Use of hyaluronidase to prevent perineal trauma during spontaneous delivery: A pilot study

Our objective was to compare the frequency, degree, and location of perineal trauma during spontaneous delivery with or without perineal injections of hyaluronidase (HAase). This was a randomized, controlled pilot study, conducted in a midwifie-led hospital birth center in Sao Paulo, Brazil. Primiparous women (N = 139) were randomly assigned to an intervention group (HAase injection, n = 71) or to a control group (no injection, n = 68). Significant differences were noted between the two groups in frequency of perineal trauma (intervention, 39.4%; control, 76.5%), degree of spontaneous laceration (intervention, 0.0%; control, 82.4%), and laceration located in the posterior region of the perineum (intervention, 54.2%; control, 84.3%). When episiotomy and second-degree lacerations were considered together and women with intact perineum were excluded from the analysis, the difference between the groups was no longer significant. With the use of the HAase enzyme, the relative risk was 0.5 for perineal trauma and 0.0 for second-degree lacerations. The present findings suggest that perineal injection of HAase prevented perineal trauma. These findings provide strong rationale for a larger follow-up study.

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: Double-blind randomised controlled trial

Objective: to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery. Design: double-blind, randomised-controlled trial. Setting: a birth centre, in the city of Sao Paulo, Brazil. Participants: from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n = 16 per treatment per group). Interventions: an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5 ml) and to suture spontaneous lacerations (1 ml), followed by repeated doses (1 ml) until pain was completely inhibited. Measurements and findings: the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1 ml, 95% confidence interval (0) 0.4-1.6) and second-degree (3.7 ml, 95% CI 1.6-5.8) lacerations (p = 0.002 and 0.001, respectively). A 0.3 ml (95% CI 1.5-2.1) average decrease in anaesthetic volume was observed with episiotomy (p = 0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1-2 ml in 95% and 3-4 ml in 50% of first-degree lacerations, respectively, and 1-6 ml in 88% and 7-15 ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15 ml, regardless of anaesthetic solution used. Key conclusions: our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy. (C) 2007 Elsevier Ltd. All rights reserved.

Nasopharyngeal Intubation in Robin Sequence: Technique and Management

Objective: To provide a detailed description of the nasopharyngeal intubation (NPI) technique and photographs, which should be helpful for those who may need to perform it for treating the airway obstruction in Robin sequence. Design: To describe and illustrate the NPI technique and the necessary considerations for its application. Setting: Hospital de Reabilitacao de Anomalias Craniofacial of University of Sao Paulo, Brazil. Result: The NPI procedure involves the use of a whitish, Portex, number 3.0 or 3.5, silicone tube, introduced 8 cm deep into the infant`s nostril and fixed with Micropore tape. The tube is to be removed at least twice a day for proper hygiene (with running water, detergent, and swabs) and should be changed every 7 days. This procedure is taught to the children`s parents or caretakers by the nurse during hospitalization. Conclusion: The technique is so simple that it can be performed by the parents themselves, allowing continuation of the treatment at home.

The central role of human resource management in the search for sustainable organizations

The aim of this article is to present the main contributions of human resource management to develop sustainable organizations. The relationship between human resources and organizational sustainability, which is based on economical, social and environmental performance, involves some important aspects concerning management such as innovation, cultural diversity and the environment. The integration of items from the triple bottom line approach leads to developing a model based on a strategic and central posture of human resource management. Based on this model, propositions and recommendations for future research on this theme are presented.

Environmental management system and human resource practices: is there a link between them in four Brazilian companies?

The aim of this article is to analyze the theoretical model proposed by [Jabbour CJC, Santos FCA. Relationships between human resource dimensions and environmental management in companies: proposal of a model. Journal of Cleaner Production 2008;16(1):5 1-8.] based on the data collected in four Brazilian companies. This model investigates how the phases of the environmental management system can be linked to human resource practices in order to attain continuous improvement of a company`s environmental performance. Our aim is to contribute to a field, which has little empirical evidence. Although the interaction between the phases of the environmental management system and human resource practices is recommended by the specialized literature [Daily BE Huang S. Achieving sustainability through attention to human resource factors in environmental management. International Journal of Operations and Production Management 2001:21(12):1539-52.], the results indicate that most of the theoretical assumptions could not be confirmed in these Brazilian companies. (C) 2008 Elsevier Ltd. All rights reserved.

Relationships between human resource dimensions and environmental management in companies: proposal of a model

This work deals with the main contributions of human resource dimensions for the environmental management in a company. While the specialized literature concerning the technical aspects of environmental management expands, there is a gap in the bibliography: integrated approaches between human resource dimensions and environmental management. An extensive bibliographical review was undertaken in order to systematize the human resource dimensions and their contributions concerning the effectiveness of the environmental management system. A model that analyses the relationships between these dimensions and the typical phases of an environmental management system is presented, within a perspective of application for academicians and managers. (c) 2006 Elsevier Ltd. All rights reserved.

Integrating technology roadmapping and portfolio management at the front-end of new product development

Many authors point out that the front-end of new product development (NPD) is a critical success factor in the NPD process and that numerous companies face difficulties in carrying it out appropriately. Therefore, it is important to develop new theories and proposals that support the effective implementation of this earliest phase of NPD. This paper presents a new method to support the development of front-end activities based on integrating technology roadmapping (TRM) and project portfolio management (PPM). This new method, called the ITP Method, was implemented at a small Brazilian high-tech company in the nanotechnology industry to explore the integration proposal. The case study demonstrated that the ITP Method provides a systematic procedure for the fuzzy front-end and integrates innovation perspectives into a single roadmap, which allows for a better alignment of business efforts and communication of product innovation goals. Furthermore, the results indicated that the method may also improve quality, functional integration and strategy alignment. (C) 2010 Elsevier Inc. All rights reserved.

Contributions of HRM throughout the stages of environmental management: methodological triangulation applied to companies in Brazil

The purpose of this research is to analyze the contribution of human resources management throughout the evolutionary stages of environmental management in Brazilian companies. A theoretical framework concerning environmental management and its evolution and the `greening` of the functional and competitive dimensions of human resource management were developed. A methodological triangulation was developed in two complimentary phases. In the first phase, data were collected from 94 Brazilian companies with ISO 14001 certification. The data collected were analyzed and processed using statistical techniques. The conclusions of the first phase supported the second phase of this empirical research. The second phase consisted of a study of multiple cases in four Brazilian companies. The results show evidence of the first known empirical study of contributions of human resource dimensions throughout the stages of environmental management in Brazilian manufacturing companies.

GIS applied to geotechnical and environmental risk management in a Brazilian oil pipeline

The paper presents the development of a decision support system for the management of geotechnical and environmental risks in oil pipelines using a geographical information system. The system covers a 48.5 km long section of the So Paulo to Brasilia (OSBRA) oil pipeline, which crosses three municipalities in the northeast region of the So Paulo state (Brazil) and represents an area of 205.8 km(2). The spatial database was created using geo-processing procedures, surface and intrusive investigations and geotechnical reports. The risk assessment was based mainly on qualitative models (relative numeric weights and multicriteria decision analysis) and considered pluvial erosion, slope movements, soil corrosion and third party activities. The maps were produced at a scale of 1:10,000.

Motivations for the establishment of PNHRs and analysis of the incentives for their creation and management in Mato Grosso do Sul

The development of efficient programs of incentive to voluntary conservation in private lands require an extensive knowledge on the motivations of land owners for conservation and their degree of acceptance on the benefits offered. Thus, this paper intended to evaluate the motivations for the establishment of PNHRs, the difficulties faced by their recognition and the incentives received for their establishment and management in Mato Grosso do Sul, and also to discuss some possibilities of widening the benefits offered. To this end, people responsible for 34 PNHRs were interviewed between March/2008 and March/2009. The results show that conservation is among the main reasons for the creation of these areas, in spite of economical and personal factors also being mentioned. The slowness and the red tape during the process of recognition were also emphasized as problems; on the other hand, several PNHRs received or receive support for their creation or management. Finally, some considerations are made on the benefits offered to owners of PNHRs and their possibilities of widening throughout the state.

A QUALITY MANAGEMENT SYSTEM FOR POSITIONING WITH GNSS TECHNOLOGY

This paper presents a proposal for a Quality Management System for a generic GNSS Surveying Company as an alternative for management and service quality improvements. As a result of the increased demand for GNSS measurements, a large number of new or restructured companies were established to operate in that market. Considering that GNSS surveying is a new process, some changes must be performed in order to accommodate the old surveying techniques and the old fashioned management to the new reality. This requires a new management model that must be based on a well-described procedure sequence aiming at the Total Management Quality for the company. The proposed Quality Management System was based on the requirements of the Quality System ISO 9000:2000, applied to the whole company, focusing on the productive process of GNSS surveying work.

Improvement of radiology services based on the process management approach

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Urban upgrading interventions and engaging residents in fuzzy management: Case studies from Novos Alagados, Salvador, Brazil

International theory and practice have promoted state-assisted upgrading of `informal` urban areas worldwide since the late 1970s, with various forms of monitoring and assessment of impact. Two independent studies of how residents perceive and evaluate such interventions have recently been undertaken for neighbouring parts of the upgraded area of Novos Alagados on the Itapagipe peninsula in the northwestern part of Salvador, Brazil`s third largest city. These studies start from different premises and have been implemented in very different ways, but both have the objective of permitting the `voice` of the residents to be heard concerning the upgrading process. Comparing them helps highlight the essential `fuzzy` nature of values concerning urban interventions of this nature and leaves us with thought-provoking questions concerning the role of local society in relation to the state in urban development, and the potential this has for on-going forms of urban management in cities which are emerging globally. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.

FWM Constraints Management for Lightpath Establishment in GMPLS Networks

In all-optical networks, management of physical layer restrictions should collaborate in lightpath establishment. Label-Switched Path validation in Generalized MultiProtocol Label Switching on Dense Wavelength Division Multiplexing network requires the treatment of the physical impairment-related parameters along the provisioned route. In this paper we propose, for the first time in our view, the generation of an optical layer database by simulation that specifically characterizes the dynamic FWM impairments for the lightpaths provisioned in a GMPLS/DWDM network.

A survey on key management mechanisms for distributed Wireless Sensor Networks

Wireless Sensor Networks (WSNs) have a vast field of applications, including deployment in hostile environments. Thus, the adoption of security mechanisms is fundamental. However, the extremely constrained nature of sensors and the potentially dynamic behavior of WSNs hinder the use of key management mechanisms commonly applied in modern networks. For this reason, many lightweight key management solutions have been proposed to overcome these constraints. In this paper, we review the state of the art of these solutions and evaluate them based on metrics adequate for WSNs. We focus on pre-distribution schemes well-adapted for homogeneous networks (since this is a more general network organization), thus identifying generic features that can improve some of these metrics. We also discuss some challenges in the area and future research directions. (C) 2010 Elsevier B.V. All rights reserved.