Aseptic intussuscepted incidental appendectomy: three successful cases

BACKGROUND: Incidental appendectomy remains a controversial issue. We aimed to collect experience using a modified surgical technique that could be applied securely in infants. METHODS: We performed aseptic intussuscepted incidental appendectomy (AIIA) in three patients using a technique that is thought to assure appendix necrosis along with intact cecal wall. RESULTS: There was no perioperative morbidity due to AIIA in the three patients. In two infants the necrotic appendix was found in the diaper. One infant died secondary to diaphragmatic hernia. Autopsy with histological examination revealed that the cecum was intact along with appendix necrosis. CONCLUSIONS: Modified AIIA could securely be performed in the 3 reported cases. We advocate prospective evaluation of the method.

Delayed delivery of second twin: a multicentre study of 35 cases.

OBJECTIVE: The aim of this study was to conduct a statistical analysis to determine the outcome of conservative treatment after delivery of a first fetus in multiple pregnancy and thus define new prognostic factors. STUDY DESIGN: Multicentre retrospective study involving 12 centers over a 10-year period. RESULTS: Twenty-eight twin pregnancies and seven triplet pregnancies which were managed conservatively. In twin pregnancies, 79% of the delayed-delivery fetuses survived; only 7% of the first delivered fetuses survived. The mean interval between deliveries was 47 days. No statistical difference was found concerning cerclage, antibiotic therapy, tocolysis and hospitalization. Earlier delivery of the first twin and premature rupture of membranes for the second twin were significantly related to a longer interval between deliveries. CONCLUSION: Delayed delivery in multifetal pregnancies can be successful if there are no contraindications and these pregnancies are managed in a tertiary perinatal center. Publications limited to successful cases have undoubtedly introduced some bias in assessment.

Percutaneous central venous catheterization through the external jugular vein in children: improved success rate with body maneuvers and fluoroscopy assistance

Background/Purpose: Central venous catheterization is among the most common procedures performed by pediatric surgeons. Significant morbidity and even mortality can ensue from the widespread approach to the deep veins of the neck and femoral region. The external jugular vein (EJV) is a low-morbidity alternative for percutaneous catheterization in children, but it has yielded a low success rate in previous reports The authors show an improved success rate with this option. Methods: We performed an analysis of 33 patients` charts in which central venous catheterization using Seldinger technique through the EJV was attempted in 2005. Age, diagnosis, maneuvers used for success, fluoroscopy usefulness, and types of inserted catheters were evaluated. Results: The procedure was successful in 26 (78.8%) patients without complications. Diagnosis was neoplasia in almost half of the patients (42%). In half of the successful cases, body maneuvers were used, namely, twisting the head of the patient to the side of the vein and stretching the ipsilateral arm and shoulder. All but one procedure were completed under fluoroscopic guidance. In 6 (23%) patients, a long-term catheter was inserted. Conclusions: The EJV is an excellent option for central venous catheterization in children. The execution of simple maneuvers along with fluoroscopic assistance might allow for an improved success rate not only for short-term but also for long-term catheter insertion. (C) 2008 Elsevier Inc. All rights reserved.

Using remote lab networks to provide support to public secondary school education level

The advantages of networking are widely known in many areas (from business to personal ones). One particular area where networks have also proved their benefits is education. Taking the secondary school education level into account, some successful cases can be found in literature. In this paper we describe a particular remote lab network supporting physical experiments accessible to students of institutions geographically separated. The network architecture and application examples of using some of the available remote experiments are illustrated in detail.

Adaptive Game Design Study of a fully adaptive framework

Adventure! The Paladin Order foi um projecto ambicioso que começou por ser desenvolvido como um video jogo completo. Tinha como objéctivo implementar uma ferramenta diferente que permitisse tornar o jogo completamente adaptativo às decisões do jogador tanto nas interacções e no diálogo com outras personagens, assim como no combate contra os variados inímigos do jogo. Devido à inexperiência do autor uma grande parte do tempo foi passado a estudar e a pesquisar várias possíveis soluções que permitissem criar um ambiente que fosse adaptativo de uma forma simples e interessante, não só para os programadores mas também para qualquer pessoa que fosse responsável por editar o diálogo e a história do jogo. Os resultados foram bastante interessantes, revelando um sistema que depende simultaneamente dos ficheiros de onde é retirado o diálogo, e de um sistema de personalidades que permite definir qual será o comportamento de qualquer objecto do jogo ou, pelo menos, como as outras personagens irão reagir. O produto final é uma ferramenta de bases sólidas que permite uma implementação relativamente simples de um sistema abrangente e adaptativo, com poucas falhas e apenas algumas questões de simplicidade de código.

Crowdfunding

Crowdfunding, as we know it today, is a very recent activity that was born almost accidentally in the end of the 90’s decade. Due to the advent of the internet and the social networks, entrepreneurs are now able to promote their projects to a very large community. Whether it is composed by family, friends, acquaintances or simply people that are interested in the same topic or share the passion, the community is able to fund new ventures by individually investing modest amounts of money. In return, the entrepreneur can offer symbolic rewards, shares or other financial returns. New crowdfunding platforms are born almost every day all over the world, offering a new way of raising capital for their projects or a new way to invest their money in innovative ventures. Although crowdfunding is still finding its place in the financial services, successful cases such as Kickstarter demonstrate the power of the crowd in boosting creativity and productivity, financing thousands of projects by raising millions of dollars from thousands of investors. Due to regulatory restrictions, the most prominent model for now is reward-based crowdfunding, where the investors are prized with symbolic returns or privileged access to the products or services offered by the entrepreneurs. Other models such as peer-to-peer lending are also surging, allowing borrowers access to capital at a lower cost compared to so-called traditional financial institutions, and offering lenders a higher rate of return. But when it comes to offering shares to investors, i.e. using equity-based crowdfunding, entrepreneurs face regulatory obstacles in almost every country, where legislation was passed decades ago with the objective of promoting financially-capable ventures and protecting investors. Access to capital has become more difficult after the global economic recession of 2008, and for most countries it will not get easier in the near future, leaving start-ups and small enterprises with few options to start or expand their operations. In this study we attempt to answer the following research questions: how has equity-based crowdfunding evolved since its creation? Where and how has equity-based crowdfunding been implemented so far? What are the constraints and opportunities for implementing equity-crowdfunding in the world, and more particularly in Portugal? Finally, we will discuss the risks of crowdfunding and reflect on the future of this industry.

Resolução da ambivalência em terapia narrativa

Dissertação de mestrado integrado em Psicologia

Business Development Efforts and Performance Improvements in SMEs Case Study of Business Development Projects Implemented in SME

Under the circumstances of the increasing market pressure, enterprises try to improve their competitive position by development efforts, and a business development project is one tool for that. There are not many answers to the question of how the development projects launched to improve the business performance in SMEs have succeeded. Theacademic interest in the business development project success has mainly focused on projects implemented in larger organisations rather than in SMEs. The previous studies on the business success of SMEs have mainly focused on new business ventures rather than on existing SMEs. However, nowadays a large number of business development projects are undertaken in existing SMEs, where they can pose a great challenge. This study focuses on business development success in SMEs thathave already established their business. The objective of the present study is to gain a deep understanding on business development project success in the SME-context and to identify the dimensions and factors affecting the project success. Further, the aim is to clarify how the business development projects implemented in SMEs have affected their performance. The empirical evidence is based on multiple case study. This study builds a framework for a generic theory of business development success in the SME-context, based on literature from the areas ofproject and change management, entrepreneurship and small business management, as well as performance measurement, and on empirical evidence from SMES. The framework consists of five success dimensions: entrepreneurial, project preparation, change management, project management and project success. The framework provides a systematic way for analysing the business development project and its impact on the performance and on the performing company. This case evidence indicates that successful business development projects have a balanced, high performance concerning all the dimensions. Good performance in one dimension is not enoughfor the project success, but it gives a good ground for the other dimensions. The other way round, poor performance in one success dimension affects the others, leading to poor performance of the project. In the SME-context the business development project success seems to be dependent on several interrelated dimensions and factors. Success in one area leads to success in other areas, and so creates an upward success spiral. Failure in one area seems to lead to failure in other areas, creating a downward failure spiral. The study indicates that the internal business development projects have affected the SMEs' performance widely also on areas and functions not initially targeted. The implications cover all thesuccess categories: the project efficiency, the impact on the customer, the business success and the future potentiality. With successful cases, the success tends to spread out to areas and functions not mentioned as the project goals, andwith unsuccessful cases the failure seems to spread out widely to the SMEs' other functions. This study also indicates that the most important key factors for successful business development project implementation are the strength of intention, business ability, knowledge, motivation and participation of the employees, as well as adequate and well-timed training provided to the employees.

E-hankinta ja sen käyttö ja hyödyntäminen teollisuusyrityksessä

Tässä tutkimuksessa olen selvittänyt sähköisten työkalujen hyödyntämisen mandollisuuksista teollisuusyrityksessä epäsuorissa hankinnoissa. Tutkimuksessa olen paneuduttu e-hankinnan terminologiaan ja menetelmiin, joita markkinoilla on käytössä. E-hankinta on keskeisin tutkimusalue. Toimittajien etsintään ja niiden hallinnointiin keskittyvät työkalut olen rajannut pois tutkimuksestani. Tutkimuksessa olen selvittänyt e-hankinnan keskeisiä haasteita ja onnistumisen elementtejä, jotta e-hankinnan käyttöönotto olisi mandollisimman helposti tehtävissä. Lukuisten esimerkkien avulla pyrin kartoittamaan e-hankinnan levinneisyyttä ja lisäksi tuon esille niitä potentiaalisia säästökohteita ja kustannusten leikkauksia, joita on mandollista toteuttaa ottamalla käyttöön sähköisen hankintamallin. Tutkimuksen loppuosassa keskityn tutkimaan Perloksen hankintavolyymeja ja löytämään sieltä ne hankintakategoriat, joille tämä sähköinen hankintamalli olisi mandollista ottaa käyttöön. Tässä tutkimuksessa tulen esittämään sähköisen hankintamallin käyttöönottoa ja samalla merkittävän kehityshankkeen toteuttamista lähitulevaisuudessa. Lopullisen päätöksen sähköisen hankintamallin käyttöönotosta ja projektin toteuttamisesta tekee yrityksen johto. Yrityksen johdolle sitten lopulta jää punnittavaksi, kuinka strategisena ja ajankohtaan nähden sopivana tämän tyyppisen kehitysprojektin toteuttaminen nähdään.

The underestimated role of universities for the Brazilian system of innovation

Conventional wisdom usually underestimates the important role of public research institutes and universities in successful cases of Brazilian economy. History of science and technology institutions shows a long-term process of formation of these institutions and their interactions with industrial firms, agricultural producers or society. This paper investigates historical roots of successful cases of Brazil. First, we present the late onset of National Innovation System (NSI) institutions and waves of institutional formation in Brazil. Second, we describe the history of three selected successful cases, which spans from a low-tech sector (agriculture), a medium-tech sector (steel and special metal alloys), to a high-tech sector (aircraft). These findings present new challenges for present-day developmental policies.

Reimplantes de punta de dedo. Fundación Santafé de Bogotá 2003 – 2011. Serie de Casos

Introducción: El objetivo de este trabajo es caracterizar los pacientes con amputaciones de punta de dedo en zonas I & II de Ishikawa & Tamai y describir los casos exitosos y de fallas en estos niveles tan distales de reimplantación. Materiales y Métodos: serie de casos retrospectiva de reimplantes de punta de dedo. Se registraron variables pre, intra y postoperatorias y de seguimiento. Resultados preliminares: 8 casos fueron reimplantes en las zonas I y II. Tiempo promedio de isquemia: 5,1 hs, promedio de edad 39,5. Se reimplantaron: 2 pulgares, 2 índices, 2 medios y 2 anulares, 6 dedos del lado derecho y 2 dedos del lado izquierdo. 5 reimplantes en zona II y 3 en zona I. El mecanismo de trauma más frecuente fue avulsión, seguido de aplastamiento. En todos los casos se logro hacer una anastomosis arterial. En cinco pacientes no se logro hacer una anastomosis venosa. No se observó estandarización el esquema antitrombótico ni en la estrategia para manejar la congestión venosa. Cinco reimplantes fueron exitosos. Todos los pacientes durante el primer año fueron tratados con fisioterapia. A pesar de que los pacientes reportan perdida de la movilidad comparativa con el dedo contralateral, ninguno reportó molestias a causa de este déficit o alteraciones en la sensibilidad que impactaran negativamente su calidad de vida. Discusión: se requieren estudios prospectivos para evaluar los resultados objetivamente y estandarizar el protocolo de reimplantes en la FSFB.

Competitividade no agronegócio: proposta de modelo para elaboração de estratégia de integração de cadeias para os defensivos agrícolas – o caso do café

A produção sustentável de alimentos é fundamental para suportar o crescimento populacional. Segundo estimativa da FAO, se a população atingir 9,1 bilhões de habitantes em 2050, a produção de alimentos deverá crescer 70%, e a produção nos países em desenvolvimento deverá dobrar. Ou seja, a maior parte do crescimento vem de países emergentes, onde se concentra o maior potencial de crescimento agrícola. Com o aumento populacional e o aumento da renda da população destes países emergentes, há aumento na demanda por produtos de melhor qualidade, fazendo com que o crescimento na produção de alimentos seja não somente de quantidade, mas também, de qualidade e valor. Portanto, a maior a exigência em termos de segurança do alimento, faz com que rastreabilidade e transparência com relação ao uso de tecnologias de produção se transformem em fatores que influenciam a aceitação de alimentos por parte dos consumidores do mercado doméstico e também de mercados internacionais. Neste contexto, o varejo ganha importância estratégica pela proximidade do seu negócio com o consumidor final. Ele é o primeiro elo da cadeia a receber informações sobre o cliente em termos de comportamento de compra e demandas, podendo assim, repassá-las aos outros elos da cadeia chegando até os produtores, que tem que ajustar suas práticas em geral, e principalmente, as práticas agronômicas, no que diz respeito à qualidade e a segurança do alimento. As empresas de insumos e as agroindústrias, que contribuem para uma produção agrícola sustentável terão a preferência dos produtores rurais e varejistas, que tem a missão de entregar produtos de qualidade, seguros, de forma conveniente para o consumidor final que é o elo capaz de movimentar a cadeia em uma única direção - a da agricultura sustentável. É neste contexto que as empresas de defensivos agrícolas devem desenvolver suas estratégias de negócio. Torna-se necessário ter maior “controle” sobre a cadeia, visando o uso correto de seus produtos, visando contribuir para a agricultura sustentável, ganhando participação de mercado e/ou aumentando sua rentabilidade. Para isso, algumas empresas têm desenvolvido estratégias de coordenação de cadeias, ou “food value chain”, com alguns casos exitosos. Neste trabalho, é proposta metodologia para o desenvolvimento e implementação de estratégias de “food value chain” para os defensivos agrícolas. Ao final do trabalho, conclui-se que existem ganhos importantes para a empresa que adota este tipo de estratégia; entretanto, há um aumento na complexidade da operação. Por isso, é uma escolha importante, que deve ser parte da missão da empresa.

Evaluation of the adequacy of diflubenzuron and dechlorane in toxic baits for leaf-cutting ants (Hymenoptera : Formicidae) based on formicidal activity

Studies assessing the characteristics of active ingredients (AIs) of toxic baits for leaf-cutting ants are still scarce, although the need for a delayed action of these compounds on adult workers has been well accepted (mortality <= 15% at 24 h and <= 90% at 21 days). Therefore, we determined the insecticidal action of two AIs used in commercial baits, diflubenzuron and dechlorane, over time in workers, and discussed the control of colonies in relation to the existing literature. Dechlorane presented excellent insecticidal activity with a delayed action at all concentrations tested, although its commercial use has been prohibited due to its organochlorine nature. In contrast, diflubenzuron did not cause significant mortality or symptoms of intoxication, indicating that the successful cases reported with the use of baits containing this AI were in fact due to an accidental contamination with dechlorane. We comment about the ineffectiveness of diflubenzuron on alternative targets, i.e., young forms and the mutualistic fungus, supporting the concept that the AI needs to a have a delayed action on adult workers.

Using remote lab networks to provide support to public secondary school education level

The advantages of networking are widely known in many areas (from business to personal ones). One particular area where networks have also proved their benefits is education. Taking the secondary school education level into account, some successful cases can be found in literature. In this paper we describe a particular remote lab network supporting physical experiments accessible to students of institutions geographically separated. The network architecture and application examples of using some of the available remote experiments are illustrated in detail. ©2008 IEEE.

Tourism for whom?: Different paths to development and alternative experiments in Brazil

The tourism policies pursued by the Brazilian government since the 1990s have not produced the benefits that were expected from mass tourism. The example of two very successful cases of community-based tourism, stressing paths rooted in a development model that is fair and environmentally responsible, shows that tourism development can improve the quality of life in communities that receive an influx of tourists provided that the local community is taken into account and the planning and implementation of such development focus on creating opportunities and benefits for its members. © 2008 Latin American Perpectives.