaphors and analogues, decision aids, and by helping users to reach common ground and shared understanding. In order for the knowledge to be really usable, the knowledge creation should aim at producing knowledge in explicit and actionable form. Producing knowledge in the form of guidelines was found to be beneficial for the utilization of knowledge. Guidelines support learning-by-doing and reflection-in-action, which are crucial for the emergence of new tacit knowledge. Evidence-based information and decision aid tools can help in choosing the knowledge that is to be applied. Finally, the results suggest that in the era of Web 2.0, many low-cost experiences inducing constant exposure to knowledge might work better than a few high-cost experiences requiring very deep thinking. The reason for this is that contemporary users seem to be so accustomed to the ease-of-use of Web services that they simply will not use more useful but less usable solutions.

Abstract The aim of this thesis is to devise novel co-primary spectrum sharing (CoPSS) methods for future fifth generation (5G) networks and beyond. The target is to improve data rates of small cell networks (SCNs) in which mobile network operators (MNOs) share their dedicated frequency spectrum (spectrum pooling) or a common spectrum (mutual renting). The performance of the proposed methods is assessed through extensive system-level simulations. MNOs typically acquire exclusive usage rights for certain frequency bands and have little incentive to share spectrums with other operators. However, due to higher cost and spectrum scarcity at lower frequencies it is expected that efficient use of the spectrum in 5G networks will rely more on spectrum sharing than exclusive licenses. This is especially true for new higher candidate frequencies (> 6 GHz) that do not have a pre-existing spectrum regulation framework. In the first part of the thesis, we tackle the challenge of providing higher data rates within limited spectral resources. Each SCN MNO has its own dedicated spectrum, and each MNO defines a percentage of how much its spectrum it is willing to share. The idea of the proposed CoPSS algorithms is that the spectrum is dynamically shared among MNOs based on their spectrum utilization, which is shared among MNOs in the network. This way interference can be avoided and spectrum utilization is maximized. Unused resources are shared equally between overloaded MNOs for a given time instant. Thus, only short-term fairness among overloaded SCNs can be guaranteed. In the second part, we consider a multi-operator small cell network where MNOs share a common pool of radio resources. The goal is to ensure the long term fairness of spectrum sharing without coordination among small cell base stations. We develop a decentralized control mechanism for base stations using the Gibbs sampling based learning tool, which allocates suitable amount of the spectrum for each base station while avoiding interference from SCNs and maximizing the total network throughput. In the studied scenarios, we show the importance of coordination among MNOs when the dedicated spectrum is shared. However, when MNOs share a common spectrum, a decentralized control mechanism can be used to allocate suitable amounts of spectrum for each base station. The proposed algorithms are shown to be effective for different network layouts, by achieving significant data rate enhancements with a low overhead. / Tiivistelmä Tämä väitöskirja keskittyy kehittämään uusia menetelmiä, joilla jaetaan taajuuksia useiden operaattoreiden kesken tulevista viidennen sukupolven verkoista alkaen. Päätavoite on parantaa tiedonsiirtonopeuksia sellaisissa piensoluverkoissa, joissa matkapuhelinoperaattorit jakavat joko heidän omia taajuusalueitaan tai heillä yhteisomistuksessa olevia taajuuksia. Kehitettyjen menetelmien suorituskykyä arvioidaan mittavien järjestelmätason simulointien avulla. Matkapuhelinoperaattorit tyypillisesti omistavat yksin tietyt taajuusalueet, eivätkä ole valmiita jakamaan niitä. On kuitenkin oletettu, että tulevaisuudessa matkapuhelinoperaattorit joutuvat jakamaan taajuuksia, koska taajuusalueet ovat kalliita ja niukkoja erityisesti matalilla taajuusalueilla. Korkeammat taajuusalueet (> 6 GHz) puolestaan muodostavat otollisen alustan tehokkaalle spektrin jaetulle käytölle, koska niillä ei ole vielä olemassa olevaa taajuussääntelyä. Väitöskirjan ensimmäisessä osassa keskitytään kasvattamaan tiedonsiirtonopeuksia kun jokainen matkapuhelinoperaattori omistaa oman taajuuskaistansa ja matkapuhelinoperaattorit määrittävät kuinka suuren prosentuaalisen osuuden ovat valmiita jakamaan. Esitettyjen algoritmien päätavoite on jakaa taajuuksia dynaamisesti matkapuhelinoperaattoreiden kesken. Algoritmeissa hyödynnetään tietoa matkapuhelinoperaattoreiden taajuuden käyttöasteesta, jonka matkapuhelinoperaattoritkommunikoivat toisilleen. Näin häiriö voidaan välttää ja taajuuden käyttö maksimoidaan. Käyttämättömät taajuudet jaetaan tasaisesti matkapuhelinoperaattorien kesken tietyllä ajanhetkellä. Näin voidaan taata lyhytaikainen oikeudenmukainen taajuuksien käyttö, mutta ei pitkäaikaista oikeudenmukaista taajuuksien käyttöä. Väitöskirjan toisessa osassa matkapuhelinoperaattorit jakavat yhteisomistuksessa olevia taajuuksia. Tavoitteena on saavuttaa pitkäaikainen taajuuksien oikeudenmukainen käyttö, kun piensoluverkot eivät kommunikoi keskenään. Työssä kehitetään piensoluverkoille hajautettu algoritmi, joka perustuu oppimistyökaluun Gibbs-näytteistys. Näin saadaan allokoitua jokaiselle tukiasemalle tarvittava määrä taajuusresursseja niin, että häiriö tukiasemien välillä minimoidaan ja koko piensoluverkon suorituskyky maksimoidaan. Tutkituissa skenaarioissa osoitetaan matkapuhelinoperaattoreiden välisen koordinaation tärkeys, kun jaetaan omia taajuusalueita. Toisaalta kun operaattorit jakavat yhteisomistuksessa olevia taajuuksia on mahdollista käyttää algoritmeja, joissa ei ole koordinaatiota matkapuhelinoperaattoreiden kesken. Väitöskirjassa vahvistetaan kehitettyjen algoritmien olevan tehokkaita ja sopivan monenlaisiin verkkoympäristöihin saavuttaen merkittäviä parannuksia tiedonsiirtonopeuteen ilman suuria kustannuksia.

Background Drug use has increased over recent decades, and is especially great among women and among people with mental health problems. To take advantage of the full potential of drugs and to avoid drug-related problems, drug prescription needs to be correct and the drugs need to be taken according to the prescribed regimens. Research on drug utilization is thus important to the public health. Aim To study the influence of gender and depression on drug utilization, prescription of drugs and self-reported use of drugs, i.e. adherence. Methods The thesis included two population-based questionnaires and data from the Swedish Prescribed Drug Register (SPDR) covering Swedish citizens 18-84 years. The questionnaire in Study I and II included items on prescription drug use and adherence to treatment regimens; Study II also included the Hospital Anxiety and Depression Scale (HADS) for self-estimation of anxiety/depression. The questionnaire in Study III included the HADS and data from the SPDR on prescribed antidepressants. Study IV included data from the SPDR on all types of prescribed drugs. Results Men and women differed in non-adherent behaviours and reasons for non-adherence, for example, men were more likely to report forgetting to take the drug, while women were more likely to report adverse drug reactions (ADRs) as a reason for non-adherence. Further, both anxiety and depression were associated with non-adherence and with ADRs as a reason for non-adherence. In addition, men reported depression to a greater extent than women did but used antidepressants to a lesser extent, while women used antidepressants without reporting depression more often than men did, which may be a sign of under-treatment among men and over-treatment among women. Moreover, the associations between antidepressants and other types of drugs differed by gender; they were often specific, or stronger, in women than in men, which may be a sign of a gender difference in comorbidity between depression and other conditions. Conclusions Although the cross-sectional study design prevented confirmation of causality, the thesis found that gender and depression influence both prescription of drugs and adherence, and are thus important to pay attention to in clinical practice as well as research.