Linking customer satisfaction, quality, and strategic planning

By acknowledging and dissecting the interconnected roles of customer satisfaction, quality, and strategic planning, this paper provides an analytical framework for creating a customer-driven organization and culture. It shows how quality starts and ends with the customer. Companies that are achieving long-term continuous improvement in quality tailored to customer satisfaction possess lasting characteristics such as customer orientation, customer consciousness, and customer responsiveness. In doing so, they liberate the quality concept from the narrow product or service focus to encompass total conformance to customer requirements in spite of the existing functionalization and departmentalization of modern complex structures. In addition to these key components, a customer-driven organization demands building and nurturing a customer satisfaction culture and value system that makes quality improvement and heightened concern for customer satisfaction a permanent aspect of organizational life.

Evaluation of the diagnostic value of the tourniquet test in predicting severe dengue cases in a population from Belo Horizonte, State of Minas Gerais, Brazil

Introduction Dengue is prevalent in many tropical and sub-tropical regions. The clinical diagnosis of dengue is still complex, and not much data are available. This work aimed at assessing the diagnostic accuracy of the tourniquet test in patients with suspected dengue infection and its positivity in different classifications of this disease as reported to the Information System for Notifiable Disease in Belo Horizonte, State of Minas Gerais, Brazil between 2001 and 2006. Methods Cross-section analysis of the diagnostic accuracy of the tourniquet test for dengue, using IgM-anti-DENV ELISA as a gold standard. Results We selected 9,836 suspected cases, of which 41.1% were confirmed to be dengue. Classic dengue was present in 95.8%, dengue with complications in 2.5% and dengue hemorrhagic fever in 1.7%. The tourniquet test was positive in 16.9% of classic dengue cases, 61.7% of dengue cases with complications and 82.9% of cases of dengue hemorrhagic fever. The sensitivity and specificity of the tourniquet test were 19.1% and 86.4%, respectively. Conclusions A positive tourniquet test can be a valuable tool to support diagnosis of dengue where laboratory tests are not available. However, the absence of a positive test should not be read as the absence of infection. In addition, the tourniquet test was demonstrated to be an indicator of dengue severity.

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

AbstractBackground:Heart surgery has developed with increasing patient complexity.Objective:To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).Method:All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.Results:Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.Conclusion:Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

Morphological Study of the Larval Spiracular System in Eight Lutzomyia Species (Diptera: Psychodidae)

The morphology of the spiracles of fourth instar larva in eight sandfly species were examined by light and scanning electron microscopy. Species studied were: Lutzomyia longipalpis (Lutz & Neiva), L. ovallesi (Ortiz), L. youngi Feliciangeli & Murillo, L. evansi (Nuñez-Tovar), L. trinidadensis (Newstead), L. migonei (França), L. absonodonta Feliciangeli, and L. venezuelensis (Floch & Abonnenc). In larvae of all eight species both thoracic and abdominal spiracles are located at the top of a globular bulge. Their structure consists of a spiracular plate with a sclerotized central portion and a rose-like peripheral portion. The latter has circularly arranged papillae, separated from each other by elongated septa. Each papilla is longitudinally crossed by a fine cleft dividing it into two identical parts. The taxonomic and adaptative value of spiracular morphology is discussed

Beyond sepsis pathophysiology with cytokines: what is their value as biomarkers for disease severity?

Sepsis is a major challenge in medicine. It is a common and frequently fatal infectious condition. The incidence continues to increase, with unacceptably high mortality rates, despite the use of specific antibiotics, aggressive operative intervention, nutritional support, and anti-inflammatory therapies. Typically, septic patients exhibit a high degree of heterogeneity due to variables such as age, weight, gender, the presence of secondary disease, the state of the immune system, and the severity of the infection. We are at urgent need for biomarkers and reliable measurements that can be applied to risk stratification of septic patients and that would easily identify those patients at the highest risk of a poor outcome. Such markers would be of fundamental importance to decision making for early intervention therapy or for the design of septic clinical trials. In the present work, we will review current biomarkers for sepsis severity and especially the use of cytokines as biomarkers with important pathophysiological role.

Physical quality of a yellow latossol under integrated crop-livestock system

Soil physical quality is essential to global sustainability of agroecosystems, once it is related to processes that are essential to agricultural crop development. This study aimed to evaluate physical attributes of a Yellow Latossol under different management systems in the savanna area in the state of Piaui. This study was developed in Uruçuí southwest of the state of Piauí. Three systems of soil management were studied: an area under conventional tillage (CT) with disk plowi and heavy harrow and soybean crop; an area under no-tillage with soybean-maize rotation and millet as cover crop (NT + M); two areas under Integrated Crop-Livestock System, with five-month pasture grazing and soybean cultivation and then continuous pasture grazing (ICL + S and ICL + P, respectively). Also, an area under Native Forest (NF) was studied. The soil depths studied were 0.00-0.05, 0.05-0.10 and 0.10-0.20 m. Soil bulk density, as well as porosity and stability of soil aggregates were analyzed as physical attributes. Anthropic action has changed the soil physical attributes, in depth, in most systems studied, in comparison to NF. In the 0.00 to 0.05 m depth, ICL + P showed higher soil bulk density value. As to macroporosity, there was no difference between the management systems studied and NF. The management systems studied changed the soil structure, having, as a result, a small proportion of soil in great aggregate classes (MWD). Converting native forest into agricultural production systems changes the soil physical quality. The Integrated Crop-Livestock System did not promote the improvement in soil physical quality.

Economic analysis of an agrosilvipastoral system for a mountainous area in Zona da Mata Mineira, Brazil

The objective of this work was to evaluate the economic viability of an agrosilvipastoral system developed for Zona da Mata mountainous areas in Minas Gerais state, Brazil, as well as to compare different options for wood (Eucalyptus grandis and Acacia mangium) commercialization of the second thinning. The data were obtained from a 10 year-old agrosilvipastoral system established in four hectares at Embrapa Gado de Leite station in Coronel Pacheco, MG, Brazil. As evaluation criteria for the economic viability analysis, the adopted methods were the net present value (NPV) and the internal rate of return (IRR), both calculated at 6% interest rate. Despite the small difference, adding value to forest products increased the attractiveness of the proposed system. Considered separately, the agricultural activity was impracticable, whereas the forestry and livestock activities were independently viable. The studied system seems to be equally tolerant to price variations for forest and livestock products, as well as strongly tolerant to variations in production costs.

Breeding objectives for a Nellore cattle rearing system

Abstract:The objective of this work was to define the traits that should be included as breeding objectives for Nellore cattle, according to simulations with a bio-economic model for rearing systems. The economic values (EVs) of the traits were calculated as the differences between the profits due to an increased performance of 1% in each trait, with the others traits remaining constant. To determine the impact of each selection on the revenue system, two scenarios were simulated based on the traits being selected. In the first scenario, the adopted selection criteria were: weaning weight (WW), weaning rate (WR), yearling weight (YW), and mature cow weight (MCW). In the second scenario, the cumulative productivity (CP) of dams was used as an indirect evaluation of the performance of calves, with all the other traits included, except WW. In the first scenario, an EV of R$ 1.44 kg-1 was obtained for WW. In the second scenario, an EV of R$ 2.91 kg-1 was obtained for CP. The trait with the highest EV in both scenarios was WR, which enhanced the profits by R$ 3.21 for each 1% increased performance. The meat price paid to the producer is the factor with the greatest impact on the EVs of all examined traits.

Breast Imaging Reporting and Data System - BI-RADS®: valor preditivo positivo das categorias 3, 4 e 5. revisão sistemática da literatura

OBJETIVO: Avaliar artigos, na literatura, que verificam o valor preditivo positivo das categorias 3, 4 e 5 do Breast Imaging Reporting and Data System (BI-RADS®). MATERIAIS E MÉTODOS: Foi realizada pesquisa na base de dados Medline utilizando os termos "predictive value" e "BI-RADS". Foram incluídos 11 artigos nesta revisão. RESULTADOS: O valor preditivo positivo das categorias 3, 4 e 5 variou entre 0% e 8%, 4% e 62%, 54% e 100%, respectivamente. Três artigos avaliaram, concomitantemente, os critérios morfológicos das lesões que apresentaram maior valor preditivo positivo na mamografia, sendo nódulo espiculado o critério com maior valor preditivo positivo. CONCLUSÃO: Houve grande variabilidade do valor preditivo positivo das categorias 3, 4 e 5 do BI-RADS® em todos os estudos, porém foram identificadas diferenças metodológicas que limitaram a comparação desses estudos.

Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy

Objective To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. Materials and Methods Retrospective, analytical and cross-sectional study including 725 patients with mammographic and/or sonographic findings classified as BI-RADS categories 3, 4 and 5 who were referred to the authors' institution to undergo percutaneous biopsy. The tests results were reviewed and the positive predictive value was calculated by means of a specific mathematical equation. Results Positive predictive values found for categories 3, 4 and 5 were respectively the following: 0.74%, 33.08% and 92.95%, for cases submitted to ultrasound-guided biopsy, and 0.00%, 14.90% and 100% for cases submitted to stereotactic biopsy. Conclusion The present study demonstrated high suspicion for malignancy in lesions classified as category 5 and low risk for category 3. As regards category 4, the need for systematic biopsies was observed.

Covalent anion of Li(HF)3- system: an ab initio study

In this paper, we report the stability of the Li(HF)3- molecular anion calculated at the MP2/6-31++G** and CCSD(T)/6-31++G** level of theory. Five possible conformers of Li(HF)3- molecular anions have been determined employing ab initio MP2 method with 6-31++G** basis set. The most stable conformer of five Li(HF)3- anions is in a cyclic ring structure Li(HF)3-(1). From our calculations we show that the molecule is stable towards electron attachment, with an electron adiabatic electron affinity (AEA) of 199.5 meV (233.1 meV with zero point energy correction) and 471.3 meV at the MP2 and CCSD(T) levels, respectively. In addition we present vertical detachment energies of 230.2 meV and 795.8 meV at the MP2, CCSD(T), respectively. The importance of the latter has to do with the ability of experimental detection of this value.

Application and validation of a warning system for grapevine downy mildew controlusing fungicides

Most warning systems for plant disease control are based on Vinho, in Bento Gonçalves - RS, during the growing seasons 2000/ weather models dependent on the relationships between leaf wetness 01, 2002/03 and 2003/2004, using the grape cultivar Isabel. The duration and mean air temperature in this period considering the conventional system used by local growers was compared with the target disease intensity. For the development of a warning system to new warning system by using different cumulative daily disease severity control grapevine downy mildew, the equation generated by Lalancette values (CDDSV) as the criterion to schedule fungicide application and et al. (7) was used. This equation was employed to elaborate a critical reapplication. In experiments conducted in 2003/04, CDDSV of 12 - period table and program a computerized device, which records, though 14 showed promising to schedule the first spraying and the interval electronic sensors, leaf wetness duration, mean temperature in this between fungicide applications, reducing by 37.5% the number of period and automatically calculates the daily value of probability of applications and maintaining the same control efficiency in leaves infection occurrence. The system was validated at Embrapa Uva e and bunches, similarly to the conventional system.

Crop coefficient and water consumption of eggplant in no-tillage system and conventional soil preparation

Under organic management in Seropédica-RJ, Brazil, using a weighing lysimeter, the crop coefficients (kc), the maximum evapotranspiration and the productivity of eggplant cultivation under two cropping systems (no tillage with straw plus soil with conventional preparation) were determined. A whole randomized layout with two treatments (no tillage and conventional) and five replicates during 134 days of cultivation were adopted. There were no significant differences in the eggplant cultivation in the two cropping systems, with a maximum commercial productivity obtained from 47.42 Mg ha-1 for the no-tillage system, and 47.91 Mg ha-1 for the conventional tillage. The accumulated ETc was 285.15 and 323.44 mm for the no-tillage and conventional, respectively. The crop coefficients value for the phases: 1 - transplanting, flowering, 2 - flowering-fruiting, 3 - fruit- first harvesting, 4- first harvesting of the final crop cycle was 0.83, 0.77, 0.90 and 0.97 in no-tillage system for the respective phases and for the conventional one 0.81, 1.14, 1.17 and 1.05 for the same steps described above.

Infestation of weed species in monocrop coffee or intercropped with banana, under agroecological system

We aimed with this study to compare weed infestation in coffee under two different cropping managements: conventional coffee grown alone, or intercropped with banana plantation in a year-round basis (late spring, late summer, late fall and late winter). The experiment was installed in 2009 under field conditions at the Escola Municipal Rural Benedita Figueiró de Oliveira, in the city of Ivinhema in the state of Mato Grosso do Sul, Brazil. Assessments of weed occurrence were made three years after employment, on both cropping systems, and density, frequency, dominance and the importance value for each plant species in each system and season were quantified. Plant diversity within each system was estimated by Simpson and Shannon-Weiner indexes. Similarity between cropping systems were also assessed by the binary asymmetric similarity coefficient of Jaccard. Absolute infestation and spontaneous species differed between the two cropping systems in all seasons. Overall species diversity is higher in the monocrop compared with the intercrop, and it is associated in this study with the higher incidence of troublesome species. Areas were similar in terms of weed composition only in the Fall. Shading provided by the banana trees shows to be an efficient culture management aiming to suppress weeds in agro-ecological planting systems.

Fuzzy expert system in the prediction of neonatal resuscitation

In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.