Impact de trois interventions: méthode mère kangourou, massage en incubateur et massage en position kangourou sur la croissance et le développement des enfants prématurés nés à moins de 33 semaines d’âge gestationnel

Cette recherche vise à étudier l’impact d’interventions réalisées par les parents dans l’unité néonatale de soins intensifs. Plus spécifiquement, le premier objectif est de documenter les effets différentiels de la Méthode Mère Kangourou « MMK » accompagnée ou non du Massage en incubateur «MI » ou du Massage en Position Kangourou « MPK » et des Soins Traditionnels «ST » accompagnés ou non du massage dans l’incubateur sur la croissance physique mesurée par le poids, la taille et le périmètre crânien pendant une période de 5 et 15 jours dans l’unité néonatale et l’impact à 40 semaines d’âge gestationnel. Le second objectif est de comparer, chez des enfants qui bénéficient de la « MMK » la valeur ajoutée du « MPK » ou du «MI » sur le neuro-développement à 6 et 12 mois d’âge corrigé de l’enfant. Un échantillon total de 198 enfants et leur famille a été recruté de la façon suivante dans trois hôpitaux de Bogota. Dans chaque hôpital, 66 sujets ont été répartis aléatoirement à deux conditions. Ces hôpitaux ont été choisis afin de tester les effets de diverses conditions expérimentales et de diminuer les bais de sélection. Dans chaque hôpital, deux techniques ont été assignées aléatoirement. Il s’agit, dans le premier, de la « MMK & MPK » vs « MMK & MI ». Dans le second, « MMK sans massage » vs « MMK & MI ». Dans le troisième, « MI » a été comparé aux « ST » ce qui implique une absence de contact physique continu des bébés avec leurs parents. Les résultats rapportés dans le premier article sont à l’effet que, dans le premier hôpital, il y a un effet compensatoire de l’intervention « MMK & MPK » sur la perte physiologique du poids de l’enfant prématuré dans les 15 premiers jours de vie avec un impact sur le poids à 40 semaines d’âge gestationnel, sur la durée du portage kangourou et sur la durée d’hospitalisation totale. Aucun effet sur le périmètre crânien ou la taille n’est apparu. Dans le deuxième hôpital, aucune différence significative n’est rapportée pour le poids sauf quand l’intervention est commencée après le 10ième jours de vie alors que l’enfant « MPK» semble grossir mieux que le «MMK avec MI». Finalement, dans le troisième hôpital il n’y a aucun effet du massage sur les variables anthropométriques, le groupe avec MI grossissant moins vite avec un léger impact sur le poids à 40 semaines. Cela pourrait être dû à la perte de chaleur due à l’ouverture de l’incubateur quand l’enfant est très immature. Dans le second article, les 66 enfants de l’hôpital sont répartis aléatoirement dans le groupe « MMK & MPK» vs le groupe « MMK & MI», ont complété, à 6 et 12 mois d’âge corrigé, un test de neuro-développement, le Griffiths. Les résultats à 6 mois ne montrent aucune différence entre les 2 interventions, mais a 12 mois le IQ semble dépendant du nombre de jours d’hospitalisation de l’enfant, cette durée d’hospitalisation correspond au temps que met l’enfant à se stabiliser physiquement et correspond également au temps que mettent la mère et l’enfant à s’adapter à la méthode kangourou. Une fois, l’adaptation kangourou réussie, la dyade mère enfant sort avec l’enfant toujours en position kangourou. Le temps d’hospitalisation correspond au temps que met l’enfant à être éligible à l’apprentissage de la MMK par la mère. À 12 mois les deux groupes montrent des résultats équivalents, mais des différences positives sont apparues pour le groupe « MMK & MPK» dans les sous échelle Coordination Oculo Manuelle et Audition et Langage du test Griffiths. Dans l’ensemble, les résultats suggèrent que la pratique des deux interventions non traditionnelles peut contribuer à une meilleure croissance physique dans nos cohortes. Le gain de poids du bébé, notamment, est affecté par l’intervention MPK (Hôpital 1) ou sans l’ajout du Massage (Hôpital 2). Par ailleurs, le massage en incubateur n’a pas de différence significative en comparaison aux soins traditionnels, ces interventions ont toutefois un impact mineur (tendances) sur le neuro développement à 6 et 12 mois d’âge corrigé dans cette étude.

Análisis sobre la destrucción y creación de valor dentro del sector de la salud en Bogotá

Una de las maneras que existen para lograr niveles de ingreso mayores y a su vez incrementar las posibilidades de perdurabilidad de las empresas es la generación de valor, el cual permite que las compañías tengan la capacidad de adaptarse a su entorno y así sacar provecho del mismo. Sin embargo, son pocas las herramientas con las que dichas empresas cuentan para determinar de manera efectiva la creación o destrucción de valor que se genera a través del tiempo. El presente proyecto tiene como fin utilizar la herramienta del Valor Económico Agregado (EVA, por sus siglas en inglés) para analizar específicamente la creación de valor en un periodo de cinco años en el sector de la salud en Bogotá, tomando como base de investigación los hospitales pertenecientes al nivel III de atención dentro del total de la red hospitalaria de la capital del país. De igual manera, el análisis permitirá realizar proyecciones acerca de la creación de valor, cuyos resultados serán utilizados como base para evaluar estrategias que permitan a las empresas de este sector mantener dicho valor a través del tiempo o revertir una situación desfavorable en el caso que los resultados arrojados evidencien una destrucción de valor dentro de las instituciones prestadoras de salud. Para llegar a comprender el alcance de estos resultados, este proyecto explicará en qué consiste el valor, cómo se mide en las empresas y la viabilidad y aplicación de estas medidas en el caso específico de las sociedades colombianas pertenecientes al sector de la salud.

The significant role of third-party logistics (3pl) operators as fosterers of organizational performance in colombian companies

La eliminación de barreras entre países es una consecuencia que llega con la globalización y con los acuerdos de TLC firmados en los últimos años. Esto implica un crecimiento significativo del comercio exterior, lo cual se ve reflejado en un aumento de la complejidad de la cadena de suministro de las empresas. Debido a lo anterior, se hace necesaria la búsqueda de alternativas para obtener altos niveles de productividad y competitividad dentro de las empresas en Colombia, ya que el entorno se ha vuelto cada vez más complejo, saturado de competencia no sólo nacional, sino también internacional. Para mantenerse en una posición competitiva favorable, las compañías deben enfocarse en las actividades que le agregan valor a su negocio, por lo cual una de las alternativas que se están adoptando hoy en día es la tercerización de funciones logísticas a empresas especializadas en el manejo de estos servicios. Tales empresas son los Proveedores de servicios logísticos (LSP), quienes actúan como agentes externos a la organización al gestionar, controlar y proporcionar actividades logísticas en nombre de un contratante. Las actividades realizadas pueden incluir todas o parte de las actividades logísticas, pero como mínimo la gestión y ejecución del transporte y almacenamiento deben estar incluidos (Berglund, 2000). El propósito del documento es analizar el papel de los Operadores Logísticos de Tercer nivel (3PL) como promotores del desempeño organizacional en las empresas colombianas, con el fin de informar a las MIPYMES acerca de los beneficios que se obtienen al trabajar con LSP como un medio para mejorar la posición competitiva del país.

Plan de mejoramiento a la Supply Chain de BCD TRAVEL Colombia

Mediante el acercamiento que se hizo al área corporativa de BCD TRAVEL COLOMBIA y considerando el importante crecimiento actual del Sector Turismo y más precisamente de los viajes con motivo corporativo en el país, surge la necesidad del presente trabajo. Al hacer un análisis interno en la organización y de su entorno, se evidenció que la compañía tiene carencia en procesos y establecimiento de nuevas estrategias que le permitan identificar y potencializar oportunidades en su mercado objetivo y en torno a sus clientes y proveedores, lo cual, puede amenazar y comprometer la estabilidad y prestigio de empresa y así mismo su perdurabilidad. Se elaborará un propuesta de mejora en torno a el área de mercadeo y de logística con el fin de estructurar herramientas que le permitan a la compañía tener un horizonte definido, conocer su posición estratégica en el mercado actual, a donde quiere llegar y que debe hacer para lograr los objetivos establecidos en su unidad de negocio corporativa, la cual representa el mayor porcentaje de ingresos para la compañía. . Se espera que los planes de mejora y estrategias establecidas generen servicios de valor agregado e impacten positivamente a lo largo de la cadena de suministro logrando mayor rentabilidad, competitividad y seguimiento de todos los procesos de esta unidad de negocio.

Financing innovative start-ups in Portuguese context: what is the role of business angels networks?

Business angels provide both financing and managerial experience, which increase the likelihood of the survival of innovative start-ups. Over the last years, European countries with developing informal venture capital markets have seen governments support the creation of business angels networks (BANs) to increase and consolidate these markets. Using the Portuguese context to carry out the empirical work, this paper provides an assessment of value added provided by angels’ networks. A total of 88 useable responses were received and analysed using non-parametric statistical techniques. This paper demonstrates that is evidence of positive contribution of BANs in terms of bringing together investors and linking them with entrepreneur’s seeking finance. BANs played an important role in financing innovative start-ups also in peripheral regions. Results lead us to conclude that government support BANs would appear to be an effective mechanism to stimulate the angel market in developing informal venture capital markets. The conclusions of this paper are likely to have relevance for countries where there is growing interest in the potential of business angels as a means of financing innovative start-ups.

Non-Equilibrium Atmospheric Plasma As A Novel Route To Nanomaterial Synthesis And Processing For Biomedical Applications

Since last century, the rising interest of value-added and advanced functional materials has spurred a ceaseless development in terms of industrial processes and applications. Among the emerging technologies, thanks to their unique features and versatility in terms of supported processes, non-equilibrium plasma discharges appear as a key solvent-free, high-throughput and cost-efficient technique. Nevertheless, applied research studies are needed with the aim of addressing plasma potentialities optimizing devices and processes for future industrial applications. In this framework, the aim of this dissertation is to report on the activities carried out and the results achieved concerning the development and optimization of plasma techniques for nanomaterial synthesis and processing to be applied in the biomedical field. In the first section, the design and investigation of a plasma assisted process for the production of silver (Ag) nanostructured multilayer coatings exhibiting anti-biofilm and anti-clot properties is described. With the aim on enabling in-situ and on-demand deposition of Ag nanoparticles (NPs), the optimization of a continuous in-flight aerosol process for particle synthesis is reported. The stability and promising biological performances of deposited coatings spurred further investigation through in-vitro and in-vivo tests which results are reported and discussed. With the aim of addressing the unanswered questions and tuning NPs functionalities, the second section concerns the study of silver containing droplet conversion in a flow-through plasma reactor. The presented results, obtained combining different analysis techniques, support a formation mechanism based on droplet to particle conversion driven by plasma induced precursor reduction. Finally, the third section deals with the development of a simulative and experimental approach used to investigate the in-situ droplet evaporation inside the plasma discharge addressing the main contributions to liquid evaporation in the perspective of process industrial scale up.

3D electrocatalysts for the selective glucose oxidation

Nowadays, one of the most important scientific and environmental concern is to reduce global dependence on fossil fuels. The use of lignocellulosic biomass makes it possible to produce important platform molecules such as D-glucose, which is used to synthesize high value-added chemical products such as gluconic acid (GO) and glucaric acid (GA). Moreover, the electrocatalytic oxidation of glucose shows advantages compared to the classical synthesis route, such as the use of non-toxic reactants and milder conditions, making the process greener and more sustainable. In this work, electrocatalysts based on open-cell Ni metal foams were investigated for the glucose electrooxidation. They were used as supplied, oxidized at 500°C and 600°C, and after electrodeposition of Ni(OH)2. The electrocatalysts were characterized by cyclic voltammetry in NaOH solution 0.1M and in a basic D-glucose solution with different glucose concentrations (10mM and 50mM). The effect of the potential applied, the glucose concentration and the reaction time on conversion, selectivity and faradic efficiency were also investigated. 3D Ni electrocatalyst showed promising activity in the conversion of glucose towards gluconic acid, the sample calcined at 500°C showing the best results.

Theoretical and experimental studies of gold catalysts for glucose oxidation

The glucaric acid (GLA) has been identified as a “top value-added chemical from biomass” that can be employed for many uses; for instance, it could be a precursor of adipic acid, a monomer of Nylon-6,6. GLA can be synthetized by the oxidation of glucose (GLU), passing through the intermediate gluconic acid (GLO). In recent years, a new process has been sought to obtain GLA in an economic and environmental sustainable way, in order to replace the current use of HNO3 as a stoichiometric oxidant, or electrocatalysis and biochemical synthesis, which show several disadvantages. Thereby, this work is focused on the study of catalysts based on gold nanoparticles supported on activated carbon for the oxidation reaction of GLU to GLA using O2 as an oxidant agent and NaOH as base. The sol-immobilization method leads us to obtain small and well dispersed nanoparticles, characterized by UV-Vis, XRD and TEM techniques. Repeating the reaction on different batches of catalyst, both the synthesis and the reaction were confirmed to be reproducible. The effect of the reaction time feeding GLO as reagent was studied: the results show that the conversion of GLO increases as the reaction time increases; however, the yields of GLA and others increase up to 1 hour, and then they remain constant. In order to obtain information on the catalytic mechanism at the atomistic level, a computational study based on density functional theory and atomistic modeling of the gold nano-catalyst were performed. Highly symmetric (icosahedral and cubo-octahedral) and distorted Au55 nanoparticles have been optimized along with Au(111) and Au(100) surfaces. Distorted structures were found to be more stable than symmetrical ones due to relativistic effects. On these various models the adsorptions of various species involved in the catalysis have been studied, including OH- species, GLU and GLO. The study carried out aims to provide a method for approaching to the study of nanoparticellary catalytic systems.

I servizi di investimento nella disciplina dell'imposta sul valore aggiunto: il quadro normativo europeo e la sua attuazione nazionale

Il presente lavoro di ricerca ha ad oggetto i profili fiscali IVA dei servizi di investimento, in ambito sia europeo che nazionale, prestati dalle banche, dalle Sim e da consulenti/società di consulenza finanziaria nei confronti della clientela al dettaglio. Ciò al fine di individuarne il corretto trattamento fiscale nonché le possibili soluzioni agli interrogativi che ancora oggi rimangono aperti, anche alla luce delle indicazioni fornite nel tempo dalla Corte di Giustizia europea. Constatata la profonda differenza esistente tra la classificazione MiFID dei servizi di investimento e quella fiscale delle operazioni finanziarie, oltre alla mancanza di coordinamento tra le relative normative europee, che non si incontrano neanche nell’attività ermeneutica della Corte di giustizia, si è cercato di interpretare la Direttiva IVA alla luce della normativa di settore (MIFID). L’analisi della Direttiva IVA e, più in particolare, del trattamento da essa riservato alle operazioni finanziarie è stata, quindi, svolta cercando di ricondurre queste ultime ai (singoli) servizi di investimento (e, quindi, alla Direttiva MiFID) al fine di tracciare un collegamento che né il legislatore comunitario né la CGE hanno individuato. È, tuttavia, apparso evidente come l’intero sistema dell’IVA, con particolare riferimento alle operazioni finanziarie, si sia ormai consolidato sulle interpretazioni della Corte di giustizia le quali hanno mostrato una elevata resilienza intrinseca. È, pertanto, auspicabile un intervento legislativo, a livello comunitario, finalizzato a rimettere mano alla Direttiva IVA al fine di fornire criteri più chiari e stringenti per l’applicazione delle disposizioni in essa contenute, con particolare riferimento a quelle relative alle operazioni finanziarie.

Le nozioni autonome di diritto europeo nel sistema dell'imposta sul valore aggiunto

Il presente lavoro intende indagare la formulazione di nozioni autonome di diritto europeo nell’ambito dell’imposta sul valore aggiunto elaborate dalla Corte di giustizia. Più specificamente si intende proporre una tassonomia convenzionale delle nozioni autonome, utile alla loro sistematizzazione e miglior comprensione, fondata sulla distinzione fondamentale tra nozioni autonome e nozioni proprie. A questo scopo il lavoro propone un’ampia analisi delle nozioni nella giurisprudenza europea che vengono distinte a seconda che l’obiettivo finale dell’autonomia sia quello di limitare la discrezionalità applicativa degli Stati relativamente a ipotesi derogatorie, nel caso delle nozioni autonome in senso stretto; oppure che l’obiettivo ultimo sia quello di meglio definire l’ambito di applicazione di nozioni fondamentali nella struttura dell’imposta, nel caso delle nozioni proprie. Lo scopo del lavoro è dimostrare che la definizione funzionalistica risponde a obiettivi diversi, accomunati dal fatto di far valere comunque il primato dell'ordinamento europeo. L’analisi e la sistematizzazione proposte possono essere uno strumento utile nell’attuazione, interpretazione e applicazione delle nozioni. In questo senso, il lavoro esamina anche esempi tratti dalle esperienze nazionali che dimostrino, da un lato, che gli interventi della Corte relativi alle nozioni influenzano gli ordinamenti nazionali; dall’altro, che permangono ancora disallineamenti. L’analisi della giurisprudenza europea e dei regimi nazionali, infine, vuole dimostrare che l’elaborazione di nozioni autonome si inserisce nel processo verso un’armonizzazione sempre più incisiva in ambito IVA, di cui è protagonista la Corte di giustizia. Questo processo, cui l’elaborazione di un “tessuto concettuale europeo” contribuisce, comporta una limitazione della discrezionalità degli Stati, e quindi del principio di attribuzione, in nome dell’efficacia e della primazia del diritto europeo.

Optimization of an innovative T6 heat treatment for the AlSi10Mg alloy processed by Laser-based Powder Bed Fusion: effect on microstructure, mechanical properties, and tribological behavior

Laser-based Powder Bed Fusion (L-PBF) technology is one of the most commonly used metal Additive Manufacturing (AM) techniques to produce highly customized and value-added parts. The AlSi10Mg alloy has received more attention in the L-PBF process due to its good printability, high strength/weight ratio, corrosion resistance, and relatively low cost. However, a deep understanding of the effect of heat treatments on this alloy's metastable microstructure is still required for developing tailored heat treatments for the L-PBF AlSi10Mg alloy to overcome the limits of the as-built condition. Several authors have already investigated the effects of conventional heat treatment on the microstructure and mechanical behavior of the L-PBF AlSi10Mg alloy but often overlooked the peculiarities of the starting supersatured and ultrafine microstructure induced by rapid solidification. For this reason, the effects of innovative T6 heat treatment (T6R) on the microstructure and mechanical behavior of the L-PBF AlSi10Mg alloy were assessed. The short solution soaking time (10 min) and the relatively low temperature (510 °C) reduced the typical porosity growth at high temperatures and led to a homogeneous distribution of fine globular Si particles in the Al matrix. In addition, it increased the amount of Mg and Si in the solid solution available for precipitation hardening during the aging step. The mechanical (at room temperature and 200 °C) and tribological properties of the T6R alloy were evaluated and compared with other solutions, especially with an optimized direct-aged alloy (T5 alloy). Results showed that the innovative T6R alloy exhibits the best mechanical trade-off between strength and ductility, the highest fatigue strength among the analyzed conditions, and interesting tribological behavior. Furthermore, the high-temperature mechanical performances of the heat-treated L-PBF AlSi10Mg alloy make it suitable for structural components operating in mild service conditions at 200 °C.

Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.

Valorization of pumpkin residue by supercritical extraction of added-value compounds

Dissertação para a obtenção do Grau de Mestre em Engenharia Química e Bioquímica

Evaluating the potential of yeast strains to produce added value products for the food and/or pharmaceutical industries

This study focus in the valorization of the apple pomace with the main goal of obtaining added value products. For that, hot compressed water technology was used for the extraction of phenolic compounds and hydrolysis of polysaccharides presents in the lignocellulosic structure of apple pomace to obtain simple sugars. The sugars have been utilized as alternative carbon source for growth, lipid accumulation and carotenoids production by five different yeast Yarrowia lipolytica, Rhodotorula mucilaginosa, Rhodotorula glutinis, Rhodosporidium babjevae and Rhodosporidium toruloides. Hydrolysis experiments were carried out with constant pressure of 100 bar, flow rate of 2mL/min and temperatures between 50°C and 250°C. The amount of total sugars present in apple pomace hydrolysates showed maximum values for the hydrolysis temperatures of 110°C and 190°C. In fact, these temperatures revealed the best results regarding the monosaccharides quantities. The amount of 5-HMF and furfural in each hydrolysate varied through the different temperatures. Maximum values for 5-HMF were obtained with 170°C, while furfural showed to be maximum at 210°C. Extraction of phenolic compounds were performed in simultaneously with hydrolysis reactions. Total phenolic compounds (TPC) increased along the temperature, however with small variations between 170°C and 250°C. Hydrolysates were then used as alternative carbon source to yeast growth. R. mucilaginosa shows the highest optical density, with the hydrolysate obtained at 130°C. Carotenoids produced by these yeast scored a total of 7.02μg carotenoids/g cell dry weight, while for the control assay, the same yeast scored 9.31μg caratonoides/g cell dry weight. β-carotene was quantified by HPLC, were 33% of the carotenoid production by R. mucilaginosa with hydrolysate as carbon source, corresponded to β-caroteno.

The added value from adopting a CGE approach to analyse changes in environmental trade balances

The application of multi-region environmental input-output (IO) analysis to the problem of accounting for emissions generation (and/or resource use) under different accounting principles has become increasingly common in the ecological and environmental economics literature in particular, with applications at the international and interregional subnational level. However, while environmental IO analysis is invaluable in accounting for pollution flows in the single time period that the accounts relate to, it is limited when the focus is on modelling the impacts of any marginal change in activity. This is because a conventional demand-driven IO model assumes an entirely passive supply-side in the economy (i.e. all supply is infinitely elastic) and is further restricted by the assumption of universal Leontief (fixed proportions) technology implied by the use of the A and multiplier matrices. Where analysis of marginal changes in activity is required, extension from an IO accounting framework to a more flexible interregional computable general equilibrium (CGE) approach, where behavioural relationships can be modelled in a more realistic and theory-consistent manner, is appropriate. Our argument is illustrated by comparing the results of introducing a positive demand stimulus in the UK economy using IO and CGE interregional models of Scotland and the rest of the UK. In the case of the latter, we demonstrate how more theory consistent modelling of both demand and supply side behaviour at the regional and national levels effect model results, including the impact on the interregional CO2 ‘trade balance’.