87 resultados para CRD
Resumo:
Objective: to identify non-invasive interventions in the perinatal period that could enable midwives to offer effective support to women within the area of maternal mental health and well-being.
Methods: a total of 9 databases were searched: MEDLINE, PubMed, EBSCO (CINAHL/British Nursing Index), MIDIRS Online Database, Web of Science, The Cochrane library, CRD (NHS EED/DARE/HTA), Joanne Briggs Institute and EconLit. A systematic search strategy was formulated using key MeSH terms and related text words for midwifery, study aim, study design and mental health. Inclusion criteria were articles published from 1999 onwards, English language publications and articles originating from economically developed countries, indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Data were independently extracted using a data collection form, which recorded data on the number of papers reviewed, time frame of the review, objectives, key findings and recommendations. Summary data tables were set up outlining key data for each study and findings were organised into related groups. The methodological quality of the reviews was assessed based on predefined quality assessment criteria for reviews.
Findings: 32 reviews were identified as examining interventions that could be used or co-ordinated by midwives in relation to some aspect of maternal mental health and well-being from the antenatal to the postnatal period and met the inclusion criteria. The review highlighted that based on current systematic review evidence it would be premature to consider introducing any of the identified interventions into midwifery training or practice. However there were a number of examples of possible interventions worthy of further research including midwifery led models of care in the prevention of postpartum depression, psychological and psychosocial interventions for treating postpartum depression and facilitation/co-ordination of parent-training programmes. No reviews were identified that supported a specific midwifery role in maternal mental health and well-being in pregnancy, and yet, this is the point of most intensive contact.
Key conclusions and implications for practice: This systematic review of systematic reviews provides a valuable overview of the current strengths and gaps in relation to maternal mental health interventions in the perinatal period. While there was little evidence identified to inform the current role of midwives in maternal mental health, the review provides the opportunity to reflect on what is achievable by midwives now and in the future and the need for high quality randomised controlled trials to inform a strategic approach to promoting maternal mental health in midwifery.
Resumo:
Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.
Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.
Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.
Systematic review registration
PROSPERO CRD42013005608. (http://www.crd.york.ac.uk/PROSPERO/)
Resumo:
Este trabalho é uma análise dos efeitos da implementação das últimas recomendações do Basel Committee on Banking Supervision (BCBS) também conhecidas como o Basel III de 2010 que deverão ser faseadamente implementadas desde 1 de Janeiro de 2013 até 1 de Janeiro de 2019, no capital próprio dos bancos Portugueses. Neste trabalho assume-se que os ativos pesados pelo risco de 2012 mantêm-se constantes e o capital terá de ser aumentado segundo as recomendações ano após ano até ao fim de 2018. Com esta análise, pretende-se entender o nível de robustez do capital próprio dos bancos Portugueses e se os mesmos têm capital e reservas suficientes para satisfazer as recomendações de capital mínimo sugeridas pelo BCBS ou caso contrário, se necessitarão de novas injeções de capital ou terão de reduzir a sua atividade económica. O Basel III ainda não foi implementado em Portugal, pois a União Europeia está no processo de desenvolvimento e implementação do Credit Requirement Directive IV (CRD IV) que é uma recomendação que todos os bancos centrais dos países da zona Euro deverão impor aos respetivos bancos. Esta diretiva da União Europeia é baseada totalmente nas recomendações do Basel III e deverá ser implementada em 2014 ou nos anos seguintes. Até agora, os bancos Portugueses seguem um sistema com base no aviso 6/2010 do Banco de Portugal que recomenda o cálculo dos rácios core tier 1, tier 1 e tier 2 usando o método notações internas (IRB) de avaliação da exposição do banco aos riscos de crédito, operacional, etc. e onde os ativos ponderados pelo risco são calculados como 12,5 vezes o valor dos requisitos totais de fundos calculados pelo banco. Este método é baseado nas recomendações do Basel II que serão substituídas pelo Basel III. Dado que um dos principais motivos para a crise económica e financeira que assolou o mundo em 2007 foi a acumulação de alavancagem excessiva e gradual erosão da qualidade da base do capital próprio dos bancos, é importante analisar a posição dos bancos Portugueses, que embora não sejam muito grandes a nível global, controlam a economia do país. Espera-se que com a implementação das recomendações do Basel III não haja no futuro uma repetição dos choques sistémicos de 2007. Os resultados deste estudo usando o método padrão recomendado pelo BCBS mostram que de catorze bancos Portugueses incluídos neste estudo, apenas seis (BES, Montepio, Finantia, BIG, Invest e BIC) conseguem enquadrar nas recomendações mínimas do Basel III até 1-1- 2019 e alguns outros estão marginalmente abaixo dos rácios mínimos (CGD, Itaú e Crédito Agrícola).
Resumo:
RESUMO - A doença renal crónica (DRC) resulta da perda de função renal, sendo necessário a terapêutica de substituição, no estádio terminal. Em Portugal está atualmente em vigor o modelo de Gestão Integrada da Doença, que tem inerente o cumprimento de objetivos e metas pelas unidades de diálise. Uma alimentação adequada é um pilar fundamental ao sucesso do tratamento desta doença, o que torna o profissional de nutrição indispensável. Este trabalho pretendeu avaliar o cumprimento das metas e objetivos estabelecidos no modelo referido, e relacionar os resultados obtidos com a existência de contacto entre o profissional de nutrição e os pacientes. Para a persecução dos objetivos, foram analisadas duas bases de dados disponibilizadas pela Direção Geral da Saúde: a base de dados da Plataforma de Gestão Integrada da Doença Renal Crónica em 2012 e a do Questionário de Avaliação da Satisfação dos Doentes em Hemodiálise em 2013. Verificou-se uma melhoria contínua ao longo dos anos do cumprimento das metas e objetivos preconizados em Portugal para o tratamento da DRC, com um cumprimento da maioria no ano de 2012. No entanto, os parâmetros ferritina e albumina sérica ficaram aquém da recomendação. Observou-se um nível elevado de satisfação do paciente quanto ao trabalho do profissional de nutrição, apesar de ser frequente a inexistência de contacto entre ambas as partes. Os resultados obtidos demonstram também que o profissional de nutrição tem um papel importante para a obtenção de melhores resultados de saúde nos pacientes em tratamento por hemodiálise, pelo que se sugere um acompanhamento da totalidade deste tipo de população por este profissional.
Resumo:
L’introduction du développement durable apporte de nouvelles préoccupations environnementales au niveau de la construction et de la rénovation résidentielles, une industrie qui représente un marché économique important au Canada. En plus d’engendrer plusieurs impacts sur l’environnement, la conception actuelle ne permet pas d’accommoder le changement initié par l’évolution des pratiques, les avancées technologiques, mais également par l’évolution des patrons de vie des occupants. Dans un premier temps, la revue de littérature dresse le portrait de l’industrie de la construction, rénovation et démolition (CRD) au Canada, ainsi que le profil de gestion des débris de CRD. Ensuite, une analyse documentaire traite de différents outils de conception développés pour améliorer la performance du secteur : 3RV-E, écoconception, écoconstruction et LEED®. De plus, la recension des écrits permet également de cerner les concepts d’adaptabilité et de flexibilité au niveau du bâtiment et dans les approches et mouvements émergents en architecture. Cette démarche nous amène à établir l’hypothèse que l’intégration des critères d’adaptabilité et de flexibilité au niveau du logement aurait pour effet d’améliorer l’adéquation entre les besoins évolutifs des occupants et les nouvelles considérations environnementales. Au niveau méthodologique, l’analyse du cycle de vie simplifiée par l’Eco-indicator99 encadre l’analyse environnementale de l’ossature de trois types de construction de cloison. De cette évaluation, on conclut que c’est la construction traditionnelle à ossature de bois qui produit le moins d’impacts. Dans l’ordre suivant la proposition de construction de cloison à ossature d’aluminium, plus adaptable et flexible, et finalement la construction à ossature d’acier qui est le système le plus dommageable. Par contre, en intégrant le facteur temporel, cette analyse démontre que l’intégration de l’adaptabilité et de la flexibilité procure plusieurs cycles de vie et de rénovation au produit et à ses composantes. Finalement, ces concepts offrent également le potentiel de diminuer les impacts générés par la construction et la rénovation, un constat qui mériterait d’être abordé dans une approche plus systémique.
Resumo:
Rapport de stage présenté à la Faculté de médecine en vue de l'obtention du grade de Maître ès sciences appliquées (M.Sc.A.) en génie biomédical, option génie clinique.
Resumo:
Summary - Cooking banana is one of the most important crops in Uganda; it is a staple food and source of household income in rural areas. The most common cooking banana is locally called matooke, a Musa sp triploid acuminate genome group (AAA-EAHB). It is perishable and traded in fresh form leading to very high postharvest losses (22-45%). This is attributed to: non-uniform level of harvest maturity, poor handling, bulk transportation and lack of value addition/processing technologies, which are currently the main challenges for trade and export, and diversified utilization of matooke. Drying is one of the oldest technologies employed in processing of agricultural produce. A lot of research has been carried out on drying of fruits and vegetables, but little information is available on matooke. Drying of matooke and milling it to flour extends its shelf-life is an important means to overcome the above challenges. Raw matooke flour is a generic flour developed to improve shelf stability of the fruit and to find alternative uses. It is rich in starch (80 - 85%db) and subsequently has a high potential as a calorie resource base. It possesses good properties for both food and non-food industrial use. Some effort has been done to commercialize the processing of matooke but there is still limited information on its processing into flour. It was imperative to carry out an in-depth study to bridge the following gaps: lack of accurate information on the maturity window within which matooke for processing into flour can be harvested leading to non-uniform quality of matooke flour; there is no information on moisture sorption isotherm for matooke from which the minimum equilibrium moisture content in relation to temperature and relative humidity is obtainable, below which the dry matooke would be microbiologically shelf-stable; and lack of information on drying behavior of matooke and standardized processing parameters for matooke in relation to physicochemical properties of the flour. The main objective of the study was to establish the optimum harvest maturity window and optimize the processing parameters for obtaining standardized microbiologically shelf-stable matooke flour with good starch quality attributes. This research was designed to: i) establish the optimum maturity harvest window within which matooke can be harvested to produce a consistent quality of matooke flour, ii) establish the sorption isotherms for matooke, iii) establish the effect of process parameters on drying characteristics of matooke, iv) optimize the drying process parameters for matooke, v) validate the models of maturity and optimum process parameters and vi) standardize process parameters for commercial processing of matooke. Samples were obtained from a banana plantation at Presidential Initiative on Banana Industrial Development (PIBID), Technology Business Incubation Center (TBI) at Nyaruzunga – Bushenyi in Western Uganda. A completely randomized design (CRD) was employed in selecting the banana stools from which samples for the experiments were picked. The cultivar Mbwazirume which is soft cooking and commonly grown in Bushenyi was selected for the study. The static gravitation method recommended by COST 90 Project (Wolf et al., 1985), was used for determination of moisture sorption isotherms. A research dryer developed for this research. All experiments were carried out in laboratories at TBI. The physiological maturity of matooke cv. mbwazirume at Bushenyi is 21 weeks. The optimum harvest maturity window for commercial processing of matooke flour (Raw Tooke Flour - RTF) at Bushenyi is between 15-21 weeks. The finger weight model is recommended for farmers to estimate harvest maturity for matooke and the combined model of finger weight and pulp peel ratio is recommended for commercial processors. Matooke isotherms exhibited type II curve behavior which is characteristic of foodstuffs. The GAB model best described all the adsorption and desorption moisture isotherms. For commercial processing of matooke, in order to obtain a microbiologically shelf-stable dry product. It is recommended to dry it to moisture content below or equal to 10% (wb). The hysteresis phenomenon was exhibited by the moisture sorption isotherms for matooke. The isoteric heat of sorption for both adsorptions and desorption isotherms increased with decreased moisture content. The total isosteric heat of sorption for matooke: adsorption isotherm ranged from 4,586 – 2,386 kJ/kg and desorption isotherm from 18,194– 2,391 kJ/kg for equilibrium moisture content from 0.3 – 0.01 (db) respectively. The minimum energy required for drying matooke from 80 – 10% (wb) is 8,124 kJ/kg of water removed. Implying that the minimum energy required for drying of 1 kg of fresh matooke from 80 - 10% (wb) is 5,793 kJ. The drying of matooke takes place in three steps: the warm-up and the two falling rate periods. The drying rate constant for all processing parameters ranged from 5,793 kJ and effective diffusivity ranged from 1.5E-10 - 8.27E-10 m2/s. The activation energy (Ea) for matooke was 16.3kJ/mol (1,605 kJ/kg). Comparing the activation energy (Ea) with the net isosteric heat of sorption for desorption isotherm (qst) (1,297.62) at 0.1 (kg water/kg dry matter), indicated that Ea was higher than qst suggesting that moisture molecules travel in liquid form in matooke slices. The total color difference (ΔE*) between the fresh and dry samples, was lowest for effect of thickness of 7 mm, followed by air velocity of 6 m/s, and then drying air temperature at 70˚C. The drying system controlled by set surface product temperature, reduced the drying time by 50% compared to that of a drying system controlled by set air drying temperature. The processing parameters did not have a significant effect on physicochemical and quality attributes, suggesting that any drying air temperature can be used in the initial stages of drying as long as the product temperature does not exceed gelatinization temperature of matooke (72˚C). The optimum processing parameters for single-layer drying of matooke are: thickness = 3 mm, air temperatures 70˚C, dew point temperature 18˚C and air velocity 6 m/s overflow mode. From practical point of view it is recommended that for commercial processing of matooke, to employ multi-layer drying of loading capacity equal or less than 7 kg/m², thickness 3 mm, air temperatures 70˚C, dew point temperature 18˚C and air velocity 6 m/s overflow mode.
Resumo:
Existen en la actualidad múltiples modelos de gestión de conocimiento y medición del capital humano, los cuales son aplicados en las organizaciones, pero ninguno de éstos ha sido diseñado para Instituciones de Educación Superior. En este trabajo se hace un recuento de algunos de los modelos de gestión del conocimiento y capital intelectual más destacados como el Modelo de conversión del conocimiento de Nonaka y Takeuchi, el Modelo de GC de Arthur Andersen, el Cuadro de Mando Integral de Kaplan y Norton, entre otros, pero es a partir del Modelo Organizacional Estrella de Galbraith que se presenta una propuesta teórica para caracterizar un modelo de gestión del conocimiento aplicable a las funciones universitarias de investigación y extensión en la Universidad CES – Medellín, Colombia, a través de una investigación cualitativa en donde, a partir de la correlación entre la teoría general de la GC, particularmente de los modelos y el análisis de las características de la Universidad CES, así como la revisión sistemática, el grupo focal y el análisis documental se propone el Modelo Hexagonal de GC.
Resumo:
La enfermedad respiratoria crónica (ERC) es un problema de salud pública en Colombia, cuya gravedad va en aumento por la presencia de factores de riesgo, como el tabaquismo, que tienden a imponerse en poblaciones cada vez más jóvenes y que con el tiempo generan consecuencias a nivel físico, social y mental. La ERC comprende una serie de entidades clínicas con características propias, dadas por el sufrimiento, el aislamiento social, el deterioro fisiológico y la morbilidad asociada, que contribuyen a la limitación funcional, a la pérdida de la calidad de vida y, en definitiva, pueden convertir al individuo que la padece en un ser dependiente y sin futuro. Lo anterior lleva a un mayor consumo de recursos en salud sin que esto signifique una mejor atención, ya que en muchas oportunidades los esfuerzos aislados, la falta de normatividad, de propuestas sustentadas y el no uso de guías clínicas, entre otras causas, consienten que la intervención realizada esté destinada a paliar los síntomas presentes, pero lejos de abarcar un manejo integral, efectivo y que responda a necesidades individuales. En este artículo se pretende analizar las normas y políticas públicas que cobijan a los pacientes con ERC, los aspectos relacionados con los derechos a un tratamiento integral, seguro y real en el individuo afectado, así como los obstáculos para su realización.
Resumo:
A insuficiência renal crónica (IRC) é uma das doenças renais que afecta com mais incidência os animais de companhia, sendo a doença renal frequentemente mais diagnosticada no gato. O objetivo deste estudo consistiu determinar a distribuição de ocorrência dos diferentes níveis de estadiamento em pacientes diagnosticados com doença renal crónica, identificar os sinais mais comuns na apresentação clínica, avaliar os parâmetros bioquímicos e clínicos abrangidos no estadiamento e substadiamento, caracterizar os diversos estadios de doença de acordo com as características individuais (sexo, raça e idade), e determinar a existência de relação entre os parâmetros anteriores com o desenvolvimento e duração temporal de doença. O estudo contemplou uma amostra aleatória de 100 gatos com Insuficiência Renal Crónica (IRC) apresentados à consulta ou internados no Hospital Veterinário do Restelo, no período compreendido de Abril de 2011 a Maio de 2012 inclusive. Os animais foram estadiados e subestadiados segundo os valores propostos pela International Renal Interest Society (IRIS). O estudo serviu ainda, para compreender algumas limitações associadas aos exames complementares necessários ao estadiamento e subestadiamento da doença, que podem limitar um diagnóstico precoce. No estudo foi possível verificar que da distribuição de faixas etárias, os geriátricos são mais afectados, assim como o sinal clínico mais apresentado pelos pacientes foi PU/PD, seguido de anorexia e vómito. A maioria dos felinos encontra-se no estádio II (azotémia renal ligeira), vindo o número de indivíduos a diminuir com o aumento do grau dos estadios de doença.
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This Policy Brief provides a preliminary diagnosis of the proposed regulatory reforms contained in the Capital Requirements Directive and Regulation (CRD IV-CRR), which translate into EU law the Basel III standards adopted by the Basel Committee for Banking Supervision, and suggests avenues for improvement. The main criticism is that the proposal is not ambitious enough. In some crucial areas, such as the leverage ratio and the long-term liquidity requirements adopted under the Basel III framework, the CRD IV-CRR proposal stops short of making a strict commitment to introduce binding requirements and instead is contented with weaker (and possibly divergent) disclosure requirements.
Resumo:
Introdução. Danos no DNA mitocondrial (DNAmt) têm sido descritos em pacientes com doença renal crônica (DRC). Estes danos podem ser avaliados através da deleção 4977pb do DNAmt em diversos tecidos. Métodos. Identificamos a prevalência da deleção 4977pb do DNAmt através da técnica da reação em cadeia da polimerase (PCR) no sangue de pacientes com DRC em tratamento conservador (creatinina >2mg/dl) ou submetidos a hemodiálise. Resultados. A freqüência da ocorrência da deleção do DNAmt foi de 73.1% (38/52) nos pacientes com DRC submetidos a hemodiálise, 57.1% (27/42) nos pacientes com DRC em tratamento conservador e 27.8% (15/54) nos controles (P< 0.001). Não encontramos aumento da freqüência desta deleção em relação a idade dos pacientes com DRC (P= 0.54) ou ao tempo de diálise (P= 0.70). Conclusão. Danos no DNAmt podem ser induzidos pela DRC em especial nos pacientes submetidos a hemodiálise. Desta forma, a deleção 4977pb do DNAmt pode servir como um marcador de danos moleculares em pacientes com DRC.
Resumo:
Background: Diet compounds may influence obesity-related cardiac oxidative stress and metabolic sifting. Carbohydrate-rich diet may be disadvantageous from fat-rich diet to cardiac tissue and glycemic index rather than lipid profile may predict the obesity-related cardiac effects.Materials and methods: Male Wistar rats were divided into three groups (n=8/group): (C) receiving standard chow (3.0 kcal/g); (CRD) receiving carbohydrate-rich diet (4.0 kcal/g), and (FRD) receiving fat-rich diet (4.0 kcal/g). Rats were sacrificed after the oral glucose tolerance test (OGTT) at 60 days of dietary treatments. Lipid profile and oxidative stress parameters were determined in serum. Myocardial samples were used to determine oxidative stress, metabolic enzymes, glycogen and triacylglycerol.Results: FRD rats showed higher final body weight and body mass index than CRD and C. Serum cholesterol and low-density lipoprotein were higher in FRD than in CRD, while triacylglycerol and oxidized low-density lipoprotein cholesterol were higher in CRD than in FRD. CRD rats had the highest myocardial lipid hydroperoxide and diminished superoxide dismutase and catalase activities. Myocardial glycogen was lower and triacylglycerol was higher in CRD than in C and FRD rats. Although FRD rats had depressed myocardial-reducing power, no significant changes were observed in myocardial energy metabolism. Myocardial beta-hydroxyacyl coenzyme-A dehydrogenase and citrate synthase, as well as the enhanced lactate debydrogenase/citrate synthase ratio indicated that fatty acid degradation was decreased in CRD rats. Glycemic index was positively correlated with obesity-related cardiac effects.Conclusions: Isoenergetic carbohydrate-rich and fat-rich diets induced different degree of obesity and differently affected lipid profile. Carbohydrate-rich diet was deleterious relative to fat-rich diet in the heart enhancing lipoperoxidation and shifting the metabolic pathway for energy production. Glycemic index rather than dyslipidemic profile may predict the obesity effects on cardiac tissue. (C) 2007 Elsevier B.V. All rights reserved.
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The merozoite surface protein-2 (MSP-2) of Plasmodium falciparum comprises repeats flanked by dimorphic domains defining the allelic families FC27 and IC1. Here, we examined sequence diversity at the msp-2 locus in Brazil and its impact on MSP-2 antibody recognition by local patients. Only 25 unique partial sequences of msp-2 were found in 61 isolates examined. The finding of identical msp-2 sequences in unrelated parasites, collected 6-13 years apart, suggests that no major directional selection is exerted by variant-specific immunity in this malaria-endemic area. To examine antibody cross-reactivity, recombinant polypeptides derived from locally prevalent and foreign MSP-2 variants were used in ELISA. Foreign IC1-type variants, such as 3D7 (currently tested for human vaccination), were less frequently recognized than FC27-type and local IC1-type variants. Antibodies discriminated between local and foreign IC1-type variants, but cross-recognized structurally different local IC1-type variants. The use of evolutionary models of MSP-2 is suggested to design vaccines that minimize differences between local parasites and vaccine antigens. (C) 2004 Elsevier B.V. All rights reserved.
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O Brasil, terceiro maior produtor de biodiesel do mundo e terceiro maior produtor mundial de frango, pode incrementar, na sua matriz energética, o uso de óleo oriundo de aves como alternativa aos combustíveis fósseis e à redução da dependência do óleo de soja para esse fim. O país dispõe de mais de 350 milhões de litros de óleo de frango por ano. Considerando a aplicação dos combustíveis alternativos para os motores a diesel, em máquinas agrícolas, o trabalho teve por objetivo avaliar o desempenho do motor de um trator agrícola de 53kW acoplado pela TDP em bancada dinamométrica, operando com biodiesel metílico de óleo de frango e misturas com óleo diesel, sendo: B5 (testemunha), B20, B40, B60, B80 e B100. Avaliaram-se a potência, o torque, a reserva de torque, o consumo de combustível, o consumo de energia e a eficiência térmica do motor. O ensaio foi instalado com delineamento inteiramente casualizado (DIC) em esquema fatorial com seis tratamentos. Os resultados foram submetidos à análise de variância e as médias ajustadas por equações de regressão. Foram observadas perdas na geração de potência e torque, aumento no consumo de combustível, redução do consumo energético e melhoria na eficiência térmica do motor, de acordo com o aumento da proporção de biodiesel na mistura.