Os serviços de emergências hospitalares (EH) desempenham um papel fundamental no sistema de saúde, servindo de porta de entrada para hospitais e fornecendo cuidados para pacientes com lesões e doenças graves. No entanto, as EH em todo o mundo sofrem com o aumento da demanda e superlotação. Múltiplos fatores convergem simultaneamente para resultar nessa superlotação, porém a otimização do gerenciamento do fluxo dos pacientes pode auxiliar na redução do problema. Nesse contexto, o tempo de permanência dos pacientes na EH (TPEH) é consolidado na literatura como indicador de qualidade do fluxo de pacientes. O tema desta dissertação é a previsão e gestão da demanda em EH com alto grau de congestionamento, que é abordado através de três artigos científicos. O objeto de estudo é o Hospital de Clínicas de Porto Alegre (HCPA). No primeiro artigo, são aplicados quatro modelos de previsão da procura por atendimento na EH, avaliando-se a influência de fatores climáticos e de calendário. O segundo artigo utiliza a técnica de regressão por mínimos quadrados parciais (PLS – partial least squares) para previsão de quatro indicadores relacionados ao TPEH para hospitais com alto grau de congestionamento. O tempo médio de permanência (TM) na EH resultou em um modelo preditivo com melhor ajuste, com erro médio absoluto percentual (MAPE - mean absolute percent error) de 5,68%. O terceiro artigo apresenta um estudo de simulação para identificação dos fatores internos do hospital que influenciam o TPEH. O número de exames de tomografias e a taxa de ocupação nas enfermarias clínicas e cirúrgicas (ECC) foram as que mais influenciaram. / Emergency departments (ED) play a key role in the health system, serving as gateway to hospitals and providing care for patients with injuries and serious illnesses. However, EDs worldwide suffer from increased demand and overcrowding. Multiple factors simultaneously converge to result in such overcrowding, and the optimization of patient flow management can help reduce the problem. In this context, the length of stay of patients in ED (LSED) is consolidated in the literature as a patient flow quality indicator. This thesis deals with forecast and demand management in EDs with a high degree of congestion. The subject is covered in three scientific papers, all analyzing data from the Hospital de Clínicas de Porto Alegre’s ED. In the first paper we apply four demand forecasting models to predict demand for service in the ED, evaluating the influence of climatic and calendar factors. The second article uses partial least squares (PLS) regression to predict four indicators related to LSED. The mean length of stay in the ED resulted in a model with the best fit, with mean percent absolute error (MAPE) of 5.68%. The third article presents a simulation study to identify the internal hospital factors influencing LSED. The number of CT exams and the occupancy rate in the clinical and surgical wards were the most influential factors.

Introdução: A terapia nutricional (TN) em pacientes cirúrgicos é fundamental para o manejo da desnutrição hospitalar, podendo reduzir as complicações pós-operatórias e a ocorrência de desfechos negativos durante a hospitalização. Não há evidências sobre o impacto da TN implementada na prática clínica, como período de jejum pós-operatório (PO) e ingestão de calorias e proteínas, sobre a incidência de infecção e tempo de internação. Objetivo: Verificar o efeito do jejum PO prolongado e da adequada TN sobre infecção e tempo de internação hospitalar. Métodos: Trata-se de um estudo de coorte prospectivo realizado em hospital terciário e universitário. Incluiu-se pacientes adultos submetidos à cirurgia eletiva. Excluíram-se aqueles sem condições de submeter-se à avaliação do estado nutricional, admitidos em unidades de cuidados mínimos e de terapia intensiva, com previsão menor ou igual a 72h de internação e para realização de exames. Os dados demográficos e clínicos, as variáveis de exposição e os desfechos de interesse foram coletados por meio dos registros informatizados da assistência. A avaliação do estado nutricional foi realizada na admissão e a cada sete dias até a alta hospitalar ou o óbito. Considerou-se jejum PO prolongado período maior ou igual a 5 dias e internação prolongada quando 1 dia a mais que a média de cada especialidade. O controle de ingestão foi realizado, pelos pesquisadores, seis vezes por semana em formulários específicos do estudo. Considerou-se TN adequada quando ingestão maior ou igual a 75% do prescrito. Realizou-se análise multivariada e um modelo de regressão logística para verificar as associações e ajustar para os fatores de confusão. Resultados: Os resultados demonstraram que 5,6% dos pacientes analisados ficaram em jejum PO prolongado e 16,2% receberam TN adequada. O jejum PO prolongado foi mais freqüente entre os pacientes da especialidade do aparelho digestivo e proctologia. Após ajuste para variáveis de confusão, verificamos que entre pacientes com jejum PO prolongado o risco para infecção é 2,88 vezes maior (IC95%:1,17–7,16) e o risco para internação prolongada é 4,43 vezes maior (IC95%:1,73–11,35). A TN adequada foi fator de proteção, com redução de 36% (RO=0,36; IC95%: 0,15-0,76) do risco de infecção e de 46% (RO=0,46; IC95%: 0,25-0,84) do risco de internação prolongada. Conclusão: O jejum PO prolongado foi fator de risco independente para infecção e internação hospitalar prolongada. A maioria dos pacientes recebeu inadequada TN e aqueles com adequada TN apresentaram redução do risco de infecção e tempo de internação prolongada. / Background: Nutrition therapy (NT) in surgical patients is important to the management of hospital malnutrition and may reduce postoperative complications and the occurrence of adverse outcomes during hospitalization. There is no evidence on the impact of NT implemented in clinical practice, such as fasting period postoperatively (PO) and intake of calories and proteins, on the incidence of infection and prolonged length of stay. Objective: The aim of this study is to determine the effect of prolonged fasting PO and proper NT on infection and prolonged length of stay. Methods: It is a prospective cohort study conducted in a tertiary, university hospital. Were included adult patients undergoing elective surgery. Those with no conditions for nutritional assessment were excluded, as weel as those admitted in minimal care and intensive care units, with the prediction of a shorter stay (less than 72 hours) or admitted for exams. Demographic and clinical data, the exposure variables, as well as the pertinent endpoints were collected from the electronic records. Nutritional status was assessed upon admission and every seven days until hospital discharge or death. A period equal or longer than 5 days was considered as prolonged PO fasting, and prolonged length of stay when there was 1 extra day as compared to the average of each specialty. Dietary intake control was carried out by researches six times a week. NT was considered adequate if dietary intake was equal to or greater than 75% of the prescribed amount. Data was analyzed using logistic multivariate regression. Results: The results showed that 5.6% of the patients studied, were in prolonged PO fasting and 16.2% had adequate NT. Prolonged PO fasting was more frequent among the patients of the digestive tract and colorectal surgeries. After adjustment for confounding variables, we verified that among patients with prolonged PO fasting the risk for infection is 2.88 times higher (CI 95%:1.17–7.16) and the risk for prolonged stay is 4.43 times higher (CI 95%:1.73–11.35). The adequate NT reduced infection risks by 36% (OR=0.36; 95%CI: 0.15-0.76) and reduced the rates of prolonged hospital length of stay by 46% (OR=0.46; 95%CI: 0.25-0.84). Conclusion: Prolonged PO fasting was an independent risk factor both for infection and prolonged hospital stay. Most patients received inadequate NT, those under adequate NT had reduced infection rates and were less likely to have prolonged hospital length of stay.

nÃo hà / O Brasil, apesar de possuir aspectos histÃricos, demandas especÃficas, caracterÃsticas quanto ao acesso e à permanÃncia nos cursos em instituiÃÃes de educaÃÃo superior privada, recebe influÃncia dos princÃpios, diretrizes e aÃÃes delineados pela OrganizaÃÃo das NaÃÃes Unidas para a EducaÃÃo, a CiÃncia e a Cultura (UNESCO) e pelo Banco Mundial, para desenvolver as polÃticas pÃblicas, referentes à educaÃÃo superior. Dentre as polÃticas pÃblicas desenvolvidas pelo Governo para a educaÃÃo superior, trÃs merecem destaque, por contribuÃrem diretamente para o acesso e permanÃncia dos estudantes no ensino superior; sÃo elas: Fundo de Financiamento ao Estudante do Ensino Superior (FIES), Programa Universidade para Todos (ProUni) e Programa Nacional de AssistÃncia Estudantil (PNAES). Este trabalho tem como objetivo analisar de que forma essas polÃticas, em especial o FIES, permitem o acesso e a permanÃncia de estudantes nos cursos superiores promovidos pela Faculdade Cearense. Para propiciar uma maior reflexÃo a respeito do tema, foi utilizada a Pesquisa de Campo, que consiste na observaÃÃo dos fatos tal como ocorrem espontaneamente, na coleta de dados e no registro de variÃveis presumivelmente para posteriores anÃlises. A pesquisa, quanto aos procedimentos, classifica-se como do tipo descritiva, podendo ainda ser definida, quanto aos procedimentos tÃcnicos utilizados, bibliogrÃfica e documental. Quanto à natureza das variÃveis que serÃo pesquisadas, o estudo se caracteriza por uma abordagem quali-quantitativa. O estudo terà como recorte metodolÃgico, inicialmente, o perÃodo de 2010.1 a 2013.2, tempo em que a Faculdade Cearense dispÃe do financiamento estudantil na cobertura total da mensalidade dos alunos beneficiados. A observaÃÃo de como ocorre o acesso e a permanÃncia dos estudantes matriculados ofereceu subsÃdios que enriqueceram a anÃlise da questÃo, principalmente para se entender como os sujeitos da pesquisa utilizam o FIES para ingressar e permanecer no ensino superior. / The Brasil, despite having historical aspects, specific demands, characteristics regarding access and permanence in courses at private higher education institutions, is influenced by the principles, guidelines and actions outlined by the United Nations Educational, Scientific and cultural Organization (UNESCO) and the World Bank to develop the public, relating to higher education policy. Among the public policies developed by the government for higher education, three deserve special mention, as they contribute directly to the access and retention of students in higher education; they are: Fund Student Financing of Higher Education (FIES), the University for All Program (ProUni) and National Student Assistance Program (PNAES). This study aims to analyze how these policies, in particular the FIES, allow access and permanence of students in higher courses offered by the Faculdade Cearense. To encourage greater reflection on the subject, the Field Survey, which consists in observing the facts as they occur spontaneously in data collection and recording variables presumably was used for further analysis. The research as to the procedures, it is classified as descriptive, and may also be defined as the technical procedures used, bibliographic and documentary. The nature of the variables to be surveyed, the study is characterized by a qualitative and quantitative approach. The study will methodological approach, initially, the period 2010.1 to 2013.2, while in the Faculdade Cearense offers the student finance in total cover the tuition of students benefited. The observation occurs as access and permanence of students enrolled offered subsidies that enriched the analysis of the question, especially to understand how the subjects using the FIES to enter and remain in higher education. .

Introdução: A terapia nutricional (TN) em pacientes cirúrgicos é fundamental para o manejo da desnutrição hospitalar, podendo reduzir as complicações pós-operatórias e a ocorrência de desfechos negativos durante a hospitalização. Não há evidências sobre o impacto da TN implementada na prática clínica, como período de jejum pós-operatório (PO) e ingestão de calorias e proteínas, sobre a incidência de infecção e tempo de internação. Objetivo: Verificar o efeito do jejum PO prolongado e da adequada TN sobre infecção e tempo de internação hospitalar. Métodos: Trata-se de um estudo de coorte prospectivo realizado em hospital terciário e universitário. Incluiu-se pacientes adultos submetidos à cirurgia eletiva. Excluíram-se aqueles sem condições de submeter-se à avaliação do estado nutricional, admitidos em unidades de cuidados mínimos e de terapia intensiva, com previsão menor ou igual a 72h de internação e para realização de exames. Os dados demográficos e clínicos, as variáveis de exposição e os desfechos de interesse foram coletados por meio dos registros informatizados da assistência. A avaliação do estado nutricional foi realizada na admissão e a cada sete dias até a alta hospitalar ou o óbito. Considerou-se jejum PO prolongado período maior ou igual a 5 dias e internação prolongada quando 1 dia a mais que a média de cada especialidade. O controle de ingestão foi realizado, pelos pesquisadores, seis vezes por semana em formulários específicos do estudo. Considerou-se TN adequada quando ingestão maior ou igual a 75% do prescrito. Realizou-se análise multivariada e um modelo de regressão logística para verificar as associações e ajustar para os fatores de confusão. Resultados: Os resultados demonstraram que 5,6% dos pacientes analisados ficaram em jejum PO prolongado e 16,2% receberam TN adequada. O jejum PO prolongado foi mais freqüente entre os pacientes da especialidade do aparelho digestivo e proctologia. Após ajuste para variáveis de confusão, verificamos que entre pacientes com jejum PO prolongado o risco para infecção é 2,88 vezes maior (IC95%:1,17–7,16) e o risco para internação prolongada é 4,43 vezes maior (IC95%:1,73–11,35). A TN adequada foi fator de proteção, com redução de 36% (RO=0,36; IC95%: 0,15-0,76) do risco de infecção e de 46% (RO=0,46; IC95%: 0,25-0,84) do risco de internação prolongada. Conclusão: O jejum PO prolongado foi fator de risco independente para infecção e internação hospitalar prolongada. A maioria dos pacientes recebeu inadequada TN e aqueles com adequada TN apresentaram redução do risco de infecção e tempo de internação prolongada. / Background: Nutrition therapy (NT) in surgical patients is important to the management of hospital malnutrition and may reduce postoperative complications and the occurrence of adverse outcomes during hospitalization. There is no evidence on the impact of NT implemented in clinical practice, such as fasting period postoperatively (PO) and intake of calories and proteins, on the incidence of infection and prolonged length of stay. Objective: The aim of this study is to determine the effect of prolonged fasting PO and proper NT on infection and prolonged length of stay. Methods: It is a prospective cohort study conducted in a tertiary, university hospital. Were included adult patients undergoing elective surgery. Those with no conditions for nutritional assessment were excluded, as weel as those admitted in minimal care and intensive care units, with the prediction of a shorter stay (less than 72 hours) or admitted for exams. Demographic and clinical data, the exposure variables, as well as the pertinent endpoints were collected from the electronic records. Nutritional status was assessed upon admission and every seven days until hospital discharge or death. A period equal or longer than 5 days was considered as prolonged PO fasting, and prolonged length of stay when there was 1 extra day as compared to the average of each specialty. Dietary intake control was carried out by researches six times a week. NT was considered adequate if dietary intake was equal to or greater than 75% of the prescribed amount. Data was analyzed using logistic multivariate regression. Results: The results showed that 5.6% of the patients studied, were in prolonged PO fasting and 16.2% had adequate NT. Prolonged PO fasting was more frequent among the patients of the digestive tract and colorectal surgeries. After adjustment for confounding variables, we verified that among patients with prolonged PO fasting the risk for infection is 2.88 times higher (CI 95%:1.17–7.16) and the risk for prolonged stay is 4.43 times higher (CI 95%:1.73–11.35). The adequate NT reduced infection risks by 36% (OR=0.36; 95%CI: 0.15-0.76) and reduced the rates of prolonged hospital length of stay by 46% (OR=0.46; 95%CI: 0.25-0.84). Conclusion: Prolonged PO fasting was an independent risk factor both for infection and prolonged hospital stay. Most patients received inadequate NT, those under adequate NT had reduced infection rates and were less likely to have prolonged hospital length of stay.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR / OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

This research deals with truancy at the Instituto Federal de Educação, Ciência e Tecnologia do Tocantins - Campus Porto Nacional, considering school dropout as one of the concerns that plague many school units and that can cause various effects on people's lives. One has to analyze the factors involved in truancy at the federal level and its impact on the educational process of the Federal Institute of Tocantins - Campus Porto Nacional, considering the conflicts in the implementation of public policy in Professional Education.And how specific objectives are: to understand how public policies for vocational education are formulated and its relations with the educational processes of the Federal Institute of Tocantins - Porto Nacional Campus; understand the students' conditions of stay regarding the curriculum and teacher training for vocational education; identify the intervening factors that cause school dropout. The methodological approach used was quantitative and qualitative through the case study.For the theoretical foundation appealed to the bibliographic research on vocational education in Brazil, was used as authors Manfredi (2002), Pereira (2003), Romanelli (2005), among others; in public policy area applied to education: we sought to Kuenzer (2006), Oliveira and Duarte (2001), among others, on truancy, we used the studies of authors such as Marchesi (2004), Patto (1993 ), Arroyo (1993), and the current legislation. For desk review, so worked triangulation of sources: Census of Higher Education and Educacenso, prepared by the National Institute of Educational Studies and Research Teixeira - INEP, reports of School Records Coordination CORES - Campus Porto Nacional.Classes were analyzed that had large dropout rate, if the technical classes in Sales and Degree in Computer, in the period from 2010 to 2013. Among the respondents have three dropout students of the institution who were located and studied further two teachers, 2 Coordinators Course, 1 Technician Educational Affairs, 1 Student Assistant and one social worker. We highlight some of the avoidance of causes are: incompatibility combine studies with work; students who did not identify with the course; students with learning disabilities; and has as a consequence the closure of one of the courses of the Federal Institute - Campus Porto Nacional. It is intended with this dissertation contribute to the deepening of discussions in order to combat the dropout at the Instituto Federal de Educação. / Esta pesquisa versa sobre a evasão escolar no Instituto Federal de Educação, Ciência e Tecnologia do Tocantins IFTO - Campus Porto Nacional, como uma das preocupações que afligem não só o Instituto, mas outras unidades escolares e que pode ocasionar várias consequências na vida das pessoas. Tem-se com objetivo analisar os fatores intervenientes da evasão escolar no âmbito federal e suas repercussões no processo educacional do Instituto Federal do Tocantins Campus Porto Nacional, considerando os conflitos existentes na implementação das políticas públicas na Educação Profissional. E, como objetivos específicos, compreender como as políticas públicas para a educação profissional são formuladas e suas relações com os processos educacionais do Instituto Federal do Tocantins Campus Porto Nacional; compreender as condições de permanência dos alunos em relação ao currículo e a formação de professores para a educação profissional e identificar os fatores intervenientes que provocam a evasão escolar. A abordagem metodológica utilizada foi quanti-qualitativa através do estudo de caso. Para o embasamento teórico recorreu-se às pesquisas documentais sobre a Educação Profissional no Brasil, utilizou-se autores como Manfredi (2002), Pereira (2003), Romanelli (2005), entre outros; na área de políticas públicas aplicadas à educação, buscou-se Kuenzer (2006), Oliveira e Duarte (2001), entre outros e, sobre a evasão escolar, recorreu-se a estudos feitos com autores como Marchesi (2004), Patto (1993), Arroyo (1993), além da legislação vigente. Trabalhalhou-se a triangulação das fontes: dados do Censo da Educação Superior e do Educacenso, elaborados pelo Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira - INEP, relatórios da Coordenação de Registros Escolares - CORES do Campus Porto Nacional. Foram analisadas as turmas que tiveram grande índice de evasão, no caso as turmas de Técnico em Vendas e Licenciatura em Computação, no período de 2010 a 2013. Entre os entrevistados temos três alunos evadidos da Instituição que foram localizados e estudados, além disso, 2 professores, 2 Coordenadores de Curso, 1 Técnico em Assuntos Educacionais, 1 Assistente de Aluno e 1 Assistente Social. Destaca-se que algumas das causas da evasão são: incompatibilidade de conciliar os estudos com o trabalho; alunos que não se identificaram com curso; alunos com dificuldade de aprendizagem; e tem como uma das consequências o fechamento de um dos Cursos do Instituto Federal Campus Porto Nacional. Pretendeu-se com esta dissertação contribuir para o aprofundamento de discussões, a fim de combater à evasão escolar no Instituto Federal de Educação.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual's life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients' folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay. / South Africa

Customer's ever increasing bargaining power makes it particularly important that practitioners and researchers more thoroughly understand the complex nature of customer commitment. Not surprisingly, however, although the construct of commitment has emerged as one of the key constructs in relationship marketing and has been widely studied in literature, there has been very little agreement on the conceptualisation of the construct. Building upon relationship marketing and organisational behaviour literature, the aim of this research is to extend our understanding of the nature of customer commitment by developing a three-dimensional customer commitment model relaying on commitment theory from the organisational behaviour literature; affective desire-based (AC), calculative cost-based (CC), and normative obligation-based (NC). Relationships among the commitment dimensions and relationships with a number of loyalty relational outcomes, namely, intention to stay (ITS), word of mouth (WOM), and willingness to pay (WTP) were investigated in this study. Using survey questionnaire distributed among customers of cell phone services (N=525), the data was analysed by structural equation modeling (SEM) and then additional analysis was employed to further demystify the complexity of the commitment concept. The results suggest that AC is the dominant source that generates customer loyalty, in line with the state of literature. Both cost-based and surprisingly obligation-based have shown detrimental effects on maintaining and developing the customer-service provider relationship. Additional analysis with various scenarios was implemented using mean split as cut score for high/low commitment dimensions. The findings suggest NC turns to have important positive role on relational outcomes when both AC and CC are below the mean split. When both AC and CC are high NC negatively affect at least ITS but at the same time make a clear positive effect on WTP. The findings can be instructional for identifying how firms can bend various marketing sources to secure more loyal customers to the service provider.

Reducing ED wait times is a top health care priority for the Ontario government and hospitals in Ontario are incentivised to meet provincial ED wait time targets. In this study, we considered the costs and benefits associated with increasing the number of acute-care beds to reduce the time an admitted patient spends boarding in the ED. A shorter hospital LOS has often been cited as a potential benefit associated with shorter ED wait times. We derived a multivariable Cox regression model to examine this association. We found no significant association between ED boarding times and the time to discharge. Using a Markov model, we estimated an increased annual operating cost of $2.1m to meet the prescribed wait time targets. We concluded that increasing acute-care beds to reduce ED wait times would require significant funding from hospitals and would have no effect on total length of stay of hospitalized patients.

Performance of bridges during previous earthquakes has demonstrated that many structural failures could be attributed to seismic deficiencies in bridge columns. Lack of transverse reinforcement and inadequate splicing of longitudinal reinforcement in potential plastic hinge regions of columns constitute primary reasons for their poor performance. A number of column retrofit techniques have been developed and tested in the past. These techniques include steel jacketing, reinforced concrete jacketing and use of transverse prestressing (RetroBelt) for concrete confinement, shear strengthening and splice clamping. A new retrofit technique, involving fibre reinforced polymer (FRP) jacketing has emerged as a convenient and structurally sound alternative with improved durability. The new technique, although received acceptance in the construction industry, needs to be fully developed as a viable seismic retrofit methodology, supported by reliable design and construction procedures. The successful application of externally applied FRP jackets to existing columns, coupled with deteriorating bridge infrastructure, raised the possibility of using FRP reinforcement for new construction. Stay-in-place formwork, in the form of FRP tubes are being researched for its feasibility. The FRP stay-in-place tubes offer ease in construction, convenient formwork, and when left in place, the protection of concrete against environmental effects, including the protection of steel reinforcement against corrosion, while also serving as column transverse reinforcement. Combined experimental and analytical research was conducted in the current project to i) improve the performance of FRP column jacketing for existing bridge columns, and ii) to develop FRP stay-in-place formwork for new bridge columns. The experimental phase consisted of design, construction and testing of 7 full-scale reinforced concrete bridge columns under simulated seismic loading. The columns represented both existing seismically deficient bridge columns, and new columns in stay-in-place formwork. The existing columns were deficient in either shear, or flexure, where the flexural deficiencies stemmed from lack of concrete confinement and/or use of inadequately spliced longitudinal reinforcement. The test parameters included cross-sectional shape (circular or square), reinforcement splicing, column shear span for flexure and shear-dominant behaviour, FRP jacket thickness, as well as use of FRP tubes as stay-in-place formwork, with or without internally embedded FRP crossties. The columns were subjected to a constant axial compression and incrementally increasing inelastic deformation reversals. The results, presented and discussed in this thesis, indicate that the FRP retrofit methodology provides significant confinement to circular and square columns, improving column ductility substantially. The FRP jack also improved diagonal tension capacity of columns, changing brittle shear-dominant column behavior to ductile flexure dominant response. The jackets, when the transverse strains are controlled, are able to improve performance of inadequately spliced circular columns, while remain somewhat ineffective in improving the performance of spliced square columns. FRP stay-in-place formwork provides excellent ductility to circular and square columns in new concrete columns, offering tremendous potential for use in practice. The analytical phase of the project demonstrates that the current analytical techniques for column analysis can be used for columns with external FRP reinforcement, provided that appropriate material models are used for confined concrete, FRP composites and reinforcement steel. Plastic analysis for flexure, starting with sectional moment-curvature analysis and continuing into member analysis incorporating the formation of plastic hinging, provide excellent predictions of inelastic force-deformation envelopes of recorded hysteretic behaviour. A displacement based design procedure adapted to FRP jacketed columns, as well as columns in FRP stay-in-place formwork provide a reliable design procedure for both retrofitting existing columns and designing new FRP reinforced concrete columns.