854 resultados para Nurses with management functions
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In order to produce useful knowledge to the initiatives of protection and management of forest fragments, more specifically for tropical dry forests which suffer with frequent anthropic activities, and due to the lack of specific studies, this article aimed describe the structure and the floristic similarity among three areas of dry forest with different management histories. The study was developed in Capitão Enéas municipality, Northern Minas Gerais, Brazil, where three fragments were evaluated, being one in regeneration for 30 years, another submitted to occasional fire and the third with selective cut in small scale. The sampling was developed through the point quarter method considering all the alive phanerophyte individuals with circumference at breast height (CBH) > 15 cm. In the three fragments, 512 individuals, distributed in 60 species, 47 genera, and 23 families were sampled. The most representative families were Fabaceae (26), Anacardiaceae (4), Bignoniaceae (3) and Combretaceae (3). However, fourteen families were represented by only one species. Only eight species were common to all fragments - Myracrodruon urundeuva standed out with 26.9% of all sampled individuals - while a great number of species were exclusive of each fragment. The floristic and structural differences between the fragments are possibly related to the history and intensity of management in each area besides the topography variations and the presence or absence of limestone outcrops. These results show the importance of each fragment, indicating that the loss of anyone would cause negative impacts on the regional flora and consequently to the associated biodiversity.
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The increasing demand for water resources accentuates the need to reduce water waste through a more appropriate irrigation management. In the particular case of irrigated coffee planting, which in recent years presented growth with the predominance of drip irrigation, the improvement of drip irrigation management techniques is a necessity. The proper management of drip irrigation depends on the knowledge of the spatial pattern of soil moisture distribution inside the wetted strip formed under the irrigation lines. In this study, grids of 24 tensiometers were used to determine the water storage within the wetted strip formed under drippers, with a 3.78 L h-1 discharge, evenly spaced by 0.4 m, subjected to two different management criteria (fixed irrigation interval and 60 kPa tension). Estimates of storage based on a one-dimensional analysis, that only considers depth variations, were compared with two-dimensional estimates. The results indicate that for high-frequency irrigation the one-dimensional analysis is not appropriate. However, under less frequent irrigation, the two-dimensional analysis is dispensable, being the one-dimensional sufficient for calculating the water volume stored in the wetted strip.
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Target company of this study is a large machinery company, which is, inter alia, engaged in energy and pulp engineering, procurement and construction management (EPCM) supply business. The main objective of this study was to develop cost estimation of the target company by providing more accurate, reliable and up-to-date information through enterprise resource planning (ERP) system. Another objective was to find cost-effective methods to collect total cost of ownership information to support more informed supplier selection decision making. This study is primarily action-oriented, but also constructive, and it can be divided in two sections: theoretical literature review and empirical study on the abovementioned part of the target company’s business. Development of information collection is, in addition to literature review, based on nearly 30 qualitative interviews of employees at various organizational units, functions and levels at the target company. At the core of development was to make initial data more accurate, reliable and available, a necessary prerequisite for informed use of the information. Certain development suggestions and paths were presented in order to regain confidence in ERP system as information source by reorganizing work breakdown structure and by complementing mere cost information with quantitative, technical and scope information. Several methods to use the information ever more effectively were also discussed. While implementation of the development suggestions outreached the scope of this study, it was forwarded in test environment and interest groups.
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OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.
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ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.
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PURPOSE: To evaluate the effectiveness, recurrence rate, and complications of carbon-dioxide laser vaporization in the treatment of Bartholin's gland cysts. METHODS: A retrospective study including 127 patients with symptomatic Bartholin' gland cysts submitted to carbon-dioxide laser vaporization at our institution from January 2005 to June 2011. Patients with Bartholin's gland abscesses and those suspected of having neoplasia were excluded. All procedures were performed in an outpatient setting under local anaesthesia. Clinical records were reviewed for demographic characteristics, anatomic parameters, intraoperative and postoperative complications, and follow-up data. Data were stored and analyzed in Microsoft Excel® 2007 software. A descriptive statistical analysis was performed, and its results were expressed as frequency (percentage) or mean±standard deviation. Complication, recurrence, and cure rates were calculated. RESULTS: The mean age of the patients was 37.3±9.5 years-old (range from 18 to 61 years-old). Seventy percent (n=85) of them were multiparous. The most common symptom was pain and 47.2% (n=60) of patients had a history of previous medical and/or surgical treatment for Bartholin's gland abscesses. Mean cyst size was 2.7±0.9 cm. There were three (2.4%) cases of minor intraoperative bleeding. Overall, there were 17 (13.4%) recurrences within a mean of 14.6 months (range from 1 to 56 months): ten Bartholin's gland abscesses and seven recurrent cysts requiring reintervention. The cure rate after single laser treatment was 86.6%. Among the five patients with recurrent disease that had a second laser procedure, the cure rate was 100%. CONCLUSIONS: At this institution, carbon-dioxide laser vaporization seems to be a safe and effective procedure for the treatment of Bartholin's gland cysts.
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Few people see both opportunities and threats coming from IT legacy in current world. On one hand, effective legacy management can bring substantial hard savings and smooth transition to the desired future state. On the other hand, its mismanagement contributes to serious operational business risks, as old systems are not as reliable as it is required by the business users. This thesis offers one perspective of dealing with IT legacy – through effective contract management, as a component towards achieving Procurement Excellence in IT, thus bridging IT delivery departments, IT procurement, business units, and suppliers. It developed a model for assessing the impact of improvements on contract management process and set of tools and advices with regards to analysis and improvement actions. The thesis conducted case study to present and justify the implementation of Lean Six Sigma in IT legacy contract management environment. Lean Six Sigma proved to be successful and this thesis presents and discusses all the steps necessary, and pitfalls to avoid, to achieve breakthrough improvement in IT contract management process performance. For the IT legacy contract management process two improvements require special attention and can be easily copied to any organization. First is the issue of diluted contract ownership that stops all the improvements, as people do not know who is responsible for performing those actions. Second is the contract management performance evaluation tool, which can be used for monitoring, identifying outlying contracts and opportunities for improvements in the process. The study resulted in a valuable insight on the benefits of applying Lean Six Sigma to improve IT legacy contract management, as well as on how Lean Six Sigma can be applied in IT environment. Managerial implications are discussed. It is concluded that the use of data-driven Lean Six Sigma methodology for improving the existing IT contract management processes is a significant addition to the existing best practices in contract management.
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This study will concentrate on Product Data Management (PDM) systems, and sheet metal design features and classification. In this thesis, PDM is seen as an individual system which handles all product-related data and information. The meaning of relevant data is to take the manufacturing process further with fewer errors. The features of sheet metals are giving more information and value to the designed models. The possibility of implementing PDM and sheet metal features recognition are the core of this study. Their integration should make the design process faster and manufacturing-friendly products easier to design. The triangulation method is the basis for this research. The sections of this triangle are: scientific literature review, interview using the Delphi method and the author’s experience and observations. The main key findings of this study are: (1) the area of focus in triangle (the triangle of three different point of views: business, information exchange and technical) depends on the person’s background and their role in the company, (2) the classification in the PDM system (and also in the CAD system) should be done using the materials, tools and machines that are in use in the company and (3) the design process has to be more effective because of the increase of industrial production, sheet metal blank production and the designer’s time spent on actual design and (4) because Design For Manufacture (DFM) integration can be done with CAD-programs, DFM integration with the PDM system should also be possible.
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ABSTRACTGlyphosate has significant effects on the growth and development of plants when in underdoses. This work was developed to verify the effect of the application of glyphosate in underdoses in lignin synthesis and consequently decomposition of maize stover. Two experiments were conducted; the first one in a greenhouse for underdoses adjustments and the second one in the production area. The experimental design of the first trial was completely randomized with four replications. The treatments consisted in the application of the underdoses: 0, 25, 50 and 100 g ha-1 of glyphosate. In the production area, the experimental design was a randomized block with four replications, in underdoses: 0, 12.5, 25 and 50 g ha-1. The results were submitted to analysis of variance and regression. The underdoses of 25 g a.e. ha-1in a greenhouse promoted 36% increase in productivity of stover, in addition to increasing the lignin content in 16%, with no change in the unwanted growth of maize plants. In the production area, the concentration of 12.5 g a.e. ha-1 of glyphosate reduced the lignin content and the other underdoses have not changed this feature in maize plants. None of the underdoses affected the height and biomass produced by the maize plants. The highest underdose tested promoted acceleration in the decomposition of maize stover.
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ABSTRACT The aim of this work was to evaluate the weed management with herbicides applied in pre and postemergence on castor crop. The treatments were constituted by management systems using herbicides in pre (PRE) and postemergence (POS): 1) S-metolachlor at 576 g ha-1 (PRE 1) and chlorimuron-methyl at 15 g ha-1 (POS 1); 2) PRE 1 + clomazone at 650 g ha-1(PRE 2) and POS 1; 3) PRE 1, POS 1 and halosulfuron-methyl at 112.5 g ha-1(POS 2); 4) PRE 1, POS 1 and ethoxysulfuron at 60 g ha-1 (POS 3); 5) PRE 1, POS 1 and ethoxysulfuron at 120 g ha-1 (POS 4); 6) PRE 1 + PRE 2, POS 1 and POS 2; 7) PRE 1 + PRE 2, POS 1 and POS 3; 8) PRE 1 + PRE 2, POS 1 and POS 4; 9) hand-hoeing control and 10) non-weeded control. The experimental design was randomized blocks with four replications. The association of the herbicides in PRE combined to sequence applications of chlorimuron-ethyl and halosulfuron-methyl or ethoxysulfuron in POS resulted in the highest control levels of Richardia scabraand Cyperus ferax. Mild phytointoxication symptoms to the crop were more persistent with ethoxysulfuron at 120 g ha-1. The acceptable control of the weed species and similar yield to the hand-hoeing control permitted to conclude that S-metolachlor + clomazone PRE, followed by chlorimuron-ethyl and halosulfuron-methyl POS proved to be more adequate as a weed management strategy on castor crop.
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The success of the intercropping among cultivated species depends on the adoption of practices that provide, in due course, greater competitive ability of a species over another. The objective of this study was to evaluate the use of glyphosate herbicide in the suppression of Brachiaria (signalgrass) intercropped with maize. The experiment was conducted in a randomized complete block design with four replications. The treatments were arranged in a 5 x 2 + 2 factorial arrangement, the first factor corresponding to the doses of glyphosate (48, 96, 144, 240, 480 g ha-1 of the acid equivalent (a.e)) and the second one to the vegetative stages of the signalgrass at the time of application (2 and 4 tillers). Two controls were added to the treatment list, comprising controls without herbicide application and hand removal of the signalgrass. The number of plants, tillers and dry matter of signalgrass was reduced with glyphosate. The increase of the glyphosate doses enhanced the injure to the forage plants, mainly when the compound was sprayed at the two-tiller vegetative stage. The dry matter of maize plants increased proportionally to the glyphosate dose. However, the height of the maize plants was not affected. The grain mass and productivity of maize grain increased with increasing dose of glyphosate. The maize yield was negatively influenced on the untreated control. Glyphosate at 96 and 144 g ha-1, when applied at 2 and 4 tiller stage, respectively, reduces the growth of signalgrass and does not affect the maize grain yield.
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Poster at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014
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The overall goal of the study was to describe nurses’ acceptance of an Internet-based support system in the care of adolescents with depression. The data were collected in four phases during the period 2006 – 2010 from nurses working in adolescent psychiatric outpatient clinics and from professionals working with adolescents in basic public services. In the first phase, the nurses’ anticipated perceptions of the usefulness of the Internet-based support system before its implementation was explored. In the second phase, the nurses’ perceived ease of computer and Internet use and attitudes toward it were explored. In the third phase, the features of the support system and its implementation process were described. In the fourth phase, the nurses’ experiences of behavioural intention and actual system use of the Internet-based support were described in psychiatric out-patient care after one year use. The Technology Acceptance Model (TAM) was used to structure the various research phases. Several benefits were identified from the nurses’ perspective in using the Internet-based support system in the care of adolescents with depression. The nurses’ technology skills were good and their attitudes towards computer use were positive. The support system was developed in various phases to meet the adolescents’ needs. Before the implementation of the information technology (IT)-based support system, it is important to pay attention to the nurses’ IT-training, technology support, resources, and safety as well as ethical issues related to the support system. After one year of using the system, the nurses perceived the Internet-based support system to be useful in the care of adolescents with depression. The adolescents’ independent work with the support system at home and the program’s systematic character were experienced as conducive from the point of view of the treatment. However, the Internet-based support system was integrated only partly into the nurseadolescent interaction even though the nurses’ perceptions of it were positive. The use of the IT-based system as part of the adolescents’ depression care was seen positively and its benefits were recognized. This serves as a good basis for future IT-based techniques. Successful implementations of IT-based support systems need a systematic implementation plan and commitment from the part of the organization and its managers. Supporting and evaluating the implementation of an IT-based system should pay attention to changing the nurses’ work styles. Health care organizations should be offered more flexible opportunities to utilize IT-based systems in direct patient care in the future.
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Data management consists of collecting, storing, and processing the data into the format which provides value-adding information for decision-making process. The development of data management has enabled of designing increasingly effective database management systems to support business needs. Therefore as well as advanced systems are designed for reporting purposes, also operational systems allow reporting and data analyzing. The used research method in the theory part is qualitative research and the research type in the empirical part is case study. Objective of this paper is to examine database management system requirements from reporting managements and data managements perspectives. In the theory part these requirements are identified and the appropriateness of the relational data model is evaluated. In addition key performance indicators applied to the operational monitoring of production are studied. The study has revealed that the appropriate operational key performance indicators of production takes into account time, quality, flexibility and cost aspects. Especially manufacturing efficiency has been highlighted. In this paper, reporting management is defined as a continuous monitoring of given performance measures. According to the literature review, the data management tool should cover performance, usability, reliability, scalability, and data privacy aspects in order to fulfill reporting managements demands. A framework is created for the system development phase based on requirements, and is used in the empirical part of the thesis where such a system is designed and created for reporting management purposes for a company which operates in the manufacturing industry. Relational data modeling and database architectures are utilized when the system is built for relational database platform.