Orientador: Edson Lazarini / Banca: Leandro Coelho de Araujo / Banca: Roberto Giolo de Almeida / Resumo: A integração lavoura pecuária (ILP) é uma ferramenta que favorece o estabelecimento de um Sistema de Plantio Direto (SPD) eficiente. A utilização de gramíneas forrageiras do gênero Urochloa, permite grande produção de matéria seca e oferta de forragem podendo interferir positivamente na produtividade de grãos. O presente trabalho avaliou a viabilidade da sobressemeadura de espécies de braquiárias, em diferentes estádios de desenvolvimento da cultura da soja, visando ocupação da área em período de outono/inverno, com possibilidade de uso destas espécies para pastejo e/ou produção de palha para o SPD. O trabalho foi desenvolvido na área experimental da FEPE/Unesp - Campus de Ilha Solteira, localizada no município de Selvíria - MS, no período de outubro de 2012 a outubro de 2013. O delineamento experimental utilizado foi o de blocos ao acaso em esquema fatorial 2 x 5 com 4 repetições, ou seja, duas braquiárias (Marandu e Ruziziensis) e cinco épocas de semeadura (em sobressemeadura no início dos estádios de desenvolvimento R6, R7 e R8 da soja, semeadura direta após a colheita da soja de forma solteira ou em consórcio com o sorgo safrinha. Foram avaliadas, na cultura da soja a matéria seca produzida em cada época de semeadura, população final de plantas, características agronômicas e produtividade de grãos, nas braquiárias a produção de matéria seca e a densidade de perfilhos e na cultura do sorgo a população final de plantas, altura das plantas, matéria seca produzida e produtividade de grãos. Os resultados obtidos permitiram concluir que o tratamento com sobressemeadura em R6 proporcionou maior produção de palha para o sistema plantio direto, os tratamentos com sobressemeadura em R6 e R7 permitem o uso das braquiárias como pasto de forma antecipada e por mais tempo, a sobressemeadura de braquiárias Marandu ou Ruziziensis são viáveis nos estádios de desenvolvimento R6 ou R7 da soja / Abstract: The Crop-livestock system is a tool that favors the establishment of an efficient no tillage system. The use of forage grasses of the genus Urochloa allows large dry matter yield and forage supply without affecting the grain yield. This study evaluated the feasibility of overseeding the Urochloa species in different developmental stages of soybean, aiming occupation of the area in Autumn / Winter, with the possibility of using these species for grazing and / or production of straw. The study was conducted in the avaliation area of FEPE/ Unesp - Ilha Solteira's Campus, located in the city of Selvíria - MS, between October 2012 and October 2013. The experimental design was a randomized block factorial 2 x 5 with 4 replicates, ie, two braquiárias (Mrandu and Ruziziensis) and five sowing dates (overseeded in the early stages of soybean R6, R7 and R8, no tillage after harvest of soybean in single crop or intercropping with winter sorghum . Dry matter yield, plant population, agronomic characteristics,yield of the grain and dry matter production were evaluated in soybean, in brachiarias the dry matter yield and number of tillers and in the sorghum, plant population, plant height, dry matter yield and grain yield. The results showed that the treatment overseeding in R6 allowed more straw production to tillage conservation, overseedin in R6 and R7 treatments allow the use of Braquiária, as pasture, earlier and for longer period, overseeding of braquiárias Marandu or Ruziziensis is feasable in the R6 or R7 developing stages os soybean / Mestre

The Brazilian program of higher education evaluation, broadly known by the National Exam of Students\' Performance (ENADE), represents a governmental effort to gather information on undergraduate educational quality. As a product of that evaluation, reports are made available to each program evaluated; the main intent of the present research is to discover the extent to which these reports are used by undergraduate accounting program administrators and the impact of evaluation utilization on the programs\' performance. Based on the theoretical support of the literature on evaluation utilization, a web-based survey was developed and applied to collect the data. With a response rate of 62% (322 completed surveys), analyses were conducted through four steps: (1) a logistic regression to verify which factors were associated with the use of the ENADE evaluation report, (2) a descriptive verification of the incidence of use of the evaluation report among the undergraduate accounting program administrators and the most frequent types of use that they report, (3) multiple regressions to analyze the impact of the evaluation report\'s use or misuse on the programs\' performance in the subsequent evaluation, and (4) a descriptive analysis of the reasons for the nonuse of the evaluation report. The key findings of this research were as follows: the longer the program administrator\'s tenure, the higher his or her academic degree, the greater his or her involvement in the evaluation process, and the more positive his or her perception of the effectiveness of the communication between the evaluator and the programs, the greater the likelihood that the ENADE evaluation report would be used; the most frequent type of use among the administrators studied was conceptual; the main reason for nonuse was a lack of information about the online availability of the evaluation report; and finally, there was a positive correlation between the use of the ENADE evaluation report and the performance of undergraduate accounting programs in the subsequent evaluation. / O programa Brasileiro de avaliação da educação superior, largamente conhecido pelo Exame Nacional de Desempenho de Estudantes (ENADE), representa um esforço governamental para reunir informações sobre a qualidade dos cursos de graduação. Como um produto da avaliação, um relatório é disponibilizado para cada curso avaliado; e saber em que extensão esses relatórios são utilizados pelos coordenadores de cursos de graduação em ciências contábeis, assim como qual é o impacto do uso desse relatório sobre a performance dos cursos, foram os principais objetivos desse estudo. Fundamentado teoricamente na literatura sobre uso de avaliação, um questionário, que inclui uma escala para mensurar tipos de utilização, foi desenvolvido e aplicado. Com base em uma taxa de resposta de 62% (322 questionários completos), quatro diferentes aspectos foram analisados: (1) estudo dos fatores associados ao uso do relatório de avaliação do ENADE, através de regressão logística; (2) análise descritiva acerca da incidência de uso dos relatórios de avaliação, e acerca dos tipos de uso mais frequentes entre os coordenadores de cursos de ciências contábeis; (3) estudo do impacto da utilização, bem como do uso inadequado dos relatórios de avaliação, sobre o desempenho dos cursos de graduação em ciências contábeis na avaliação subsequente, por meio de regressão múltipla; e (4) análise descritiva das razões apontadas pelos coordenadores para o não uso dos relatórios de avaliação. Os principais resultados, a partir das evidências reunidas pelo presente estudo, foram: quanto maior o número de anos do coordenador no cargo, a sua titulação, o seu envolvimento no processo de avaliação e quanto mais positiva a sua percepção sobre a efetividade da comunicação entre o INEP e os cursos, maior a probabilidade de uso do relatório do ENADE; o uso conceitual foi o mais frequente entre os coordenadores pesquisados; a falta de conhecimento sobre a disponibilidade online dos relatórios de avaliação foi a principal causa de não uso verificada entre os pesquisados; e por fim, foi identificada uma correlação positiva entre o uso do relatório do ENADE e o desempenho dos cursos de graduação em ciências contábeis na avaliação subsequente.

A presente pesquisa, tipo descritivo, objetivou descrever o sistema de utilização de medicamentos em dois hospitais situados na cidade de Recife-PE. Com essa finalidade, buscou-se caracterizar a estrutura do sistema de medicação, descrever o processo de medicação e analisar os resultados sob a perspectiva do paciente e dos profissionais de enfermagem sobre o sistema. Para tanto, a população foi composta por 14 médicos, 14 enfermeiros, 22 farmacêuticos, 30 auxiliares de farmácia, 50 auxiliares de enfermagem, 63 pacientes e 372 folhas de prescrição de medicamentos e evolução de enfermagem. As técnicas utilizadas para coleta de dados foram a observação não participante e a entrevista, por meio de roteiros estruturados. Os resultados revelaram que, na estrutura, os ambientes do preparo de medicamentos se encontraram em discordância com a legislação vigente; os recursos materiais para o preparo e administração dos medicamentos precisam ser revisados e ajustados de modo a suprirem as necessidades do serviço e oferecerem mais segurança aos pacientes; os recursos humanos da farmácia e da enfermagem precisam ser dimensionados. Foi observado que os recursos humanos de nível médio não receberam treinamento e nem foram reciclados, nos últimos cinco anos, sobre o tema medicamentos. Na análise do processo foi observado o conteúdo das prescrições e constatou-se que nelas faltavam informações importantes sobre as especificações dos medicamentos. Quanto ao processo de preparo e administração dos medicamentos revelaram pontos críticos nos dois hospitais. Apesar do sistema ter apresentado esses aspectos que comprometem a qualidade da assistência, na opinião de 70% dos pacientes no Hospital 1 e 52,4% do Hospital 2, o sistema foi considerado bom e na opinião de 44% dos profissionais de enfermagem do Hospital 1 e 53,3% do Hospital 2 o consideraram regular. Diante dos resultados apresentados para se atingir a qualidade no sistema de medicação, mudanças são necessárias em termos da política dos recursos humanos e do incremento da educação continuada. / The present descriptive research had the goal of describing the medication –use utilization system in two teaching hospitals located in the city of Recife – State of Pernambuco. With this aim, it was sought to characterize the structure of the medication system, describe the medication process, and analyze the results under the perspective of both patient and nursing professionals about the system. In order to do this, the population was composed of 14 doctors, 14 nurses, 22 pharmacists, 30 pharmacy auxiliaries, 50 nursing auxiliaries, 63 patients, and 372 medication prescription and nursing evolution sheets. The techniques used for data collection were non-participating observation and interview by means of structured questionnaires. The results showed that, within the structure, the environments for medication preparation are in disagreement with current legislation; material resources for the preparation and administration of medication must be reviewed and adjusted in a way to meet the needs of this service and offer greater safety to patients; human resources of both pharmacy and nursing must be better dimensioned. It was observed that the medium level human resources did not receive training and have not been recycled in the last five years regarding the theme of medications. In the analysis of the medication process, in regards to the content of the prescription, it was observed that the prescriptions lacked important information about the specifications of the medications. In regards to the process of preparation and administration of medications, critical points were revealed in both hospitals. Among these, special attention is drawn to the deficiency in washing hands and infusion lines during the administration of more than one medication. Despite the system having presented such aspects that compromise the quality of assistance, in the opinion of 70% of patients in Hospital 1 and 52.4% of patients in Hospital 2 the system was considered to be good, and 44% of the nursing professions of Hospital 1 and 53.3% of Hospital 2 considered the system medium. In view of the presented results, in order to achieve the quality in the medication system, there is a need for changes in terms of policy of human resources, and an increase of continuing education

BACKGROUND: Early-term infants (37-38 weeks) are at increased risk of short- and long-term morbidities compared with full term infants (39-40 weeks). In 2009, the American College of Obstetricians and Gynecologists (ACOG) issued guidelines to discourage early elective deliveries prior to 39 weeks of gestation, and Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, adopted a policy to implement these guidelines. The impact of this policy on Neonatal Intensive Care Unit (NICU) utilization at BIDMC is unknown. Objectives: The objectives of this study were to (1) examine the gestational age distribution of infants at BIDMC from 2004 to 2015 and confirm a reduction in proportion of early-term births (37-38 weeks) after policy implementation in 2009, (2) compare the incidence of NICU admissions among infants ≥37 weeks of gestation before and after policy implementation, and (3) compare the length of NICU stays among infants ≥37 weeks of gestation before and after policy implementation. METHODS: We conducted a medical record review of infants ≥37 weeks of gestation born from January 1, 2004, through November 10, 2015. We used chi-square tests to compare the incidence of early-term deliveries and NICU admissions in two time periods: 2004-2008 (pre-period) and 2010-2015 (post-period). We excluded infants born in 2009 from the analysis. We used logistic regression to calculate the odds ratio of both short (>4 to <24 hours) and long (≥24 hours) NICU admissions in the two time periods. NICU stays ≤4 hours were excluded as they most often occur among asymptomatic infants for evaluation of sepsis in the setting of maternal fever during labor. We also excluded infants transferred to other hospitals. We considered potential confounding variables such as multiple births, maternal age, race and ethnicity, parity, insurance, and marital status. We compared median lengths of stay using a Wilcoxon test. RESULTS: A total of 50,373 infants were born ≥37 weeks of gestation during the study period, 46,254 of whom were included in the analysis excluding 4,119 infants born in 2009, the washout period. The incidence of early-term delivery was lower in the post-period (27.1%) versus the pre-period (34.2%) (P <0.0001). We detected a slight but statistically insignificant decrease in the incidence of overall NICU admissions from 9.1% in the pre-period to 8.9% in the post-period (P = 0.3). The incidence of short NICU admissions also decreased from 5.3% in the pre-period to 4.6% in the post-period (P < 0.0001). Interestingly, there was an increase in the incidence of long NICU stays from 3.8% in the pre-period to 4.3% in the post-period (P = 0.006). Term infants born after 2009 had lower odds of short NICU stays in adjusted models (adj. OR 0.84; 95% CI 0.77, 0.91). Among NICU admissions >4 hours, the median length of stay (LOS) increased from 21 hours (pre-period) to 39 hours (post-period) (P <0.0001). CONCLUSION: A local policy aligned with ACOG national guidelines to reduce early elective deliveries was associated with a reduction in early-term births. We observed a concurrent reduction of short but not long NICU stays. Our findings suggest that a reduction in early elective deliveries before 39 weeks of gestation may lead to more opportunities for infants to stay with their families in the first 24 hours but may not affect the incidence of significant morbidities requiring longer NICU stays. / 2017-06-16T00:00:00Z

INTRODUCTION: The anesthetic management for pediatric patients undergoing direct laryngoscopy and/or bronchoscopy (DLB) is administered based on the anesthesiologist’s preference. Objectives: The preliminary analysis of this study aims to identify variables that decrease surgical end-to-transport (SET) time and directly impacts patient outcomes. SET time is defined as the time of surgery end to the time of patient exit from the operating room. METHODS: After IRB approval, all DLBs performed at Boston Children’s Hospital (Boston, MA) by the Otolaryngology Department from June 2012 to December 2014 (n= 2419) were obtained from the Anesthesia Information Management System. With a 0.05 level of significance, a multivariate logistic regression was performed in SAS v9.3 with SET time as the dependent variable and surgery duration, age, gender, ASA status, airway device and extubation status as the independent variables. Airway device and extubation status were found to be moderately predictable of each other, so separate models were conducted. Spearman correlation testing was performed to evaluate the relationship between SET time and post-anesthesia care unit (PACU) duration. RESULTS: We excluded cases having ASA classification >2, age >21 years, regional nerve blocks, tracheostomy, nasal cannula, or unknown airway or extubation status. Remaining cases (n = 967) were arranged by SET times and dichotomized by the median value (14 minutes) into two groups (≤14 minutes and >14 minutes). After adjusting for other variables, we found that patients with an endotracheal tube (ETT) were 4.85 times more likely to have a SET time higher than the median, as compared with to those having with a laryngeal mask airway (LMA) (p = 0.0023, 95% CI: 1.76, 13.33). We also found that patients with an ETT were 2.89 times more likely to have a SET time higher than the median compared with those having a mask airway device. (p < 0.0001, 95% CI: 2.09, 3.98). In addition, there was a weak positive correlation between SET time and PACU duration (r = 0.09406, p = 0.0069). DISCUSSION: Preliminary analysis indicates that airway management has a significant impact on SET time after adjusting for surgery duration, age, gender, and ASA status. The use of either a mask or an LMA resulted in a lower SET time than the use of an ETT. The correlation of SET time and PACU duration suggests that reducing SET time does not negatively impact post-operative outcomes and may even be positively, though weakly, correlated. This study is limited by its retrospective nature. Future analysis will include the evaluation of commonly used perioperative anesthetics with dosage and timing variables and their correlation with SET time and patient outcomes.

Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.

BACKGROUND: Rising rates of maternal morbidity and mortality and persistent disparities in care utilization and outcomes signal a need for new approaches to prenatal care delivery. This study uses perspectives of low-socioeconomic status (SES) pregnant women to generate features of a patient-centered intervention aimed at improving outcomes in high cost, high need pregnant individuals. METHODS: We performed a secondary analysis of qualitative interviews with Medicaid-insured pregnant high and low utilizers of unscheduled obstetric care. Using a grounded theory approach, we tightly mapped themes to generate intervention strategies with potential to improve prenatal care delivery. RESULTS: Three key themes translated into intervention features: social support, care delivery, and access. Unlike low utilizers, high utilizers had a desire for more social support, improved communication in care delivery, and access to timely and efficient appointments. For low utilizers, improved insurance access and the ability to opt out of support services that didn’t align with their priorities were essential. CONCLUSION: High and low utilizers of unscheduled obstetric care have unique ideas for improving their care. Targeted interventions to improve prenatal care can be tested to potentially address unmet needs of vulnerable subgroups of low-SES pregnant women at risk for poor outcomes. / 2019-10-31T00:00:00Z

Thesis. 1975. M.Arch.--Massachusetts Institute of Technology. Dept. of Architecture. / Bibliography: leaves 50-52. / by Steven C. Hayes. / M.Arch.

Thesis. 1979. M.S.--Massachusetts Institute of Technology. Alfred P. Sloan School of Management. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND DEWEY. / Includes bibliographical references. / by Martin Howard Flax and Michael John Dinnis Brand. / M.S.

Typescript (photocopy). / Digitized by Kansas Correctional Industries