Effect of the Novel Thienopyridine Prasugrel Compared With Clopidogrel on Spontaneous and Procedural Myocardial Infarction in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38 An Application of the Classification System From the Universal Definition of Myocardial Infarction

Background-Prasugrel is a novel thienopyridine that reduces new or recurrent myocardial infarctions (MIs) compared with clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention. This effect must be balanced against an increased bleeding risk. We aimed to characterize the effect of prasugrel with respect to the type, size, and timing of MI using the universal classification of MI. Methods and Results-We studied 13 608 patients with acute coronary syndrome undergoing percutaneous coronary intervention randomized to prasugrel or clopidogrel and treated for 6 to 15 months in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI 38). Each MI underwent supplemental classification as spontaneous, secondary, or sudden cardiac death (types 1, 2, and 3) or procedure related (Types 4 and 5) and examined events occurring early and after 30 days. Prasugrel significantly reduced the overall risk of MI (7.4% versus 9.7%; hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.67 to 0.85; P < 0.0001). This benefit was present for procedure-related MIs (4.9% versus 6.4%; HR, 0.76; 95% CI, 0.66 to 0.88; P = 0.0002) and nonprocedural (type 1, 2, or 3) MIs (2.8% versus 3.7%; HR, 0.72; 95% CI, 0.59 to 0.88; P = 0.0013) and consistently across MI size, including MIs with a biomarker peak >= 5 times the reference limit (HR. 0.74; 95% CI, 0.64 to 0.86; P = 0.0001). In landmark analyses starting at 30 days, patients treated with prasugrel had a lower risk of any MI (2.9% versus 3.7%; HR, 0.77; P = 0.014), including nonprocedural MI (2.3% versus 3.1%; HR, 0.74; 95% CI, 0.60 to 0.92; P = 0.0069). Conclusion-Treatment with prasugrel compared with clopidogrel for up to 15 months in patients with acute coronary syndrome undergoing percutaneous coronary intervention significantly reduces the risk of MIs that are procedure related and spontaneous and those that are small and large, including new MIs occurring during maintenance therapy. (Circulation. 2009; 119: 2758-2764.)

Equity in regional service provision

Most transportation agencies stipulate that an important planning goal is to provide equitable and just public transport services. However, who is to be served and the type of service that should be provided has been ambiguous. This paper develops a methodology for examining equity in the provision of public transportation services. An approach for identifying areas in need of public transport is developed based upon the use of socio-demographic and economic information. Public transport need is then related to levels of access to service. This approach makes it possible to establish the degree to which public transport services may be considered equitable in relation to need and suitable access. A detailed analysis of the southeast Queensland region of Australia illustrates how this approach may be used to inform public transport decision making.

Qualifound – a modular tool developed for quality improvement in foundries

Purpose – Castings defects are usually easy to characterize, but to eradicate them can be a difficult task. In many cases, defects are caused by the combined effect of different factors, whose identification is often difficult. Besides, the real non-quality costs are usually unknown, and even neglected. This paper aims to describe the development of a modular tool for quality improvement in foundries, and its main objective is to present the application potential and the foundry process areas that are covered and taken into account. Design/methodology/approach – The integrated model was conceived as an expert system, designated Qualifound, which performs both qualitative and quantitative analyses. For the qualitative analyses mode, the nomenclature and the description of defects are based on the classification suggested by the International Committee of the Foundry Technical Association. Thus, a database of defects was established, enabling one to associate the defects with the relevant process operations and the identification of their possible causes. The quantitative analysis mode deals with the number of produced and rejected castings and includes the calculation of the non-quality costs. Findings – The validation of Qualifound was carried out in a Portuguese foundry, whose quality system had been certified according to the ISO 9000 standards. Qualifound was used in every management area and it was concluded that the application had the required technological requisites to provide the necessary information for the foundry management to improve process quality. Originality/value – The paper presents a successful application of an informatics tool on quality improvement in foundries.

Strategic Planning and Organizational Effectiveness in Social Service Organizations in Portugal

This study aims to understand the reality of social service organizations, the level of implementation of the strategic planning as well as the impact of its application on organizational effectiveness. At first, we will group organizations in clusters according to the level of strategic planning implementation and its degree of effectiveness. Secondly, we will analyse all the different groups. Given the growing number of social service organizations and the consequent complexity of their structures, it turns out the need for these organizations adopt formal management techniques. Strategic planning is a valuable strategic management tool and one of its main objectives is to make organizations more effective. Therefore, the research has been conducted in order to determine if strategic planning is implemented in social service organizations and which effects has its application on organizational effectiveness. The survey, applied to 220 social service organizations, allowed us to gather them into different clusters, showing that different levels of strategic planning determine distinct degrees of organizational efficiency. Finally, it should be noted that findings of this research may be essential to decision makers of these organizations, because it was shown that the adoption of strategic planning has a positive influence on organizational effectiveness of social service organizations.

Aplicação da metodologia Kaizen em gestão de armazém de peças

Mestrado em Engenharia Mecânica - Especialização em Gestão Industrial

A gestão de stocks do serviço de assistência técnica na área da eletromedicina

Dissertação apresentada ao Instituto Superior de Administração e Contabilidade do Porto para obtenção do Grau de Mestre em Logística Orientada por: Professora Doutora Maria Clara Rodrigues Bento Vaz Fernandes

Screening for pulmonary tuberculosis in Teresópolis, RJ, Brazil: the search for respiratory symptomatic patients in emergency service of "Hospital das Clínicas de Teresópolis Costantino Ottaviano, Fundação Educacional Serra dos Órgãos"

The aim of the present study was to investigate the detection percentage of tuberculosis among patients that are respiratory symptomatic (TB suspects). In this work, we present the preliminary results of research carried out at "Hospital das Clínicas de Teresópolis Costantino Ottaviano da Fundação Educacional Serra dos Órgãos (FESO)" from November 2003 to April 2004. Among the 40 respiratory symptomatic individuals identified and referred to the Tuberculosis Control Program in Teresópolis, two (5.0%) were characterized as smear-positive. These results confirm reports in the literature and underscore the need for and importance of this strategy.

A marketing plan for the ice cream brand Max Adventures in food service

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Drivers and barriers to value creation in mobile service delivery

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The role of qualitative data and systems thinking in addressing service decline in market towns

Retail services are a main contributor to municipal budget and are an activity that affects perceived quality-of-life, especially for those with mobility difficulties (e.g. the elderly, low income citizens). However, there is evidence of a decline in some of the services market towns provide to their citizens. In market towns, this decline has been reported all over the western world, from North America to Australia. The aim of this research was to understand retail decline and enlighten on some ways of addressing this decline, using a case study, Thornbury, a small town in the Southwest of England. Data collected came from two participatory approaches: photo-surveys and multicriteria mapping. The interpretation of data came from using participants as analysts, but also, using systems thinking (systems diagramming and social trap theory) for theory building. This research moves away from mainstream economic and town planning perspectives by making use of different methods and concepts used in anthropology and visual sociology (photo-surveys), decision-making and ecological economics (multicriteria mapping and social trap theory). In sum, this research has experimented with different methods, out of their context, to analyse retail decline in a small town. This research developed a conceptual model for retail decline and identified the existence of conflicting goals and interests and their implications for retail decline, as well as causes for these. Most of the potential causes have had little attention in the literature. This research also identified that some of the measures commonly used for dealing with retail decline may be contributing to the causes of retail decline itself. Additionally, this research reviewed some of the measures that can be used to deal with retail decline, implications for policy-making and reflected on the use of the data collection and analysis methods in the context of small to medium towns.