Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94% ,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

Supply chain management as beyond operational efficiency

The orthodoxy of supply chain management (SCM) emphasises competitive advantage through increased operational efficiency and market responsiveness from production and distribution processes into the hands of consumers. It anticipates that future competition will be between chains rather than between firms. While well established in other industry sectors, the SCM concept is newly developed in the Australian agri-food sector. Critical review of the concept has identified key issues of power among channel members, processes of chain initiation and innovation, and the inability of SCM to offer a viable business strategy for some firms. Building on those insights, this paper examines the supply chain concept for horticulture. Horticultural products are characterised by perishability, heterogeneity and lags in production response to market signals. Producers’ profits are vulnerable to quantity, timing of supply and product specification. Many supply chains in smaller industries are loose, fragmented, interwoven, unstable and unique! Firms operating within these environments need an astute understanding of the chains, the hierarchy of channel members and their relative position. Effective business strategies – for individual firms and supply chains - need to be developed and redeveloped to accommodate the dynamic nature of horticulture. Two case studies are discussed as contributions to this early stage of the theoretical development of supply chain management. The SCM concept also has implications for horticultural researchers, involving a wider range of industry stakeholders, technical problems and research skills. As for business management, the usefulness of the concept will depend on its capacity to increase responsiveness to customers’ preferences and customer value.

Leaf area development of ABA-deficient and wild-type peas at two levels of nitrogen supply

The ABA-deficient wilty pea (Pisum sativum L.) and its wild-type (WT) were grown at two levels of nitrogen supply (0.5 and 5.0 mM) for 5-6 weeks from sowing, to determine whether leaf ABA status altered the leaf growth response to N deprivation. Plants were grown at high relative humidity to prevent wilting of the wilty peas. Irrespective of N supply, expanding wilty leaflets had ca 50% less ABA than WT leaflets but similar ethylene evolution rates. Fully expanded wilty leaflets had lower relative water contents (RWC) and were 10-60% smaller in area (according to the node of measurement) than WT leaflets. However, there were no genotypic differences in plant relative leaf expansion rate (RLER). Growth of both genotypes at 0.5 mM N increased the RWC of fully expanded leaflets, but did not alter ethylene evolution or ABA concentration of expanding leaflets. Plants grown at 0.5 mM N showed a 20-30% reduction in RLER, which was similar in magnitude in both wilty and WT peas. Thus, leaf ABA status did not alter the leaf growth response to N deprivation.

The over-production of US sports and the new International Division of Cultural Labor

This article focuses on how US professional sports utilize the New International Division of Cultural Labor to supplement an overly costly local labor pool and over-supplied local market. We argue that while the classic problem of over-production is slowly eroding the sealed-off nature of US culture, the forces of its hyper-protectionist capitalism continue to characterize sports, precluding equal exchange.

Supply chain management

Nos últimos anos, a economia mundial e a economia brasileira têm sofrido mudanças importantes. Fusões, aquisições e alianças estratégicas têm se multiplicado. Parte considerável destas mudanças relaciona-se com profundas alterações nos sistemas de valores de todos os segmentos industriais. A busca da competitividade relaciona-se cada vez mais com a busca do ótimo sistêmico além das fronteiras da empresa. Neste contexto, a administração logística ganha nova dimensão, envolvendo a integração de todas as atividades ao longo da cadeia de valores e do sistema de valores, das matérias-primas ao cliente final. O objetivo deste trabalho é (re)situar a administração logística no contexto de mudanças, enfatizando a metodologia da gestão da cadeia de demanda (supply chain management).

GREEN SUPPLY CHAIN: PROTAGONISTA OU COADJUVANTE NO BRASIL?

Questões ambientais passaram a ser introduzidas com maior frequência nos negócios empresariais. Quanto à cadeia de suprimentos, Green Supply Chain Management (GSCM) surge como novo enfoque à responsabilidade das empresas com o meio ambiente. Este artigo objetiva analisar a difusão do conceito e das práticas de GSCM no cenário brasileiro. Para tanto, foram realizadas entrevistas com especialistas do tema cadeia de suprimentos na área de Administração no Brasil. Os resultados indicam que as razões para o lento desenvolvimento do conceito podem relacionar-se com características do mercado nacional, foco empresarial em aspectos internos, falta de legislação rígida e baixa pressão dos consumidores. Especialistas percebem, entretanto, boas perspectivas para o futuro das discussões da temática no País, em virtude da Política Nacional dos Resíduos Sólidos, de pressões do mercado internacional e da busca por certificação ambiental. Este estudo procurou fomentar novas discussões sobre GSCM no Brasil.

SUPPLY CHAIN RESILIENCE ANALYSIS: A BRAZILIAN AUTOMOTIVE CASE

Supply chain (SC) resilience and flexibility are important research topics receiving growing attention. However, the academic literature needs empirical studies on SC resilience capable of investigating the inter-organizational components of flexibility along different tiers. Therefore, this paper analyzes the main lack of flexibilities in three Brazilian automotive SCs that limit their resilience and therefore their capacity to better support and meet the demand changes in the marketplace. A multi-tier case study approach is adopted. Research findings identify lack of flexibilities in different tiers that inhibit the SC resilience as well as manufacturing and SC flexibilities that build SC resilience. The findings also highlight that the same SC may have the flexibility to be resilient for one of its products but not for another product, what sheds new lights on the academic literature. Finally, flexible SCs should be designed to increase SC resilience to cope with mishaps as significant demand changes.

The impact of improvement of water supply and sanitation facilities on diarrhea and intestinal parasites: a Brazilian experience with children in two low-income urban communities

During the second half of 1986 the impact of the improvement of water supply and excreta disposal facilities on diarrheal diseases and intestinal parasitosis was studied in 254 children up to six years of age from two favelas (shanty towns) of Belo Horizonte, Brazil. The estimated incidence of diarrhea was 6.2 episodes/child year and the estimated period prevalence reached 31.0 episode days/ child/ year. The point prevalence of parasitosis was 70.7% (Ascaris lumbricoides: 55.4%, Trichuris trichiura: 19.6%, Giardia lamblia: 17.9%). The estimated prevalence of diarrhea decreased with improvement of water supply and sanitation facilities to 45% and 44% respectively, but no statistically significant impact was observed in the case of parasitosis. School education and weaning practice were found to be other important determinants of diarrhea.

Limiting Internal Supply Voltage Spikes in DC-DC Converters

Implementing monolithic DC-DC converters for low power portable applications with a standard low voltage CMOS technology leads to lower production costs and higher reliability. Moreover, it allows miniaturization by the integration of two units in the same die: the power management unit that regulates the supply voltage for the second unit, a dedicated signal processor, that performs the functions required. This paper presents original techniques that limit spikes in the internal supply voltage on a monolithic DC-DC converter, extending the use of the same technology for both units. These spikes are mainly caused by fast current variations in the path connecting the external power supply to the internal pads of the converter power block. This path includes two parasitic inductances inbuilt in bond wires and in package pins. Although these parasitic inductances present relative low values when compared with the typical external inductances of DC-DC converters, their effects can not be neglected when switching high currents at high switching frequency. The associated overvoltage frequently causes destruction, reliability problems and/or control malfunction. Different spike reduction techniques are presented and compared. The proposed techniques were used in the design of the gate driver of a DC-DC converter included in a power management unit implemented in a standard 0.35 mu m CMOS technology.

Conservação, manutenção e construção de património estratégico das águas de Santarém

A água é um bem essencial ao ser humano. Nos dias de hoje é de extrema importância fazer chegar este bem às populações, um papel que no nosso país é desempenhado pelos municípios, por empresas municipais e por empresas concessionadas. Este relatório, enquadrado no âmbito do trabalho final de mestrado em Engenharia Civil, especialização em Hidráulica, no Instituto Superior de Engenharia de Lisboa, cujo título é “Conservação, Manutenção e Construção de Património Estratégico das Águas de Santarém”, relata a experiência de estágio do autor do presente relatório na A.S. – Empresa das Águas de Santarém – EM, S.A. O relatório aborda as temáticas do abastecimento de água, do tratamento de águas residuais, da construção de sistemas de saneamento e estações de tratamento de águas residuais, da reparação de equipamentos da empresa e do consumo de energia dos equipamentos da empresa. São descritas as actividades desenvolvidas pelo autor, que incluem o acompanhamento activo em visitas a obras de construção e manutenção de património, a monitorização e controlo de perdas de água, bem como a actualização em suporte informático do cadastro dos equipamentos pertencentes à A.S., com a criação de fichas de equipamento individuais e de um suporte informático para registo e consulta comparativa de consumos energéticos. Esta experiência de estágio permitiu ao autor um contacto com a realidade de uma empresa em toda a diversidade das actividades anteriormente nomeadas, que será descrita objectivamente nos capítulos do presente documento. O estágio foi claramente enriquecedor para o autor, fornecendo-lhe formação objectiva e a preparação necessária para a sua integração no mercado de trabalho nesta área específica da Engenharia Civil.

The role of European "ro-ro" port terminals in the automotive supply chain management

The aim of this paper is concerned with the design and development of a functional framework for maritime mode integration in European automotive supply chain management when considering outbound distribution. Furthermore, it provides a readjustment of traditional concepts and terminology with findings that the role of ro-ro port terminals should be considered as decoupling points, poles and postponement platforms. Case studies examine relevant Western European ro-ro port terminals for cars and respective links to assembly/factories of vehicles localized in the hinterland and concludes that ro-ro port terminals reduce logistical friction and impedance, as well as promote space/time compression.