Gerenciamento de custos: aplicação do método de Custeio Baseado em Atividades em Centro de Material Esterilizado

Esta pesquisa exploratória descritiva, na modalidade de estudo de caso, teve por objetivo a aplicação do Custeio Baseado em Atividades (ABC) em Centro de Material e Esterilização (CME) de um hospital de ensino de capacidade extra. A coleta de dados ocorreu durante o ano de 2006, utilizando-se as técnicas de análise documental e observação direta não participante. A análise de processos possibilitou o conhecimento dos custos do ciclo/carga de desinfecção química ($9.95) e física ($12.63), e esterilização por vapor saturado sob pressão ($31.37) e por vapor de Baixa Temperatura e Formaldeído Gasoso ($255.28). As informações geradas pelo ABC resultaram na compreensão do processo gerador de custos e forneceram base para a mensuração de desempenho e melhorias de processos do CME.

Monoubiquitination and Activity of the Paracaspase MALT1 Requires Glutamate 549 in the Dimerization Interface.

The mucosa-associated lymphoid tissue protein-1 (MALT1, also known as paracaspase) is a protease whose activity is essential for the activation of lymphocytes and the growth of cells derived from human diffuse large B-cell lymphomas of the activated B-cell subtype (ABC DLBCL). Crystallographic approaches have shown that MALT1 can form dimers via its protease domain, but why dimerization is relevant for the biological activity of MALT1 remains largely unknown. Using a molecular modeling approach, we predicted Glu 549 (E549) to be localized within the MALT1 dimer interface and thus potentially relevant. Experimental mutation of this residue into alanine (E549A) led to a complete impairment of MALT1 proteolytic activity. This correlated with an impaired capacity of the mutant to form dimers of the protease domain in vitro, and a reduced capacity to promote NF-κB activation and transcription of the growth-promoting cytokine interleukin-2 in antigen receptor-stimulated lymphocytes. Moreover, this mutant could not rescue the growth of ABC DLBCL cell lines upon MALT1 silencing. Interestingly, the MALT1 mutant E549A was unable to undergo monoubiquitination, which we identified previously as a critical step in MALT1 activation. Collectively, these findings suggest a model in which E549 at the dimerization interface is required for the formation of the enzymatically active, monoubiquitinated form of MALT1.

Cyclic AMP induces differentiation in vitro of human melanoma cells.

Treating human melanoma lines with dibutyryl adenosine 3':5'-cyclic monophosphate (dbc AMP) resulted in morphologic changes associated with the altered expression of cell surface antigens. After treatment, cells developed long cellular projections characteristic of mature melanocytes and showed the presence of an increased number of Stage II premelanosomes. In addition, induction of melanin synthesis, detected as brown perinuclear pigmentation, was observed. The AMP further drastically reduced the growth rate of the five melanoma cell lines that were tested. The influence of dbc AMP was completely reversible 3 days after the agent was removed from the culture medium. The antigenic phenotype of the melanoma lines was compared before and after dbc AMP treatment. This was done with four monoclonal antibodies directed against major histocompatibility complex (MHC) Class I and II antigens and 11 monoclonal antibodies defining eight different melanoma-associated antigenic systems. Treatment with dbc AMP reduced the expression of human leukocyte antigen (HLA)-ABC antigens and beta-2-microglobulin in five of five melanoma lines. In the two HLA-DR-positive cell lines dbc AMP reduced the expression of this antigen in one line and enhanced it in the other. No induction of HLA-DR or HLA-DC antigens was observed in the Class II negative cell lines. Furthermore, dbc-AMP modulated the expression of the majority of the melanoma antigenic systems tested. The expression of a 90-kilodalton (KD) antigen, which has been found to be upregulated by interferon-gamma, was markedly decreased in all the five cell lines. A similar decrease in the expression of the high molecular weight proteoglycan-associated antigen (220-240 KD) was observed. The reduced expression of Class I and II MHC antigens as well as the altered expression of the melanoma-associated antigens studied were shown to be reversible after dbc AMP was removed. Our results collectively show that the monoclonal antibody-defined melanoma-associated molecules are linked to differentiation. They could provide useful tools for monitoring the maturation of melanomas in vivo induced by chemical agents or natural components favoring differentiation.

La reacción española ante la revolución portuguesa a través de la prensa. El tratamiento de los principales diarios (1974-1976)

En este trabajo se presenta un proyecto para realizar el análisis de la reacción española aún durante el Franquismo ante la Revolución de los Claveles en Portugal. Esta Revolución terminó con el anterior régimen dictatorial. La reacción española será analizada a través de su propia prensa diaria, sobre todo a través de diarios publicados en Madrid y en Barcelona. Se buscará definir cual la relevancia concedida por la prensa a los hechos portugueses, y cual su postura frente el cambio portugués. Para eso se analizarán los diarios madrileños ABC, Informaciones, Arriba y Pueblo, y los diarios barceloneses La Vanguardia Española y Tele/eXpres.

Pääkaupunkiseudun perhevalmennus vuonna 2015

Opinnäytetyön tarkoitus on kuvata perhevalmennuksen ennakointia pääkaupunkiseudulla vuoteen 2015 ja kartoittaa siihen vaikuttavia tekijöitä APESTE-analyysin mukaan. Toinen tavoite on luoda visio perhevalmennuksesta vuonna 2015. Opinnäytetyö on rajattu koskemaan vain pääkaupunkiseutua. Opinnäytetyö mukailee delfoi-menetelmää. Työtä varten koottiin perhevalmennuksen asiantuntijaryhmä (n=9), jota ensimmäisellä kyselykierroksella haastateltiin APESTE-analyysin mukaan asiakkaaseen liittyvistä, poliittisista, taloudellisista, sosiaalisista, teknisistä ja ekologisista tekijöistä, jotka vaikuttavat perhevalmennukseen. Lisäksi he visioivat perhevalmennusta vuonna 2015. Haastattelut analysoitiin sisällönanalyysia käyttäen. Toisella kierroksella asiantuntijaryhmä (n=3) vastasi sähköpostikyselyyn, jossa he saivat tarkentaa näkemyksiään. Haastattelut ja kyselyvastaukset muodostivat tutkimusaineiston. Lopullinen analyysi tehtiin kummankin kierroksen vastauksista. Perhevalmennuksen asiakaskunta polarisoituu ja monipuolistuu. Asiakkaiden koulutustaso nousee, mutta myös heikosti pärjäävien määrä lisääntyy. Asiakkaiden arvomaailmat kahtiajakautuvat, heidän tarpeidensa skaala laajenee ja terveysongelmansa lisääntyvät. Perheiden tukiverkot muuttuvat: perinteisten sukulaisyhteisöjen sijaan ihmiset saavat tukea verkostoitumalla samanhenkisten ihmisten kanssa. Yhteistyö julkisen, yksityisen ja kolmannen sektorin sekä eri hallinnonalojen välillä lisääntyy. Resurssit eivät lisäänny ja palveluita karsitaan. Ihmisten oma vastuu pärjäämisestään lisääntyy ja samalla kätilön työ muuttuu vaativammaksi. Internet tulee tärkeäksi osaksi perhevalmennusta. Uusien innovaatioiden käyttöönotto on hidasta. Eettiset kysymykset tulevat entistä tärkeämmiksi tekniikan kehittymisen suomien mahdollisuuksien myötä. Ihmisten ympäristötietoisuus lisääntyy ja ympäristökäyttäytyminen muuttuu. Äitiyshuolto on keskitetty osaamiskeskuksiin. Perhevalmennuksesta vastaa kätilö moniammatillisen tiimin kanssa. Kätilö organisoi perhevalmennusta muun äitiyneuvolatyön ohessa. Näin hän tuntee odottavat perheet ja osaa toteuttaa perhevalmennusta asiakaslähtöisesti, vaikka valmennuksella onkin yhtenäinen rakenne. Valmennus muuttuu toiminnallisemmaksi ja keskustelevammaksi. Ryhmäkoot pienenevät hiukan ja puolisoidenkin toiveet otetaan paremmin huomioon. Perhevalmennus alkaa ensimmäisen raskauskolmanneksen aikana ja jatkuu vielä vauvan syntymän jälkeen. Tärkeitä aiheita synnytykseen valmentautumisen, vauvanhoidon ja imetyksen ohella ovat parisuhde ja seksuaalisuus sekä psyykkinen hyvinvointi. Avainsanat perhevalmennus, ennakointi, APESTE-analyysi

Tie omaan ääneen : kehollisuus ja kokonaisvaltaisuus laulunopetuksessa

Työ on hankkeistettu Laulupedagogit ry:n kanssa. Hankkeistamisen muoto on opinnäytetyön abstraktin julkistaminen yhdistyksen kotisivuilla www.siba.fi/laulupedagogit. Pohdin työssäni lauluoppilaan kehollisten kokemusten, opettaja-oppilas -vuorovaikutuksen ja oppimisen suhdetta. Menetelmänä on oman oppimiskokemuksen uloskirjoittaminen ja sen analyysi. Keskityn työssäni opettajani laulutunneillaan käyttämien ääniharjoitusten opetustilanteisiin. Näkökulmana on laulamisen kokemus kokonaisvaltaisena ja kehollisena tapahtumana, jossa tietoinen ajattelu yhdistyy alitajuntaan ja ajattelevaan ja muistavaan kehoon. Työ jakautuu laulutunteihin, joissa jokaisessa pohditaan teemaa eri käsitteiden ja aihepiirien valossa. Kuvaan kokemuksia ja keskusteluja opettajan kanssa subjektiivisesta näkökulmasta, minkä rinnalla pohdin kutakin aihetta myös ulkopuolelta, lähdekirjallisuuden (esim.T. Klemola, T. Koski) kanssa. Miltä tuntuu, kun laulan? Miten koen kehollisuuden laulaessani? Mitä pyrin oppimaan ja mitkä ovat päämääräni laulunopiskelussa? Miten opin laulaessani ja aistin kehittymiseni? Mikä saa minut ylittämään itseni? Pyrin löytämään vastauksia näihin kysymyksiin kielellä, jota laulajat käyttävät ja ymmärtävät. Pohdintojen kautta niin kirjoittaja kuin lukijakin voi etsiä tietä omaan ääneensä ja olemiseensa laulajana, oppilaana ja opettajana.

Partituurista oopperaksi : laulajan työvälineet

Partituurista oopperaksi on tutkielma laulajan työprosessista ja sen hallinnan keinoista. Tämä kirjallinen opinnäytetyö perustuu muistiinpanoihin ja kokemuksiin Dorabellan roolin työstämisestä W. A. Mozartin oopperassa Cosı̀ fan tutte. Lisäksi työ perustuu kirjallisuuslähteisiin ja erityisesti aikaisemman opinnäytetyöni tuloksiin Näyttelijäntyö esittävän säveltaiteen palveluksessa (Mäkelä 2005). Laulajan työ voidaan jakaa karkeasti kolmeen osaan, jotka ovat taustatyö, näyttämötyö ja esiintyminen. Ne voidaan edelleen jakaa erilaisiin elementteihin, kuten musiikin ja roolin analyysi, ohjaaja, kapellimestari, yleisö jne. Työn tarkoituksena oli selvittää, mitä laulaja tarvitsee kokonaisvaltaisen esityksen rakentamiseksi ja millaisin välinein hän voi pureutua erilaisten elementtien hallintaan. Toisin sanoen tarkoituksena oli koota jonkinlainen työkalusarja laulajan työprosessia varten, jota voi tarpeen mukaan täydentää ja karsia. Laulajan työn oppiminen perustuu hyvän vokaalitekniikan työstämiseen. Silti laulajan työ ei ole pelkästään vokaalitekniikkaa, vaan se on monimuotoinen työprosessi, jolle laulutekniikka muodostaa työskentelyn perustan. Prosessiin kuuluvat elementit vaikuttavat tähän perustaan. Keskeinen tutkimusongelma oli analysoida keinoja eli välineitä, joiden avulla elementtejä voidaan hallita laulajan työssä. Tämä opinnäytetyö tarjoaa esimerkkejä ja vihjeitä mm. musiikin, tarinan taustan ja roolin analysoimiseksi sekä yleisön impulssien hyödyntämiseksi. Työtä voi käyttää joko laulajan työprosessin kuvauksena, esimerkkinä eräästä laulajan työhön soveltuvasta työkalusarjasta tai sieltä voi poimia yksittäisiä välineitä tarpeen mukaan. Parhaimmillaan työ voi tarjota hyödyllistä informaatiota mm. laulajille, laulunopiskelijoille ja laulunopettajille työprosessin kokonaisvaltaisuudesta.

The protease activity of the paracaspase MALT1 is controlled by monoubiquitination.

The protease activity of the paracaspase MALT1 is central to lymphocyte activation and lymphomagenesis, but how this activity is controlled remains unknown. Here we identify a monoubiquitination of MALT1 on Lys644 that activated the protease function of MALT1. Monoubiquitinated MALT1 had enhanced protease activity, whereas a ubiquitination-deficient MALT1 mutant with replacement of that lysine with arginine (MALT1(K644R)) had less protease activity, which correlated with impaired induction of interleukin 2 (IL-2) via the T cell antigen receptor in activated T cells. Expression of MALT1(K644R) diminished the survival of cells derived from diffuse large B cell lymphoma of the activated B cell-like subtype (ABC DLBCL), which require constitutive protease activity of MALT1 for survival. Thus, monoubiquitination of MALT1 is essential for its catalytic activation and is therefore a potential target for the treatment of ABC-DLBCL and for immunomodulation.

The Origins of old Prtuguese features in Papiamentu

This paper is concerned with both the linguistic and historical relationships between papiamentu, spoken on the ABC-Island.

Análise de Reantabilidade através da Margem de Contribuição

Este trabalho versa sobre a análise de rentabilidade através da margem de contribuição e tem por objectivo evidenciar como a margem de contribuição pode ser utilizada pelos gestores, na rentabilidade dos clientes, dos produtos, dos canais de distribuição e dos segmentos de mercado em que as empresas operam. O estudo está assente num referencial teórico que faz incursões nos principais conceitos conexos ao tema principal nomeadamente: análise custo – volume – resultado, métodos apuramento dos resultados na óptica da absorção e da contribuição, e a curva ABC. Na aplicação prática, procurámos utilizar alguns instrumentos de gestão nomeadamente o ponto de equilíbrio, apuramento dos resultados por segmentos de clientes, negócios e territórios de comercialização e a aplicação da curva de experiência ABC. O caso de estudo incide sobre a empresa nacional de moagem (Moave S.A) e restringe-se ao plano de produção e embalagem através do pequeno ensaque. O processo de colecta de dados foi obtido directamente das informações fornecidas pela Direcção da empresa, nomeadamente os produtos a serem embalados, a estrutura de custos, o plano de produção, a capacidade máxima da máquina e o calendário de trabalho diário e mensal. Os resultados evidenciaram que a utilização da margem de contribuição como ferramenta de gestão, constitui um importante instrumento de análise e avaliação da rentabilidade dos produtos, dos clientes, dos canais de distribuição bem como dos territórios de comercialização. This work focuses on the analysis of profitability through contribution margin and aims to highlight the contribution margin can be used by managers, in the profitability of customers, products, distribution channels and market segments in which companies operate. The study is based on the referential theoretical that makes inroads in key concepts related to the main topic, namely: cost analysis – volume – result, methods of clearance results in optical absorption and contribution, and ABC. In practice, we try to use some management tools in the balance, such as breakeven point, clearance of results by segments of customers, business and marketing territories and the application of experience curve ABC. The case study focuses on the national milling company (Moave s.a), and restricts itself to plan production and packaging through small bagging. The process of collecting data was obtained directly from the information provided by the management of the undertaking, in particular the products to be packed, the cost structure, the production plan, the maximum capacity of the machine and the daily work schedule and monthly. The results showed that the use of the contribution margin as a management tool constitutes an important instrument of analysis and assessment of the profitability of products, customers, distribution channels and marketing territories.

Implementação do Custeio baseado em Actividade (CBA) numa Empresa

Os sistemas de custeio não são mais do que sistemas de informação e de suporte à tomada de decisão. Porém, a contestação em relação aos sistemas ditos de tradicionais levou à emergência de novas abordagens. Dentre todas, o Custeio Baseado nas Actividades (ABC) tem-se destacado ao nível da literatura e das próprias empresas, sobretudo nas de maiores dimensões. A compreensão e a aplicação do ABC, em especial nas PMEs e a sistematização de metodologias de implementação, assim como a elaboração de estudos que concluam das reais vantagens e desvantagens deste novo sistema são, ainda, um campo por explorar devidamente. Este trabalho procura estudar a validade de um sistema ABC ao nível de uma PME Caboverdiana, caracterizadas na sua maior parte por um grande desconhecimento em relação às técnicas e abordagens de custeio. Para além do trabalho de campo (Parte IV) que aqui é descrito também se realizou um estudo exaustivo da literatura sobre o tema (Parte III). Porém, o ABC não poderia ser entendido, descontextualizado da problemática dos custos e dos sistemas de custeio (Parte I), nem desenquadrado do conjunto de mudanças que se operaram nos últimos anos nos processos produtivos e que proporcionaram o surgimento de outras abordagens não menos interessantes (Parte II). O estudo de caso, consubstanciado na última parte, visou criar um quadro conceptual de referência que permita a realização de outros estudos semelhantes, alargando o conhecimento científico sobre este tema e providenciando ferramentas úteis para as empresas que seguem de perto estas novas abordagens.

Once-daily dolutegravir is superior to once-daily darunavir/ritonavir in treatment-naïve HIV-1-positive individuals: 96 week results from FLAMINGO.

INTRODUCTION: Dolutegravir (DTG) 50 mg once daily was superior to darunavir/ritonavir (DRV/r) 800 mg/100 mg once daily through Week 48, with 90% vs. 83% of participants achieving HIV RNA 50 c/mL (p=0.025) [1]. We present data through Week 96. MATERIAL AND METHODS: FLAMINGO is a multicentre, randomized, open-label, Phase IIIb non-inferiority study, in which HIV-1-positive ART-naïve adults with HIV-1 RNA≥1000 c/mL and no evidence of viral resistance were randomized 1:1 to receive DTG or DRV/r, with investigator-selected backbone NRTIs (TDF/FTC or ABC/3TC). Participants were stratified by screening HIV-1 RNA (≤100K c/mL) and NRTI backbone. RESULTS: A total of 484 adults were randomized and treated; 25% had baseline HIV RNA 100K c/mL. At Week 96, the proportion of participants with HIV RNA 50 c/mL was 80% in the DTG arm vs. 68% in the DRV/r arm (adjusted difference 12.4%; 95% CI 4.7, 20.2%; p=0.002). Secondary analyses supported primary results: per-protocol [(DTG 83% vs. DRV/r 70%), 95% CI 12.9 (5.3, 20.6)] and treatment-related discontinuation = failure [(98% vs. 95%), 95% CI 3.2 (-0.3, 6.7)]. Overall virologic non-response (DTG 8%; DRV/r 12%) and non-response due to other reasons (DTG 12%; DRV/r 21%) occurred less frequently on DTG. As at Week 48, the difference between arms was most pronounced in participants with high baseline viral load (82% vs. 52% response through Week 96) and in the TDF/FTC stratum (79% vs. 64%); consistent responses were seen in the ABC/3TC stratum (82% vs. 75%). Six participants (DTG 2, none post-Week 48; DRV/r 4, two post-Week 48) experienced protocol-defined virologic failure (PDVF; confirmed viral load 200 c/mL on or after Week 24); none had treatment-emergent resistance to study drugs. Most frequent drug-related adverse events (AEs) were diarrhoea, nausea and headache, with diarrhoea significantly more common on DRV/r (24%) than DTG (10%). Significantly more participants had Grade 2 fasting LDL toxicities on DRV/r (22%) vs. DTG (7%), p<0.001; mean changes in creatinine for DTG (~0.18 mg/dL) observed at Week 2 were stable through Week 96. CONCLUSIONS: Once-daily DTG was superior to once-daily DRV/r in treatment-naïve HIV-1-positive individuals, with no evidence of emergent resistance to DTG in virologic failure and relatively similar safety profiles for DTG and DRV/r through 96 Weeks.

Cost system design and cost management in the Spanish public sector

Cost systems have been shown to have developed considerably in recent years andactivity-based costing (ABC) has been shown to be a contribution to cost management,particularly in service businesses. The public sector is composed to a very great extentof service functions, yet considerably less has been reported of the use of ABC tosupport cost management in this sector.In Spain, cost systems are essential for city councils as they are obliged to calculate thecost of the services subject to taxation (eg. waste collection, etc). City councils musthave a cost system in place to calculate the cost of services, as they are legally requirednot to profit , from these services.This paper examines the development of systems to support cost management in theSpanish Public Sector. Through semi-structured interviews with 28 subjects within oneCity Council it contains a case study of cost management. The paper contains extractsfrom interviews and a number of factors are identified which contribute to thesuccessful development of the cost management system.Following the case study a number of other City Councils were identified where activity-based techniques had either failed or stalled. Based on the factors identified inthe single case study a further enquiry is reported. The paper includes a summary usingstatistical analysis which draws attention to change management, funding and politicalincentives as factors which had an influence on system success or failure.

Implementação do sistema de custeio baseado em actividades (CBA) numa Instituição de Ensino Superior em Cabo Verde

Actualmente, a gestão de gastos assume um papel fundamental nas empresas modernas. A globalização, aliada às novas tecnologias, exige que essas empresas sejam ágeis e competentes. Neste contexto, a gestão eficiente dos recursos e a obtenção de informações precisas que apoiem na tomada de decisão, dependerão em grande parte, de um sistema de custo. A utilização de diversas tecnologias e ferramentas faz com que as empresas tenham cada vez mais gastos indiretos relativamente aos gastos diretos. Logo, o método CBA surgiu como alternativa aos sistemas de custeio tradicionais numa tentativa de solucionar ou, pelo menos, minimizar o problema de atribuição dos gastos indiretos. O presente trabalho pretende abordar o método CBA e propor uma metodologia de implementação do sistema numa Instituição de Ensino Superior, evidenciando e discutindo as principais vantagens e desvantagens associadas a esta metodologia e identificando as suas contribuições para a gestão das IES. De acordo com as pesquisas feitas, conclui-se que nenhuma das IES em São Vicente possui um sistema de contabilidade de gestão, mas verificou-se que todas têm conhecimento deste sistema e consideram-no o melhor método de gestão para análise dos gastos. Os resultados obtidos no estudo de caso demonstram que o objetivo foi atingido, apurandose que o método CBA é o mais adequado para o suporte à gestão, tendo em conta que ultrapassa as insuficiências de informação sobre os gastos. Currently, cost management plays a key role in modern business. The globalization, allied to the new technologies, demands that those companies are agile and qualified. In this context, an efficient management of the resources and the gathering of precise information which support the decision-making process will depend, largely, of an effective cost management system. The use of different technologies and tools makes companies have more indirect costs than direct. Therefore, the ABC method was devised as an alternative to the conventional means of costing in an attempt of solving or, at least, minimizing the problem of the attribution of indirect costs. Our work intends to analyze the ABC method and to propose a methodology of implementation of such system in an Institution of Higher Education, showing and discussing the main advantages and disadvantages associated with this methodology and identifying its contributions for the administration of these Institutions. Our research has shown that, none of the IHEs in São Vicente has a management accounting system, although all have knowledge of it and consider it as being the best administration method for the analysis of expenses. The results obtained in the case study demonstrate that the objective was reached: to conclude the ABC method is the most adequate to support the administration, as it overcomes the problem of lack of information on the running costs.

Regulation of the expression of Fit insect toxin locus genes in the root-associated biocontrol pseudomonad CHA0

The root-colonizing Pseudomonas fluorescens strain CHA0 is a biocontrol agent of soil-borne plant diseases caused by fungal and oomycete pathogens. Remarkably, this plant-beneficial pseudomonad is also endowed with potent insecticidal activity that depends on the production of a large protein toxin termed Fit (for P. fluorescens insecticidal toxin). In our present work, the genomic locus encoding the P. fluorescens insect toxin is subjected to a detailed molecular analysis. The Fit toxin gene fitD is flanked upstream by the fitABC genes and downstream by the fitE gene that encode the ABC transporter, membrane fusion, and outer membrane efflux components of a type I protein secretion system predicted to function in toxin export. The fitF, fitG, and fitH genes located downstream of fitE code for regulatory proteins having domain structures typical of signal transduction histidine kinases, LysR-type transcriptional regulators, and response regulators, respectively. The role of these insect toxin locus-associated control elements is being investigated with mutants defective for the regulatory genes and with GFP-based reporter fusions to putative promoter regions upstream of the transporter genes fitA and fitE, the toxin gene fitD, and the regulatory genes fitF and fitH. Our preliminary findings suggest that the three regulators interact with known global regulators of biocontrol factor expression to control Fit toxin expression and secretion.