The Self-Inflicted Burns - Typology and its Prognostic Relevance in a 14-Year Review of Self-Inflicted Burns in a Tertiary Referral Centre

Self-inflicted burns (SIB) are responsible for 2-6% of admissions to Burn Units in Europe and North America, and for as many as 25% of admissions in developing nations. Recently, a promising new tool was proposed to stratify SIB patients in the following subgroups: "typical", "delirious", and "reactive". However, as far as the authors know, the clinical usefulness of this instrument has not yet been validated by others. We retrospectively reviewed the clinical records of 56 patients admitted to our Burn Unit with the diagnosis of SIB injury in the past 14 years. The following parameters were evaluated: demographic features; psychiatric illness; substance abuse; mechanism of injury; burn depth, total body surface area (TBSA) involved, Abbreviated Burn Severity Index (ABSI); length of hospital stay, and mortality. All patients were followed up by a psychologist and a psychiatrist, and were classified according to the SIB-Typology Tool, into three classes: "typical", "delirious" and "reactive". There was a slight predominance of the "typical" type (44.6%), followed by the "delirious" type (30.4%), and, finally the "reactive" type (25.0%). Mortality was significantly higher in the "typical" subgroup. In conclusion, the SIB-Typology Tool appears to be a valuable instrument in the clinical management of SIB patients.

Octreótido - Uma Terapêutica Opcional para Quilotórax Pós-Cirúrgico em Crianças com Cardiopatia Congénita

INTRODUCTION: Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax. METHODS: The objective of this work was to analyze the efficacy and safety of this treatment for chylothorax after congenital heart surgery. We reviewed the records of sixteen patients with chylothorax after surgery for congenital heart disease between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of chylothorax and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects. RESULTS: The incidence of chylothorax in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of chylothorax and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention. DISCUSSION AND CONCLUSIONS: Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication.

Autonomous guided vehicles applied to industrial engineering and management studies

This article presents a framework to an Industrial Engineering and Management Science course from School of Management and Industrial Studies using Autonomous Ground Vehicles (AGV) to supply materials to a production line as an experimental setup for the students to acquire knowledge in the production robotics area. The students must be capable to understand and put into good use several concepts that will be of utmost importance in their professional life such as critical decisions regarding the study, development and implementation of a production line. The main focus is a production line using AGVs, where the students are required to address several topics such as: sensors actuators, controllers and an high level management and optimization software. The presented framework brings to the robotics teaching community methodologies that allow students from different backgrounds, that normally don’t experiment with the robotics concepts in practice due to the big gap between theory and practice, to go straight to ”making” robotics. Our aim was to suppress the minimum start point level thus allowing any student to fully experience robotics with little background knowledge.

Clinical guideline for diagnosis and management of melioidosis

Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.

Teaching accounting and management through business simulation

Everyday accounting and management teachers face the challenge of creating learning environments that motivate students. This chapter describes the Business Simulation (BS) experience that has taken place at the Polytechnic Institute of Porto, Institute of Accounting and Administration (IPP/ISCAP). The chapter presents students’ perceptions about the course and the teaching/learning approach. The results show that pedagogical methods used (competency-oriented), generic competencies (cooperation and group work), and interpersonal skills (organisational and communication skills) are relevant for future accounting professionals. In addition, positive remarks and possible constraints based on observation, staff meetings, and past research are reported. The chapter concludes with some recommendations from the project implementation

Maturity models in the hospital information systems management initial research

Os modelos de maturidade são instrumentos facilitadores da gestão das organizações, incluindo a gestão da sua função sistemas de informação, não sendo exceção as organizações hospitalares. Neste artigo apresenta-se uma investigação inicial que visa o desenvolvimento de um abrangente modelo de maturidade para a gestão dos sistemas de informação hospitalares. O desenvolvimento deste modelo justifica-se porque os modelos de maturidade atuais no domínio da gestão dos sistemas informação hospitalares ainda se encontram numa fase embrionária de desenvolvimento, sobretudo porque são pouco detalhados, não disponibilizam ferramentas para determinação da maturidade e não apresentam as características dos estágios de maturidade estruturadas por diferentes fatores de influência.

Passive Fault-Tolerance Management in Component-based Embedded Systems

It is imperative to accept that failures can and will occur, even in meticulously designed distributed systems, and design proper measures to counter those failures. Passive replication minimises resource consumption by only activating redundant replicas in case of failures, as typically providing and applying state updates is less resource demanding than requesting execution. However, most existing solutions for passive fault tolerance are usually designed and configured at design time, explicitly and statically identifying the most critical components and their number of replicas, lacking the needed flexibility to handle the runtime dynamics of distributed component-based embedded systems. This paper proposes a cost-effective adaptive fault tolerance solution with a significant lower overhead compared to a strict active redundancy-based approach, achieving a high error coverage with the minimum amount of redundancy. The activation of passive replicas is coordinated through a feedback-based coordination model that reduces the complexity of the needed interactions among components until a new collective global service solution is determined, improving the overall maintainability and robustness of the system.

ISO 9001 Quality Management Systems through the Lens of Organizational Culture

Both managers and scholars have convictions about the organizational approaches that best support organizational performance of the respective organizations and its Quality Management Systems. After a literature review of ISO 9001 Quality Management Systems (including the changes introduced by the 2015 edition), Organizational Culture theories are addressed and input from a CEO´s focus group was gathered. The importance of organizational culture for the success of Quality Management Systems and the achievement of the organizational desired results is highlighted. The article advances a proposal to analyze ISO 9001 International Standard through the lens of organizational culture theories identifying a stronger open systems approach (influence of the environment, dynamic perspective, need for survival) of the 2015 ISO 9001 edition when compared with the 2008 one. This provides additional knowledge both to scholars and practitioners for a better understanding of the culture issues that can maximize ISO 9001 Quality Management Systems 2015 edition contributions to organizational enduring success.

Influence of Firms’ Environmental Management and Community Involvement Programs in their Employees and in the Community

To assure enduring success, firms need to generate economic value with respect for the environment and social value. They also need to be aware of the needs and expectations of relevant stakeholders and incorporate them in their business strategies and programs. These challenges imply that engineers should take into consideration societal, health and safety,environmental and commercial issues in their professional activity. This investigation accesses the influence of firms’ environmental management programs and community involvement programs on their own employees and in the community, with a focus on small and medium companies. Based on a quantitative research, the findings suggest that firms that invest both in environmental management programs and in community involvement programs have a higher involvement of their own employees with the community, while at the same time receiving more feedback (positive, but also negative) from the community, stressing the need to pay special attention to their communication policies.

Impact of Supplier Management Strategies on the Organizational Performance of ISO 9001 Certified Organizations

Purpose: The purpose of this article is to discuss the impact of Supplier orientation and the resulting Supply Chain Management (SCM) approach, on the organizational performance of ISO 9001 Quality Management Systems certified organizations. Methodology/Approach: Following a literature review, a full structural conceptual model was proposed. An online survey was administered to managers of Portuguese organizations with certified ISO 9001 Quality Management Systems. Descriptive Statistics and Structural Model Equations were used to validate the proposed conceptual model. Findings: There are positive relationships between Organization Strategy and Supplier Orientation, between Supplier Orientation and Stakeholders Satisfaction, and between Stakeholders Satisfaction and Organizational Performance Orientation, supporting ISO 9001:2015. These findings provide insights that supplier orientation, mediated by stakeholder satisfaction, is an essential tool for organizational competitive sustainable advantage. Research Limitation/implication: The analysis was based on managers of ISO 9001 certified organizations perceptions, so additional studies with actual data and longitudinal studies should be useful for further validation. Originality/Value of paper: The importance of the overall organizational ecosystem is highlighted with potential impact on the more than 1 Million ISO 9001 organizations certified worldwide and in their suppliers.

Forest management: different criteria – equal sustainability

From the forest management perspective, many definitions have been proposed for the concept of forest sustainability. Despite this apparent diversity, most of them converge on the same aspects. In this work we developed a comparative approach of two distinct forest management methodologies used in Europe, more precisely in Slovenia and in Portugal. Although in each case study differences in vegetation, climate and pedological characteristics are evident, we were able to show some peculiar aspects of both the Slovenian and the Portuguese examples. This study also dealt with the evolution of the term sustainability in the last decades and how it played an important role for forest management options.

Municipal solid waste management system: decision support through systems analysis

Thesis submitted to the Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia for the degree of Doctor of Philosophy in Environmental Engineering

Bartholin's Gland Cysts: Management with Carbon-Dioxide Laser Vaporization

OBJETIVO: Avaliar a eficácia, a taxa de recorrência e as complicações da vaporização laser com CO2 no tratamento dos cistos da glândula de Bartholin. MÉTODOS: Estudo retrospectivo com 127 pacientes que apresentavam cistos sintomáticos da glândula de Bartholin submetidas à vaporização laser CO2 na nossa instituição de janeiro de 2005 a junho de 2011. Foram excluídas todas as pacientes com abcessos da glândula de Bartholin ou com suspeita de câncer. Todos os procedimentos foram realizados em regime ambulatorial, sob anestesia local. A coleta dos dados foi feita com base na consulta do processo clínico, tendo-se procedido à análise das características demográficas, dos parâmetros anatômicos, das complicações intra e pós-operatórias e dos dados de acompanhamento. Os dados foram armazenados e analisados no software Microsoft Excel® 2007, e os resultados foram apresentados como frequência (porcentagem) ou média±desvio padrão. As taxas de complicações, recorrência e cura foram calculadas. RESULTADOS: A idade média das pacientes foi de 37,3±9,5 anos (variando entre 18 e 61 anos). Setenta por cento(n=85) delas eram multíparas. A queixa mais frequente foi dor e 47,2% (n=60) das pacientes tinham antecedentes de tratamento médico e/ou cirúrgico por abcesso da glândula de Bartholin. A dimensão média dos cistos foi de 2,7±0,9 cm. Foram verificados três (2,4%) casos de hemorragia intraoperatória ligeira e 17 (13,4%) recorrências durante um período médio de 14,6 meses (variando entre 1 e 56 meses): dez abscessos da glândula de Bartholin e sete cistos recorrentes, que precisavam de uma nova intervenção cirúrgica. A taxa de cura após um único tratamento à laser foi de 86,6%. Dentre as cinco pacientes com doença recorrente que foram submetidas a um segundo procedimento com laser, a taxa de cura foi de 100%. CONCLUSÕES: Na presente instituição, a vaporização laser com CO2 parece ser uma opção terapêutica segura e eficaz no tratamento dos cistos da glândula de Bartholin.