Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: Aesthetic and technical refinements

Although the biodimensional anatomical expander-implant system (BEIS) is a reliable technique, little information has been available regarding outcome following nipple-areola sparing mastectomy (NSM). To perform the resection of glandular tissue, while improving the surgical access and maintaining the nipple-areola vascularization we have developed a new approach for NSM based on the double concentric periareolar incision (DCPI). The purpose of this study is to analyze the feasibility, surgical planning and its outcome following NSM. 18 patients underwent NSM reconstructions. Mean time of follow-up was 29 months. The technique was indicated in patients with small/moderate volume breasts. Flap complications were evaluated and information on aesthetic results and patient satisfaction were collected. 83.3% had tumors measuring 2 cm or less (T1) and 72.1% were stage 0 and 1. All patients presented peripherally tumors located (at least 5 cm from the nipple). Skin complications occurred in 11.1%. One patient (5.5%) presented small skin necrosis and a wound dehiscence was observed in one patient (5.5%). The aesthetic result was good/very good in 94.4 percent and the majority of patients were very satisfied/satisfied. No local recurrences were observed. All complications except one were treated by a conservative approach. DCPI-BEIS is a simple and reliable technique for NSM reconstruction. The success depends on patient selection, coordinated planning with the oncologic surgeon and careful intra-operative and post-operative management. (C) 2009 Elsevier Ltd. All rights reserved.

Entre o êxito e a frustração com a sistematização da assistência de enfermagem

Pesquisa qualitativa orientada pelos referenciais teórico-metodológicos: Interacionismo Simbólico e Grounded Theory para compreender o processo planejamento-implementação da Sistematização da Assistência de Enfermagem (SAE), segundo dois grupos amostrais: enfermeiros e auxiliares/técnicos de enfermagem de um hospital universitário, e desenvolver uma síntese dos modelos teóricos representativos dessas experiências. A saturação teórica configurou-se mediante a análise da 24ª entrevista não diretiva de 12 enfermeiros e de 12 técnicos de enfermagem, lotados em unidades de internação. da análise emergiram dois modelos teóricos, cuja síntese originou o terceiro, intitulado Entre o êxito e a frustração com a operacionalização da SAE: recursos humanos como componente determinante para a visibilidade do enfermeiro no processo de trabalho. Este modelo desvela o déficit de recursos humanos, impulsionando o enfermeiro a realizar uma SAE ilusória, e perpetuando um processo cíclico de sofrimento, por vivenciar a invisibilidade de sua práxis no processo de trabalho.

Transmission network expansion planning in full open market considering security constraints

This paper presents a mathematical model and a methodology to solve the transmission network expansion planning problem with security constraints in full competitive market, assuming that all generation programming plans present in the system operation are known. The methodology let us find an optimal transmission network expansion plan that allows the power system to operate adequately in each one of the generation programming plans specified in the full competitive market case, including a single contingency situation with generation rescheduling using the security (n-1) criterion. In this context, the centralized expansion planning with security constraints and the expansion planning in full competitive market are subsets of the proposal presented in this paper. The model provides a solution using a genetic algorithm designed to efficiently solve the reliable expansion planning in full competitive market. The results obtained for several known systems from the literature show the excellent performance of the proposed methodology.

Entre o êxito e a frustação com a operacionalização da SAE: recursos humanos como componente determinante para a visibilidade do enfermeiro no processo de trabalho

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Objetivos de desenvolvimento do milênio da ONU: redução da mortalidade na infância e saneamento básico urbano no estado do Pará

Saneamento básico e saúde são inseparáveis. Sob esta premissa, é conduzida a investigação contida neste estudo, que busca contribuir oferecendo à sociedade um ponto de vista interdisciplinar na formulação e acompanhamento das políticas públicas de saneamento básico urbano. O uso de indicadores urbanos é fator de melhoria no planejamento e gestão das cidades, e matéria atualíssima. Há fartura deles, entretanto este estudo busca a simplicidade cognitiva, embora sem reducionismo, e aí reside a preocupação com a interdisciplinaridade contida na abordagem desta investigação, que culmina com a proposição de modelo econométrico relacionando dados censitários sociais e sanitários. São estudadas as relações entre mortalidade na infância, população urbana, provisão de serviços urbanos de abastecimento de água, esgotamento sanitário e coleta de lixo. São verificadas as relações explicativas entre a variável de dependente constituída pelo produto mortalidade na infância x população urbana e as variáveis independentes populações urbanas atendidas com abastecimento de água, rede de esgoto e coleta de lixo. Consideradas as políticas de investimentos em saneamento expressas no Orçamento Geral do Estado do Pará para o ano de 2006 como usuais, e a partir do modelo desenvolvido, a mortalidade na infância é inferida para o ano de 2015, e comparada com a Meta dos Objetivos de Desenvolvimento do Milênio da ONU, a qual consiste na redução da mortalidade na infância em 2/3 entre os anos de 1990 e 2015. As estimativas de recursos para o atingimento dessa Meta indicam a necessidade de manter os investimentos em abastecimento de água, coleta de lixo e incrementálos em esgotamento sanitário. Como conseqüência lógica do raciocínio e das análises contidas no trabalho, é sugerido como critério de priorização no planejamento e alocação de recursos para ampliação da provisão de serviços urbanos de saneamento básico a mortalidade na infância.

O aproveitamento de água de chuva para fins não potáveis na cidade universitária professor José da Silveira Netto - Belém/PA

A Amazônia brasileira detém cerca de 69% da água doce disponível no Brasil, quantidade que acaba criando a ilusão de que não falta e nem faltará água na região, assim, a grande oferta deste recurso se torna um problema quando se trata da Gestão e Planejamento dos Recursos Hídricos na Amazônia, em função do uso perdulário e a falta de conservação dos mananciais, agravado pelo lançamento de resíduos líquidos sem tratamento. Falar em programas de conservação de água na Amazônia algumas décadas atrás e ainda hoje, com menor intensidade, é de certa forma estranha, devido à grande quantidade de água disponível e a cultura da abundância. Porém, com as mudanças climáticas, ssociada à crise da água no século XXI e o crescimento da consciência ambiental, surgiu um novo paradigma para o uso da água. Assim, a presente pesquisa busca discutir a importância do aproveitamento de água de chuva para fins não potáveis, visto o potencial de aproveitamento, ao longo de todo ano, devido o alto índice pluviométrico presente na região amazônica, variando, em média, de 119,6mm no mês de novembro a 441,6mm no mês de março. Foi verificado o potencial de aproveitamento de água da chuva, a partir das áreas dos telhados de alguns prédios, localizados na Universidade Federal do Pará – UFPA, Campus Guamá, também conhecido como Cidade Universitária Professor José da Silveira Netto. Os métodos utilizados para o dimensionamento do reservatório foram os de Rippl e o Interativo, sendo a verificação da viabilidade econômica feita através dos métodos do Valor Presente Líquido - VPL e payback descontado. Como resultado, obteve-se através do método de Rippl um volume superior a 1000 m³, enquanto que, pelo método interativo foi de no máximo 75 m³. A viabilidade econômica apresentou-se fragilizada em função do tempo de retorno ser superior a vida útil do sistema de aproveitamento de água de chuva.

Proposta metodológica para avaliação da matriz energética brasileira em prol do equilíbrio: competitividade e sustentabilidade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Medidas de adequação dos impactos causados por uma indústria de esmagamento de soja

In the last years, environmental issues are being gradually addressed because of awareness regarding the limitation of natural resources for the maintenance of life on Earth, and the role played by the media in reporting on various issues that are related to the theme. In the industrial sector, this topic becomes ever more present in its planning. With the increase of production activities, the generation of waste causes many complications, both in industry and in the environment. For this reason laws and rules were created so that such problems are minimized, thus causing less impact on the environment. In this work was a study of the possible environmental impacts in a soybean crushing industry, situated in the city of Osvaldo Cruz, São Paulo state, detailing the sources and impacts of waste generation, and associate them relevant laws. From this, measures were proposed measures of adequacy involving compliance with commitments to environmental agencies, relevant requests of buyers and / or suppliers and improving environmental performance

Simulações de onda de cheia na sub-bacia do Ribeirão Claro - SP

Watersheds are considered important study units when it comes to environmental planning, with regard to the optimal use of water resources. Water scarcity is predicted and feared by many societies, and proves to be an increasingly tangible problem nowadays. Still from the perspective of extreme events, this dissertation considers the study of flood waves in the sub-basin of the stream Claro, which belongs to the Corumbataí watershed. - SP, since thay can also have devastating effects for the population, A Decision Support System for Flood Routing Analysis in Complex Basins, ABC 6 software was applied in order to obtain hydrographs and peak flows in the sub-basin of the stream Claro, for return periods of 10 and 100 years, aiming to comprise events of different magnitudes. The model Soil Conservation Service (SCS) and the triangular SCS hydrograph were adopted for the simulations. Simultaneously, the Kokei Uehara method was applied for the obtainment of peak flow values under the same conditions, seeking to compare results. Data collection was performed using geoprocessing tools. For data entry in ABC 6, the fragmentation of sub-basin of the stream Claro was necessary, which generated 7 small watersheds, in order to fulfill a software demand, as the maximum drainage area it accepts is 50km² for each watershed analyzed. For RT = 10 and 100 years, respectively, the results of peak flow with use of ABC 6 were 46.10 and 95.45 m³/s, while for Kokei Uehara method, the results were 47.17 and 65.26 m³/s. The adoption of a single value of discretization time for all watersheds was indicated as limitation of ABC 6, which interfered in the final results. Kokei method Uehara considered the sub-basin of the stream Claro as a whole, which reduced the error accumulation probability

A new system for computer-aided preoperative planning and intraoperative navigation during corrective jaw surgery

A new system for computer-aided corrective surgery of the jaws has been developed and introduced clinically. It combines three-dimensional (3-D) surgical planning with conventional dental occlusion planning. The developed software allows simulating the surgical correction on virtual 3-D models of the facial skeleton generated from computed tomography (CT) scans. Surgery planning and simulation include dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and segment repositioning. By coupling the software with a tracking system and with the help of a special registration procedure, we are able to acquire dental occlusion plans from plaster model mounts. Upon completion of the surgical plan, the setup is used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with the help of a display showing jaw positions and 3-D positioning guides updated in real time during the surgical procedure. The proposed approach offers the advantages of 3-D visualization and tracking technology without sacrificing long-proven cast-based techniques for dental occlusion evaluation. The system has been applied on one patient. Throughout this procedure, we have experienced improved assessment of pathology, increased precision, and augmented control.

Low back pain risk factors associated with persistence, recurrence and delayed presentation

BACKGROUND: There is little knowledge in the literature on the role of time-related variables for the prognosis of acute and subacute low back pain (LBP). OBJECTIVE: The aim of this study was to estimate the relationship between time-related LBP characteristics and prognostic factors for acute/subacute LBP. METHODS: We performed a prospective inception cohort study of 315 patients attending a health practitioner for acute/subacute LBP or recurrent LBP. One-tailed correlations were conducted between patient characteristics and time-related variables. RESULTS: The pattern of correlation between risk factors for and resources against persistent LBP differed between three time-related variables. 'Subacute LBP' and 'delayed presentation' were positively associated with psychological factors. Both indicators were negatively correlated with resources against development of persistent LBP. Moreover, 'delayed presentation' was related positively with occupational stressors. In contrast, 'recurrent LBP' was only related to more impaired health-related factors. CONCLUSIONS: Patients with current LBP waiting longer until seeking help in primary care have a more disadvantageous profile of occupational and psychological risk factors and lower resource levels. A similar but less pronounced pattern occurred in those with subacute LBP compared to those with acute LBP. Consideration of time characteristics of LBP may help to better understand LBP.

An Appraisal of the Current Status and the Potential of Surface Water in Upper Anseba Catchment, Eritrea

The study deals with the status and potential of surface water resources in Upper Anseba, Central Highlands of Eritrea, one of the most densely populated regions in Eritrea, including small scale farming and the country's capital city. water demand is increasing rapidly for all uses. The area has no perennial water course and depends very largely on reservoirs for its water supply. The report finds that there are 74 reservoirs in the area, of which 49 are in Upper Anseba. Total reservoir capacity already corresponds to 70% of runoff. the capacity of some of the reservoirs already exceeds annual runoff of their catchment. Recommendations thus include the use of water saving technologies for irrigation; and above all, preparation of a regional master plan for development, including water allocation planning with a mid term perspective.

Causes, forms and consequences of the professionalization of international sport federa-tions in Switzerland: Conceptual framework and first results

Synopsis: Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. Our study seeks to reveal and analyse the causes for professionalization processes in international sport federations, the forms resulting from it, as well as related consequences. Abstract: AIM OF ABSTRACT/PAPER - RESEARCH QUESTION Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. In this context, professionalization seems to have been adopted by sport organisations as an appropriate strategy to respond to pressures such as becoming more “business-like”. The ongoing study seeks to reveal and analyse the internal and external causes for professionalization processes in international sport federations, the forms resulting from it (e.g. organisational, managerial, economic) as well as related consequences on objectives, values, governance methods, performance management or again rationalisation. THEORETICAL BACKGROUND/LITERATURE REVIEW Studies on sport as specific non-profit sector mainly focus on the prospect of the “professionalization of individuals” (Thibault, Slack & Hinings, 1991), often within sport clubs (Thiel, Meier & Cachay, 2006) and national sport federations (Seippel, 2002) or on organisational change (Griginov & Sandanski, 2008; Slack & Hinings, 1987, 1992; Slack, 1985, 2001), thus leaving broader analysis on governance, management and professionalization in sport organisations an unaccomplished task. In order to further current research on above-mentioned topics, our intention is to analyse causes, forms and consequences of professionalisation processes in international sport federations. The social theory of action (Coleman, 1986; Esser, 1993) has been defined as appropriate theoretical framework, deriving in the following a multi-level framework for the analysis of sport organisations (Nagel, 2007). In light of the multi-level framework, sport federations are conceptualised as corporative actors whose objectives are defined and implemented with regard to the interests of member organisations (Heinemann, 2004) and/or other pressure groups. In order to understand social acting and social structures (Giddens 1984) of sport federations, two levels are in the focus of our analysis: the macro level examining the environment at large (political, social, economic systems etc.) and the meso level (Esser, 1999) examining organisational structures, actions and decisions of the federation’s headquarter as well as member organisations. METHODOLOGY, RESEARCH DESIGN AND DATA ANALYSIS The multi-level framework mentioned seeks to gather and analyse information on causes, forms and consequences of professionalization processes in sport federations. It is applied in a twofold approach: first an exploratory study based on nine semi-structured interviews with experts from umbrella sport organisations (IOC, WADA, ASOIF, AIOWF, etc.) as well as the analysis of related documents, relevant reports (IOC report 2000 on governance reform, Agenda 2020, etc.) and important moments of change in the Olympic Movement (Olympic revenue share, IOC evaluation criteria, etc.); and secondly several case studies. Whereas the exploratory study seeks more the causes for professionalization on an external, internal and headquarter level as depicted in the literature, the case studies rather focus on forms and consequences. Applying our conceptual framework, the analysis of forms is built around three dimensions: 1) Individuals (persons and positions), 2) Processes, structures (formalisation, specialisation), 3) Activities (strategic planning). With regard to consequences, we centre our attention on expectations of and relationships with stakeholders (e.g. cooperation with business partners), structure, culture and processes (e.g. governance models, performance), and expectations of and relationships with member organisations (e.g. centralisation vs. regionalisation). For the case studies, a mixed-method approach is applied to collect relevant data: questionnaires for rather quantitative data, interviews for rather qualitative data, as well as document and observatory analysis. RESULTS, DISCUSSION AND IMPLICATIONS/CONCLUSIONS With regard to causes of professionalization processes, we analyse the content of three different levels: 1. the external level, where the main pressure derives from financial resources (stakeholders, benefactors) and important turning points (scandals, media pressure, IOC requirements for Olympic sports); 2. the internal level, where pressure from member organisations turned out to be less decisive than assumed (little involvement of member organisations in decision-making); 3. the headquarter level, where specific economic models (World Cups, other international circuits, World Championships), and organisational structures (decision-making procedures, values, leadership) trigger or hinder a federation’s professionalization process. Based on our first analysis, an outline for an economic model is suggested, distinguishing four categories of IFs: “money-generating IFs” being rather based on commercialisation and strategic alliances; “classical Olympic IFs” being rather reactive and dependent on Olympic revenue; “classical non-Olympic IFs” being rather independent of the Olympic Movement; and “money-receiving IFs” being dependent on benefactors and having strong traditions and values. The results regarding forms and consequences will be outlined in the presentation. The first results from the two pilot studies will allow us to refine our conceptual framework for subsequent case studies, thus extending our data collection and developing fundamental conclusions. References: Bayle, E., & Robinson, L. (2007). A framework for understanding the performance of national governing bodies of sport. European Sport Management Quarterly, 7, 249–268 Chantelat, P. (2001). La professionnalisation des organisations sportives: Nouveaux débats, nouveaux enjeux [Professionalisation of sport organisations]. Paris: L’Harmattan. Dowling, M., Edwards, J., & Washington, M. (2014). Understanding the concept of professionalization in sport management research. Sport Management Review. Advance online publication. doi: 10.1016/j.smr.2014.02.003 Ferkins, L. & Shilbury, D. (2012). Good Boards Are Strategic: What Does That Mean for Sport Governance? Journal of Sport Management, 26, 67-80. Thibault, L., Slack, T., & Hinings, B. (1991). Professionalism, structures and systems: The impact of professional staff on voluntary sport organizations. International Review for the Sociology of Sport, 26, 83–97.

PROJECTION OF HEALTH DEMAND IN TERMS OF HOSPITAL ADMISSIONS FOR SELECTED DIAGNOSES IN HEALTH SYSTEMS AGENCY SERVICE AREAS

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) requires that health systems agencies (HSAs) plan for their health service areas by the use of existing data to the maximum extent practicable. Health planning is based on the identificaton of health needs; however, HSAs are, at present, identifying health needs in their service areas in some approximate terms. This lack of specificity has greatly reduced the effectiveness of health planning. The intent of this study is, therefore, to explore the feasibility of predicting community levels of hospitalized morbidity by diagnosis by the use of existing data so as to allow health planners to plan for the services associated with specific diagnoses.^ The specific objectives of this study are (a) to obtain by means of multiple regression analysis a prediction equation for hospital admission by diagnosis, i.e., select the variables that are related to demand for hospital admissions; (b) to examine how pertinent the variables selected are; and (c) to see if each equation obtained predicts well for health service areas.^ The existing data on hospital admissions by diagnosis are those collected from the National Hospital Discharge Surveys, and are available in a form aggregated to the nine census divisions. When the equations established with such data are applied to local health service areas for prediction, the application is subject to the criticism of the theory of ecological fallacy. Since HSAs have to rely on the availability of existing data, it is imperative to examine whether or not the theory of ecological fallacy holds true in this case.^ The results of the study show that the equations established are highly significant and the independent variables in the equations explain the variation in the demand for hospital admission well. The predictability of these equations is good when they are applied to areas at the same ecological level but become poor, predominantly due to ecological fallacy, when they are applied to health service areas.^ It is concluded that HSAs can not predict hospital admissions by diagnosis without primary data collection as discouraged by Public Law 93-641. ^

RADIANCE-A planning software for intra-operative radiation therapy

In the last decades accumulated clinical evidence has proven that intra-operative radiation therapy (IORT) is a very valuable technique. In spite of that, planning technology has not evolved since its conception, being outdated in comparison to current state of the art in other radiotherapy techniques and therefore slowing down the adoption of IORT. RADIANCE is an IORT planning system, CE and FDA certified, developed by a consortium of companies, hospitals and universities to overcome such technological backwardness. RADIANCE provides all basic radiotherapy planning tools which are specifically adapted to IORT. These include, but are not limited to image visualization, contouring, dose calculation algorithms-Pencil Beam (PB) and Monte Carlo (MC), DVH calculation and reporting. Other new tools, such as surgical simulation tools have been developed to deal with specific conditions of the technique. Planning with preoperative images (preplanning) has been evaluated and the validity of the system being proven in terms of documentation, treatment preparation, learning as well as improvement of surgeons/radiation oncologists (ROs) communication process. Preliminary studies on Navigation systems envisage benefits on how the specialist to accurately/safely apply the pre-plan into the treatment, updating the plan as needed. Improvements on the usability of this kind of systems and workflow are needed to make them more practical. Preliminary studies on Intraoperative imaging could provide an improved anatomy for the dose computation, comparing it with the previous pre-plan, although not all devices in the market provide good characteristics to do so. DICOM.RT standard, for radiotherapy information exchange, has been updated to cover IORT particularities and enabling the possibility of dose summation with external radiotherapy. The effect of this planning technology on the global risk of the IORT technique has been assessed and documented as part of a failure mode and effect analysis (FMEA). Having these technological innovations and their clinical evaluation (including risk analysis) we consider that RADIANCE is a very valuable tool to the specialist covering the demands from professional societies (AAPM, ICRU, EURATOM) for current radiotherapy procedures.