Caracterização dos processos de manutenção em equipamentos eletromédicos hospitalares

Atualmente existe uma gama considerável de procedimentos assistenciais de saúde os quais, seja por cultura, ou por exigências legais, só podem ser realizados com aporte tecnológico. Logo reduzir o tempo de parada de um equipamento médico está diretamente associado à viabilização da assistência necessária ao paciente. Em outras palavras, prestar uma manutenção otimizada representa qualidade na prestação de serviço da unidade assistencial de saúde, podendo em alguns casos, até, evitar a morte do paciente. Para isso é muito importante que os defeitos sejam reconhecidos e tratados adequadamente, não se esquecendo da otimização dos recursos financeiros. Com base nesta premissa, este trabalho propõe estabelecer uma relação dos tipos de defeitos apresentados pelos equipamentos com sua ocorrência, utilizando para tal o método de Pareto, fornecendo uma ferramenta de análise de grande utilidade na estruturação de grupos de manutenção corretiva de um serviço de engenharia clínica. Assim foram tomados como amostra quatro tipos de equipamentos que são eletrocardiógrafos, monitores cardíacos, unidades eletrocirúrgicas e incubadoras neonatais; caracterizando a existência de defeitos que podem ser classificados em baixa, média e alta complexidade de resolução, o que reflete na necessidade de ferramentas gerais ou específicas ao reparo e do nível de qualificação da equipe técnica, além do universo de componentes, partes e peças envolvidas com cada etapa de manutenção. Foram qualificados e quantificados defeitos para cada tipo de equipamentos acima, onde se constatou que nos equipamentos médico-hospitalares estudados, a maioria das paradas requisitou intervenções simples, de baixa complexidade. Ou seja, poucos defeitos foram responsáveis por muitas ordens de serviço e que o corpo técnico de manutenção pode esperar e se programar para atuar em cada um deles de acordo com o gráfico de Pareto. Desta forma o serviço de engenharia clínica pode ser direcionado para as necessidades prioritárias do estabelecimento assistencial de saúde, sendo capaz de produzir resultados com melhor custo-benefício.

Limitações aos deveres instrumentais tributários (aplicação do art. 113, §2º do código tributário nacional)

Pouca atenção tem merecido o estudo dos deveres instrumentais tributários pelos estudiosos do direito tributário em nosso país, com a preocupação de conferir contornos nítidos ao regime jurídico dos deveres instrumentais dentro do sistema tributário brasileiro e, em especial, de examinar a quais limitações está adstrita a Administração Pública na imposição desses deveres. O presente trabalho visa tentar suprir, em alguma medida, essa lacuna, promovendo uma análise das limitações à imposição de deveres instrumentais tributários, que leve em consideração, não apenas os princípios que conformam seu regime jurídico, mas, principalmente, a existência de regras objetivas disciplinando o tema, partindo-se da premissa de que, genericamente, dicções principiológicas, por sua abstração, não são suficientes para a adequada regulação das condutas intersubjetivas, seja entre particulares, seja entre estes e o Poder Público. Merecerá especial atenção a regra inserta no art. 113, §2º do Código Tributário Nacional, de forte vocação limitadora, especificamente no que tange à investigação do conteúdo semântico da expressão interesse da arrecadação ou da fiscalização dos tributos, que, a nosso ver, constitui a pedra-de-toque do regime jurídico dos deveres instrumentais e das sanções punitivas impostas em virtude de seu descumprimento. Por fim, buscar-se-á conferir a devida importância aos custos de conformidades e demonstrar que seu estudo é relevante para o sistema tributário, na medida em que tais custos, enquanto efeito econômico da imposição de deveres instrumentais, implicam efeitos relevantes no âmbito jurídico, inclusive restrições no âmbito de proteção de direitos fundamentais dos contribuintes.

Differentiated effect of advertising: Joint vs. separate consumption

In a context of intense competition, cooperative advertising between firms is critical. Accordingly, the objective of this article is to analyze the potential differentiated effect of advertising on two basic consumption patterns: individual products (i.e. hotel, restaurant) vs. bundle (i.e. hotel + restaurant). This research adds to the extant literature in that, for the first time, this potential differentiated effect is examined through a hierarchical modelling framework that reflects the way people make their decisions: first, they decide whether to visit or not a region; second, whether to purchase an advertised product in that region; and third, whether to buy products together or separately at the region. The empirical analysis, applied to a sample of 11,288 individuals, shows that the influence of advertising is positive for the decisions to visit and to purchase; however, when it comes to the joint or separate consumption, advertising has a differentiated effect: its impact is much greater on the joint alternative (“hotel + restaurant”) than the separate options (“hotel” and “restaurant”). Also, the variable distance moderates the advertising effect.

Montague, Abigale, autographed letter signed to John Winthrop; Hadley, Mass., 1 side (2 pages), 1663 July 19

Correspondence about her seven-year-old daughter, who was suffering from inflammation and discharge from her eye, in which Montague requests Winthrop's advice on whether sarsaparilla root or English barley boiled with herbs would be an effective treatment. Montague adds a postscript about her own health, writing she has a "thick rotten fleame rising out of my stomach" but no cough.

Value of health - too often ignored and forgotten by EU policy-makers? EPC Commentary, 29 September 2014

Whether on national or European level, policy-makers tend to under-value health, healthy society, and healthy citizens in policy-making. As the European Commission continue to ponder how questions related to health should be reflected in EU policy-making and what role it should take, there are three issues to keep in mind: 1) there is a need to recognise health as a value, 2) health should be considered across policies, 3) the EU has the tools to promote a healthier European society.

The economic voter and economic crisis

Theories of economic voting have a long tradition in political science and continue to inspire a large group of scholars. Classical economic voting theory assumes a reward-and-punishment mechanism (Key, 1966). This mechanism implies that incumbents are more likely to stay in power under a good economy, but are cast out under a bad economy (Lewis-Beck and Stegmaier, 2000). The economy has repeatedly been shown to be a major determinant of electoral behavior (see especially the recent book by Duch and Stevenson, 2008), but the current economic crisis seems to provide a marked illustration of how the economy affects voting. In recent elections across the Western industrialized world, most ruling coalitions lost their majority. Opposition parties, on the other hand, whether right wing or left wing, have appeared to benefit from the economic downturn.

The tea-table miscellany: a collection of choice songs, Scots and English. Reprinted from the 14th ed.

Comprises four vols. first pub. in 1724, 1725, 1727, and 1732; it is doubtful whether Ramsay collected or edited the fourth vol.

Starting a business in Illinois : handbook.

The Illinois Entrepreneurship Network was established throughout the state to provide business management, counseling and training, assistance in entering international markets, information on competing for the state and federal contracts, developing technology related products and providing a supportive environment for new, startup businesses. This network consists of Small Business Development Centers, Procurement Technical Assistance Centers, International Trade/NAFTA Centers, Small Business Incubators and of course Entrepreneurship Centers. Assistance is provided in the areas of preparing business and marketing plans, securing capital, improving business skills, accessing international trade opportunities and addressing other business management needs. DCEO also has programs targeted to assist minority and women-owned business concerns. The Illinois Entrepreneurship Network is a collaborative arrangement among DCEO, the US Small Business Administration, the US Department of Defense, colleges and universities and private business organizations. Pursuant to the Business Assistance and Regulatory Reform Act, the Illinois Department of Commerce and Economic Opportunity (DCEO) created the IEN Business Information Center of Illinois (the Center). The goal of the Center is to enhance the state's business climate by making it easier for businesses to comply with government requirements and gain access to the information they need to be competitive. Whether a startup or existing business, this handbook will inform you of various legal requirements and guide you to additional resources.

The Inefficiency of Self-Sufficiency: Uzbekistan's Response to CASA-1000

Thesis (Master's)--University of Washington, 2016-06

Effects of purinergic stimulation, CFTR and osmotic stress on amiloride-sensitive Na+ transport in epithelia and Xenopus oocytes

Both stimulation of purinergic receptors by ATP and activation of the cystic fibrosis transmembrane conductance regulator (CFTR) inhibit amiloride-sensitive Na+ transport and activate Cl-secretion. These changes in ion transport may well affect cell volume. We therefore examined whether cell shrinkage or cell swelling do affect amiloride-sensitive Na+ transport in epithelial tissues or Xenopus oocytes and whether osmotic stress interferes with regulation of Na+ transport by ATP or CFTR. Stimulation of purinergic receptors by ATP/UTP or activation of CFTR by IBMX and forskolin inhibited amiloride-sensitive transport in mouse trachea and colon, respectively, by a mechanism that was Cl- dependent. When exposed to a hypertonic but not hypotonic bath solution, amiloride-sensitive Na+ transport was inhibited in mouse trachea and colon, independent of the extracellular Cl- concentration. Both inhibition of Na+ transport by hypertonic bath solution and ATP were additive. When coexpressed in Xenopus oocytes, activation of CFTR by IBMX and forskolin inhibited the epithelial Na+ channel (ENaC) in a Cl(-)dependent fashion. However, both hypertonic and hypotonic bath solutions showed only minor effects on amiloride-sensitive conductance, independent of the bath Cl- concentration. Moreover, CFTR-induced inhibition of ENaC could be detected in chocytes even after exposure to hypertonic or bypotonic bath solutions. We conclude that amiloride-sensitive Na+ absorption in mouse airways and colon is inhibited by cell shrinkage by a mechanism that does not interfere with purinergic and CFTR-mediated inhibition of ENaC.

Treatment with interferons (including pegylated interferons) in patients with hepatitis B

Studies of 4 to 6 months of treatment with interferon for hepatitis B e antigen (HBeAg)-positive chronic hepatitis B virus (HBV) infection have shown clearance of HBeAg to be higher in treated patients than it is in controls by approximately 25%. These results are considerably better than those with antiviral agents. Therefore, the recent European Association for the Study of the Liver (EASL) Consensus Committee recommended the use of interferon alpha for this condition. Treatment with pegylated interferons in several trials has shown better results still. Lamivudine in combination with interferon, however, did not improve the results at 6 months after the end of therapy. In HBeAg-negative chronic HBV infection, pegylated interferon alpha is superior to lamivudine, and, again, combination with lamivudine does not improve the results. Side effects in all studies have been tolerable. Thus, these observations in chronic HBV infection, whether HBeAg-positive or HBeAg-negative, suggest an important, even primary, role for pegylated interferon therapy.

Comparability of skin screening histories obtained by telephone interviews and mailed questionnaires: A randomized crossover study

The comparability of information collected through telephone interviews and information collected through mailed questionnaires has not been well studied. As part of the first phase of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors compared histories of skin examination reported in telephone interviews and self-administered mailed questionnaires. A total of 1,270 subjects each completed a telephone interview and a mailed questionnaire 1 month apart in 1999; 564 subjects received the interview first, and 706 received the mailed questionnaire first. Agreement between the two methods was 91.2% and 88.6% for whole-body skin examination by a physician in the last 12 months and the last 3 years, respectively, and 81.9% for whole-body skin self-examination in the last 12 months. Agreement was lower for any skin self-examination. Agreement between the two methods was similar regardless of whether the interview or the questionnaire was administered first. Missing data were less frequent for interviews (0.5%) than for mailed questionnaires (3.8%). Costs were estimated at A$9.55 (US$6.21) per completed interview and A$3.01 (US$1.96) per questionnaire. The similarity of results obtained using telephone interviews and mailed questionnaires, coupled with the substantially higher cost of telephone interviews, suggests that self-administered mailed questionnaires are an appropriate method of assessing this health behavior.

A Complementary Economy? National Markets and International Product in Early Australian Theatre Managements

The international circulation of commercial theatre in the early twentieth century was driven not only from the centres of Great Britain and the USA, but by the specific enterprise and habitus of managers in ‘complementary’ production sites such as Australia, South Africa, and New Zealand. The activity of this period suggests a de-centred competitive trade in theatrical commodities – whether performers, scripts, or productions – wherein the perceived entertainment preferences and geographies of non-metropolitan centres were formative of international enterprise. The major producers were linked in complex bonds of partnerships, family, or common experience which crossed the globe. The fractures and commonalities displayed in the partnerships of James Cassius Williamson and George Musgrove, which came to dominate and shape the fortunes of the Australian industry for much of the century, indicate the contradictory commercial and artistic pressures bearing upon entrepreneurs seeking to provide high-quality entertainment and form advantageous combinations in competition with other local and international managements. Clarke, Meynell and Gunn mounted just such spirited competition from 1906 to 1911, and their story demonstrates both the opportunities and the centralizing logic bearing upon local managements shopping and dealing in a global market. The author, Veronica Kelly, works at the University of Queensland. She is presently undertaking a study of commercial stars and managements in late nineteenth- and early twentieth-century Australia, with a focus on the star performer as model of history, gender, and nation.

Greetings from the cybercaliphate: some notes on homeland insecurity

One of the paradoxical effects of the 7 July bombings in London was to expose the ambivalence in the British government's attempt to wage war on terror by forcefully prosecuting war against those who resort to jihad abroad, actively participating in coalitions of the wining whether in Afghanistan or Iraq, while affording some of Islamism's key ideologists and strategists a high degree of latitude in the United Kingdom itself. This indicates a number of contradictions in official policy that simultaneously recognizes the globalized threat from violent Islamic militancy while, under the rubric of multiculturalism, tolerating those very strains of Islamist radicalism, some of which draw upon the interdependent and transnational character of conflict, to render the UK vulnerable to those very same violent forces. Consequently, the British authorities displayed a studied indifference towards this developing transnational phenomenon both during the 1990s and in some respects even after the London bombings. To explore the curious character of the government's response to the Islamist threat requires the examination of the emergence of this radical ideological understanding and what it entails as a reaction to modernization and secularism in both thought and practice. The analysis explores how government policies often facilitated the non-negotiable identity politics of those promoting a pure, authentic and regenerated Islamic order both in the UK and abroad. This reflected a profound misunderstanding of the growing source and appeal of radical Islam that can be interpreted as a consequence of the slow-motion collision between modernity in its recent globalized form and an Islamic social character, which renders standard western modernization theory, and indeed, the notion of a 'social science' itself, deeply questionable.

Attenuation of cardiovascular remodeling in DOCA-salt rats by the vasopeptidase inhibitor, omapatrilat

Omapatrilat, a vasopeptidase inhibitor, inhibits both neutral endopeptidase and angiotensin-converting enzyme with similar potency. The aim of this study was to investigate whether omapatrilat prevents or reverses cardiovascular remodeling and hypertension in deoxycorticosterone acetate (DOCA)-salt rats. Male Wistar rats (313 2 g, n=114) were uninephrectomized (UNX) with or without further treatment with DOCA and 1% NaCl in the drinking water. Compared with UNX control rats, DOCA-salt rats developed hypertension, cardiovascular hypertrophy, perivascular and interstitial cardiac fibrosis and inflammation, endothelial dysfunction, and the prolongation of ventricular action potential duration within four weeks. The administration of omapatrilat (40 mg/kg/day po) for two weeks commencing two weeks after surgery attenuated the development of cardiovascular hypertrophy, inflammation, fibrosis, and ventricular action potential prolongation. In contrast, omapatrilat treatment did not lower systolic blood pressure nor improve endothelial dysfunction. This study concludes that the renin-angiotensin-aldosterone, natriuretic peptide, and bradykinin systems are directly involved in the pathogenesis of cardiovascular remodeling in the DOCA-salt model of hypertension in rats, which may be independent of their effects on blood pressure.