Effect of nitric oxide donors on blood pressure and pulse pressure in acute and subacute stroke

High blood pressure (BP), pulse pressure (PP), and rate pressure product (RPP) areeach associated independently with a poor outcome in acute ischemic stroke. Whereas nitric oxide (NO) donors, such as glyceryl trinitrate (GTN), lower blood pressure in acute ischemic stroke, their effect on other hemodynamic measures is not known. We performed a systematic review of the effects of NO donors on systemic hemodynamic measures in patients with acute/subacute stroke. Randomized controlled trials were identified from searches of the Cochrane Library, Pubmed, and Embase. Information on hemodynamic measures, including systolic BP (SBP), diastolic BP (DBP), and heart rate, were assessed, and hemodynamic derivatives of these were calculated: PP (PP SBP DBP), mean arterial pressure (MAP DBP PP/3), mid blood pressure (MBP (SBP DBP)/2), pulse pressure index (PPI PP/MAP), and RPP (RPP SBP HR). The effect of treatment on hemodynamic measures was calculated as the weighted mean difference (WMD) between treated and control groups with adjustment for baseline. Results: Three trials involving 145 patients were identified; 93 patients received the NO donor, GTN, and 52 control. As compared with placebo, GTN significantly reduced SBP (WMD -9.80 mmHg, p< 0.001), DBP (WMD -4.43 mmHg, p<0.001), MAP (WMD -6.41 mmHg, p< 0.001), MBP (WMD -7.33 mmHg,p<0.001), PP (WMD -6.11 mmHg, p<0.001 ) and PPI (WMD -0.03, p=0.04 ). 3 GTN increased HR (WMD +3.87 bpm, p<0.001) and non-significantly lowered RPP (WMD -323 mmHg.bpm, p=0.14). Conclusion: The NO donor GTN reduces BP, PP and other derivatives in acute and subacute stroke whilst increasing heart rate.

Creating a modern home: homeowners in post-war suburban Glasgow, 1945-1975

This thesis examines how married couples bought and created a modern home for their families in suburban Glasgow between 1945-1975. New homeowners were on the cusp of the middle-classes, buying in a climate of renters. As they progressed through the family lifecycle women’s return to work meant they became more comfortably ensconced within the middle-classes. Engaged with a process of homemaking through consumption and labour, couples transformed their houses into homes that reflected themselves and their social status. The interior of the home was focused on as a site of social relations. Marriage in the suburbs was one of collaboration as each partner performed distinct gender roles. The idea of a shared home was investigated and the story of ‘we’ rather than ‘I’ emerged from both testimony and contemporary literature. This thesis considers decision-making, labour and leisure to show the ways in which experiences of home were gendered. What emerged was that women’s work as everyday and mundane was overlooked and undervalued while husband’s extraordinary contributions in the form of DIY came to the fore. The impact of wider culture intruded upon the ‘private’ home as we see they ways in which the position of women in society influences their relationship to the home and their family. In the suburbs of post-war Glasgow women largely left the workforce to stay at home with their children. Mothers popped in and out of each other houses for tea and a blether, creating a homosocial network that was sociable and supportive unique to this time in their lives and to this historical context. Daily life was negotiated within the walls of the modern home. The inter-war suburbs of Glasgow needed modernising to post-war standards of modern living. ‘Modern’ was both an aesthetic and an engagement with new technologies within the house. Both middle and working-class practices for room use were found through the keeping of a ‘good’ or best room and the determination of couples to eat in their small kitchenettes. As couples updated their kitchen, the fitted kitchen revealed contemporary notions of modern décor, as kitchens became bright yellow with blue Formica worktops. The modern home was the evolution of existing ideas of modern combined with new standards of living. As Glasgow homeowners constructed their modern home what became evident was that this was a shared process and as a couple they placed their children central to all aspects of their lives to create not only a modern home, but that this was first and foremost a family home

Sistemas de avaliação de tecnologias de saúde: dispositivos médicos

As tecnologias de saúde, nomeadamente medicamentos, dispositivos médicos (DM), procedimentos médicos ou cirúrgicos, entre outros, têm ocupado uma posição de destaque no setor da saúde, e na vida dos seus utilizadores. A inovação e utilização de tecnologias de saúde, e consequente aumento das despesas fizeram emergir a necessidade de avaliação das tecnologias de saúde. Surge assim, a avaliação de tecnologias de saúde (ATS), que tem por objetivo abordar os impactos clínicos, económicos, organizacionais, sociais, legais e éticos de uma tecnologia de saúde, considerando o seu contexto médico específico, bem como as alternativas disponíveis. A ATS pretende que os processos sejam feitos de forma rigorosa, transparente, valorizando e garantindo a sustentabilidade do acesso aos cuidados em saúde. Seguindo a tendência europeia de implementação de políticas e modelos de ATS, Portugal criou o seu próprio sistema de avaliação de tecnologias. O Decreto-Lei nº 97/2015, de 1 de junho veio oficializar a criação do Sistema Nacional de Avaliação de Tecnologias de Saúde (SiNATS). O SiNATS vai permitir uma avaliação não só de medicamentos, mas também de DM e outras tecnologias tendo em consideração a avaliação técnica, terapêutica e económica das tecnologias de saúde com base em fatores sociais, políticos, éticos e a participação de entidades, como, a indústria, as instituições de ensino, as instituições de saúde, os investigadores, os profissionais de saúde, os doentes e as associações dos doentes. O SiNATS vai emitir recomendações e decisões sobre o uso das tecnologias de saúde e possibilitar o ganho em saúde e contribuir para a sustentabilidade do Serviço Nacional de Saúde (SNS). O SiNATS vem permitir a avaliação de DM. O sector dos DM é um sector caracterizado pela inovação, crescimento e também competitividade. A complexidade e especificidade deste sector devem por isso ser tidas em consideração aquando da sua análise. A implementação do SiNATS permitirá avaliar e reavaliar preços, comparticipações, recomendações, contratos ao longo do ciclo de vida de cada DM. No presente momento, ainda é difícil expor os processos através dos quais esta avaliação vai ser processada, uma vez que se aguarda a publicação de despachos e portarias referidos no Decreto-Lei nº 97/2015, de 1 de junho. Tendo em consideração a partilha de informação sobre políticas, métodos, procedimentos de ATS aplicada aos DM na Europa, foram analisados os casos de França e do Reino Unido com o objetivo de alargar o conhecimento acerca do que já é feito a nível Europeu e explorar se os mesmos poderiam ser adaptados à realidade portuguesa. Em França, a ATS está diretamente relacionada com a comparticipação de DM, já no Reino Unido, o National Institute and Centre of Excellence (NICE) tem a responsabilidade de avaliar os DM segundo procedimentos de ATS, mas não está diretamente relacionado com comparticipação. O NICE publica normas de orientação que auxiliam a decisão de aquisição ou não de um DM. Tendo em consideração a informação reunida e descrita, este trabalho também propõe um modelo hipotético sobre o sistema português de avaliação de DM. Este modelo aborda, ainda que não de forma exaustiva, os possíveis processos e procedimentos para a avaliação de DM. Este sistema caracteriza-se pela importância dada ao envolvimento dos stakeholders e partilha de informação com os mesmos, mas também na agilização dos processos, isto é, uma redução e simplificação dos processos de avaliação de DM. A reavaliação de DM durante a sua comercialização também ganha destaque, apontando que cada grupo genérico de dispositivos ou DM inovador dever ser reavaliado a cada cinco anos, ou sempre que informação emergente o justifique. Este modelo representa uma abordagem experimental sobre o futuro do SiNATS aplicado aos DM. A partilha de informação, os fóruns de discussão e o envolvimento da sociedade serão uma mais-valia para que a implementação do SiNATS aos DM seja feita de forma gradual e com a máxima transparência possível.

Early investigation towards defining and measuring sustainability as a quality attribute in software systems

Sustainability in software system is still a new practice that most software developers and companies are trying to incorporate into their software development lifecycle and has been largely discussed in academia. Sustainability is a complex concept viewed from economic, environment and social dimensions with several definitions proposed making sometimes the concept of sustainability very fuzzy and difficult to apply and assess in software systems. This has hindered the adoption of sustainability in the software industry. A little research explores sustainability as a quality property of software products and services to answer questions such as; How to quantify sustainability as a quality construct in the same way as other quality attributes such as security, usability and reliability? How can it be applied to software systems? What are the measures and measurement scale of sustainability? The Goal of this research is to investigate the definitions, perceptions and measurement of sustainability from the quality perspective. Grounded in the general theory of software measurement, the aim is to develop a method that decomposes sustainability in factors, criteria and metrics. The Result is a method to quantify and access sustainability of software systems while incorporating management and users concern. Conclusion: The method will empower the ability of companies to easily adopt sustainability while facilitating its integration to the software development process and tools. It will also help companies to measure sustainability of their software products from economic, environmental, social, individual and technological dimension.

REPORTING OF SEXUAL VIOLENCE AGAINST WOMEN IN BRAZIL

Objetivo: Apresentar o quadro de violência sexual contra a mulher no Brasil, com base nas notificações realizadas no Sistema de Informação de Agravos de Notificação (SINAN). Métodos: Trata-se de um estudo descritivo, com abordagem quantitativa, que analisou informações referentes às notificações de violência sexual contra a mulher, no período de 2009 a 2013, considerando a unidade da federação, perfil das mulheres, características da ocorrência e encaminhamentos realizados pelo setor saúde. Os dados foram analisados por meio da estatística descritiva, sendo apresentados números absolutos e relativos derivados das notificações. Resultados: No Brasil, foram registradas 21.871 notificações no período estudado. Observaram-se maiores taxas de registros no ano de 2013 e na região Norte. Predominou o ciclo de vida de 10 a 19 anos (10.806/49,4%), as raças branca (8.894/40,7%) e parda (8.535/39,0%), e a escolaridade ensino fundamental incompleto (5.444/24,9%). Os casos de violência sexual ocorreram com maior frequência na residência da mulher (13.259/60,6%), com agressor conhecido (5.649/25,8%) e sem suspeita do uso de álcool (9.249/42,3%). A maior parte do atendimento no setor saúde foi de nível ambulatorial (15.842/72,6%), e os casos evoluíram para alta (16.879/77,2%). Conclusão: As notificações cresceram progressivamente no período estudado, e a violência sexual contra a mulher no país, registrada pelo setor saúde, atingiu, principalmente, adolescentes, no ambiente doméstico e com agressor conhecido.

Construção das capacidades organizacionais de tecnologia da informação no contexto dos sistemas institucionais integrados de gestão da UFRN

The IT capability is a organizational ability to perform activities of this role more effectively and an important mechanism in creating value. Its building process (stages of creation and development) occurs through management initiatives for improvement in the performance of their activities, using human resources and IT assets complementary responsible for the evolution of their organizational routines. This research deals with the IT capabilities related to SIG (integrated institutional management systems), built and deployed in UFRN (Universidade Federal do Rio Grande do Norte) to realization and control of administrative, academic and human resources activities. Since 2009, through cooperative agreements with federal and educational institutions of direct administration, UFRN has supported the implementation of these systems, currently involving more than 30 institutions. The present study aims to understand how IT capabilities, relevant in the design, implementation and dissemination of SIG, were built over time. This is a single case study of qualitative and longitudinal nature, performed by capturing, coding and analysis from secondary data and from semi-structured interviews conducted primarily with members of Superintenência de Informática, organizational unit responsible for SIG systems in UFRN. As a result, the technical, of internal relationship and external cooperation capabilities were identified as relevant in the successful trajectory of SIG systems, which have evolved in different ways. The technical capacity, initiated in 2004, toured the stages of creation and development until it reached the stage of stability in 2013, due to technological limits. Regarding the internal relationship capability, begun in 2006, it toured the stages of creation and development, having extended its scope of activities in 2009, being in development since then. Unlike the standard life cycle observed in the literature, the external cooperation capability was initiated by an intensity of initiatives and developments in the routines in 2009, which were decreasing to cease in 2013 in order to stabilize the technological infrastructure already created for cooperative institutions. It was still identified the start of cooperation in 2009 as an important event selection, responsible for changing or creating trajectories of evolution in all three capacities. The most frequent improvements initiatives were of organizational nature and the internal planning activity has been transformed over the routines of the three capabilities. Important resources and complementary assets have been identified as important for the realization of initiatives, such as human resources technical knowledge to the technical capabilities and external cooperation, and business knowledge, for all of them, as well as IT assets: the iproject application for control of development processes, and the document repository wiki. All these resources and complementary assets grew along the capacities, demonstrating its strategic value to SINFO/UFRN

Um modelo para aferir o nível de maturidade na adoção de SOA

Tese (doutorado)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Elétrica, 2015.

Identificación de Enterobacter sakazakii y Salmonella enterica en preparados en polvo para lactantes suministrados en el Hospital de Maternidad "Dr. Raúl Argüello Escolán" de la red de salud pública de San Salvador, El Salvador

Los preparados en polvo para lactantes o PPL son sustancias utilizadas para la sustitución parcial o total de la alimentación materna; generalmente son utilizadas por los hospitales en niños prematuros, neonatos inmunodeficientes, hijos de madres VIH-positivas y/o con peso menor a los 2.5 Kg, según lo reporta la Organización Mundial para la Salud(FAO/OMS2007. Dentro de los peligros biológicos existentes en los PPL se encuentra E. sakazakii y Salmonella spp. En el entorno de la fabricación de las formúlas, cuando se trata de productos deshidratados como los PPL, no es posible utilizar la tecnología actual para producir PPL, que contenga bajas concentraciones de microrganismos, es decir, estos productos no pueden ser esterelizados. Para evitar posibles enfermedades o hasta la muerte es necesario la implementacion de buenas prácticas higiénicas (BPH) y buenas prácticas de manufactura (BPM. especialmente en paises como el nuestro.

Developing smart services by Internet of Things in manufacturing business

Manufacturing companies have passed from selling uniquely tangible products to adopting a service-oriented approach to generate steady and continuous revenue streams. Nowadays, equipment and machine manufacturers possess technologies to track and analyze product-related data for obtaining relevant information from customers’ use towards the product after it is sold. The Internet of Things on Industrial environments will allow manufacturers to leverage lifecycle product traceability for innovating towards an information-driven services approach, commonly referred as “Smart Services”, for achieving improvements in support, maintenance and usage processes. The aim of this study is to conduct a literature review and empirical analysis to present a framework that describes a customer-oriented approach for developing information-driven services leveraged by the Internet of Things in manufacturing companies. The empirical study employed tools for the assessment of customer needs for analyzing the case company in terms of information requirements and digital needs. The literature review supported the empirical analysis with a deep research on product lifecycle traceability and digitalization of product-related services within manufacturing value chains. As well as the role of simulation-based technologies on supporting the “Smart Service” development process. The results obtained from the case company analysis show that the customers mainly demand information that allow them to monitor machine conditions, machine behavior on different geographical conditions, machine-implement interactions, and resource and energy consumption. Put simply, information outputs that allow them to increase machine productivity for maximizing yields, save time and optimize resources in the most sustainable way. Based on customer needs assessment, this study presents a framework to describe the initial phases of a “Smart Service” development process, considering the requirements of Smart Engineering methodologies.

Developing strategies to mitigate the energy consumed by network infrastructures

The energy consumption by ICT (Information and Communication Technology) equipment is rapidly increasing which causes a significant economic and environmental problem. At present, the network infrastructure is becoming a large portion of the energy footprint in ICT. Thus the concept of energy efficient or green networking has been introduced. Now one of the main concerns of network industry is to minimize energy consumption of network infrastructure because of the potential economic benefits, ethical responsibility, and its environmental impact. In this paper, the energy management strategies to reduce the energy consumed by network switches in LAN (Local Area Network) have been developed. According to the lifecycle assessment of network switches, during usage phase, the highest amount of energy consumed. The study considers bandwidth, link load and traffic matrixes as input parameters which have the highest contribution in energy footprint of network switches during usage phase and energy consumption as output. Then with the objective of reducing energy usage of network infrastructure, the feasibility of putting Ethernet switches hibernate or sleep mode was investigated. After that, the network topology was reorganized using clustering method based on the spectral approach for putting network switches to hibernate or switched off mode considering the time and communications among them. Experimental results show the interest of this approach in terms of energy consumption

Influences of change strategies to achieve organizational flexibility: a system dynamics approach.

257 p.

Speeding stroke recovery? A systematic review of amphetamine after stroke

Introduction: The use of drugs to enhance recovery (“rehabilitation pharmacology”) has been assessed. Amphetamine can improve outcome in experimental models of stroke, and several small clinical trials have assessed its use in stroke. Methods: Electronic searches were performed to identify randomised controlled trials of amphetamine in stroke (ischaemic or haemorrhagic). Outcomes included functional outcome (assessed as combined death or disability/dependency), safety (death) and haemodynamic measures. Data were analysed as dichotomous or continuous outcomes, using odds ratios (OR), weighted or standardised mean difference, (WMD or SMD) using random-effects models with 95% confidence intervals (95% CI); statistical heterogeneity was assessed. Results: Eleven completed trials (n=329) were identified. Treatment with amphetamine was associated with non-significant trends to increased death (OR 2.78 (95% CI, 0.75– 10.23), n=329, 11 trials) and improved motor scores (WMD 3.28 (95% CI −0.48–7.04) n=257, 9 trials) but had no effect on the combined outcome of death and dependency (OR 1.15 (95% CI 0.65–2.06, n=206, 5 trials). Amphetamine increased systolic blood pressure (WMD 9.3 mmHg, 95% CI 3.3–15.3, n=106, 3 trials) and heart rate (WMD 7.6 beats per minute (bpm), 95% CI 1.8–13.4, n=106, 3 trials). Despite variations in treatment regimes, outcomes and follow-up duration there was no evidence of significant heterogeneity or publication bias. Conclusion: No evidence exists at present to support the use of amphetamine after stroke. Despite a trend to improved motor function, doubts remain over

Analise das melhores práticas em business process management: estudo de casos em organizações hospitalares de Natal/RN

O gerenciamento dos processos organizacionais vem sendo estudado pela ciência administrativa como forma de romper com o paradigma da estrutura organizacional funcional através da Gestão por Processos. O Business Process Management ( BPM alinhado às estratégias organizacionais e suportado cada vez mais pela Tecnologia da Informação (TI), proporciona clareza nas diversas pontas do processo colaborando para sua melhoria contínua com o objetivo de gerar valor agregado ao cliente. As organizações de saúde estão entre as empresas prestadoras de serviço pouco estudadas em relação ao gerenciamento por processos. Assim, este estudo analisou por meio de um estudo empírico de natureza qualitativa, como estão sendo conduzidos os processos organizacionais hospitalares à luz das melhores práticas em BPM. A pesquisa foi realizada através do estudo de casos múltiplos realizados em duas organizações hospitalares na cidade de Natal/RN. A literatura de referência apresentou diversos fatores para um desempenho otimizado em BPM, tratados nesta pesquisa como as melhores práticas em BPM. A partir da revisão da literatura foi elaborada uma síntese das melhores práticas de BPM que serviu de base para elaboração do modelo da pesquisa utilizado para coleta e análise dos dados. Este modelo indicou onze categorias que foram utilizadas para elaboração do roteiro de estrevistas semi-estruturadas, através da técnica de análise de conteúdo, com categorização de grade fechada. As categorias foram agrupadas em duas dimensões: Elementos relacionados à gestão ( governança ; liderança , alinhamento estratégico , cultura e conhecimento ) e elementos relacionados aos processos ( desenho , responsável , executores , tecnologia da informação e indicadores ), e ainda foi identificada uma terceira categoria: escritório de processos . Para seleção dos sujeitos desta pesquisa foi adotada a estratégia em cadeia ou bola de neve . Foi possível identificar que todas as categorias apontadas no modelo de pesquisa emergem entre os fatores buscados pelas organizações hospitalares para o gerenciamento por processos com destaque para categorias: cultura ; conhecimento ; desenho ; tecnologia da informação e indicadores . Em complemento às categorias de análise, foram identificadas dificuldades relacionadas à comunicação e integração dos diversos elos do processo. Além disso, constatou-se que nos hospitais investigados há um desvio do conceito de BPM no que diz respeito a seu objetivo final: agregar valor ao cliente. A pesquisa concluiu que o gerenciamento por processos nas organizações hospitalares investigadas encontra-se em fase inicial ou em desenvolvimento, sendo necessário superar as barreiras da comunicação e edificar uma cultura organizacional orientada às necessidades dos clientes para aplicação das melhores práticas de BPM, desta forma pesquisas futuras sobre este tema em outras organizações hospitalares, podem facilitar um estudo comparativo e ampliar o conhecimento no assunto

Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis

Background and Purpose—High blood pressure (BP) is common in acute ischemic stroke and associated independently with a poor functional outcome. However, the management of BP acutely remains unclear because no large trials have been completed. Methods—The factorial PRoFESS secondary stroke prevention trial assessed BP-lowering and antiplatelet strategies in 20 332 patients; 1360 were enrolled within 72 hours of ischemic stroke, with telmisartan (angiotensin receptor antagonist, 80 mg/d, n647) vs placebo (n713). For this nonprespecified subgroup analysis, the primary outcome was functional outcome at 30 days; secondary outcomes included death, recurrence, and hemodynamic measures at up to 90 days. Analyses were adjusted for baseline prognostic variables and antiplatelet assignment. Results—Patients were representative of the whole trial (age 67 years, male 65%, baseline BP 147/84 mm Hg, small artery disease 60%, NIHSS 3) and baseline variables were similar between treatment groups. The mean time from stroke to recruitment was 58 hours. Combined death or dependency (modified Rankin scale: OR, 1.03; 95% CI, 0.84–1.26; P0.81; death: OR, 1.05; 95% CI, 0.27–4.04; and stroke recurrence: OR, 1.40; 95% CI, 0.68–2.89; P0.36) did not differ between the treatment groups. In comparison with placebo, telmisartan lowered BP (141/82 vs 135/78 mmHg, difference 6 to 7 mmHg and 2 to 4 mmHg; P0.001), pulse pressure (3 to 4 mmHg; P0.002), and rate-pressure product (466 mmHg.bpm; P0.0004). Conclusion—Treatment with telmisartan in 1360 patients with acute mild ischemic stroke and mildly elevated BP appeared to be safe with no excess in adverse events, was not associated with a significant effect on functional dependency, death, or recurrence, and modestly lowered BP.

Forms of Collaboration in Collaborative Enterprises: An Ontological Model

Part 19: Knowledge Management in Networks