Contribuição ao estudo das hepatectomias parciais com oclusão do fluxo sanguíneo aferente

O tratamento cirúrgico dos tumores hepáticos tem sido um grande desafio na história evolutiva da cirurgia. No passado, as altas taxas de morbidade e mortalidade limitavam sua aplicação como opção terapêutica. O refinamento da técnica de ressecção hepática está associado a menores índices de mortalidade e morbidade peri-operatória e, embora, a mortalidade tenha sido reduzida a menos de 10% nos serviços especializados, a morbidade ainda é bastante significativa, sendo que a hemorragia grave e a embolia aérea permanecem como complicações graves das hepatectomias. O controle da perda sanguínea é o objetivo primordial durante este tipo de cirurgia. As técnicas descritas, com a finalidade de conter a hemorragia transoperatória, são aquelas associadas à redução do fluxo sanguíneo ao fígado, seja através da oclusão vascular aferente ou manobra de Pringle por clampeamento do pedículo hepático, seja por exclusão vascular total do órgão. Hepatectomias parciais podem ser realizadas com pequeno sangramento e, mesmo quando associadas a períodos prolongados de isquemia tecidual, não foram identificadas lesões parenquimatosas ou falência hepática persistente. A redução na necessidade de reposição de sangue, no período peri-operatório, está associada a menor morbidade e à diminuição significativa na incidência de sepse abdominal. O objetivo deste estudo foi o de avaliar uma série de hepatectomias parciais com oclusão do fluxo sanguíneo aferente, em pacientes portadores de patologias benignas e neoplasias malignas. Foram analisadas 60 hepatectomias em 59 pacientes com oclusão do fluxo sanguíneo aferente quanto a possíveis fatores de risco para morbidade e mortalidade, bem como a relação entre o tempo de isquemia hepática e a variação das transaminases, tempo de protrombina e bilirrubinas, e destes, com a evolução pós-operatória. A prevalência de complicações pós-operatórias foi de 43,3% e a mortalidade de 6,7%. O fator de risco significativo para mortalidade foi tempo cirúrgico mais prolongado, quando comparado com os pacientes que não foram a óbito. Para a morbidade pós-operatória, foram identificados como fatores de risco a idade acima de 60 anos, cirurgia por neoplasia maligna, parênquima hepático anormal, ou seja, presença de cirrose, esteatose ou colestase, perda sanguínea necessitando reposição de mais de uma unidade de sangue e outros procedimentos cirúrgicos concomitantes. Na análise multivariada por regressão logística, estes fatores de risco foram reduzidos, apenas, para presença de cirrose, esteatose ou colestase. O tempo de isquemia não apresentou relação com a morbi-mortalidade pós-operatória. A variação das transaminases foram mais acentuadas nos casos com maior tempo de isquemia, porém, retornaram aos níveis pré-operatórios em, aproximadamente, uma semana. Não houve variação de tempo de protrombina e bilirrubinas quanto ao tempo de isquemia. A variação de AST e ALT não foram diferentes entre os pacientes com e sem morbidade pós-operatória.

Continuidade e descontinuidade administrativa: uma análise de fatores que contribuem para a manutenção de programas, projetos e atividades públicas de êxito em governos locais brasileiro

Descontinuidade administrativa, ou o rompimento de atividades e programas na troca de governos e autoridades federais, estaduais e municipais, tem sido tópico constante de comentário e elemento central da imagem da área pública Brasileira presente na conversa quotidiana. Curiosamente, são poucos os estudos empíricos sobre a questão como também são poucas as reflexões sobre os fatores que podem contribuir para a continuidade. O estudo busca contribuir nos dois eixos a partir da análise de ações governamentais em 89 prefeituras no período de 1995 a 1997.

Revitalização do centro histórico de São Paulo e habitação popular: microeconomia e microgerografia

Esta tese de doutorado estuda a produção de unidades habitacionais para famílias de baixa renda coordenada com o programa de revitalização da região central do município de São Paulo. O estudo recupera o discurso da teoria microeconômica tradicional aplicada a estudos urbanos e o contrapõe a um discurso alternativo. Foi criada uma base de dados original na forma de um levantamento dos imóveis subutilizados nos distritos Sé e República a partir de visitas a campo, com observações diretas dos imóveis e utilizando técnicas de identificação por imagens de satélite e sistemas de geoprocessamento para avaliar a extensão e os padrões da degradação imobiliária. Os resultados da análise do banco de dados demonstram a plausibilidade do discurso alternativo e apontam para alguns fatores significativos que contribuem para o atual estado de degradação. Retoma-se então a análise da política de repovoamento da região central por meio de um programa de moradias para famílias de baixa renda e mostra-se como as técnicas empregadas permitem avaliar as razões para o baixo desempenho dessa agenda política no contexto de um amplo programa de revitalização urbana.

Transversalidade e políticas públicas para mulheres no Brasil: percursos de uma pré-política

Esta dissertação discute a transversalidade como instrumento estratégico para a gestão de políticas públicas para as mulheres no Brasil. Parte de uma reconstituição histórica, que leva em conta o surgimento das políticas para as mulheres com a redemocratização do país, e os caminhos percorridos para desenvolvê-las em governos locais e no nacional. Destaca o papel de organismos governamentais específicos de políticas para as mulheres, bem como de atores internacionais, que pautam a transversalidade como estratégia para a promoção da igualdade de gênero nas políticas de instituições governamentais e não governamentais. A discussão conceitual sobre transversalidade é seguida de análise sobre os fatores que a influenciam na prática, uma lacuna da literatura ainda incipiente sobre o tema. Os fatores foram identificados a partir de entrevistas-conversas com gestoras e gestores envolvidos com o Pacto Nacional pelo Enfrentamento à Violência contra as Mulheres, criado em 2007. Conclui-se que, entre constrangimentos e oportunidades trabalhadas a partir do cotidiano entre gestores de diferentes políticas setoriais, a transversalidade pode contribuir para o avanço das políticas para as mulheres no Brasil, mas está distante do que se propõe normativamente a seu respeito.

Apoio e resistência popular à realização de megaeventos: algumas lições para o Brasil

Este artigo analisa os principais fatores que influenciam a percepção da população local em relação a megaeventos internacionais, buscando identificar possíveis ações que o Poder Público pode promover para aumentar o apoio e minimizar a resistência à realização desse tipo de evento. Com base no estudo de literatura teórica e empírica sobre o tema, avalia a experiência brasileira na preparação para a Copa do Mundo de 2014 e os Jogos Olímpicos de 2016, e busca retirar algumas lições para futuros megaeventos que venham a ocorrer no País, inclusive a Exposição Universal de 2020.

O processo de institucionalização do curso de administração a distância da UFRN

This work aims to describe how is occurring through the process of institutionalizing the Administration distance course of UFRN. To this end, structured into two parts: through research and analysis of content, sought to impound as if gave historic process of creation, as well as identify variables isomórficas, proposed by Powell and DiMaggio (1991), on the actions undertaken, and still present, institutional actors-having been found three typologies; then investigated the process itself, analyzing the factors of institutionalization suggested Esman (1966-1972), internal structure doctrine, leadership programme, resources, links and exchanges, from the political plan educational course. As the research methodology was defined as qualitative, even though I used survey to collect, reviewed the second ANOVA. The results found in this step pointed out that only the doctrine and internal structure variables are consistent with the assumptions of model; we found for other, discharged indicated a gap between the political acts contemplated in teaching and the actions taken so far, unfavourable element to its legitimacy. However, although the implications found in the analysis of these factors suggest that this course can derive one more discontinuous Government proposal of distance course, this study believes that are still reasonable assistance to facilitate and promote the process aimed at strengthening the progress achieved so far in the success of its institutionalization

Síndrome de Burnout : um estudo com guias de turismo regional em Natal-RN

Burnout is a psychological syndrome triggered in response to continuous exposure to interpersonal stressors. It is considered a multifactorial construct, which is commonly characterized by three dimensions: emotional exhaustion, dehumanization, and lack of personal accomplishment.This study aimed to verify if the three characteristics of burnout (exhaustion, lack of dehumanization and personal accomplishment) are present in people working as guides Tourism in Natal - RN. It is a descriptive and quantitative study. 109 subjects were surveyed. Data collection was done through the use of questionnaires, the instrument used was the characterization of the Burnout Scale (ECB) created and validated in Brazil by Trocoli and Tamayo (2000). In order to analyze data we used descriptive statistics, analysis of core measures, exploratory and confirmatory factor analysis, reliability analysis, cluster analysis, multiple discriminant and Spearman correlation. Factor analysis identified four factors that explain 58.3% of the total variance. Those factors were named exhaustion, deception, avoidance, and dehumanization. The reliability of the instrument, as measured by Cronbach's Alpha was 0.918, which is considered excellent reliability. The 109 subjects were grouped into three cluster, which had the deception, avoidance, and dehumanization as discriminant. It is possible to conclude that the characteristics of burnout syndrome are present in the studied population where 19 people are on the high level of burnout, moderate in 32 and 56 in the light. The correlations between socio-demographic variables studied and the dimensions of burnout, were few and weak. The variable leave for health reasons in the study appeared to be related to feelings of exhaustion and avoidance behavior appeared related to younger individuals and who work only in the activity of Receptive Tourism Guide. Verification of the incidence of burnout in individuals surveyed suggest the need to adopt intervention strategies are individual, organizational and / or combined

A forma do privilégio: renda, acessibilidade e densidade em Natal-RN

The aim of this work is to understand the morphological expression of ground occupation by the higher income population, by focusing on population distribution in accordance with income layers and demographical density, as well as topological accessibility (HILLIER and HANSON, 1984) resulting from the urban grid structure. It endeavors to identify a functional organizing principle regarding the intra-urban space of Natal capital city of the state of Rio Grande do Norte, the research focus. In order to achieve this, census data as well as syntactic data were utilized for mapping and spatial analysis of income patterns, topological accessibility and demographical density using Geographical Information System GIS. The organizing principle was named as the Form of Privilege, a pattern that concentrates or tends to concentrate wealth, topological accessibility and low demographical density. Attempting to assess its extent, beyond Natal, this principle was applied to other Brazilian northeastern capitals such as: Fortaleza, CE; Teresina, PI; Aracaju, SE; Recife, PE; and João Pessoa, PB. Findings point out that although the urban structures of these cities are not immune to the Form of Privilege, Natal is emblematic of this phenomenon, a fact that demonstrates the perverse character of its spatial process, which historically creates privileged areas within the city, by means of the appropriation of accessibility as well as of the many urban benesses that are related to it by higher income groups at the expense of the major part of the population, which though being the people mostly in need of the benefits originating from the urban form are excluded from them

Contra as Secas: a engenharia e as origens de um planejamento regional no nordeste brasileiro

Droughts surfaced in 1877 as a crucial problem for the birthing Brazilian nation. Engineers, who formed the country's technical and scientific elite, took it upon themselves to study, understand and fight the problem through planned actions of intervention on space. This work, based on proposals and discussions contained in engineering magazines and reports, aims to provide elements for the comprehension of how these systematized actions against droughts, in the Iate nineteenth and early twentieth century, contributed to spatial analysis and the formation of a (then-inexistent) regional and territorial planning discipline in Brazi!. Engineers, by taking up the position of masterminds in the country's modernization, guaranteed for themselves personal economic stability, social prestige and political power. By understanding nature, either as a resource to be exploited or an adversary to national progress, they contributed to the delimitation of the region now known as the Northeast. By seeking to understand the drought phenomenon, they created knowledge about the space they sought to intervene on; by constructing their projects amid political and economical difficulty, they changed the organizational structures of cities and country in the northeast. The proposals for açudes (Iarge water reservoirs) allowed the fixation of population and the resistance against droughts; the roads - railroads and automotive roadways - connected the sertão to the capitais and the coast, speeding up help to the affected populations during droughts and allowing the circulation of goods so as to strengthen the local economies in normal rimes. The adopted practices and techniques, adapted from foreign experience and developed through trial and improvement, were consolidated as an eminently spatial intervention course, even if a theoretical body of regional or territorial planning wasn't formed in Brazil. Regional Planning proper was first applied in the country in the Northeast itself, in the 1950s, based off an economical view of reality in order to achieve development. The engineer's work prior tothat date, however, cannot be dlsconsldered. It was proved that, despite facing financial and political hurdles, engineers had a profound commitment to the problem and intended to act systematically to transform the economical and social relations in the region, in order to be victorious in their struggle against droughts

Visitabilidade-vivenciabilidade em assentamentos informais : um estudo da acessibilidade de percursos urbanos no Conjunto Santa Terezinha em Fortaleza-CE

This research approaches the issue of accessibility in informal settlements, seeking for the challenges and limits defined by informal urban settings, about the application of accessibility parameters. Take the empirical universe as the Conjunto Santa Terezinha, located in Fortaleza- Ce. Initially, the study presents a reflection about the housing issue in Brazil and the informal settlementes in view of the Right to the City. In this sense, the main references are, the works of Suzanne Pasternak (2008), Nabil Bonduki (1998) and Erminia Maricato (1996-97), among others. Follows with the discussion of the concepts and classifications of this type of settlement, making a content analysis of legislation and regulations relating to accessibility and proposed the discussion of the accessible route as the right strategy for the city. In another step, the methodology of 'walking together' created by Dischinger (2000) was applied in a passage previously chosen, which the researcher follows the disabled person during the journey through city making records like photos and video. The comments and perceptions are compared to the spatial analysis of urban morphology, made from the method of Del Rio (1990) and Panerai (2006), and the parameters of NBR 9050. Knowledge of the area is enriched by the methodology of the production of space made by Henri Lefebvre in his book 'The production of space' (1974) with these categories: space conceived, perceived and lived. Another key reference of this author it s the book 'The Right to the City' (991), which allowed in-depth reflections on the social function of town. In conclusion, the study finds that to guarantee a minimum access conditions in informal sittlements it´s necessary to know the specifics of their morphology, their relations and urban practices in view of the visitability- experiencebility, describing it as complementary concepts

Clima urbano e vegetação: estudo analítico e prospectivo do Parque das Dunas em Natal

The present study deals with the relationship between urban vegetation and climate. The process whereby the Parque das Dunas a 1,172 ha green area in the city of Natal, State of Rio Grande do Norte exerts influence on the climate of the city is analyzed. The hypothesis on which the present work rests is that the green area referred to acts upon the climate of the city. The study is based on the analysis of climatic factors and elements of this green area and of the city of Natal. In order to give rise to final recommendations, a methodology grounded on a quantitative and qualitative standpoint has been used. The data were collected both within and without the limits of the Parque das Dunas area. Secondary and primary data resulting from the measurements taken by the researcher and her work group have been used. The aim was to contribute to the understanding of the influence of vegetation on the climate of a city having a warm and humid climate. A historical and environmental characterization of the Parque das Dunas was then sought. The local climatic factors and the elements of the climate have been studied within the scope of the city of Natal. A comparative study between the climatic elements within and without the limits of the Parque das Dunas area from the survey of technical data and the systematization of the information collected has been made, aiming at proposing a set of bioclimatic recommendations for the urban design in Natal. The results of such work allowed for the validation of the important role that the Parque das Dunas plays in the climate of Natal. This has led to the acknowledgement of the relevance of the green areas on the climate of cities. They bring about important benefits to the process of rendering agreeable the climate in the urban environment by providing pleasant microclimates that give a valuable contribution to the environmental comfort of urban nuclei having the same size of Natal

Análise de agrupamentos dos dados de DFA oriundos de perfis elétricos de indução de poços de petróleo

The main objective of this study is to apply recently developed methods of physical-statistic to time series analysis, particularly in electrical induction s profiles of oil wells data, to study the petrophysical similarity of those wells in a spatial distribution. For this, we used the DFA method in order to know if we can or not use this technique to characterize spatially the fields. After obtain the DFA values for all wells, we applied clustering analysis. To do these tests we used the non-hierarchical method called K-means. Usually based on the Euclidean distance, the K-means consists in dividing the elements of a data matrix N in k groups, so that the similarities among elements belonging to different groups are the smallest possible. In order to test if a dataset generated by the K-means method or randomly generated datasets form spatial patterns, we created the parameter Ω (index of neighborhood). High values of Ω reveals more aggregated data and low values of Ω show scattered data or data without spatial correlation. Thus we concluded that data from the DFA of 54 wells are grouped and can be used to characterize spatial fields. Applying contour level technique we confirm the results obtained by the K-means, confirming that DFA is effective to perform spatial analysis

Influência de fatores biopsicossociais sobre a mortalidade de idosos no município de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Sistemas de informação geográfica e análise espacial de dados como ferramentas para determinação de agregação espacial de doenças: a hanseníase como modelo

This work demonstrates the importance of using tools used in geographic information systems (GIS) and spatial data analysis (SDA) for the study of infectious diseases. Analysis methods were used to describe more fully the spatial distribution of a particular disease by incorporating the geographical element in the analysis. In Chapter 1, we report the historical evolution of these techniques in the field of human health and use Hansen s disease (leprosy) in Rio Grande do Norte as an example. In Chapter 2, we introduced a few basic theoretical concepts on the methodology and classified the types of spatial data commonly treated. Chapters 3 and 4 defined and demonstrated the use of the two most important techniques for analysis of health data, which are data point processes and data area. We modelled the case distribution of Hansen s disease in the city of Mossoró - RN. In the analysis, we used R scripts and made available routines and analitical procedures developed by the author. This approach can be easily used by researchers in several areas. As practical results, major risk areas in Mossoró leprosy were detected, and its association with the socioeconomic profile of the population at risk was found. Moreover, it is clearly shown that his approach could be of great help to be used continuously in data analysis and processing, allowing the development of new strategies to work might increase the use of such techniques in data analysis in health care

Análises espaciais na identificação das áreas de risco para a esquistossomose mansônica no município de Lauro de Freitas, Bahia, Brasil

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