993 resultados para Glomerulosclerose segmentar e focal


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The aim of this paper is to provide a formal framework for designing highly focused fields with specific transversal features when the incoming beam is partially polarized. More specifically, we develop a field with a transversal component that remains unpolarized in the focal area. Moreover, its longitudinal component exhibits non-zero values on axis. Special attention is paid to the design of the input beam and the development of the experiment. The implementation of such fields is possible by using an interferometric setup combined with the use of digital holography techniques. Experimental results are compared with those obtained numerically.

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Diplomityössä tutkitaan sähkönjakelun käyttövarmuutta parantavia investointeja ja menetelmiä. Lopputuloksena saadaan selville mitkä ratkaisut soveltuvat teknistaloudellisesti parhaiten Imatran Seudun Sähkön jakeluverkkoon. Menetelmien kannattavuutta on tutkittu ensisijaisesti keskeytyskustannussäästöjen näkökulmasta. Sähkönjakeluverkon käyttövarmuus on tullut nykyisessä yhteiskunnassa yhä tärkeämmäksi tekijäksi. Kaikki keskijänniteverkosta aiheutuneet keskeytykset on alettu ottaa tammikuusta 2008 lähtien huomioon verkkoliiketoiminnan kohtuullisen tuoton laskennassa. Toisaalta Suomen jakeluverkot ovat vanhoja, eikä niitä ole suunniteltu käyttövarmuuden kannalta. Tilannetta voidaan parantaa mm. lisäämällä verkkoon automaatiota sekä ottamalla käyttövarmuus huomioon saneerauksia suunniteltaessa. Sähkönjakeluverkon käyttövarmuuden parantaminen on pitkän aikavälin prosessi. Tutkittujen investointien kannattavuuksista on tehty herkkyysanalyysi, joka ottaa huomioon korkotason ja KAH-arvojen vaihtelut. Investointien todellista vaikutusta käyttövarmuuteen voidaan seurata vertaamalla tulevia vikatilastoja tässä työssä tehtyyn nykytilatutkimukseen.

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La denominada «reestructuración rural» pasa ineludiblemente por la transformación de la economía de sector primario que tradicionalmente ha sustentado al campo. En los últimos tiempos, se experimenta una clara tercerización de la economía rural, en muy buena medida capitalizada por la industria turística. En este sentido, surge la necesidad de repensar la ruralidad, de construirla socialmente a partir de la proyección de imaginarios comunicados interna y externamente mediante la ayuda de marcas territoriales. El presente trabajo tiene como objetivo prioritario explorar de qué forma la marca espacial Territoris serens permite la creación de una imagen competitiva para la agrupación territorial del Lluçanès, por medio de la difusión de relatos asociados a diversos valores intangibles encabezados por la serenidad, el paisaje y, por ende, la identidad territorial. La revisión de la literatura referida a marcas de territorio, el análisis de la producción documental vinculada a Territoris serens y la organización de un grupo focal de discusión permitirá dirimir el proceso de transformación de territorios en marcas, en aras de conseguir, en nombre de la competitividad, un renovado y posmoderno «sentido de lugar».

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Systems suppliers are focal actors in mechanical engineering supply chains, in between general contractors and component suppliers. This research concentrates on the systems suppliers’ competitive flexibility, as a competitive advantage that the systems supplier gains from independence from the competitive forces of the market. The aim is to study the roles that power, dependence relations, social capital, and interorganizational learning have on the competitive flexibility. Research on this particular theme is scarce thus far. The research method applied here is the inductive multiple case study. Interviews from four case companies were used as main source of the qualitative data. The literature review presents previous literature on subcontracting, supply chain flexibility, supply chain relationships, social capital and interorganizational learning. The result of this study are seven propositions and consequently a model on the effects that the dominance of sales of few customers, power of competitors, significance of the manufactured system in the end product, professionalism in procurement and the significance of brand products in the business have on the competitive flexibility. These relationships are moderated by either social capital or interorganizational learning. The main results obtained from this study revolve around social capital and interorganizational learning, which have beneficial effects on systems suppliers’ competitive flexibility, by moderating the effects of other constructs of the model. Further research on this topic should include quantitative research to provide the extent to which the results can be reliably generalized. Also each construct of the model gives possible focus for more thorough research.

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Organizing is a general problem for global firms. Firms are seeking a balance between responsiveness at the local level and efficiency through worldwide integration. In this, supply management is the focal point where external commercial supply market relations are connected with the firm's internal functions. Here, effective supplier relationship management (SRM) is essential. Global supply integration processes create new challenges for supply management professionals and new capabilities are required. Previous research has developed several models and tools for managers to manage and categorize different supplier relationship types, but the role of the firm's internal capability of managing supplier relationships in their global integration has been a clearly neglected issue. Hence, the main objective of this dissertation is to clarify how the capability of SRM may influence the firm's global competitiveness. This objective is divided into four research questions aiming to identify the elements of SRM capability, the internal factors of integration, the effect of SRM capability on strategy and how SRM capability is linked with global integration. The dissertation has two parts. The first part presents the theoretical approaches and practical implications from previous research and draws a synthesis on them. The second part comprises four empirical research papers addressing the research questions. Both qualitative and quantitative methods are utilized in this dissertation. The main contribution of this dissertation is that it aggregates the theoretical and conceptual perspectives applied to SRM research. Furthermore, given the lack of valid scales to measure capability, this study aimed to provide a foundation for an SRM capability scale by showing that the construct of SRM capability is formed of five separate elements. Moreover, SRM capability was found to be the enabler in efforts toward value chain integration. Finally, it was found that the effect of capability on global competitiveness is twofold: it reduces conflicts between responsiveness and integration, and it creates efficiency. Thus, by identifying and developing the firm's capabilities it is possible to improve performance, and hence, global competitiveness.

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In our previous studies we have described that ST3Gal III transfected pancreatic adenocarcinoma Capan-1 and MDAPanc-28 cells show increased membrane expression levels of sialyl-Lewis x (SLex) along with a concomitant decrease in α2,6-sialic acid compared to control cells. Here we have addressed the role of this glycosylation pattern in the functional properties of two glycoproteins involved in the processes of cancer cell invasion and migration, α2β1 integrin, the main receptor for type 1 collagen, and E-cadherin, responsible for cell-cell contacts and whose deregulation determines cell invasive capabilities. Our results demonstrate that ST3Gal III transfectants showed reduced cell-cell aggregation and increased invasive capacities. ST3Gal III transfected Capan-1 cells exhibited higher SLex and lower α2,6-sialic acid content on the glycans of their α2β1 integrin molecules. As a consequence, higher phosphorylation of focal adhesion kinase tyrosine 397, which is recognized as one of the first steps of integrin-derived signaling pathways, was observed in these cells upon adhesion to type 1 collagen. This molecular mechanism underlies the increased migration through collagen of these cells. In addition, the pancreatic adenocarcinoma cell lines as well as human pancreatic tumor tissues showed colocalization of SLex and E-cadherin, which was higher in the ST3Gal III transfectants. In conclusion, changes in the sialylation pattern of α2β1 integrin and E-cadherin appear to influence the functional role of these two glycoproteins supporting the role of these glycans as an underlying mechanism regulating pancreatic cancer cell adhesion and invasion

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The bakkenolide group of sesquiterpenes has been a focal point of synthetic efforts amongst several research laboratories all linked to our common origins at the Chemistry Institute at the State University in São Paulo. In this review we would like to present a historical perspective of this research, with unpublished background information, and a definitive retrosynthetic analysis of these molecules. This chemistry spans the time period from 1972 to 2006, and traces the initial steps with Prof. Dr. Helena Ferraz to the present day.

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The purpose of this study was to investigate the nature of co-operation between a project owner and an outside engineering consultant in combined heat and power plant implementation projects. Moreover, as another focal subject of the study was to familiarize the purchasing behavior of the energy producer and how an outside engineering consultant participated into different stages of the purchasing process. The study was carried out as a multiple case study including altogether six Finnish power plant implementation projects that had been taken into commercial use during 1995 – 2015. By adjusting the findings of empirical interview data and comparing those to the theoretical framework concerning, among others, Finnish energy production, engineering consulting businesses, delivery methods of construction project and finally the purchasing process, it can be concluded that especially in the power plant implementation projects in the past have a great influence to decisions made during the project. The role of the main engineering consultant is to act as an assistant, who helps to achieve the project goals successfully rather than an advisor who only knows how the project should be conducted. At least in these five project cases this was the case, meaning that the final decision power always remaining with project owner.

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Collaboration between competing firms (coopetition) has emerged as an important issue forn business practice in many industries. Extant literature has examined coopetition on many levels of analysis, but lacks clarity in distinguishing it explicitly from cooperation between noncompeting organizations. Because of this, the performance implications of coopetition from the perspective of an individual firm are still ambiguous – some research suggests positive results whereas other studies suggest detrimental outcomes. The aim in this dissertation is to narrow these gaps by exploring how firms create and appropriate value through collaboration with their competitors. The dissertation is divided into two parts. The first part comprises an overview of the relevant literature, as well as the conclusions of the whole study, and the second part includes six research publications. Both qualitative and quantitative methodologies are utilized. The results suggest that coopetition embodies the distinctive logic of value creation and appropriation from the perspective of an individual firm, and thus differs in terms of performance implications from cooperation between non-competitors. The distinction comes from the fact that competitors have somewhat similar understanding, capabilities and interest related to certain markets, which is potentially both challenging and beneficial in terms of the individual firm’s competitiveness. It appears from the findings that there are distinctive firm-external and firm-specific factors affecting the success of a coopetition strategy. This study makes three main contributions. First, on the conceptual level it shows the distinction between coopetition and cooperation between non-rivals as a collaborative inter-organizational relationship. Secondly, it sets out a framework and propositions that enhance understanding of how value is created and appropriated in coopetition from the perspective of an individual firm. Thirdly, it offers empirical evidence of how coopetition affects firms’ innovation and market performance, and identifies the focal internal and external factors involved. In general terms, the thesis adds to our knowledge of how a firm can successfully utilize a coopetition strategy in its pursuit of improved performance.

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Metastatic bone lesions are commonly associated with prostate cancer affecting approximately 60-80% of the patients. The progression of prostate cancer into an advanced stage is a complex process and its molecular mechanisms are poorly understood. So far, no curative treatment is available for advanced stages of prostate cancer. Bisphosphonates (BPs) are synthetic pyrophosphate analogues, which are used as therapeutics for various metabolic bone diseases because of their ability to inhibit osteoclastic bone resorption. Nitrogen-containing bisphosphonates block the function of osteoclasts by disturbing the vesicular traffic and the mevalonate pathway -related enzymes, for example farnesyl diphosphate synthase, which is involved in post-translational isoprenylation of small GTPases. In addition, the anti-proliferative, anti-invasive and pro-apoptotic effects of nitrogen-containing bisphosphonates on various cancer cell lines have been reported. The aim of this thesis work was to clarify the effects of bisphosphonates on prostate cancer cells, focusing on the mechanisms of adhesion, invasion and migration. Furthermore, the role of the mevalonate pathway and prenylation reactions in invasion and regulation of the cytoskeleton of prostate cancer cells were examined. Finally, the effects of alendronate on cytoskeleton- and actin-related proteins in prostate cancer cells were studied in vitro and in vivo. The results showed that the nitrogen-containing bisphosphonate alendronate inhibited the adhesion of prostate cancer cells to various extracellular matrix proteins and migration and invasion in vitro. Inhibition of invasion and migration was reversed by mevalonate pathway intermediates. The blockage of the prenylation transferases GGTase I and FTase inhibited the invasion, migration and actin organization of prostate cancer cells. The marked decrease of cofilin was observed by the prenylation inhibitors used. Inhibition of GGTase I also disrupted the regulation of focal adhesion kinase and paxillin. In addition, alendronate disrupted the cytoskeletal organization and decreased the level of cofilin in vitro and in vivo. The decrease of the cofilin level by alendronate could be one of the key mechanisms behind the observed inhibition of migration and invasion. Based on the effects of nitrogen-containing bisphosphonates on tumor cell invasion and cytoskeletal organization, they can be suggested to be developed as therapeutics for inhibiting prostate cancer metastasis.

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The study examines the internationalisation process of a contemporary SME firm and explores the impact of its business network on this development. The objective of the study is to understand SME internationalisation and its dynamics from a network perspective. The purpose of this research project is to describe and explore the development process of a firm and its business network by identifying the changes, critical events and influence factors that form this development. It is a qualitative case study, which focuses on a Finnish focal firm and its respective business network as it expands into the Greek market. It is a longitudinal research process, which covers a period of time from 1994 to 2004. The empirical study concentrates on the paper trading and converting business. The study builds on the network theory and the framework provided by Johanson and Mattsson's (1988) model on network internationalisation. The incremental internationalisation theories and network theories form the theoretical focus. The research project is organised according to a process view. The focal firm evolves from a domestically-oriented small subsidiary into an internationally experienced company, which has activities in several market areas and numerous business networks in various market segments and product categories. The findings illustrate the importance of both the domestic and foreign business network context in a firm's internationalisation process. The results of the study suggest theoretical modifications on a firm's internationalisation process by broadening the perspective and incorporating the strategic context of a firm. The findings suggest that internationalisation process is a non-linear process, which does not have a deterministic order in its development. The findings emphasise the significance of relational networks, both managerial and entrepreneurial, for establishing position in foreign markets. It implies that a firm's evolution is significantly influenced by its business network and by critical events. Business networks gain coherence due to common goals and they use accumulated capabilities to exploit market opportunities. The business network sets constraints and provides opportunities, which makes the related decision making strategically important. The firm co-evolves with its business network. The research project provides an instrumental case study with a description of an SME internationalisation process. It contributes to existing knowledge by illustrating dynamics in an international business network and by pinpointing the importance of suppliers, customers, partners, ownerships and competition to the internationalisation process.

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Objetivo: Avaliar a percepção dos pacientes quanto à relação estabelecida com profissionais e alunos durante internação no Hospital das Clínicas da Faculdade de Medicina de Botucatu (FMB-Unesp). Metodologia: Trata-se de um estudo observacional, no qual as informações foram colhidas por meio de entrevistas para obter dados sobre as internações, tendo sido realizado também grupo focal com pacientes de uma das enfermarias. Resultados: A internação foi avaliada como boa e ótima pela maior parte dos pacientes, tanto nas respostas às entrevistas quanto no grupo focal. As poucas queixas que surgiram foram dirigidas principalmente à visita médica. Conclusões: Embora as avaliações tenham sido positivas, os pacientes se mostraram ambivalentes em relação à visita médica. Diretrizes que norteiem sua realização são necessárias para que a mesma preserve seu papel didático sem prejuízo para o paciente. Estratégias institucionais de avaliação contínua devem ser desenvolvidas, especialmente em serviços universitários, aliando metodologias quantitativas e qualitativas.

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Este artigo analisa o enfoque da Saúde Coletiva no desenvolvimento curricular na graduação em Medicina da Universidade Estadual de Londrina (UEL), focalizando as diferentes visões de gestores, professores e estudantes sobre o processo de ensino-aprendizagem, introduzindo a análise da progressão do conhecimento em Saúde Coletiva no curso médico. Trata-se de um estudo qualitativo sobre a percepção dos entrevistados, tendo como população de estudo quatro gestores, quatro professores e um grupo focal de estudantes. Os resultados evidenciaram uma importante vinculação das atividades docentes da área junto à rede de serviços de saúde. No entanto, constata-se que os temas da área têm pequena inserção no currículo atual (5%), não considerando os estágios do internato e a estratégia de ensino que vem sendo utilizada. Concluiu-se que os docentes do Departamento de Saúde Coletiva sempre tiveram uma participação de vanguarda nos processos de mudança no curso de Medicina da UEL, havendo um grande esforço em tomar a realidade dos serviços de saúde de Londrina como eixo articulador do ensino em Saúde Coletiva, na tentativa de contribuir para a formação de médicos com maior conhecimento da realidade e comprometidos com o SUS.

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Sob a perspectiva do ensino e saúde, este trabalho analisa a discussão realizada durante o processo de formação de um grupo de tutores no fórum do curso de especialização em Ativação de processos de mudança na formação superior de profissionais de Saúde, no período de junho a agosto de 2005, promovido pelo Ministério da Saúde do Brasil, Fiocruz e Rede Unida, resultante do processamento do relato de prática, intitulado Quando a pergunta qualifica o olhar. O objetivo foi analisar a produção coletiva do fórum na discussão das seguintes questões, elaboradas pelo grupo durante o encontro presencial: Como se deu historicamente a construção do conceito de cuidado a partir dos diferentes saberes-profissões?; Como lidar com uma experiência focal (inovadora) de ensino-aprendizagem?; Como garantir a governabilidade-viabilidade inovadora no contexto da gestão? A questão de aprendizagem inicial foi: o que mudar para fazer a mudança? Utilizou-se como metodologia a técnica de interpretação qualitativa do discurso do sujeito coletivo, a partir do referencial teórico de Lefréve, Lefréve e Teixeira (2000).

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A formação médica para Saúde Pública é tema que ganha visibilidade na literatura, conforme este profissional se confronta com a prática na Estratégia de Saúde da Família (ESF). Para investigar se a formação do médico no Estado do Amazonas está em consonância com o preconizado para a atuação nesse modelo, empreendeu-se uma pesquisa empírica qualitativa, utilizando-se grupo focal e entrevista individual semiestruturada com acadêmicos do último período do curso de Medicina de uma universidade pública no referido Estado. Uma vez que os médicos recém-formados preenchem as vagas existentes na ESF no interior, estudar sua formação para atuar na atenção primária tem sua importância justificada. As informações levantadas indicam a deficiência do modelo pedagógico no ensino superior em Medicina quanto à formação em Saúde Coletiva e para a prática na ESF.