Uma especulação sobre a internet no operador de turismo: o caso CVC

O trabalho analisa em caráter exploratório, através de um estudo de caso com a CVC, quais são as possíveis utilizações da Internet na operação de turismo. Para direcionar essa abordagem verifica-se o impacto em relação às variáveis do composto mercadológico e ao processo de prestação de serviços sob a ótica do usuário. O referencial teórico adotado na pesquisa estabelece as bases para análise das evidências empíricas e proporciona adaptações dos conceitos utilizados às características do operador. O modelo de composto mercadológico é utilizado como fio condutor na construção de um referencial. Ele é adaptado à prestação de serviços e ao operador. Desta forma, considera-se que o produto do operador de turismo é a prestação do serviço que envolve a contratação, organização e execução. A análise da internet está direcionada para os dois primeiros processos. O que se conclui em relação às variáveis do composto mercadológico na empresa analisada é que a internet é pouco utilizada para romper as limitações de tempo e lugar, consideradas pela literatura como os principais benefícios da Internet como canal direto para o usuário. Seu uso está mais associado à integração dos membros da indústria do que para atingir maior satisfação do usuário pela possibilidade que o site oferece para personalização do composto mercadológico. A flexibilidade do composto, no produto e no preço, é mais aproveitada nas agências de viagens. Os efeitos do uso da Internet no processo de prestação de serviço da CVC são percebidos na agência virtual (o site) e no agente de viagem. A prestação de serviço via site representa a primeira grande alteração, pois a interação entre usuários, funcionários e ambiente físico é substituída pela interação eletrônica, chat e e-mail, ou mesmo telefone, e a infra-estrutura física por computadores e linhas de comunicação. No caso das agências de viagens, a alteração está relacionada à possibilidade de participação ativa do usuário na fase de elaboração do pacote, o que propicia flexibilidade nos programas de turismo.

Gas exchange rates at different vapor pressure deficits and water relations of 'Pera' sweet orange plants with citrus variegated chlorosis (CVC)

Net photosynthesis (A) and transpiration rates (E), stomatal conductance (g), water use efficiency (WUE), intrinsic water use efficiency (IWUE) and internal leaf CO2 concentration (C) in response to different vapor pressure deficit (1.2 and 2.5 kPa) were investigated in 'Pera' sweet orange plants affected by citrus variegated chlorosis (CVC), a disease caused by Xylella fastidiosa. All plants were well watered and leaf water potential (Pw) was also measured by the psychrometric technique. Results showed that healthy plants responded to higher vapor pressure deficit (VPD), lowering its net photosynthesis and transpiration rates, and stomatal conductance. However, diseased plants presented no clear response to VPD, showing lower A, E and g for both VPDs studied and very similar values to these variables in healthy plants at the highest VPD. Internal leaf CO2 concentration also decreased for healthy plants when under the highest VPD, and surprisingly, the same pattern of response was found in plants with CVC. These results, the lower Psi(w) and higher WUE values for diseased plants, indicated that this disease may cause stomatal dysfunction and affect the water resistance through xylem vessels, which ultimately may play some role in photosynthetic metabolism. (C) 2003 Elsevier B.V. B.V. All rights reserved.

Rooting of healthy and CVC-affected 'Valência' sweet orange stem cuttings, through the use of plant regulators

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação da ponta de diamante CVC (Chemical Vapor Deposition) associada ao aparelho de ultra-som

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Logistic Regression in Modelling Data for CVC - Related Infection

2000 Mathematics Subject Classification: 62J12, 62P10.

Propuesta de diseño de una Oficina de Gestión de Proyectos para la Dirección de Planeación de la Corporación Autónoma Regional del Valle del Cauca (CVC)

Con el propósito de contribuir a los resultados de gestión en una entidad ambiental como es la Corporación Autónoma Regional del Valle del Cauca (CVC), se diseñó una Oficina de Gestión de Proyectos (PMO), con base en el PMI, por su sigla Project Management Institute, integrada a la estructura orgánica de la entidad -- La idea surgió de la necesidad de posicionar su imagen corporativa en un escalón más alto ante la comunidad, al considerar para el efecto las circunstancias organizativas internas de la entidad, como los nuevos sistemas competitivos de gestión administrativa, operativa y técnica -- En dicho contexto, la entidad requiere fortalecer su capacidad de gestión institucional y se deben adoptar tácticas que definan el direccionamiento de la gestión, como la propuesta de diseño de una Oficina de Gestión de Proyectos para la Dirección de Planeación en cuanto a las políticas, los objetivos y los proyectos, que la lleven a superar los condicionantes, soportado en procesos de modernización, innovación y tecnología, mediante la organización de sus funciones y sus competencias y la formalización de sus procesos y procedimientos, tanto los técnicos como los administrativos y financieros, así como sus instrumentos de coordinación, comunicaciones, seguimiento y control

Cost effectiveness of antimicrobial catheters in the intensive care unit : Addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of $948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.

Spatial variation of particle number concentration in school microscale environments and its impact on exposure assessment

It has not yet been established whether the spatial variation of particle number concentration (PNC) within a microscale environment can have an effect on exposure estimation results. In general, the degree of spatial variation within microscale environments remains unclear, since previous studies have only focused on spatial variation within macroscale environments. The aims of this study were to determine the spatial variation of PNC within microscale school environments, in order to assess the importance of the number of monitoring sites on exposure estimation. Furthermore, this paper aims to identify which parameters have the largest influence on spatial variation, as well as the relationship between those parameters and spatial variation. Air quality measurements were conducted for two consecutive weeks at each of the 25 schools across Brisbane, Australia. PNC was measured at three sites within the grounds of each school, along with the measurement of meteorological and several other air quality parameters. Traffic density was recorded for the busiest road adjacent to the school. Spatial variation at each school was quantified using coefficient of variation (CV). The portion of CV associated with instrument uncertainty was found to be 0.3 and therefore, CV was corrected so that only non-instrument uncertainty was analysed in the data. The median corrected CV (CVc) ranged from 0 to 0.35 across the schools, with 12 schools found to exhibit spatial variation. The study determined the number of required monitoring sites at schools with spatial variability and tested the deviation in exposure estimation arising from using only a single site. Nine schools required two measurement sites and three schools required three sites. Overall, the deviation in exposure estimation from using only one monitoring site was as much as one order of magnitude. The study also tested the association of spatial variation with wind speed/direction and traffic density, using partial correlation coefficients to identify sources of variation and non-parametric function estimation to quantify the level of variability. Traffic density and road to school wind direction were found to have a positive effect on CVc, and therefore, also on spatial variation. Wind speed was found to have a decreasing effect on spatial variation when it exceeded a threshold of 1.5 (m/s), while it had no effect below this threshold. Traffic density had a positive effect on spatial variation and its effect increased until it reached a density of 70 vehicles per five minutes, at which point its effect plateaued and did not increase further as a result of increasing traffic density.

In Response: "Oral versus IV treatment for catheter-related bloodstream infections - by Burke A. Cunha"

In his letter Cunha suggests that oral antibiotic therapy is safer and less expensive than intravenous therapy via central venous catheters (CVCs) (1). The implication is that costs will fall and increased health benefits will be enjoyed resulting in a gain in efficiency within the healthcare system. CVCs are often used in critically ill patients to deliver antimicrobial therapy, but expose patients to a risk of catheter-related bloodstream infection (CRBSI). Our current knowledge about the efficiency (i.e. costeffectiveness) of allocating resources toward interventions that prevent CRBSI in patients requiring a CVC has already been reviewed (2). If for some patient groups antimicrobial therapy can be delivered orally, instead of through a CVC, then the costs and benefits of this alternate strategy should be evaluated...

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children

Background Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. Objectives To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Search Methods The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Selection criteria Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Data Collection and Analysis Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Main Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). Authors' Conclusions The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.