Pain and tactile stimuli during arterial puncture in preterm neonates

The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antispsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P): Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the National Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increases in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL an BR phases. There was evidence of distress responses immediately before and after a painful event, quite apart form the pain reaction to the puncture procedure. Published by Elsevier B.V. on behalf of International Association for the Study of Pain.

Programa de competências pessoais e sociais para adultos em exclusão social

Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 8 Interculturalidad, inclusión social y educación. Universidad da Coruña, 3 de Setembro de 2015.

A gestão e avaliação do risco: perspectiva das organizações e da auditoria no sector público

Mestrado em Auditoria

Análise estocástica com recurso a ferramentas informáticas no planeamento de empreitadas de construção

O presente trabalho, desenvolvido sob a orientação do Prof. Jaime Gabriel Silva, centra-se na procura e aplicação de metodologias de planeamento com apoio de ferramentas informáticas de análise de risco, que permitem realizar, em tempo útil, o cálculo dos prazos resultantes de inúmeras combinações possíveis associadas à incerteza das durações das atividades, recorrendo a modelos estocásticos. O trabalho aborda inicialmente o contexto da Gestão na Construção, com particular enfase na Gestão do Risco. Nessa fase inicial, fez-se também um pequeno inquérito a profissionais com diferentes níveis de responsabilidade organizacional e empresas do setor. A parte fundamental do trabalho, incide nos procedimentos a adotar na elaboração do planeamento de empreitadas. Nesta parte do trabalho, introduzem-se os conceitos da análise de risco com recurso a uma ferramenta informática de apoio, o @Risk, que permite a utilização do Método de Monte Carlo, para obtenção de resultados num contexto de uma tomada de decisão baseada no risco. Refira-se que houve vários contactos com o fornecedor do programa, que permitiram tirar partido de outro programa da Palisade, Evolver, direcionado para otimização matemática, podendo ser utilizado, por exemplo, na perspetiva da minimização dos custos, o que pode interessar pela relação destes com as opções adotadas na elaboração do planeamento de empreendimentos. Finalmente, toma-se um exemplo real do planeamento de uma empreitada em execução à data da realização deste trabalho, onde se aplicaram os conceitos desenvolvidos no trabalho, confrontando os resultados com o andamento da obra.

A responsabilidade pela gestão dos riscos de negócio

Dissertação de Mestrado Apresentada ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria, sob orientação do Dr. Carlos Mendes

Crowdsourcing innovation: a proposal for a brokering architecture focused in the innovation needs of SMEs

Crowdsourcing is evolving into powerful outsourcing options for organizations by providing access to the intellectual capital within a vast knowledge community. Innovation brokering services have emerged to facilitate crowdsourcing projects by connecting up companies with potential solution providers within the wider ‘crowd’. Most existing innovation brokering services are primarily aimed at larger organizations, however, Small and Medium Enterprises (SMEs) offer considerable potential for crowdsourcing activity since they are typically the innovation and employment engines in society; they are typically more nimble and responsive to the business environment than the larger companies. SMEs have very different challenges and needs to larger organizations since they have fewer resources, a more limited knowledge and skill base, and immature management practices. Consequently, innovation brokering for SMEs require considerably more support than for larger organizations. This paper identifies the crowdsourcing innovation brokerage facilities needed by SMEs, and presents an architecture that encourages knowledge sharing, development of community, support in mixing and matching capabilities, and management of stakeholders’ risks. Innovation brokering is emerging as a novel business model that is challenging concepts of the traditional value chain and organizational boundaries.

Fístula gastrocolocutánea: una infrecuente complicación de la gastrostomía endoscópica percutánea

Endoscopic percutaneous gastrostomy is a safe technique although with potential complications before which the clinician has to be on alert in order to early detect them even after a long period of normal functioning. Most of them represent minor problems. Gastrocolocutaneous fistula is a rare but severe complication favored by some risk factors such as previous post-surgical adherences, deformities of the spine, or excessive gastric inflation at the time of performing the technique. We present the case of a patient with PEG with this complication that occurred after the first tube replacement. Our goal was in two senses: on the one hand, to analyze the preventive aspects and basic guidelines for a safe PEG placement to minimize the risks; on the other hand, to alert on the possible presence of this entity to prevent a progressive nutritional impairment. This complication ought to be included in the differential diagnosis of the diarrhea syndrome in the patient carrying a PEG. The diagnostic techniques of choice are radiologic tests such as CT scan and contrast media administration through the tube. Surgical therapy should be reserved to patients with acute peritonitis in order to perform a new gastrostomy.

Liver safety assessment: required data elements and best practices for data collection and standardization in clinical trials.

A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials. In a breakout session, workshop attendees discussed necessary data elements and standards for the accurate measurement of DILI risk associated with new therapeutic agents in clinical trials. There was agreement that in order to achieve this goal the systematic acquisition of protocol-specified clinical measures and lab specimens from all study subjects is crucial. In addition, standard DILI terms that address the diverse clinical and pathologic signatures of DILI were considered essential. There was a strong consensus that clinical and lab analyses necessary for the evaluation of cases of acute liver injury should be consistent with the US Food and Drug Administration (FDA) guidance on pre-marketing risk assessment of DILI in clinical trials issued in 2009. A recommendation that liver injury case review and management be guided by clinicians with hepatologic expertise was made. Of note, there was agreement that emerging DILI signals should prompt the systematic collection of candidate pharmacogenomic, proteomic and/or metabonomic biomarkers from all study subjects. The use of emerging standardized clinical terminology, CRFs and graphic tools for data review to enable harmonization across clinical trials was strongly encouraged. Many of the recommendations made in the breakout session are in alignment with those made in the other parallel sessions on methodology to assess clinical liver safety data, causality assessment for suspected DILI, and liver safety assessment in special populations (hepatitis B, C, and oncology trials). Nonetheless, a few outstanding issues remain for future consideration.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

A gestão das Instituições de Ensino Superior está a ser repensada num contexto de globalização tendo em conta a missão destas, a responsabilidade e a sua cultura (ou culturas), impondo-se novos modelos de gestão e governação. A Qualidade e a Responsabilidade Social do Ensino Superior constituem um tema pertinente e actual. As transformações estruturais que as sociedades atravessam aconselham e justificam da parte do Ensino Superior uma atitude consentânea com as necessidades daquelas. Os desafios que, as Instituições de Ensino Superior enfrentam, exigem novas perspectivas estratégicas e nova visão perante cenários de incerteza que surgem a nível mundial, desempenhando a liderança um papel fundamental na qualidade destas instituições. Neste sentido, lança-se no presente estudo, a seguinte questão: Que Modelos de Gestão e Governação contribuem para a melhoria da Qualidade no Ensino Superior? A metodologia utilizada para a realização deste estudo passa pelo delineamento de uma estratégia com cinco fases: elaboração de um plano ajustável à evolução do trabalho, levantamento do estado da arte de uma forma gradual, trabalho de pesquisa e criação, escrita da tese e análise crítica e reflexão. Para além de outros aspectos relevantes no domínio do Ensino Superior, foram estudados diversos modelos, Modelos de Excelência, modelos para implementação de Sistemas de Gestão da Qualidade, Gestão Ambiental, Gestão da Segurança e Saúde do Trabalho, Gestão de Risco; entre outros. Criaram-se diversos Indicadores de Responsabilidade Social neste contexto e foi feito um estudo piloto no âmbito da Responsabilidade Social em Instituições de Ensino Superior. Por último, destacaram-se as conclusões que decorrem do estudo piloto efectuado, bem como reflexões que surgem da investigação teórica realizada. O estudo piloto efectuado permitiu concluir, por exemplo, que existem indícios de algum alheamento no seio das Instituições às temáticas relacionadas com os princípios éticos e com a educação ambiental. Por outro lado, uma grande parte dos indivíduos inquiridos disseram não ter qualquer opinião quando confrontados com questões sobre Participação Social Responsável, Investigação Socialmente Útil e Gestão Social do Conhecimento. Conclui-se que as questões para as pessoas ainda são muito vagas, daí que, faça sentido o debate de todas estas questões, bem como estudos que contribuam para uma mudança de paradigma relativamente à educação, e em particular no Ensino Superior, com vista à qualidade, num sentido abrangente.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

Asset pricing implications of benchmarking: A two-factor CAPM

In this paper we consider the equilibrium effects of an institutionalinvestor whose performance is benchmarked to an index. In a partialequilibrium setting, the objective of the institutional investor is modeledas the maximization of expected utility (an increasing and concave function,in order to accommodate risk aversion) of final wealth minus a benchmark.In equilibrium this optimal strategy gives rise to the two-beta CAPM inBrennan (1993): together with the market beta a new risk-factor (that wecall active management risk) is brought into the analysis. This new betais deffined as the normalized (to the benchmark's variance) covariancebetween the asset excess return and the excess return of the market overthe benchmark index. Different to Brennan, the empirical test supports themodel's predictions. The cross-section return on the active management riskis positive and signifficant especially after 1990, when institutionalinvestors have become the representative agent of the market.

La probabilidad de supervivencia en un modelo con reaseguro proporcional de umbral

[spa] En este artículo presentamos una nueva estrategia de reaseguro, a la que denominamos estrategia de reaseguro umbral, que actúa de forma diferente en función del nivel de las reservas. Así, para unos niveles de las reservas inferiores a un determinado nivel, el gestor decide aplicar un reaseguro proporcional, y para niveles superiores, al considerar que se ha alcanzado cierta solvencia en la cartera, opta por no ceder ningún porcentaje del riesgo. El análisis del efecto de la introducción del reaseguro umbral sobre la probabilidad de supervivencia, y su comparación con el reaseguro proporcional y la opción de no reasegurar, nos permite hallar estrategias de reaseguro equivalentes desde el punto de vista de la solvencia. Palabras clave: teoría del riesgo, reaseguro de umbral, reaseguro proporcional, probabilidad de supervivencia.