917 resultados para Bilateral balanced occlusion
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Dissertação apresentada ao Instituto Superior de Contabilidade e Administração do Porto para obtenção do Grau de Mestre em Empreendedorismo e Internacionalização Orientadora: Professora Doutora Celsa Maria de Carvalho Machado
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Traditional vertically integrated power utilities around the world have evolved from monopoly structures to open markets that promote competition among suppliers and provide consumers with a choice of services. Market forces drive the price of electricity and reduce the net cost through increased competition. Electricity can be traded in both organized markets or using forward bilateral contracts. This article focuses on bilateral contracts and describes some important features of an agent-based system for bilateral trading in competitive markets. Special attention is devoted to the negotiation process, demand response in bilateral contracting, and risk management. The article also presents a case study on forward bilateral contracting: a retailer agent and a customer agent negotiate a 24h-rate tariff.
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Atualmente, existe uma constante necessidade de inovação tecnológica e organizacional das empresas, face às exigências do mercado e ao aumento constante da competitividade. No contexto da economia atual, e para contrariar a falta de investimento dos últimos anos, as empresas concentram-se no desenvolvimento de negócios bem estruturados e organizados, que satisfaçam as exigências de cada cliente. Revela-se, assim, muito importante a avaliação de desempenho para o alcance do seu sucesso, permitindo alinhar as atividades operacionais com a visão organizacional, fomentar a comunicação da estratégia e gerir o seu desempenho. É neste contexto que ganha importância o Balanced Scorecard, um instrumento que permite avaliar o desempenho organizacional, funcionando também como uma ferramenta de gestão. Tem, portanto, como principais objetivos definir claramente uma estratégia, definir objetivos, indicadores e medidas estratégicas, planear e estabelecer metas e melhorar continuamente os resultados obtidos. Esta ferramenta analisa a organização em quatro diferentes perspetivas: financeira, clientes, processos internos e apendizagem e crescimento. Cada uma delas deve estrututrar os seus próprios objetivos, indicadores, metas e iniciativas de forma a contribuir para o desenvolvimento da estratégia da organização e avaliar o seu desempenho. O desafio deste relatório é adaptar esta metodologia durante a realização de um estágio curricular na empresa Bysteel, que tem por base a implementação de um processo de gestão estratégica nas suas empreitadas, através do Balanced Scorecard. Este planemamento surge como um dos principais requisitos para uma gestão eficaz de custos e de tempo planeados para cada empreitada da Bysteel. Este processo torna-se bastante complexo dado que cada obra apresenta diferentes particularidades. A implementação desta metodologia numa empresa desta dimensão é um fator muito motivador, tornando-se ainda mais interessante pelo facto de se tratar de uma implementação numa nova vertente.
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A avaliação do desempenho das Organizações sem fins lucrativos (OSFL) tornou-se para os gestores um dos desafios mais importantes na atualidade. O estudo visa analisar a implementação do Balanced Scorecard (BSC) nas associações mutualistas, uma das formas legais de instituição das OSFL. Os principais objetivos são verificar se o BSC é adotado por estas organizações, quais as alterações necessárias para a sua implementação e por último, as vantagens e desvantagens inerentes dessa aplicação. O método de investigação utilizado foi o estudo de caso. Como procedimentos foram selecionados a análise documental, dos decretos-lei e código das Associações Mutualistas, os questionários e uma entrevista. As associações analisadas foram escolhidas com base na sua filiação na União das Mutualidades (UM), uma associação de grau superior. Apesar da evidência recolhida mostrar que o BSC não é implementado, são reconhecidas vantagens superiores às limitações para uma gestão mais eficaz. Adicionalmente os resultados sugerem que a estrutura do BSC teria de ser diversa daquela que está subjacente ao setor empresarial. Inicialmente o BSC era dirigido para organizações com fins lucrativos, pelo que a falta de informação e a necessidade de alteração desta ferramenta de gestão não tenha despertado o interesse na sua implementação. Contudo, os potenciais desta aplicação são reconhecidos.
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Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.
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Traditional approaches to evaluate performance in hotels, have mainly used financial measures. Building on Speckbacher et al. (2003), this Work Project aims to design and propose a Balanced Scorecard Type II as a performance measurement/management system for the hospitality industry based on data collected at the Luxury Brand Hotels of Pestana Group. The main contribution is to better align the vision, strategy and financial and non-financial performance measures in this category of hotels, in particular those of Pestana Group, and by doing so, lead their managers to focus on what is really critical and, consequently improve the overall performance.
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Pontine ischemia usually results in focal deficits such as hemiparesis, facial palsy, dysarthria, disorders of eye movements or vertigo. Although rarely described, involuntary abnormal movements and "convulsions" due to pontine lesions can also occur. Here we describe a 67-year-old woman with hypertension who presented with a tonic movement mimicking a versive seizure in the acute phase of bilateral pontine ischemia. Post-stroke movement disorders are well known. They are usually associated with supratentorial lesions and rarely occur in the acute phase, but "seizure-like" episodes can be seen in pontine ischemia. Awareness of this rare phenomenon is useful for the management of acute stroke patients.
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BACKGROUND AND PURPOSE: Surgical clipping of unruptured intracranial aneurysms (UIAs) has recently been challenged by the emergence of endovascular treatment. We performed an updated systematic review and meta-analysis on the surgical treatment of UIAs, in an attempt to determine the aneurysm occlusion rates and safety of surgery in the modern era. METHODS: A detailed protocol was developed prior to conducting the review according to the Cochrane Collaboration guidelines. Electronic databases spanning January 1990-April 2011 were searched, complemented by hand searching. Heterogeneity was assessed using I(2), and publication bias with funnel plots. Surgical mortality and morbidity were analysed with weighted random effect models. RESULTS: 60 studies with 9845 patients harbouring 10 845 aneurysms were included. Mortality occurred in 157 patients (1.7%; 99% CI 0.9% to 3.0%; I(2)=82%). Unfavourable outcomes, including death, occurred in 692 patients (6.7%; 99% CI 4.9% to 9.0%; I(2)=85%). Morbidity rates were significantly greater in higher quality studies, and with large or posterior circulation aneurysms. Reported morbidity rates decreased over time. Studies were generally of poor quality; funnel plots showed heterogeneous results and publication bias, and data on aneurysm occlusion rates were scant. CONCLUSIONS: In studies published between 1990 and 2011, clipping of UIAs was associated with 1.7% mortality and 6.7% overall morbidity. The reputed durability of clipping has not been rigorously documented. Due to the quality of the included studies, the available literature cannot properly guide clinical decisions.
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BACKGROUND AND PURPOSE: None of the randomized trials of intravenous tissue-type plasminogen activator reported vascular imaging acquired before thrombolysis. Efficacy of tissue-type plasminogen activator in stroke without arterial occlusion on vascular imaging remains unknown and speculative. METHODS: We performed a retrospective, multicenter study to collect data of patients who presented to participating centers during a 5-year period with ischemic stroke diagnosed by clinical examination and MRI and with imaging evidence of no vascular occlusion. These patients were divided into 2 groups: those who received thrombolytic therapy and those who did not. Primary outcome measure of the study was excellent clinical outcome defined as modified Rankin Scale of 0 to 1 at 90 days from stroke onset. Secondary outcome measures were good clinical outcome (modified Rankin Scale, 0-2) and perfect outcome (modified Rankin Scale, 0). Safety outcome measures were incidence of symptomatic intracerebral hemorrhage and poor outcome (modified Rankin Scale, 4-6). RESULTS: A total of 256 patients met study criteria, 103 with thrombolysis and 153 without. Logistic regression analysis showed that patients who received thrombolysis had more frequent excellent outcomes with odds ratio of 3.79 (P<0.01). Symptomatic intracerebral hemorrhage was more frequent in thrombolysis group (4.9 versus 0.7%; P=0.04). Thrombolysis led to more frequent excellent outcome in nonlacunar group with odds ratio 4.90 (P<0.01) and more frequent perfect outcome in lacunar group with odds ratio 8.25 (P<0.01). CONCLUSIONS: This study provides crucial data that patients with ischemic stroke who do not have visible arterial occlusion at presentation may benefit from thrombolysis.
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The molecular characterization of balanced chromosomal rearrangements have always been of advantage in identifying disease-causing genes. Here, we describe the breakpoint mapping of a de novo balanced translocation t(7;12)(q11.22;q14.2) in a patient presenting with a failure to thrive associated with moderate mental retardation, facial anomalies, and chronic constipation. The localization of the breakpoints and the co-occurrence of Williams-Beuren syndrome and 12q14 microdeletion syndrome phenotypes suggested that the expression of some of the dosage-sensitive genes of these two segmental aneuploidies were modified in cells of the proposita. However, we were unable to identify chromosomes 7 and/or 12-mapping genes that showed disturbed expression in the lymphoblastoids of the proposita. This case showed that position-effect might operate in some tissues, but not in others. It also illustrates the overlap of phenotypes presented by patients with the recently described 12q14 structural rearrangements.