877 resultados para First psychotherapy case


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A indústria de serviços online é caracterizada por um volume alto de Fusões e Aquisições no período de 2005 a 2015. As líderes de mercado, Apple, Google e Microsoft, incorporaram essa forma de crescimento inorgânico em suas estratégias corporativas. Essa tese examina as atividades de Fusões e Aquisições dessas três empresas. Consequentemente, ela tem foco em dois aspectos principais. Primeiro, existe o objetivo de saciar uma escassez na literatura acadêmica, no que se diz respeito ao estabelecimento de uma conexão entre a estratégia corporativa dessas empresas e as decisões tomadas de Fusões e Aquisições. Segundo, há também o objetivo de estimar possíveis futuros desenvolvimentos no setor. Através de uma análise de conteúdo qualitativa das publicações das empresas, relatórios de análise de mercado, e outros conteúdos de terceiros, estudos de caso foram desenvolvidos. Os resultados mostram o processo de posicionamento estratégico por parte da Apple, Google e Microsoft, dentro do mercado de serviços online, entre os anos de 2005 e 2015. As recorrentes fusões e aquisições são analisadas, no que se diz respeito as estratégias corporativas dessas empresas e a responsividade perante as atividades de seus competidores. Os resultados evidenciam atividades agressivas de Fusões e Aquisições em grupos estratégicos em comum entre as três empresas, especialmente no mercado de aparelhos de comunicação móvel e serviços de comunicação.

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While pursuing the objective to investigate the potential for the P2P innovation to enhance financial inclusion in Brazil, the P2P industry and the current market environment were analyzed in order to highlight the factors that can facilitate this desired enhancement. There seems to be no doubt that there is substantial potential for the P2P industry worldwide and in Brazil but, beyond this, a considerable part of this industry could be providing financially inclusive products. The P2P industry in Brazil needs to recognize the potential for growing, not only the industry itself, but also the market for financially inclusive P2P products. The first section of this thesis focuses on financial inclusion briefly in order to establish the frame of what is being addressed. Subsequently the P2P industry is analyzed globally, locally in Brazil and with regard to financial inclusion. The study is conducted through an interview with the founder of a P2P platform in Brazil and its data collection is used to build a case study which allowed for an analysis of the potential for financial inclusion of the P2P industry and the development of key success factors with regard to converting this potential into results.

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The work done in this thesis attempts to demonstrate the importance of using models that can predict and represent the mobility of our society. To answer the proposed challenges two models were examined, the first corresponds to macro simulation with the intention of finding a solution to the frequency of the bus company Horários do Funchal, responsible for transport in the city of Funchal, and some surrounding areas. Where based on a simplified model of the city it was possible to increase the frequency of journeys getting an overall reduction in costs. The second model concerns the micro simulation of Avenida do Mar, where currently is being built a new roundabout (Praça da Autonomia), which connects with this avenue. Therefore it was proposed to study the impact on local traffic, and the implementation of new traffic lights for this purpose. Four possible situations in which was seen the possibility of increasing the number of lanes on the roundabout or the insertion of a bus lane were created. The results showed that having a roundabout with three lanes running is the best option because the waiting queues are minimal, and at environmental level this model will project fewer pollutants. Thus, this thesis presents two possible methods of urban planning. Transport modelling is an area that is under constant development, the global goal is to encourage more and more the use of these models, and as such it is important to have more people to devote themselves to studying new ways of addressing current problems, so that we can have more accurate models and increasing their credibility.

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Na avaliação da dispneia pós-exercício em uma cadela de 10 meses de idade, não castrada e sem raça definida, foi detectado sopro sistólico leve grau II/VI. A comunicação entre a aorta ascendente e o tronco pulmonar, observada pela presença de fluxo contínuo logo abaixo das valvas semilunares, à ecoDopplercardiografia, foi confirmada pela cirurgia. Após o procedimento cirúrgico, a cadela apresentou boa condição clínica e ausência de dispneia mesmo ao exercício. Ressalta-se a importância do diagnóstico precoce e preciso para o sucesso terapêutico. Este é o primeiro relato brasileiro dessa rara doença e a única cirurgia, bem sucedida, descrita na literatura veterinária consultada.

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The Global Positioning System (GPS) transmits signals in two frequencies. It allows the correction of the first order ionospheric effect by using the ionosphere free combination. However, the second and third order ionospheric effects, which combined may cause errors of the order of centimeters in the GPS measurements, still remain. In this paper the second and third order ionospheric effects, which were taken into account in the GPS data processing in the Brazilian region, were investigated. The corrected and not corrected GPS data from these effects were processed in the relative and precise point positioning (PPP) approaches, respectively, using Bernese V5.0 software and the PPP software (GPSPPP) from NRCAN (Natural Resources Canada). The second and third order corrections were applied in the GPS data using an in-house software that is capable of reading a RINEX file and applying the corrections to the GPS observables, creating a corrected RINEX file. For the relative processing case, a Brazilian network with long baselines was processed in a daily solution considering a period of approximately one year. For the PPP case, the processing was accomplished using data collected by the IGS FORT station considering the period from 2001 to 2006 and a seasonal analysis was carried out, showing a semi-annual and an annual variation in the vertical component. In addition, a geographical variation analysis in the PPP for the Brazilian region has confirmed that the equatorial regions are more affected by the second and third order ionospheric effects than other regions.

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Purpose - The purpose of this paper is to verify if Brazilian companies are adopting environmental requirements in the supplier selection process. Further, this paper intends to analyze whether there is a relation between the level of environmental management maturity and the inclusion of environmental criteria in the companies' selection of suppliers.Design/methodology/approach - A review of mainstream literature on environmental management, traditional criteria in the supplier selection process and the incorporation of environmental requirements in this context. The empirical study's strategy is based on five Brazilian case studies with industrial companies. Face-to-face interviews and informal conversations are to be held, explanations made by e-mail with representatives from the purchasing, environmental management, logistics and other areas, and observation and the collection of company documents are also employed.Findings - Based on the cases, it is concluded that companies still use traditional criteria to select suppliers, such as quality and cost, and do not adopt environmental requirements in the supplier selection process in a uniform manner. Evidence found shows that the level of environmental management maturity influences the depth with which companies adopt environmental criteria when selecting suppliers. Thus, a company with more advanced environmental management adopts more formal procedures for selecting environmentally appropriate suppliers than others.Originality/value - This is the first known study to verify if Brazilian companies are adopting environmental requirements in the supplier selection process.

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Speech and language disorders are some of the most common referral reasons to child development centers accounting for approximately 40% of cases. Stuttering is a disorder in which involuntary repetition, prolongation, or cessation of the sound precludes the flow of speech. About 5% of individuals in the general population have a stuttering problem, and about 80% of the affected children recover naturally. The causal factors of stuttering remain uncertain in most cases; studies suggest that genetic factors are responsible for 70% of the variance in liability for stuttering, whereas the remaining 30% is due to environmental effects supporting a complex cause of the disorder. The use of high-resolution genome wide array comparative genomic hybridization has proven to be a powerful strategy to narrow down candidate regions for complex disorders. We report on a case with a complex set of speech and language difficulties including stuttering who presented with a 10Mb deletion of chromosome region 7q33-35 causing the deletion of several genes and the disruption of CNTNAP2 by deleting the first three exons of the gene. CNTNAP2 is known to be involved in the cause of language and speech disorders and autism spectrum disorder and is in the same pathway as FOXP2, another important language gene, which makes it a candidate gene for causal studies speech and language disorders such as stuttering. (C) 2010 Wiley-Liss, Inc.

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PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.

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Infartos cerebrais de etiologia cardíaca são observados em cerca de 20% dos pacientes com acidente vascular cerebral isquêmico. Infarto cerebral ocorre como manifestação clínica inicial em um terço dos casos de mixoma atrial. Embora quase metade dos pacientes com mixoma atrial apresente alteração ao exame neurológico, infarto cerebral não hemorrágico é visto na tomografia computadorizada em praticamente todos os casos. Os autores apresentam o caso de uma paciente, cuja primeira manifestação clínica do mixoma atrial foi um acidente vascular cerebral isquêmico e chamam a atenção para a possibilidade de infarto cerebral silencioso em pacientes portadores de mixoma atrial.

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The relationship between malnutrition and social support was first suggested in the mid-1990s. Despite its plausibility, no empirical studies aimed at obtaining evidence of this association could be located. The goal of the present study was to investigate such evidence. A case-control study was carried out including 101 malnourished children (weight-for-age National Center for Health Statistics/WHO 5th percentile) aged 12-23 months, who were compared with 200 well-nourished children with regard to exposure to a series of factors related to their social support system. Univariate and multiple logistic regressions were carried out, odds ratios being adjusted for per capita family income, mother's schooling, and number of children. The presence of an interaction between income and social support variables was also tested. Absence of a partner living with the mother increased risk of malnutrition (odds ratio 2.4 (95 % CI 1.19, 4.89)), even after adjustment for per capita family income, mother's schooling, and number of children. The lack of economic support during adverse situations accounted for a very high risk of malnutrition (odds ratio 10.1 (95 % CI 3.48, 29.13)) among low-income children, but had no effect on children of higher-income families. Results indicate that receiving economic support is an efficient risk modulator for malnutrition among low-income children. In addition, it was shown that the absence of a partner living with the mother is an important risk factor for malnutrition, with an effect independent from per capita family income, mother's schooling, and number of children.

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Background: Some studies have suggested that the suppression of endogenous LH secretion does not seem to affect the majority of patients who are undergoing assisted reproduction and stimulation with recombinant FSH (r-FSH). Other studies have indicated that a group of normogonadotrophic women down-regulated and stimulated with pure FSH preparations may experience low LH concentrations that compromise the IVF parameters. The present study aimed to compare the efficacy of recombinant LH (r-LH) supplementation for controlled ovarian stimulation in r-FSH and GnRH-agonist (GnRH-a) protocol in ICSI cycles.Methods: A total of 244 patients without ovulatory dysfunction, aged < 40 years and at the first ICSI cycle were divided into two groups matched by age according to an ovarian stimulation scheme: Group I (n = 122): Down-regulation with GnRH-a + r-FSH and Group II (n = 122): Downregulation with GnRH-a + r-FSH and r-LH (beginning simultaneously).Result(s): The number of oocytes collected, the number of oocytes in metaphase II and fertilization rate were significantly lower in the Group I than in Group II (P = 0.036, P = 0.0014 and P = 0.017, respectively). In addition, the mean number of embryos produced per cycle and the mean number of frozen embryos per cycle were statistically lower (P = 0.0092 and P = 0.0008, respectively) in Group I than in Group II. Finally the cumulative implantation rate (fresh+thaw ed embryos) was significantly lower (P = 0.04) in Group I than in Group II. The other clinical and laboratory results analyzed did not show difference between groups.Conclusion: These data support r-LH supplementation in ovarian stimulation protocols with r-FSH and GnRH-a for assisted reproduction treatment.

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OBJECTIVE: A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1-P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin.CLINICAL PRESENTATION: A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1-P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin.INTERVENTION: Surgical trapping of the right P1 -P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life.CONCLUSION: To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1-P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

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The phenotype of partial trisomy 9p includes global developmental delay, microcephaly, bulbous nose, downturned oral commissures, malformed ears, hypotonia, and severe cognitive and language disorders. We present a case report and a comparative review of clinical findings on this condition, focusing on speech-language development, cognitive abilities and swallowing evaluation. We suggest that oropharyngeal dysphagia should be further investigated, considering that pulmonary and nutritional disorders affect the survival and quality of life of the patient. As far as we know, this is the first study of a patient with partial trisomy 9p described with oropharyngeal dysphagia.

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Neste trabalho, é relatada a infecção natural por Leishmania em um gato doméstico no qual, formas amastigotas do parasito foram observadas em imprint de linfonodo poplíteo. Reações sorológicas positivas e negativas foram observadas pelo teste de imunoadsorção enzimática (ELISA) e reação de imunofluorescência indireta (RIFI), respectivamente. A reação em cadeia da polimerase (PCR) revelou que a sequência de nucleotídeos foi idêntica à Leishmania (L.) chagasi. Este é o primeiro relato da doença em felino da cidade de Andradina, Estado de São Paulo, Brasil, área considerada endêmica para leishmaniose visceral canina e humana.

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Doenças infecciosas em animais selvagens têm aumentado devido às alterações em seu habitat e ao maior contato com animais domésticos. A cinomose já foi descrita em diversas espécies de carnívoros selvagens, representando uma ameaça à conservação da vida selvagem. Nesse estudo é descrito o primeiro caso de infecção pelo vírus da cinomose em um furão (Galictis cuja). Um indivíduo de vida livre, sem sinais clínicos aparentes, apresentou morte súbita após um dia em cativeiro. Foi realizado o diagnóstico molecular para detecção do vírus da cinomose canina, sendo o resultado positivo. A filogenia do vírus indicou que cães domésticos foram a provável fonte de infecção.