710 resultados para Angina instável


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Faced with an agribusiness expansion scenario and the increase in fertilizer consumption due to the exponential growth of the population, it is necessary to make better use of existing reserves, by obtaining products of better quality and in adequate quantities to meet demand national. In Tapira Mining Complex, Vale Fertilizantes, the phosphate concentrate is produced with content of 35.0% P2O5 from ore with content of about 8.0% P2O5, which are intended to supply Complex Industrial Uberaba and Araxá Minero Chemical Complex for the production of fertilizers. The industrial flotation step responsible for the recovery of P2O5 and hence the viability of the business is divided into the crumbly, grainy and ultrathin circuits, and, friable and granular concentrate comprise the conventional concentrated. Today only 14.7% of the mass which feeds the mill product becomes, the remainder being considered losses in the process, and the larger mass losses are located in the waste of flotation, representing 42.3%. From 2012 to 2014, the daily global mass recovery processing plants varied from 12.4 to 15.9% while the daily metallurgical recovery of P2O5 from 48.7 to 82.4%. By the degree of variability, it appears that the plant operated under different conditions. Seen this, this study aimed to analyze the influence of operational and process variables in P2O5 mass and metallurgical recoveries of industrial flotation circuits of grainy, crumbly and ultrathin. And besides was made an analysis of the effect of ore variables, as degrees, hardnesse and the ore front 02 percentage, in global recoveries of processing plant and the effect of dosages of reagents in the recoveries obtained from the bench flotation using the experimental design methodology. All work was performed using the historical database of Vale Fertilizantes of Tapira-MG, where all independent variables were dimensionless as the experimental range used. To make the statistical analysis it used the response surface technique and the values of the independent variables that maximize recoveries were found by canonical analysis. In the study of industrial flotation circuit crispy were obtained from 41.3% mass recovery and 91.3% metallurgical recovery P2O5, good values for the circuit, and the highest recoveries occur for solids concentration of the new flotation power between 45 and 50%, which values are assigned to the residence time of the pulp in cells and industrial flotation columns. The greater the number of ore heaps resumed on the higher the mass recovery, but in this scenario flotation becomes unstable because there is enormous weight variation in the feed. Higher recoveries are obtained for mass depressant dosage exceeding 120 g / t for synthetic collector dosage of 11.6%. In the study of industrial flotation circuit of the granulate were obtained 28.3% to 79.4% mass recovery and metallurgical recovery of P2O5 being considered good values for the circuit. Higher recoveries are obtained when the front ore 02 percentage is above 90%, because the ore of this front have more clear apatite. Likewise recoveries increase when the level of pulp rougher step is highest due to the high mass of circulating step receives loads. In the analysis of industrial flotation circuit of the ultrafine were obtained 23.95% of mass recovery, and the same is maximized to depressant dosage and the top collector 420 and 300 g / t, respectively. The analysis of the influence of variables ore, it was observed that higher recoveries are obtained for ores with P2O5 content above 8.0%, Fe2O3 content in the order of 28% forward and 02 of ore percentage of 83%. Hard ore percentage has strong influence on recoveries due to mass division in the circuit that is linked to this variable. However, the hard ore percentage that maximizes recoveries was very close to the design capacity of the processing plant, which is 20%. Finally, the study of the bench flotation, has noted that in friable and granular circuits the highest recoveries are achieved for a collector dosage exceeding 250 g / t and the simultaneous increase of collector dosage and synthetic collector percentage contributes to the increase recovery in the flotation, but this scenario is suitable to produce a concentrate poorer in terms of P2O5 content, showing that higher recovery is not always the ideal scenario. Thus, the results show the values of variables that provide higher recoveries in the flotation and hence lower losses in the waste.

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Num ambiente economicamente instável, as organizações devem criar condições para vingarem no mercado onde se inserem. A aposta das empresas em fatores diferenciadores como a Gestão do Conhecimento e a Gestão da Qualidade Total torna-se cada vez mais evidente. De acordo com a literatura, a Gestão do Conhecimento e a Gestão da Qualidade Total têm características análogas, na medida em que se baseiam nos recursos humanos, na partilha de conhecimentos e na satisfação dos clientes, estando por isso relacionadas. Como forma de verificar a importância que as organizações atribuem a estes conceitos, avançou-se com o presente estudo que incidiu nas Pequenas e Médias Empresas que foram distinguidas como PME líder em 2012. O principal objetivo desta investigação é analisar a influência que a Gestão do Conhecimento exerce na Gestão da Qualidade Total nas PME que se destacaram em 2012 como líderes. Os resultados obtidos indicam que a Gestão do Conhecimento está associada positivamente com a Gestão da Qualidade Total. Apesar de esta conclusão ir ao encontro da teoria, a generalização deverá ser feita com alguma precaução, tendo em conta que a amostra é pouco representativa da população. Importa ainda realçar que a Gestão do Conhecimento e a Gestão da Qualidade Total são conceitos que não se podem dissociar uma vez que ambos criam valor organizacional

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Background: Workplace demographics are changing in many European countries with a higher proportion of older workers in employment. Research has shown that there is an association between job strain and cardiovascular disease, but this relationship is unclear for the older worker. Aims: To investigate the association between job strain and a coronary event comparing younger and older male workers. Methods: Cases with a first-time coronary event were recruited from four coronary/intensive care units (1999-2001). Matched controls were recruited from the case's general practitioner surgery. Physical measurements were taken and self-administered questionnaires completed with questions on job characteristics, job demands and control. Unconditional logistic regression was carried out adjusting for classical cardiovascular risk factors. Results: There were 227 cases and 277 matched controls. Age stratified analyses showed a clear difference between younger (= 50 years) workers with regard to the exposure of job strain (job demands and control) and the association between these factors and cardiovascular disease. Older workers who had a coronary event were four times as likely to have high job strain [OR = 4.09 (1.29-13.02)] and more likely to report low job control [ OR = 0.83 (0.72-0.95)]. Conclusions: Job control emerged as a potential protective factor for heart disease and this evidence was stronger in the older male worker. Nevertheless, they were significantly more likely to have job strain. These results suggest that older workers may be more susceptible to job strain.

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Cardiac Syndrome X (CSX), the presence of angina pectoris with objective signs of myocardial ischaemia despite angiographically normal epicardial coronary arteries, appears to be due to coronary microvascular dysfunction and is known to be associated with an elevation of several inflammatory biomarkers, suggesting a possible role for inflammation in its pathogenesis. We aimed to further characterise this relationship by prospectively analysing a wide variety of molecular biomarkers in a cohort of CSX patients thereby charting the changes in biomarkers throughout the natural history of CSX from its initial diagnosis to eventual disease quiescence. We found that CSX patients, when compared to healthy controls, have a persistent low-grade systemic inflammatory response characterised by an elevation of Tumour Necrosis Factor and Interferon-gamma, regardless of the presence of contemporaneous signs or symptoms of disease activity. Interleukin-6 and C-reactive Protein (CRP) are only elevated when patients have clinical evidence of disease activity and may be state markers in CSX. Moreover, CRP levels appear to correlate with signals of disease severity such as the time taken to develop symptoms during exercise stress testing. We have also demonstrated that the enzyme Indoleamine-2,3- dioxygenase is upregulated in active disease thus providing a possible explanation for the increased burden of psychological disease encountered in CSX. Analysis of the microRNA transcriptome showed that miR-143 is significantly under-expressed in CSX patients. This could allow phenotype switching in vascular smooth muscle cells with the resultant vascular remodelling causing reduced vessel responsiveness to local rheological stimuli and reduced luminal diameter with consequent increased microvascular resistance during times of increased myocardial oxygen demand, thereby limiting maximal hyperaemia during exercise. Our findings corroborate many previous hypotheses regarding the role of inflammation in CSX, generate new insights into possible pathogenic mechanisms and offer new therapeutic targets for the future management of this important cardiological condition.

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Esta Monografia intitulada, “A importância da liderança no clima organizacional” realizada na Cidade do Mindelo, na Universidade do Mindelo, incide sobre a problemática da organização das empresas, como sendo um dos pilares base para a liderança dentro das empresas, centrando a sua importância na influência que esta tem no clima organizacional, sem descorar do seu impacto para o bom funcionamento de qualquer empresa. Por isso, apresentam-se ao longo deste trabalho os vários aspetos que podem ser determinantes para que possa haver um bom clima organizacional, e como é que a liderança pode contribuir para tal, como sendo determinante para o sucesso ou insucesso de uma empresa ou serviço. Ele revela ainda os diferentes modelos e finalidades de liderança, versando também a importância da formação e do conhecimento do líder para um melhor acompanhamento da sua empresa tendo como pano de fundo um bom clima organizacional. Realça-se também, as consequências que são causados por uma má liderança ou um clima organizacional instável, bem como as suas consequências para o ambiente profissional e as interferências que isto pode ter no sucesso ou insucesso de uma empresa ou serviço, conduzindo assim a performance deste ou aquele serviço. A partir da metodologia utilizada conseguiu-se avaliar o tipo de clima organizacional e a liderança existentes na empresa em estudo e estabelecer a uma comparação da forma como a teoria se articula com a prática. Os resultados alcançados demostram que a liderança influencia no clima organizacional de forma positiva ou negativa.

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Trata-se de um caso clínico que teve como objetivo traçar diagnósticos, intervenções e resultados de enfermagem em um paciente com Síndrome de Marfan internado na unidade de terapia intensiva no pós-operatório de correção de aneurisma de aorta. Foi desenvolvido em um Hospital Universitário, localizado no município de Natal-Brasil, em abril de 2011. Entre os principais diagnósticos de enfermagem identificados, destaca-se: Débito Cardíaco Diminuído; Risco de Infecção; Dor Aguda; Risco de Glicemia Instável; Integridade da Pele Prejudicada e Ansiedade. Percebeu-se que a aplicação do processo de enfermagem neste paciente contribuiu para delimitar o campo de atuação específico da enfermagem, bem como identificar os cuidados prioritários, contribuindo para uma melhoria na qualidade da assistência

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The central interest of this thesis is to comprehend how the public action impels the formation and transformation of the tourist destinies. The research was based on the premise that the public actions are the result of the mediation process of state and non-state actors considered important in a section, which interact aiming for prevailing their interests and world visions above the others. The case of Porto de Galinhas beach, in Pernambuco, locus of the investigation of this thesis, allowed the analysis of a multiplicity of actors on the formation and implementation of local actions toward the development of the tourism between the years 1970 and 2010, as well as permitted the comprehension of the construction of the referential on the interventions made. This thesis, of a qualitative nature, has as theoretical support the cognitive approach of analysis of the public policies developed in France, and it has as main exponents the authors Bruno Jobert and Pierre Muller. This choice was made by the emphasis on the cognitive and normative factors of the politics, which aspects are not very explored in the studies of public policies in Brazil. As the source of the data collection, documental, bibliographic and field researches were utilized to the (re)constitution of the formation and transformation in the site concerned. The analysis techniques applied were the content and the documental analysis. To trace the public action referential, it started by the characterization of the touristic section frontiers and the creation of images by the main international body: the World Tourism Organization, of which analysis of the minutes of the meetings underscored guidelines to the member countries, including Brazil, which compounds the global-sectorial reference of the section. As from the analysis of the evolution of the tourism in the country, was identified that public policies in Brazil passed by transformations in their organization over the years, indicating changes in the referential that guided the interventions. These guidelines and transformations were identified in the construction of the tourist destination of Porto de Galinhas, of which data was systematized and presented in four historical periods, in which were discussed the values, the standard, the algorithms, the images and the important mediators. It has been revealed that the State worked in different roles in the decades analyzed in local tourism. From the 1990s, however, new actors were inserted in the formulation and implementation of policies developed, especially for local hotelkeepers. These, through their association, establishes a leadership relation in the local touristic section, thereby, they could set their hegemony and spread their own interest. The leadership acquired by a group of actors, in the case of Porto de Galinhas, does not mean that trade within the industry were neutralized, but that there is a cognitive framework that confronts the actors involved. In spite of the advances achieved by the work of the mediators in the last decades, that resulted in an amplification and diversification of the activity in the area, as well as the consolidation at the beach, as a tourist destiny of national standout, the position of the place is instable, concerned to the competitiveness, once that there is an situation of social and environmental unsustainability

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Introdução: Os efeitos a longo prazo de exercícios de Pilates têm sido bem documentados, não entanto os seus efeitos imediatos no controlo postural estático e dinâmico de jovens adultos com dor lombar não específica permanecem por desvendar. Objetivo: Avaliar os efeitos imediatos de uma sessão composta por 4 exercícios de Pilates Clínico no controlo postural estático e dinâmico de jovens adultos com dor lombar não específica. Métodos: 46 estudantes universitários com dor lombar não específica participaram no estudo randomizado e controlado. Os participantes foram randomizados para um grupo de Pilates (n = 23, 10 do sexo masculino, idade: 21,8 ± 3,2 anos; peso: 64,5 ± 11,5 kg; altura: 1,70 ± 0,1 m) e um grupo controlo (n = 23, 9 do sexo masculino; idade: 22,8 ± 3,6 anos; peso: 62,5 ± 9,9 kg; altura: 1,68 ± 0,1 m). O controlo postural estático foi avaliado com uma plataforma de forças e o controlo postural dinâmico com o Star Excursion Balance Test, antes e depois da intervenção ou período de repouso. Para avaliar o controlo postural estático, os participantes estavam em posição ortostática, o mais quietos possível durante 90s, com os olhos fechados em superfície instável. A intervenção durou 20 minutos e consistiu em 4 exercícios de Pilates Clínico: single leg stretch (nível 1), pelvic press (nível 1), swimming (nível 1) e kneeling opposite arm and leg reach. Resultados: No momento de avaliação inicial, não foram encontradas diferenças estatisticamente significativas entre os grupos em nenhuma das variáveis. Após a intervenção, o grupo Pilates melhorou em todos as variáveis do controlo postural estático (COPx: 5,7 ± 1,0 para 5,1 ± 0,7 cm, p = 0,005; COPy: 4,4 ± 1,0 para 3,8 ± 0,7 cm, p < 0,001; comprimento total: 255,2 ± 55,9 para 210,5 ± 42,7 cm, p < 0,001 ; área: 11,5 ± 3,4 para 9,7 ± 2,7 cm2, p = 0,002 e velocidade : 2,8 ± 0,6 para 2,3 ± 0,5 cm/s, p < 0,001) e no Star Excursion Balance Test (anterior: 65,3 ± 8,3 para 68,6 ± 6,4%, p = 0,001; póstero-medial: 82,6 ± 11,7 para 89,5 ± 9,7%, p < 0,001; póstero-lateral: 83,9 ± 11,0 para 87,6 ± 10,2%, p < 0,001 e composite: 86,2 ± 12,4 para 91,1 ± 11,0%, p < 0,001). O grupo de controlo só melhorou na velocidade (2,8 ± 0,5 para 2,6 ± 0,5 cm/s, p = 0,009) e comprimento total (248,5 ± 45,3 para 237,3 ± 47,2 cm, p = 0,009) no controlo postural estático. No entanto, as melhorias no grupo Pilates foram significativamente maiores do que as do grupo de controlo. Conclusão: Os exercícios de Pilates Clínico melhoraram, no imediato, o controlo postural estático e dinâmico em jovens adultos com dor lombar não específica.

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Background. Indirect revascularization is a therapeutic approach in case of severe angina not suitable for percutaneous or surgical revascularization. Transmyocardial revascularization (TMR) is one of the techniques used for indirect revascularization and it allows to create transmyocardial channels by a laser energy bundle delivered on left ventricular epicardial surface. Benefits of the procedure are related mainly to the angiogenesis caused by inflammation and secondly to the destruction of the nervous fibers of the heart. Patients and method. From September 1996 up to July 1997, 14 patients (9 males – 66.7%, mean age 64.8±7.9 years) underwent TMR. All patients referred angina at rest; Canadian Angina Class was IV in 7 patients (58.3%), III in 5 (41.7%). Before the enrollment, coronarography was routinely performed to find out the feasibility of Coronary Artery Bypass Graft (CABG): 13 patients (91,6%) had coronary arteries lesions not suitable for direct revascularization; this condition was limited only to postero-lateral area in one patient submitted to combined TMR + CABG procedures. Results. Mean discharge time was 3,2±1,3 days after surgery. All patients were discharged in good clinical conditions. Perfusion thallium scintigraphy was performed in 7 patients at a mean follow-up of 4±2 months, showing in all but one an improvement of perfusion defects. Moreover an exercise treadmill improvement was observed in the same patients and all of them are in good clinical conditions, with significantly reduced use of active drugs. Conclusion. Our experience confirms that TMR is a safe and feasible procedure and it offers a therapeutic solution in case of untreatable angina. Moreover, it could be a hybrid approach for patients undergoing CABGs in case of absence of vessels suitable for surgical approach in limited areas of the heart.

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O ambiente organizacional no mundo globalizado actual é altamente instável, como consequência quer a gestão estratégica quer a sua implementação operacional, são solicitadas constantemente a adaptar-se a novos modelos de gestão e suscitam problemas às organizações que fazem sentir os seus efeitos transversalmente, uma das áreas que faz ressonância destas constantes mudanças são os Recursos Humanos. O presente trabalho centra-se no segmento restrito dessa realidade que se focaliza na liderança, motivação e recompensa. O objecto da investigação é uma instituição bancária em Luanda (Angola), como instrumento de investigação foi usado um inquérito, cujas questões decorreram do acervo conceptual patente na literatura. Concluiu-se que a avaliação da liderança é simétrica à avaliação da recompensa e que a motivação apresenta um perfil aproximado à média geral, analisados os dados em função das categorias das variáveis sociodemográficas, foi possível concluir que em múltiplas instâncias, elas condicionam e sobre determinam os resultados globais.

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BACKGROUND: The identification of patients' health needs is pivotal in optimising the quality of health care, increasing patient satisfaction and directing resource allocation. Health needs are complex and not so easily evaluated as health-related quality of life (HRQL), which is becoming increasingly accepted as a means of providing a more global, patient-orientated assessment of the outcome of health care interventions than the simple medical model. The potential of HRQL as a surrogate measure of healthcare needs has not been evaluated. OBJECTIVES AND METHOD: A generic (Short Form-12; SF-12) and a disease-specific questionnaire (Seattle Angina Questionnaire; SAQ) were tested for their potential to predict health needs in patients with acute coronary disease. A wide range of healthcare needs were determined using a questionnaire specifically developed for this purpose. RESULTS: With the exception of information needs, healthcare needs were highly correlated with health-related quality of life. Patients with limited enjoyment of personal interests, weak financial situation, greater dependency on others to access health services, and dissatisfaction with accommodation reported poorer HRQL (SF-12: p < 0.001; SAQ: p < 0.01). Difficulties with mobility, aids to daily living and activities requiring assistance from someone else were strongly associated with both generic and disease-specific questionnaires (SF-12: r = 0.46-0.55, p < 0.01; SAQ: r = 0.53-0.65, p < 0.001). Variables relating to quality of care and health services were more highly correlated with SAQ components (r = 0.33-0.59) than with SF-12 (r = 0.07-0.33). Overall, the disease-specific Seattle Angina Questionnaire was superior to the generic Short Form-12 in detecting healthcare needs in patients with coronary disease. Receiver-operator curves supported the sensitivity of HRQL tools in detecting health needs. CONCLUSION: Healthcare needs are complex and developing suitable questionnaires to measure these is difficult and time-consuming. Without a satisfactory means of measuring these needs, the extent to which disease impacts on health will continue to be underestimated. Further investigation on larger populations is warranted but HRQL tools appear to be a reasonable proxy for healthcare needs, as they identify the majority of needs in patients with coronary disease, an observation not previously reported in this patient group

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OBJECTIVES: To assess satisfaction of survivors of coronary artery diseases (CAD) with healthcare services and to determine whether specific components of standard health-related quality of life (HRQL) assessment tools might identify areas of satisfaction and dissatisfaction. METHOD: A specific tool developed to provide a comprehensive assessment of healthcare needs was administered concomitantly with generic and specific HRQL instruments, on 242 patients with CAD, admitted to an acute coronary unit during a single year. RESULTS: 92.5% of patients confirmed their trust in and satisfaction with the care given by their General Practitioner; even so, one third experienced difficulty getting an appointment and a quarter wanted more time for each consultation or prompt referral to a specialist when needed. Around a third expressed dissatisfaction with advice from the practice nurse or hospital consultant. Overall 54% were highly satisfied with services, 33% moderately satisfied and 13% dissatisfied.Cronbach's alpha was 0.87; the corrected total-item correlation ranged between 0.55-0.75, with trivial 'floor' score and low 'ceiling' effect. Several domains in all three HRQL tools correlated with items relating to satisfaction. The Seattle Angina Questionnaire Treatment Score correlated significantly with all satisfaction items and with the global satisfaction score. CONCLUSION: Cardiac patients' demanded better services and advice from, and more time with, health professionals and easier surgery access. The satisfaction tool showed acceptable psychometric properties. In this patient group, disease-specific HRQL tools seem more appropriate than generic tools for surveys of patient satisfaction

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BACKGROUND: Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment. METHOD: A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham. RESULTS: 38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001). CONCLUSIONS: Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services

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The composition and condition of membrane lipids, the morphology of erythrocytes, and hemoglobin distribution were explored with the help of laser interference microscopy (LIM) and Raman spectroscopy. It is shown that patients with cardiovascular diseases (CVD) have significant changes in the composition of their phospholipids and the fatty acids of membrane lipids. Furthermore, the microviscosity of the membranes and morphology of the erythrocytes are altered causing disordered oxygen transport by hemoglobin. Basic therapy carried out with the use of antiaggregants, statins, antianginals, beta-blockers, and calcium antagonists does not help to recover themorphofunctional properties of erythrocytes. Based on the results the authors assume that, for the relief of the ischemic crisis and further therapeutic treatment, it is necessary to include, in addition to cardiovascular disease medicines, medication that increases the ability of erythrocytes’ hemoglobin to transport oxygen to the tissues. We assume that the use of LIM and Raman spectroscopy is advisable for early diagnosis of changes in the structure and functional state of erythrocytes when cardiovascular diseases develop.

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A fixação biológica de dióxido de carbono por microalgas é considerada a melhor forma de fixar CO2. Dentre os microrganismos utilizados destaca-se Spirulina platensis devido às suas altas taxas de fixação de CO2 e variedade de aplicações da biomassa gerada. A aplicação de modelos e simulações pode auxiliar na previsão de custos e na escolha das condições ideais de cultivo. Este trabalho teve como objetivo etsabelecer um modelo cinético no qual a iluminância é o fator limitante para o crescimento da microalga Spirulina platensis. A fim de validar o modelo proposto foi utilizada a microalga S. platensis, cultivada em meio Zarrouk modificado (NaHCO3 1,0 g.L-1 ), em biorreator aberto tipo raceway de 200L, mantido a 30°C, sob iluminação natural. A concentração celular variou de 0,19 a 0,34 g.L-1 e a velocidade específica de crescimento celular obtida a partir da regressão exponencial das curvas de crescimento de cada período iluminado variou de 0,55 a 0,59 d-1 . O modelo proposto gerou dados estimados satisfatórios (r2 =0,97). De acordo com os dados obtidos 16,2% da biomassa é consumida durante o período não iluminado.