“YOU TAKE CARE OF THE BABY’S CLOTHES AND I TAKE CARE OF THE DELIVERY” – COMMUNICATION BETWEEN PROFESSIONALS AND PATIENTS AND DECISIONS ABOUT THE MODE OF DELIVERY IN THE PRIVATE SECTOR IN SÃO PAULO, BRAZIL

High rates of cesarean sections and invasive interventions in labor and delivery, disregarding recommendations on safety and quality of healthcare characterize childbirth care in the Brazilian private sector. We aimed to understand how professionals and patients communicate about risks and benefits of the interventions and take decisions in the Internet era. We interviewed 28 professionals and female users of the private health sector in São Paulo, including those we will call “typical” and “atypical” of the national scenario. The communication about procedures among “typical” patients was scarce, biased or actively blocked, tending to strengthen a behaved attitude. “Atypical” patients sought further information from professionals and peer groups and used more Internet resources (discussion lists, evidence websites and narrative banks). The availability of such information allows more women to seek a care aligned to their values and notions of rights, frequently confronting the medical authority, creating needs to be (or not to be) satisfied

Molecular Sieve Silica (MSS) Membranes for Gas Separation and Reaction Processes

Weakly branched silica films formed by the two-step sol-gel process allow for the formation of high selectivity membranes for gas separation. 29Si NMR and gas permeation showed that reduced crosslinking leads to He/CH4 selectivity improvement from 300 to 1000. Applied in membrane reactor for cyclohexane conversion to benzene, conversions were achieved at 14 fold higher than a conventional reactor at 250°C. Hydrothermal stability studies showed that carbon templating of silica is required for hydrothermally stable membranes. From our work it was shown that with correct application of chemistry, practical membrane systems can be built to suit gas separation (e. g. hydrogen fuel) and reactor systems

A diversidade cultural no ambiente organizacional: a estratégia e as práticas de integração utilizadas pelas multinacionais

O movimento global dos mercados acarretou no surgimento de um novo problema no mundo corporativo: a diversidade cultural. Embora tal questão seja aparentemente de fácil resolução, grandes empresas de diversos países encontram inúmeros obstáculos culturais ao implantar filiais além das fronteiras de seu país de origem ou ao contratar funcionários de nacionalidades distintas. O presente estudo visa esclarecer os problemas inerentes à diversidade cultural no ambiente organizacional, além de sugerir alternativas à barreira cultural e à necessidade de adequação cultural. Para tal, artifícios como teorias, exemplos de casos reais de empresas que enfrentaram tal processo e os estudos realizados por Hofstede serão utilizados. Objetiva-se sugerir um novo olhar epistemológico sobre esse fenômeno e propor técnicas de integração de pessoas e culturas. Pode-se dizer que se pretende propor maneiras de empregar a diversidade cultural para benefício próprio das organizações

Enhanced Ethanol Dehydration with Hydrostable Inorganic Pervaporation Membranes

Membranes which allow water diffusion in favour of other substances can offer increased efficiency in processes to dehydrate ethanol. Silica membranes can perform this selective diffusion, but have mostly been reported for their gas high gas separating ability. This work investigates the effectiveness of carbonised template molecular sieve (CTMSS) membrane to dehydrate ethanol/water mixtures. The silica derived top layer of the membrane was measured at 20nm thickness by XPS sputtering technique. However, the silica enters the porous structure of -alumina layer in excess of 90nm. After 200 minutes of operation, H2O/EtOH selectivity increased to 5.6 from around 1 due to gradual pore filling by adsorbed water and ethanol which contributed to inhibiting ethanol transport. The smaller water molecules were thus favoured in transporting to the permeate side. Total mass flux using a 10% ethanol feed remained constant at around 1.5 kg.m-2.hr-1. Selectivity of up to 9.5 was achieved when azeotropic feed solutions of 95% were used, displaying the potential for this technology for a wide range of ethanol dehydration applications. Pressurising the feed up to 400 kPa doubled the permeate flux, but enhanced the transport of ethanol over water

A Sinergia entre a Sustentabilidade e a Produção Eficiente pela Aplicação do Lean-Green

É notável como problemas ambientais tem levado a uma consciencialização da população e à consequente tomada de medidas legais por parte do Poder Político. A indústria tem vindo a adotar métodos de produção ambientalmente mais responsáveis, sendo que, inicialmente estas alterações foram uma consequência de imposições legais. Todavia, o emprego de práticas ecológicas tem-se mostrado ser vantajoso para as empresas em termos económicos, seja através da economia em recursos ou por permitir alcançar vantagens competitivas perante os concorrentes. A elaboração desta dissertação priorizou a visão voltada para a necessidade de compreender e incluir os princípios e os objetivos da sustentabilidade na produção industrial. Para isso, foram exploradas as temáticas do desenvolvimento sustentável, economia circular, Green Production, Lean Manufacturing e as suas ferramentas, bem como a legislação ambiental em Portugal e no Brasil e os acordos mundiais referentes ao ambiente dos quais são signatários. No desenvolvimento do trabalho de investigação verificou-se que há uma grande variedade de ferramentas voltadas para a sustentabilidade. A mais atrativa demonstrou ser o Lean-Green, porque se trata da junção da Lean Manufacturing com a Green Production, sendo uma metodologia que agrega práticas ecológicas. Ela tem demonstrado ser uma excelente alternativa para congregar sustentabilidade à produção eficiente, visto que ambas as filosofias têm como objetivo primordial a eliminação de resíduos. Verificou-se através da pesquisa bibliográfica que estas filosofias realmente demonstram ser sinérgicas. O uso de ferramentas Lean possibilita uma melhor implementação e resultados Green, bem como o Green potencia a redução de resíduos Lean, assim, a aplicação conjunta destas filosofias proporciona melhores resultados tanto por parte do Lean como do Green. Contudo, também são relatados possíveis trade-offs existentes. Mesmo assim, as vantagens da aplicação conjunta superam as da implementação individual.It is remarkable how environmental matters have led to the population awareness and the consequent taking of legal actions by the Political Power. The industry has adopted more environmentally responsible production methods, and initially these changes were a consequence of legal requirements. However, the use of green practices has been shown to be advantageous for companies in economic terms, either through savings in resources or by allowing competitive advantages to be achieved towards competitors. The writing of this essay aimed to prioritize the view focused on the need to understand and include the principles and aims of sustainability in industrial production. In order to get this, the topics of sustainable development, circular economy, Green Production, Lean Manufacturing and its tools, as well as environmental law in Portugal and in Brazil and the global agreements concerning to the environment of which they are signatories. In the development of the research work it was verified that there is a great variety of tools aimed at sustainability. Lean-Green proved to be the most attractive because it is the combination of Lean Manufacturing and Green Production, a methodology that aggregates ecological practices. It has proved to be an excellent alternative to gather sustainability to an effective production, since both philosophies aim the waste disposal firstly. It has been proven, through a bibliographical research, that these philosophies are actually synergistic. The use of Lean tools enables better implementation and Green results, as well as Green enhances the Lean waste reduction, thus the joint application of these philosophies provides better results for both Lean and Green. However, it is also reported there are trade-offs. Even so, the advantages of joint application overtake those of individual implementation

Desempenho hidrodinamico de proteses valvares aorticas porcinas e de pericardio bovino sem anel de suporte : estudo em duplicador de pulso

Orientador: Gregorio BussyguinTese(doutorado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: O objetivo do presente trabalho foi o de avaliar, comparativamente, o desempenho hidrodinâmico "in vitro" de próteses aórticas porcinas e de pericárdio bovino sem anel de suporte. Para tanto, utilizamos um duplicador de pulso desenvolvido na Universidade Federal do Paraná, modificado especificamente para a análise de próteses sem suporte. Foram estudados três tipos de prótese: Prótese porcina sem suporte (PSS), Prótese de pericárdio bovino sem suporte (PBSS) e Prótese de pericárdio bovino com suporte (PBCS). Este último tipo já foi extensamente estudado por outros investigadores, e foi incluído neste trabalho como um referencial, a partir do qual, comparações com os resultados de outros investigadores fossem mais fundamentadas. As próteses foram estudadas em seus diâmetros nominais 19, 21 e 23 mm. Esses diâmetros foram escolhidos por serem os tamanhos nos quais o desempenho hidrodinâmico das próteses se torna crítico. Para cada tipo de prótese, foram estudados 3 exemplares em cada diâmetro, perfazendo 9 exemplares testados de cada tipo. Cada prótese foi testada com débitos cardíacos que variaram entre 3 a 9 l/min, através da combinação de volumes sistólicos de 45, 65 e 75 ml e freqüências cardíacas de 80, 100 e 120 bpm, aproximadamente. A resistência periférica e complacência arterial foram mantidas constantes, assim como a pressão atrial foi fixada em 15 mmHg. O desempenho hidrodinâmico foi avaliado pelas áreas efetivas de fluxo de pico e média (AEFp, AEFm), coeficiente de descarga (Cd), índice de desempenho (ID) e índice de eficiência (EE). Foram também calculadas as perdas percentuais de energia sistólica (%AEs), por refluxo de fechamento (%AEr) e totais (%AEt). Durante a realização dos ensaios, todas as próteses foram filmadas por suas faces aórtica e ventricular, possibilitando a análise visual de seu mecanismo de abertura e fechamento. As PBSS tiveram o melhor desempenho hidrodinâmico quanto às AEF, ID e IE. Por estes parâmetros, as PSS e PBCS tiveram desempenho similares nos diâmetros 21 e 23 mm. No diâmetro 19 mm, as PSS tiveram desempenho superior às PBCS. As AEF das PBCS foram constantes em todas as condições de ensaios, enquanto que as PSS e PBSS apresentaram aumento de suas AEF em resposta à incrementos no débito cardíaco. As PBCS tiveram o melhor Cd entre os três tipos de prótese, seguidos das PBSS e PSS. Analisadas quanto às perdas percentuais totais de energia, as PBSS e PSS tiveram desempenho similares. Embora as PBSS tenham apresentado %AEs menores, suas %AEr foram maiores, pois estão associadas a maiores refluxos de fechamento. As perdas percentuais totais de energia das PBCS foram maiores que as dos outros dois tipos de prótese. A observação visual do mecanismo de abertura e fechamento das próteses revelou que, nos três tipos estudados, as cúspides tendem a abrir simultâneamente. Entretanto, em algumas PBCS e PBSS, verificou-se, ocasionalmente, abertura e fechamento seqüencial das mesmas quando analisadas quadro a quadro nas filmagens. Esse mecanismo foi imperceptível à inspeção visual habitual. Já nas PSS a abertura e fechamento de suas cúspides foi sempre simultâneo, mesmo quando analisadas quadro a quadro. As PBSS e PBCS apresentaram amplo orifício circular de abertura ao nível de suas margens livres. Nas PSS, as três cúspides abriram de forma regular sem a formação de dobraduras, descritas nas próteses com suporte. A sua cúspide coronariana direita pode apresentar menor abertura que as demais. As próteses sem suporte tiveram desempenho hidrodinâmico "in vitro" superior ao das próteses com suporte, e apresentaram características que, teoricamente, podem aumentar sua durabilidade.Abstract: The purpose of this study was to evaluate, comparatively, the "in vitro" hydrodynamic performance of stentless porcine and pericardial prostheses for replacement of the aortic valve. We used a pulse duplicator developed at the Federal University of Parana and specially adapted for the study of stentless prostheses. Three types of prostheses were studied: stentless porcine (SPV), stentless pericardial (SPP) and stented pericardial prosthesis (PP). The latter was extensively investigated in the past and served as a reference to our results. The prostheses were studied in their 19, 21 and 23 mm nominal diameters because it is in these diameters where their hydrodynamic performance may become critical. For each prosthesis type, three specimens were studied in each diameter, so that the total number was 9, for each type. Each prosthesis was tested with cardiac outputs varying from 3 to 9 1/m, obtained by the combination of systolic volumes of 45, 65 and 75 ml and heart rates of approximately 80, 100 and 120 beats per minute. Peripheral resistance and arterial compliance were kept constant as well as the atrial pressure which was fixed at 15 mmHg. Hydrodynamic performance was evaluated by the peak and mean effective orifice areas (EOAp, EOAm), discharge coefficient (Cd), performance index (PI) and efficiency index (EI). Percentual systolic energy loss (%AEs), percentual closing reflux energy loss (%AEr), and percentual total energy loss (%AEt) were also calculated. During the essays, the prostheses were filmed viewing their ventricular and aortic faces so that their opening and closing mechanism could be analysed. The SPP prostheses had the better hydrodynamic performance as judged by the EOA, PI and EI. By these parameters, the 21 and 23 mm SPV and PP had similar performances. The 19 mm SPV performed better than the 19 mm PP. The EOA of the PP tended to be constant during all essays, whereas the SPP and SPV showed an increase in their EOA in response to flow increments. The PP had the better Cd among the three types, followed by the SPP and SPV. Judged by the percentual total energy loss, the SPP and SPV had similar performances. Although the SPP displayed lower %AEs, their %AEr were higher because they had greater closing reflux. The percentual total energy loss of the PP were higher than that of the other types. Visual observation of the opening and closing mechanism of the prostheses showed that, in all types, their cusps tended to open simultaneously. However in some SPP and PP a sequential opening and closing mechanism was evident when viewed in frame to frame images. This mechanism was imperceptible at the usual visual observation. In the SPV, their cusps always opened simultaneously, even when viewed in frame to frame images. The PP and SPP had an ample circular orifice at their free margins. In the SPV the three cusps opened regularly without forming the kinks described for the stented porcine prostheses. The right coronary cusp may present a more limited excursion than the other two. Stentless prostheses had superior "in vitro" hydrodynamic performance than the stented ones, and have characteristics that may improve their long term durability

Values and their relationship to pro-environmental engagement: A comprehensive and systematic investigation

Environmental problems are a result of maladaptive human behaviour. One way to tackle these problems is by fostering values that underlie pro-environmental engagement. Research has shown that self-transcendence values (e.g., social justice, equality, and world at peace) are positively correlated to environmental attitudes and behaviours. The present research aims to advance past research by systematically assessing the role of values in motivating individuals’ pro-environmental engagement. Three empirical studies were conducted. Study 1 used a meta-analytical approach to provide a quantitative summary of research on the link between values and environmental outcomes. The final dataset included 47,660 participants from 41 countries and 90 independent samples. Results showed that the self-transcendence versus self-enhancement values dimension is the most often considered in the literature and, as expected, self-transcendence values are the best predictors of environmental outcomes. The analysis also showed that methodological aspects, such as the type of values measured, affected the association between values and environmental outcomes. Study 2 comprised two experiments using the value self-confrontation technique to promote value change and influence individuals’ environmental behavioural intentions. Experiment 1 was conducted with 189 university students (M = 20.00, SD = 3.43). Results from Experiment 1 showed that values were susceptible to change and that value change predicted environmental behavioural intentions. Experiment 2 was conducted with a sample of 115 participants from the general population (M = 35.00, SD = 4.61) and partially replicated the findings of Experiment 1. Importantly, Experiment 2 found that value change was dependent on how strongly individuals felt connected to the reference group. Study 3 tested the moderation effect of moral identity, self-efficacy, self-control and consideration of future consequences in the link between values and environmental behavioural intentions. A total of 221 participants (M = 21.68; SD = 5.92) took part in an online survey. Results indicated that only moral identity moderated the relationship between values and environmental behavioural intentions. It was found that moral identity enhanced the positive influence of self-transcendence values on environmental behavioural intentions. Findings are discussed considering the key role of self-transcendence values in fostering environmental behavioural intentions and the importance of identity in the values-environmental behavioural intentions link. Practical implications of the findings are also discussed. Note: This thesis was a finalist for the Outstanding Postgraduate Research Award

Desempenho hidrodinâmico de próteses de pericárdio bovino : análise em sistema de fluxo contínuo

Orientador: Gregório BussyguinDissertaçao (mestrado) - Universidade Federal do Páraná, Setor de Ciêniciasda Saúde, Programa de Pós graduação em Clínica CirúrgicaResumo: O presente estudo visou a analisar a influência do tratamento químico , espessura dos pericárdios e métodos de montagem, no desempenho hidrodiriâniico de próteses de pericárdio bovino,, Para isso, utilizou-se um sistema de f 1 u >; o c o n t í n u o desenvolvido na Universidade Federal do Paraná. O tratamento químico consistiu em fixar os pericárdios inicialmente com solução de GA 0.1% por dois dias, GA 0.2% por dois dias e GA 0.5% por mais três dias, sendo então estocados em solução de FA 4%. No tratamento químico 2, os pericárdios foram fixados diretamente em solução de GA 0., 5% por três dias, passando após para solução de FA 4%. Em relação as espessuras, os pericárdios foram arbitrarianiente divididos em finos (até 0,25mm), ''normais" (+ 0,30mm) e espessos (igual ou superior a 0,35mm}" 0 método de montagem sem pressão, utiliouperirdios frescos , não sendo necessárias qualquer tipo de pressão para a moldagem das cúspides" No método com pressão, as cúspides foram moldadas em sua posição definitiva com auxílio demodes de acrílico " Mantendo se duas variáveis constantes, e variando apenas uma, foram constituídos três grupo s de estudo. No Estudo 1 avaliou-se a influência do tratamento químico , no Estudo 2 a espessura dos pericárdios e no Estudo 3 o método de montagem. Nos três estudos não houve diferenças estatisticamente significativas (p< 0,05) quanto 3. Q S Ap observados, A E A , Cd e ID calculados,, . No Estudo 2, verificou-se que pericárdios finos são mais propensos a vibrar sob condições de fluxo alto. No Estudo 3, verificou-se que as próteses montadas com pressão não apresentaram vibração de suas cúspides;, ao contrário das; próteses montadas sem pressão,. Entretanto, os pericárdios das próteses montadas ompressão apresentaram 3 e são histológica provocada pelos moldes, enquanto no outro grupo a histologia foi normal. Concluiu 50 que os três parâmetros estuda dos não influíram no desempenho hidrodinâmica das próteses quando analisadas em sistema de fluxo continuo, Entretanto, d comportamento das cúspides foi alterado por essas variáveis, o que p o d e determinar diferenças em suas durabilidades. Achamos fundamental prosseguir esses estudos, para se obter perfeita compreensão do funcionamento dessas prótesesDurante a realização dos ensaios, julgou--se adequado a inclusão de um quarto grupo de estudo, que consistiu de próteses montadas; sem pressão, porém, com algumas modificações técnicas. Observou-se que estas próteses não apresentaram vibração de suas cúspides.Abstract: The aim of this study was to analise the influence of chemical treatment, pericardia thickness and mounting technique upon the hidrodynamic performance of bovine pericardium bioprostheses. For this ur pose a steady flow system, deveIope da the universidade Federal do Paraná" was used. For chemical treatment, the pericardia were inicially tanned with GA 0,1% for two days GA 02% for two days and a further three days in GA 0,5% Afterwards they were stored in FA 4% solution In chemical treatment the pericardia were tanned directly in GA 0.5% for three days and afterwards stored in FA 4%" 7he pericardia were arbitrari y divided into fine (up to 0,25mm), "normal" (± 0,30mm) and thick (equal or greater than 0,35mm). For the mounting tochnicue without pressure, fresh pericardia were used and not subjected to any type of pressure in the moulding of the cusps. For the mounting technique with prassure, cusps were moulded in their actual position u sing acriIicmou 1 ds Three study groups were formed by varying one parameter while the cither two remained constant In study, influence of chemical treatment was assessed, in study 2 the thickness of the pericardia and in study 3 the mounting tech.ni que" From the three study groups no statistically significant differences (p < 0,05) were found in Ap or in the calculated EDA, Cd and PI ' Study 2 verified that thin pericardi a are more prone to flutter under high flow conditions" Study 3 demonstrated that prostheses mounted without pressure -fluttered while all those mounted with pressure did not. However, histological e sions were noted in the prost he se s mount edwith pressure? as opposed to the normal structure seen in the other group. During the tests it was considered approppriate to include a fourth study group consisting of prostheses mounted without pressure but with some technical modifications. These prostheses did not flutter It is concluded that the three parameters assessed did not influence the hidrodyna i. c per f or mance of the prostheses, when observed in tIne steady f 1 ow system" However, the behaviour of the cusps is affected by those variables and this can dstermins differences in long term durability of the prostheses" For these reasons, further studies; including pulse dup cat orevau at Lonand fatiguetests , are warranted to achieve further progress in this field