769 resultados para consulting
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The case describes the development of MyFARM’s internationalization plan, a service of Deimos Engenharia, under the GloCal Radar. This space engineering company hired Lisbon Consulting Company to undertake the project to overcome its lack of market orientation. The consultants’ analysis revealed Stevens County, Kansas, as the market with the highest potential for MyFARM. A suitable entry strategy and adaptation of the service for the local market was proposed. The case culminates with the Board of Directors discussing the viability of implementing the consultants’ recommendations to start diversifying their sources of revenue streams.
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Com o desenvolvimento das Tecnologias de Informação e Comunicação, as mesmas têm permitido dotar as pessoas de conhecimentos, através de formas mais rápidas e eficientes como é o caso da formação em e-learning. O número de organizações a apostar na formação em e-learning é cada vez maior, tornando-se importante perceber em que medida é que o método é eficaz e quais as vantagens que proporciona à organização, bem como o seu impacto no capital humano. Assim e visando averiguar como esta situação é vivenciada na prática decidiu-se pela realização de um estágio, na PT PRO pertencente Grupo Portugal Telecom. Para a construção deste relatório de estágio foi preciso para além da consulta e análise documental de aquivos internos e intranet, reuniões tidas com os elementos do departamento da Gestão de Formação, onde decorreu o estágio, visando dar uma resposta mais cabal à questão de partida que norteia o estágio: “Qual o impacto gerado pelas ações de e-learning, sua aplicabilidade e satisfação dos colaboradores face às mesmas na PT PRO?” O método utilizado neste estudo foi do tipo quantitativo, tendo sido aplicado um inquérito por questionário construído para o efeito. Face aos resultados obtidos, concluímos que na PT PRO, os colaboradores encontram-se globalmente satisfeitos com o conhecimento gerado e acima de tudo com a aplicabilidade do mesmo nas suas funções de trabalho.
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O presente relatório resultou do estágio efetuado na DGPC, no âmbito da componente não-letiva do Mestrado em Arqueologia. O seu propósito centrou-se no Inventário e Georreferenciação das manifestações funerárias rupestres medievais, enquadradas na região do Centro de Portugal. Este trabalho possibilitou a atualização e introdução de inúmeras ocorrências, respeitantes a sepulturas e necrópoles escavadas na rocha, na base de dados da DGPC – o Endovélico. A concretização deste objetivo assentou essencialmente na consulta de bibliografia especializada, assim como de relatórios técnico-científicos. Ao constar do Endovélico, a informação inserida afigura-se como um contributo para o conhecimento e divulgação deste tipo de património medieval, auxiliando, inevitavelmente, no que concerne à sua salvaguarda e proteção. O processamento e sistematização da vasta informação inventariada e georreferenciada possibilitou o desenvolvimento de uma análise, na perspetiva das sepulturas escavadas na rocha como fenómeno funerário alto-medieval. Esta permitiu a criação de uma imagem, ainda que incompleta, dos tipos de agrupamentos existentes e da relação entre as sepulturas e as zonas envolventes, com lugar numa parte do território de Viseu.
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Dissertação de mestrado em Enfermagem
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Aims: Depression is the most common psychiatric disorder among people infected with HIV. This study aims to characterize the Hospital of Joaquim Urbano population of HIV-infected patients’ profile regarding depressive symptoms and whether they correlate with the analytical parameters most frequently evaluated in the context of infection by this virus – HIV viral load, CD4+ count and CD4+ percentage. Methods: We conducted an observational descriptive and analytical study. The participants’ level of depressive symptoms was assessed with the Beck Depression Inventory. The medical and psychiatric history and the analytical values of viral load, CD4+ count and CD4+ percentage were obtained by consulting the participants’ clinical processes. Results: A prevalence of 65.5% in HIV-infected patients’ depressive symptoms was found, with a considerable high percentage of subjects presenting with severe symptoms (32.7%). No associations between the depressive symptoms’ levels and CD4+ count, CD4+ percentage or viral load were found. However, depressive symptoms were associated with substance abuse and education level. Conclusions: The high prevalence of depressive symptoms found in this study reinforces the importance of monitoring this type of symptoms in HIV-infected subjects. The fact that there have been no associations between depressive symptoms and the analytical parameters evaluated is in line with previous studies.
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Dissertação de mestrado em Ciências da Comunicação (área de especialização em Publicidade e Relações Públicas)
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Transformation, Russia, system theory, organistion theory, enterprises, reform, post-sovietic, organization building, management consulting
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Introductions: In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. Objective: To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Methods: Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. Results: The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. Conclusion: The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.
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En aquest projecte s'ha implementat un sistema de data archiving amb SAP-IXOS per a una empresa després que aquesta demanés consell a la nostra consultora per reduir espai en la base de dades, ja que només els quedava lliure un 14% de l'ocupació total, i d'aquesta forma millorar el rendiment del sistema. S'ha realitzat un estudi de la base de dades, ocupació en Mb i creixement mensual de les dades en les taules. S'han parametritzat objectes d'arxivat, creat i definits repositoris de contingut, fitxers lògics i s'han programat reports addicionals per arxivar les dades correctament. El resultat ha estat reduir la base de dades en un 22% sent posible l'entrada de noves dades obtenint una resposta més àgil del sistema.
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BACKGROUND: The presence of multiple melanocytic naevi is a strong risk factor for melanoma. Use of the whole body naevus count to identify at-risk patients is impractical. OBJECTIVES: To (i) identify a valid anatomical predictor of total naevus count; (ii) determine the number of naevi that most accurately predict total naevus count above 25, 50 and 100; and (iii) evaluate determinants of multiple melanocytic naevi and atypical naevi. METHODS: Clinical data from 292 consecutive Spanish patients consulting for skin lesions requiring debriding were collected throughout 2009 and 2010. Correlations between site-specific and whole body naevus counts were analysed. Cut-offs to predict total naevus counts were determined using the area under the receiver operating characteristic curve. RESULTS: The studied population was young (median age 31 years, interquartile range 28-43). The naevus count on the right arm correlated best with the total nevus count (R(2) 0·80 for men, 0·86 for women). Presence of at least five naevi on the right arm was the strongest determinant of a total naevus count above 50 [odds ratio (OR) 34·4, 95% confidence interval (CI) 13·9-85·0] and of having at least one atypical naevus (OR 5·7, 95% CI 2·4-13·5). Cut-off values of 6, 8 and 11 naevi on the right arm best predicted total naevus count above 25, 50 and 100, respectively. CONCLUSIONS: Our results support the arm as a practical and reliable site to estimate the total naevus count when screening or phenotyping large populations. Threshold values for the number of naevi on the arm are proposed to help identify patients for melanoma screening.
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BACKGROUND: Many emergency department (ED) providers do not follow guideline recommendations for the use of the pneumonia severity index (PSI) to determine the initial site of treatment for patients with community-acquired pneumonia (CAP). We identified the reasons why ED providers hospitalize low-risk patients or manage higher-risk patients as outpatients. METHODS: As a part of a trial to implement a PSI-based guideline for the initial site of treatment of patients with CAP, we analyzed data for patients managed at 12 EDs allocated to a high-intensity guideline implementation strategy study arm. The guideline recommended outpatient care for low-risk patients (nonhypoxemic patients with a PSI risk classification of I, II, or III) and hospitalization for higher-risk patients (hypoxemic patients or patients with a PSI risk classification of IV or V). We asked providers who made guideline-discordant decisions on site of treatment to detail the reasons for nonadherence to guideline recommendations. RESULTS: There were 1,306 patients with CAP (689 low-risk patients and 617 higher-risk patients). Among these patients, physicians admitted 258 (37.4%) of 689 low-risk patients and treated 20 (3.2%) of 617 higher-risk patients as outpatients. The most commonly reported reasons for admitting low-risk patients were the presence of a comorbid illness (178 [71.5%] of 249 patients); a laboratory value, vital sign, or symptom that precluded ED discharge (73 patients [29.3%]); or a recommendation from a primary care or a consulting physician (48 patients [19.3%]). Higher-risk patients were most often treated as outpatients because of a recommendation by a primary care or consulting physician (6 [40.0%] of 15 patients). CONCLUSION: ED providers hospitalize many low-risk patients with CAP, most frequently for a comorbid illness. Although higher-risk patients are infrequently treated as outpatients, this decision is often based on the request of an involved physician.
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Background and Aims: Gender differences have been reported among pathological gamblers populations. These differences concern variables such as type of gambling (men are more likely engaged in ''strategic gambling'' whereas women prefer ''non-strategic'' gambling), evolution of the gambling problem (faster progression for women) and suicidal behaviours (more attempted suicide by women). The aim of the present study is to investigate the relationship between gender and clinical status in a Swiss sample of treatment seeking pathological gamblers. Method: Prospective descriptive study of 260 new outpatients entering treatment between October 1999 and October 2007 at the Center for Excessive Gambling Studies, Lausanne, Switzerland. Data are issued from standardised medical records. Gender differences were examined (Chi-squares and ANOVAs) on interval between first gambling behaviours and first specialized treatment, interval between pathological gambling onset and first specialized treatment, purpose of consulting, type of gambling (« strategic gambling » vs « nonstrategic gambling ») and suicidality. Results and Discussion: In line with international findings, gender differences were observed on type of gambling, suicidality and interval between pathological gambling onset and first specialized treatment. A tendency emerged on interval between first gambling behaviours and first specialized treatment. As a new finding, we observed a difference on the purpose of consulting, with emotional crisis more reported by women whereas men are more likely to report familial crisis. Gender seems to be relevant in the context of pathological gambling and should be integrated in prevention and clinical strategies.
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PTSA és el projecte resultat del desenvolupament de la Plataforma Telemàtica de Serveis Administratius proposada com a iniciativa per l'Ajuntament de Ripollet. Amb l'objectiu de promoure la utilització dels canals de comunicació segurs entre el ciutadà i l'Administració, aporta els serveis d'acreditació, registre i consulta. Integrada amb el portal ripollet.cat, implementa les tecnologies per al tractament de l'acreditació d'usuaris mitjançant certificació digital i la generació dinàmica de documents signats electrònicament. Dins el marc d'execució de la llei 11/2007 d'accés electrònic dels ciutadans als serveis públics, és un gran primer pas en el llarg camí amb destinació a una Administració electrònica completa i de qualitat.
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BACKGROUND: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. METHODS: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. RESULTS: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. CONCLUSION: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive interventions.
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RésuméCette thèse traite d'un domaine d'application de l'écologie industrielle, les symbioses industrielles, comme stratégie d'amélioration de la consommation des ressources matérielles et énergétiques et de la gestion des déchets par les activités économiques. Les symbioses industrielles cherchent à créer de nouvelles collaborations directement entre les acteurs économiques d'un territoire dans le but d'échanger de l'information, des matières premières et des déchets, et d'intensifier les mutualisations de services et d'infrastructures possibles entre entreprises voisines. Ces quatre types de collaboration sont représentés schématiquement dans la figure ci-dessous.Dans ce travail, la détection et la mise en oeuvre de symbioses industrielles sont abordées sous plusieurs angles. Les recherches réalisées concernent le développement de procédures de mise en oeuvre s'adressant aux collectivités publiques, aux institutions académiques et aux bureaux de conseil dans le domaine de l'environnement. Les objectifs des procédures sont de créer une dynamique de collaboration et de confiance entre les acteurs économiques et l'administration publique d'un territoire afin de détecter des symbioses industrielles potentielles. Ces procédures requièrent la gestion de grandes quantités d'informations relatives aux flux de matière et d'énergie.Un travail de terrain, réalisé sur les territoires du canton de Genève et de Lausanne Région et utilisé comme études de cas, a permis de mettre en évidence un grand nombre de symbioses industrielles qui existent déjà en Suisse romande. Plusieurs dizaines d'exemples ont été identifiés principalement dans lesdomaines de la gestion de l'eau, de l'énergie, des produits chimiques et des matériaux de construction. La législation suisse autoriserait cependant la concrétisation de nombreuses autres opportunités. Dans cette recherche, celles-ci sont évaluées techniquement, légalement, économiquement et environnementalement. La création d'un référentiel d'évaluation des opportunités permet de déterminer quelles sont les symbioses industrielles techniquement réalisables et pertinentes dans le contexte suisse et dans quels cas celles-ci représenteraient une réelle plus-value par rapport à l'utilisation actuelle de la ressource et aux filières existantes de collecte et de valorisation des déchets.Finalement, un logiciel, SymbioGIS, destiné à soutenir la détection et l'évaluation de symbioses industrielles potentielles a été développé. Il s'agit d'une interface web accessible pour de nombreux utilisateurs, couplée à une interface de systèmes d'information géographique. En plus de la détection de symbioses industrielles, plusieurs fonctionnalités sont proposées pour faciliter la prise en compte des flux de matière et d'énergie dans les problématiques liées à l'aménagement du territoire et au positionnement des activités économiques.En conclusion, cette recherche met en évidence la nécessité de rapprocher les institutions publiques en charge de la protection de l'environnement, de la promotion économique et de l'aménagement du territoire pour favoriser l'essor des symbioses industrielles comme stratégie pour la gestion des ressources matérielles et énergétiques. Elle propose des pistes pour intensifier les collaborations entre ces domaines et accélérer le partage des connaissances liées aux flux de matière et d'énergie et à leur cheminement au sein des activités économiques afin de rendre le système industriel existant en Suisse romande viable à long terme. Parallèlement, elle étudie les possibilités de transposer ces considérations et les procédures et outils développés dans le contexte économique et social de la région Asie-Pacifique, où se trouvent aujourd'hui de nombreuses activités de production.SummaryIndustrial symbioses: A new strategy for improving how economic activities use material and energy resourcesThis thesis focuses on one application of industrial ecology, industrial symbioses, as a strategy for improving how economic activities consume material and energy resources. Industrial symbioses seek to create new collaborations among economic players with the goal of exchanging information, raw materials, and waste directly among area businesses, and to step up the potential pooling of services and infrastructure among neighboring companies.The identification and implementation of industrial symbioses are studied from several angles. The research first examines the development of implementation procedures for government bodies, academic institutions, and environmental consulting services. The purpose of the procedures is to create a dynamic of collaboration and trust between the economic players and the public officials in a region in order to identify potential industrial symbioses. The procedures necessitate managing large amounts of information about material and energy flows.Fieldwork conducted in the canton of Geneva and the Lausanne region, and used as case studies for the research, highlights a great number of industrial symbioses that already exist in French-speaking Switzerland. Several dozen examples are identified, primarily in the areas of water management, energy, chemical products, and building materials; however, Swiss law would permit many others. The research evaluates these opportunities from a technical, legal, economic, and environmental standpoint. By developing an assessment framework it is possible to determine which industrial symbioses are technically feasible and pertinent in Switzerland, and under what circumstances they would represent real added value compared to the current use of the resource and to existing systems for collecting and reusing waste.Lastly, SymbioGIS software was developed to help identify and assess potential industrial symbioses. The program's Web-based interface can be accessed by multiple users and is coupled with an interface that provides geographic information. In addition to identifying industrial symbioses, several program functionalities make it easier to consider material and energy flows with regard to local development issues and siting economic activities.In conclusion, the research highlights the need to bring together public institutions charged with protecting the environment, promoting economic activity, and overseeing development in order to foster the expansion of industrial symbioses as a strategy for managing material and energy resources. It proposes solutions for stepping up collaboration among these players and accelerating the sharing of knowledge about material and energy flows and their paths within economic activities with the goal of making theexisting industrial system in French-speaking Switzerland viable long-term. Also examined were thepossibilities of transposing these considerations and the study's findings about Switzerland to the economic and social context of the Asia-Pacific region, where much production is now located.