Fluid Replacement With Hypertonic or Isotonic Solutions Guided by Mixed Venous Oxygen Saturation in Experimental Hypodynamic Sepsis

Background: Splanchnic perfusion is prone to early injury and persists despite normalization of global hemodynamic variables in sepsis. Volume replacement guided by oxygen derived variables has been recommended in the management of septic patients. Our hypothesis was that a hypertonic isoneotic solution Would improve the benefits of crystalloids replacement guided by mixed venous oxygen saturation. Methods: Seventeen anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live E. coli in 30 minutes. They were then randomized into three groups: control group (n = 3) bacterial infusion without treatment; normal saline (n = 7), initial fluid replacement with 32 mL/kg of normal saline during 20 minutes; hypertonic solution (n = 7), initial fluid replacement with 4 mL/kg of hypertonic solution during 5 minutes. After 30 and 60 Minutes, additional boluses of normal saline were administered when mixed venous oxygen saturation remained below 70%. Mean arterial pressure, cardiac output; regional blood flows, systemic and regional oxygen-derived variables, and lactate levels were assessed. Animals were observed for 90 minutes and then killed. Hystopathological analysis including apoptosis detection using terminal deoxynucleotidil transferase mediated dUTP-biotin nick end labeling was performed. Results: A hypodynamic septic shock was observed after bacterial infusion. Both the fluid-treated groups presented similar transient benefits in systemic and regional variables. A greater degree of gut epithelial cells apoptosis was observed in normal saline-treated animals. Conclusions: Although normalization of mixed venous oxygen saturation was not associated with restoration of markers of splanchnic or other systemic perfusion variables, the initial fluid savings with hypertonic saline and its latter effect on gut apoptosis may be of interest in sepsis management.

Responses of sugarcane, maize, and soybean to phosphorus and vesicular-arbuscular mycorrhizal fungi

The presence of vesicular-arbuscular mycorrhizal (VAM) fungi in long-term cane-growing fields associated with yield decline led to the supposition that VAM fungi may be responsible for the poor yields. A glasshouse trial was established to test the effectiveness of a species of VAM fungi, Glomus clarum, extracted from one of these North Queensland fields on the growth of sugarcane (Saccharum interspecific hybrid), maize (Zea mays), and soybean (Glycine max) for 6 phosphorus (P) rates (0, 2.7, 8.2, 25, 74, 222 mg/kg). For maize and soybean plants that received VAM (+ VAM), root colonisation was associated with enhanced P uptake, improved dry weight (DW) production, and higher index tissue-P concentrations than those without VAM (-VAM). By comparing DW responses of maize and soybean for different P rates, savings in fertiliser P of up to 160 and 213 kg/ha, respectively, were realised. Sugarcane plants were generally less responsive. Apart from a 30% DW increase with VAM when 2.7 mg P/kg was added, DW of +VAM plants was equivalent to, or worse than in the case of 222 mg P/kg, DW of -VAM plants. For all 3 host species, colonisation was least at the highest P application, presumably from excessive P within the plant tissue. Critical P concentrations for the 3 host species were below those reported elsewhere, and for soybean and sugarcane, the critical concentration for +VAM plants was lower than that of -VAM plants. There are 3 implications that arise from this study. First, VAM fungi present in cane-growing soils can promote the growth of maize and soybean, which are potential rotation crops, over a range of P levels. Second, the mycorrhizal strain taken from this site did not generally contribute to a yield decline in sugarcane plants. Third, application of P fertiliser is not necessary for sugarcane when acid-extractable P is

The point-of-referral barrier - a factor in the success of telehealth

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh

In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.

Managing the Brisbane River and Moreton Bay: an integrated research/management program to reduce impacts on an Australian estuary

The Brisbane River and Moreton Bay Study, an interdisciplinary study of Moreton Bay and its major tributaries, was initiated to address water quality issues which link sewage and diffuse loading with environmental degradation. Runoff and deposition of fine-grained sediments into Moreton Bay, followed by resuspension, have been linked with increased turbidity and significant loss of seagrass habitat. Sewage-derived nutrient enrichment, particularly nitrogen (N), has been linked to algal blooms by sewage plume maps. Blooms of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay have resulted in significant impacts on human health (e.g., contact dermatitis) and ecological health (e.g., seagrass loss), and the availability of dissolved iron from acid sulfate soil runoff has been hypothesised. The impacts of catchment activities resulting in runoff of sediments, nutrients and dissolved iron on the health of the Moreton Bay waterways are addressed. The Study, established by 6 local councils in association with two state departments in 1994, forms a regional component of a national and state program to achieve ecologically sustainable use of the waterways by protecting and enhancing their health, while maintaining economic and social development. The Study framework illustrates a unique integrated approach to water quality management whereby scientific research, community participation and the strategy development were done in parallel with each other. This collaborative effort resulted in a water quality management strategy which focuses on the integration of socioeconomic and ecological values of the waterways. This work has led to significant cost savings in infrastructure by providing a clear focus on initiatives towards achieving healthy waterways. The Study's Stage 2 initiatives form the basis for this paper.

Benchmarking nitrogen removal suspended-carrier biofilm systems using dynamic simulation

We are witnessing an enormous growth in biological nitrogen removal from wastewater. It presents specific challenges beyond traditional COD (carbon) removal. A possibility for optimised process design is the use of biomass-supporting media. In this paper, attached growth processes (AGP) are evaluated using dynamic simulations. The advantages of these systems that were qualitatively described elsewhere, are validated quantitatively based on a simulation benchmark for activated sludge treatment systems. This simulation benchmark is extended with a biofilm model that allows for fast and accurate simulation of the conversion of different substrates in a biofilm. The economic feasibility of this system is evaluated using the data generated with the benchmark simulations. Capital savings due to volume reduction and reduced sludge production are weighed out against increased aeration costs. In this evaluation, effluent quality is integrated as well.

Reforma do setor p??blico e participa????o sindical: o caso do sistema de pens??o italiano

O paper estuda o caso da recente reforma da Previd??ncia na It??lia, ilustrando a possibilidade de uma participa????o positiva dos sindicatos ??? tradicionalmente contr??rios ??s reformas ??? no processo de transforma????o do setor p??blico. Ap??s uma revis??o do sistema previdenci??rio italiano, altamente fragmentado e particularista na opini??o dos autores, e o apontamento de suas principais defici??ncias, o estudo concentra-se na an??lise de tr??s propostas de reforma ligadas aos governos de Amato (1992-93), Berlusconi (1994) e Dini (1995), respectivamente. O texto aborda tanto as propostas concretas de mudan??a, trazendo contribui????es sobre uma variedade consider??vel de medidas, seu impacto e aceita????o sociais e por categoria, como os objetivos visados e o processo pol??tico relacionado ?? sua discuss??o e tramita????o. Uma preocupa????o constante dos autores ?? a correla????o entre a postura e a participa????o dos sindicatos em mat??ria de reforma previdenci??ria, por um lado, e o avan??o das propostas governamentais, por outro. Segundo o estudo, a ampla participa????o da for??a sindical na negocia????o do projeto de reforma previdenci??ria do governo Dini representou um fator decisivo para sua aprova????o e implementa????o bem-sucedidas. Ao mesmo tempo, a delibera????o democr??tica para concilia????o de prefer??ncias e interesses (m??ltiplos no caso de assuntos norteados pela dicotomia bem comum/interesse particular) ??? objeto da ??ltima sess??o do estudo ??? ?? vista como uma forma de ampliar a participa????o sindical al??m das lideran??as, passando a incluir os rank-and-file trabalhadores, um procedimento que traz, igualmente, a for??a de uma decis??o majorit??ria. A an??lise da reforma da Previd??ncia italiana ?? ilustrada no paper com tabelas que trazem e comparam dados referentes ?? contribui????o previdenci??ria, ??s categorias de beneficiados e ??s diferentes propostas de reforma formuladas por sucessivos governos italianos.

Aplicação da matemática em investimentos financeiros : caderneta de poupança e títulos públicos

Iniciando com um breve estudo de porcentagem e algumas de suas aplicações, o desenvolvimento deste trabalho consiste de uma revisão dos fundamentos da matemática financeira e suas aplicações em dois tipos de investimentos financeiros denominados caderneta de poupança e títulos públicos. Além do clássico estudo de juros simples e compostos, associando-os a progressões aritméticas e geométricas, respectivamente, aborda-se sobre os vários tipos de taxas (proporcionais e equivalentes, nominais e efetivas, variáveis e acumuladas) incluindo a conceituação de taxa por dia útil. Fundamentado nos assuntos mencionados, o trabalho encerra-se com uma aplicação da matemática financeira associada a investimentos na caderneta de poupança e nos diversos títulos públicos negociados no Tesouro Direto.

Uma aplicação de matemática financeira à análise de títulos de renda fixa

No dia a dia, as pessoas sabem que existem várias aplicações financeiras, mas a grande maioria não possui o conhecimento necessário para escolher qual o melhor investimento para o seu dinheiro. E assim, muitas vezes acabam investindo somente na poupança, talvez pela sua simplicidade ou por sua popularidade. Neste trabalho, buscamos mostrar a importância da Matemática Financeira para o entendimento de investimentos. Através de uma abordagem de Progressões Geométrica e Aritmética e, consequentemente, da Matemática Financeira, são apresentadas algumas aplicações financeiras, com seus conceitos, cálculos e atividades que mostram como compará-las. Assim, no trabalho são descritos conceitos e propriedades das Progressões Geométrica e Aritmética, e da Matemática Financeira e, como aplicação desse conteúdo, são apresentados o conceito e o cálculo de diversas taxas (equivalência de taxas, taxas efetiva e nominal, taxa pré e pós-fixada, taxas variáveis, taxa referencial), além de alguns investimentos financeiros (poupança, CDB, LCI). Buscando consolidar esse estudo desenvolvido, apresentamos no final do trabalho uma proposta de atividades a serem realizadas em sala de aula, que contemplam cálculos da rentabilidade dos investimentos, mostrando ao aluno como calcular e comparar esses rendimentos.

The estimation of the return on firms’ investments – as to ISO 9001

The aim of this paper was to estimate the return on investment in QMS (quality management systems) certification undertaken in Portuguese firms, according to the ISO 9000 series. A total of 426 certified Portuguese firms were surveyed. The response rate was 61.03 percent. The different payback periods were validated through statistical analysis and the relationship between expected and perceived payback periods was discussed. This study suggests that a firm’s sector of activity, size and degree of internationalization are related to the length of the investment in QMS certification recovery period. Furthermore, our findings suggest, that the time taken to obtain the certification is not directly related to the economic component of the certification. The majority of Portuguese firms (58.9%) took up to three years to recoup their investment and 35.5% of companies said they had not yet recovered the initial investment made. The recoup of investment was measured by the increase in the number of customers and consequent volume of deliveries, improved profitability and productivity of the company, improvement of competitive position and performance (cost savings), reduction in the number of external complaints and internal defects/scrap, achievement of some important clientele, among others. We compared our work to similar studies undertaken in other countries. This paper provides a contribution to the research related to the return on investment for costs related to the certification QMS according to ISO 9000. This paper provides a valuable contribution to the field and is one of the first studies to undertake this type of analysis in Portugal.

Effects and determinants of household debt in Portugal

As the amount of debt has gradually increased, particularly in recent years, Portugal is currently one of the European countries exhibiting one of the highest levels of overall indebtedness, including in both sovereign and private sectors. Indeed, this condition is the outcome of increasing levels of debt assumed not only by the government, but also by companies and families, being the later mostly due to mortgage loans and due charges. This paper focuses on the study of borrowing by Portuguese households. The research has been made in respect to the notion of debt, the consequences of recent developments in debt, among other factors. In order to analyse the factors that are most associated with debt, a study was developed using two multiple regression models, one using a longer time series and another shorter, evaluating the effect of several variables, such as consumption, savings, unemployment, inflation and interest rates, in order to check whether they could be associated with a higher level of debt.

Integration of management systems: towards a sustained success and development of organizations

Effective environmental management within companies, integrated with other management areas like quality and occupational health and safety, is nowadays assumed to be a strategic way to implement and improve lean and cleaner production. Also, sustainable development (SD) and business sustainability can be achieved through a better coordinated management of processes versus associated resources. This paper presents an in depth discussion regarding the promotion of integrated management systems, their benefits and major contribution towards the sustainable development of cleaner production related features. It addresses issues regarding the contributions resulting from the integration of standardized Management System (MS) from both internal and external perspectives. Complementing the overall review of aspects to the development of integrated management systems a survey was conducted in order to better understand the relevance of the identified success factors. The main findings in this paper are as follows: a contextualization model of sustainable development and integrated management systems considering the Triple Bottom Line: economic, social and environmental; and, a method and associated model to support the development of integrated management systems as well as general guidelines to support integration. It can be concluded that a proactive approach and commitment to cleaner production, supported by an integrated management system, brings relevant savings for organizations as well as providing value to the relevant interested parties.

International transfer pricing restrictions: impact on corporate financial policy

Transfer pricing is a pervasive issue that presents significant tax savings potential concerning international enterprises. The authors discuss company incentives to manage transfer prices in an article appearing in the preceding issue of this journal. In response to these incentives, governments have increasingly enacted and enforced domestic restrictions on transfer prices. In this article, contemporary norms restricting transfer pricing are analyzed. The OEGO and US pricing standards are assessed and Brazil's recent application of these standards is considered. Transfer pricing methods are described and evidence of their use is presented. We conclude by describing an intercompany transfer pricing policy intended to facilitate internaI financiaI management and minimize externaI tax threats.

ANTECEDENTS AND CONSEQUENCES OF HOUSEHOLD FINANCIAL MANAGEMENT IN BRAZILIAN LOWER-MIDDLE-CLASS

Through two complementary and exploratory studies – one qualitative and one quantitative – this research aims to understand the ways in which lower-middle-class families in Brazil manage their household finances. The study proposes an integrated framework that brings together various previously disconnected theoretical fragments. Based on a survey with a sample of 165 lower-middle-class female consumers of a retail company in São Paulo, we explored and tested, via a quantitative study, how antecedents such as personal characteristics affect the financial management process, as well as its consequences, either negatively as defaults or positively as savings. The model calibration and analysis were derived from a series of regression analyses. The results revealed the mediator role that financial management plays in the relationship between personal characteristics and defaults and savings. Compared to previous studies with consumers of more affluent countries, we identified peculiar findings among Brazilian lower-middle-class consumers: inadequate attention to control, weak or no focus on short- or long-range planning, widespread absence of budget surplus, and influence of critical events on episodes of default.

Monetary channels of social inclusion: a case study of basic income and the Caixa Econômica Federal in Brazil

This article reports evidence of new monetary channels for social inclusion involving basic income policies and the Caixa Econômica Federal, a Brazilian government savings bank. Since the Plano Real (Brazilian currency) and the liberalization of banking in the 1990s, the realization of competitive advantages by the Caixa as social policy agent and the importance of citizenship cards differ from existing theories of bank change, financial inclusion and monetary policy. Multi-method research reveals the importance of 1) political theories of basic income, 2) conceptions of citizenship and social justice, and 3) a back to the future modernization of government banking. This provides alternatives to contemporary market-based banking theory, neo-liberal policies, private and non-governmental microfinance strategies, and theories in political economy about fiscal constraints to social policies. New monetary channels of change also suggest that zero sum theories about politics, monetary authority and social inclusion are amiss.