879 resultados para Elective surgery of small-to-medium scope


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A kis- és középvállalkozások (kkv-k) a legtöbb országban, így Magyarországon is kiemelt szerepet töltenek be a gazdaság életében. A velük kapcsolatos kutatások elérkeztek abba a fázisba, amikor például a kisvállalkozás- fejlesztés és az ellátásilánc-menedzsment összekapcsolásával megismerhetjük egy adott vállalati funkció szerepét és helyét a célcsoportban. A szerzők tanulmányukban egy kutatás eredményeit mutatják be, mely egyenrangú módon fókuszál a beszerzési tevékenység és a kkv-k sajátosságaira. A beszerzési aspektusok kiemelésével lehetőség van mélyebben megismerni a kkv-k bizonytalanságának forrásait, a beszállítókkal kapcsolatos igényeik megfogalmazását, a vevők preferenciáit, melyen keresztül általános kép kapható a szállítófejlesztés lehetőségeiről, kifejezetten a beszerzési tevékenység informatikai támogatásáról, továbbá véleményükről a beszerzés mint szolgáltatás kiszervezésével kapcsolatban. A kutatást megalapozó kérdőíves felmérés nemzeti összehasonlításra is lehetőséget ad, valamint segíti egy adott tevékenységre fókuszálva a hazai kis- és középvállalkozások helyzetének bemutatását. ______ Small and medium enterprises (SME) play an important role in the economy of Hungary, just like in most other countries. Studies on SMEs recently have focused on the role of a particular company function in the target group by linking the development of SMEs to new advanced options, such as supply chain management. This paper provides an overview of authors’ ques a questionnaire research focusing on the specific characteristics of both purchasing and SMEs. Focusing on the purchasing aspects enables us to gain a deeper knowledge on the main causes of the instability of SMEs as well as on their expectations regarding suppliers and a better understanding on the preferences of the clients. As a result authors can highlight the main options of developing the supply chain as well as the IT support of purchasing and they can state their opinion on the outsourcing of the purchasing as a service. The questionnaire survey providing the basis for the study enables authors to make international comparisons as well as to present the current state of the Hungarian SMEs focusing on a particular business activity.

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A cikk a magyarországi kis- és középvállalkozások logisztikai költségeit vizsgálja a nemzetközi kutatások tükrében és a 2009-es közel kétezer hazai KKV-re kiterjedő „Vállalkozások helyzetének felmérése” alapján. A hazai logisztikai költségeket leginkább a vállalatméret és az ágazat befolyásolja. A magyarországi kis- és középvállalkozások ki nem szervezett szállítási és raktározási tevékenységei a hazai fuvarozóknak és raktárszolgáltatóknak jelentős piacbővülést jelenthetnének. Ez azonban csak látens piacbővülés, mivel a hazai KKV-k nem tervezik, hogy szállítási és raktározási tevékenységeiket nagyobb arányban szervezzék ki. Ez részben azzal magyarázható, hogy a feldolgozóipari, mezőgazdasági és kereskedő kis- és középvállalkozások viszonylag nagy arányban tekintik a logisztikát alapvető képességnek. Nemzetközi viszonylatban a magyarországi KKV-k magas logisztikai költségszintekkel szembesülnek, melynek mérséklésével az adminisztrációs terhek csökkentéséhez hasonló megtakarítást lehetne elérni. ____ This article examines total logistics costs and its components of the Hungarian small- and medium-sized enterprises in the light of international researches. It shows that company-size and its sector are the most important drivers of logistics costs and its components according to „Survey of position of enterprises”, which covered nearly 2000 Hungarian SMEs in 2009. It also proves that transport and warehousing demand of the Hungarian SMEs means a significant market growth for national carriers and warehouse providers. It is only a latent growth, because the Hungarian SMEs do not plan to outsource their transport and warehouse activities in a greater extent. The relative high level of logistics as a core competence among processing industry, agriculture and trade SMEs can be a partial explanation to this. The Hungarian small- and medium-sized enterprises face with high logistics costs in international comparison. Its reduction may bring similar savings as reduction of administrative burdens.

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Enterprise Resource Planning (ERP) systems are software programs designed to integrate the functional requirements, and operational information needs of a business. Pressures of competition and entry standards for participation in major manufacturing supply chains are creating greater demand for small business ERP systems. The proliferation of new offerings of ERP systems introduces complexity to the selection process to identify the right ERP business software for a small and medium-sized enterprise (SME). The selection of an ERP system is a process in which a faulty conclusion poses a significant risk of failure to SME’s. The literature reveals that there are still very high failure rates in ERP implementation, and that faulty selection processes contribute to this failure rate. However, the literature is devoid of a systematic methodology for the selection process for an ERP system by SME’s. This study provides a methodological approach to selecting the right ERP system for a small or medium-sized enterprise. The study employs Thomann’s meta-methodology for methodology development; a survey of SME’s is conducted to inform the development of the methodology, and a case study is employed to test, and revise the new methodology. The study shows that a rigorously developed, effective methodology that includes benchmarking experiences has been developed and successfully employed. It is verified that the methodology may be applied to the domain of users it was developed to serve, and that the test results are validated by expert users and stakeholders. Future research should investigate in greater detail the application of meta-methodologies to supplier selection and evaluation processes for services and software; additional research into the purchasing practices of small firms is clearly needed.^

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Although urbanization in smaller cities is arguably not imperative, the future of urban living is no longer expected to be principally in mega-cities. People increasingly live in intermediate and smaller cities, in line with the proportion of people residing in urban areas, which is also gradually rising. Smaller cities in Indonesia, like other smaller cities in the developing world, are relatively densely populated, and many of them are experiencing extended urbanization, thereby exceeding their administrative boundaries. This paper seeks to explore the factors triggering urban development in these smaller cities, for a case in Indonesia. Urban change in Cirebon Region has accelerated in recent years, very much in line with the decentralization policy in Indonesia. This paper shows how urban change is in!uenced by economic restructuring, which encourages people to live closer to the core of the region, representing a new link between the core and new emerging urban areas in the region. This paper reveals these attributes to identify the characteristics of smaller urban centres, thereby contributing a more nuanced image of small cities in general.

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A smooth inflaton potential is generally assumed when calculating the primordial power spectrum, implicitly assuming that a very small oscillation in the inflaton potential creates a negligible change in the predicted halo mass function. We show that this is not true. We find that a small oscillating perturbation in the inflaton potential in the slow-roll regime can alter significantly the predicted number of small halos. A class of models derived from supergravity theories gives rise to inflaton potentials with a large number of steps and many trans-Planckian effects may generate oscillations in the primordial power spectrum. The potentials we study are the simple quadratic (chaotic inflation) potential with superimposed small oscillations for small field values. Without leaving the slow-roll regime, we find that for a wide choice of parameters, the predicted number of halos change appreciably. For the oscillations beginning in the 10(7)-10(8) M(circle dot) range, for example, we find that only a 5% change in the amplitude of the chaotic potential causes a 50% suppression of the number of halos for masses between 10(7)-10(8) M(circle dot) and an increase in the number of halos for masses <10(6) M(circle dot) by factors similar to 15-50. We suggest that this might be a solution to the problem of the lack of observed dwarf galaxies in the range 10(7)-10(8) M(circle dot). This might also be a solution to the reionization problem where a very large number of Population III stars in low mass halos are required.

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A participative ergonomics approach to reducing injuries associated with manual tasks is widely promoted; however only limited evidence from uncontrolled trials has been available to support the efficacy of such an approach. This paper reports on a randomized and controlled trial of PErforM, a participative ergonomics intervention designed to reduce the risks of injury associated with manual tasks. One hundred and seventeen small to medium sized food, construction, and health workplaces were audited by government inspectors using a manual tasks risk assessment tool (ManTRA). Forty-eight volunteer workplaces were then randomly assigned to Experimental and Control groups with the Experimental group receiving the PErforM program. Inspectors audited the workplaces again, 9 months following the intervention. The results showed a significant decrease in estimates of manual task risk and suggested better legal compliance in the Experimental group.

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Certification of an ISO 14001 Environmental Management System (EMS) is currently an important requirement for those enterprises wishing to sell their products in the context of a global market. The system`s structure is based on environmental impact evaluation (EIE). However, if an erroneous or inadequate methodology is applied, the entire process may be jeopardized. Many methodologies have been developed for making of EIEs, some of them are fairly complex and unsuitable for EMS implementation in an organizational context, principally when small and medium size enterprises (SMEs) are involved. The proposed methodology for EIE is part of a model for implementing EMS. The methodological approach used was a qualitative exploratory research method based upon sources of evidence such as document analyses, semi-structured interviews and participant observations. By adopting a cooperative implementation model based on the theory of system engineering, difficulties relating to implementation of the sub-system were overcome thus encouraging SMEs to implement EMS. (C) 2007 Elsevier Ltd. All rights reserved.

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Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial. Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas (diameter <= 2.8cm) treated with radical surgical removal. Total resection (Simpson`s Grade 1) [43] was possible with minimal morbidity and no mortality. Background. We present a series of small petroclival meningiomas (SPM) treated by radical surgical removal and compare the outcome with other management modalities proposed for these lesions. Methods. Eighteen patients with SPM were surgically treated at our department of neurological surgery. The tumours were classified as small when they had a diameter < 3.0cm. Headaches (n = 12), diplopia (n = 8), facial hypoaesthesia (n = 3) and tinnitus (n = 6) were the most frequent symptoms at presentation. The approaches used were retrosigmoid (n = 14), fronto-orbito-zygomatic (n = 3) and presigmoid (n = 1). The post-operative follow-up ranged from 1 to 110 months (mean 41.8 months). Findings. Radical tumour resection (Simpson`s Grades 1 and 2) was achieved in all patients. There was no major morbidity or mortality related to the surgical procedure. Transient abducent nerve palsy was the only post-operative complication. The pre-operative cranial nerves deficits improved after surgery. Only one patient had persistent diplopia postoperatively. Conclusion. Radical surgical removal of SPM is possible with minimal morbidity and may cure the patient. The effectiveness and outcome of surgery for small petroclival meningiomas should be compared with series treated by radiosurgery.

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Recently, Barrett's esophagus and early adenocarcinomas have been detected increasingly frequently in routine follow-up of patients with gastroesophageal reflux. Although surgery is the treatment of choice, some patients are medically unfit for esophagectomy and, in this case, the only alternative curative therapy is radical chemoradiation therapy. In addition, some patients who present with symptoms have small tumors that cannot be localized accurately using routine imaging techniques. This report describes a series of eight patients with small esophageal cancers in whom the tumors were successfully localized following endoscopic injection of contrast, and treated with chemoradiation therapy. The treatment was successful in seven patients. This method of tumor localization demonstrated that conventional techniques are mostly, unreliable when applied to very early cancers.

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This study investigated the receptor binding affinities of a C5a agonist and cyclic antagonists for polymorphonuclear leukocytes (PMNs) isolated from human, sheep, pig, dog, rabbit, guinea pig, rat and mouse. The affinities of the two small molecule antagonists, F-[OPdChaWR] and AcF-[OPdChaWR], and the agonist, YSFKPMPLaR, revealed large differences in C5a receptor (C5aR) affinities between species. The antagonists bound to human, rat and dog PMNs with similar high affinities, but with lower affinities to PMNs from all other species. The C5a agonist also bound with varying affinities between species, but showed a different affinity profile to the antagonists. In contrast, recombinant human C5a had similar affinity for PMNs of all species investigated. The low correlation between the affinities of the antagonists and the agonist between species either suggests that different receptor residues are important for distinguishing between agonist/antagonist binding, or that the agonist and antagonist peptides bind to two distinct sites within the C5aR.

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The purpose of this study is to characterize how Portuguese Small and Medium Enterprises (SMEs) view the Occupational Health and Safety Management Systems (OHSMSs) certification process, after receiving the Quality Management System (QMS) certification. References were based on the ISO 9001 standard for a QMS and OHSAS 18001 for OHSMS. The method used to evaluate the implemented systems, was by form of questionnaire. Those questioned had to have a certified quality management system, an implemented OHSMS and be a SME. The questionnaire was sent to 300 SMEs; 46 responses were received and validated. Of them, only 12 SMEs had the OHSMS certificate according to OHSAS 18001. Within those 12 companies that participated: 7 SMEs are from the industrial sector; 3 belong to the electricity/telecommunications sector and 2 SMEs are from the trade/services activity sector. The size of the sample was small, but corresponds to Portuguese reality. Moreover, 34 SMEs did not have the OHSMS certificate. The questionnaire requested the main reasons for SMEs to opt for non-certification and it was related with high costs, while the main reasons to certificate were, among others, needed to eliminate or minimize risks to workers. The main benefits that Portuguese SMEs have gained from the referred certifications have been, improved working conditions, ensuring compliance with legislation and better internal communication about risks and hazards. Also presented are the main difficulties in achieving an OHSMS certification including high certification costs, difficulties motivating personnel, difficulties in changing the company’s culture and increased bureaucracy.

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Artigo elaborador no âmbito dos trabalhos decorrentes à dissertação de Mestrado do Aluno David Leite, no Mestrado em Gestão Integrada Qualidade, Ambiente e Segurança, ESTGF-IPP, Oreintados pelos Professores Luís Fonseca (ISEP-IPP) e Vanda Lima (ESTGF-IPP).

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Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

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Leadership and Management in Engineering, January 2009