O Valor dos Indices Plaquetários na Púrpura Trombocitopénica Imune e Leucémia Linfo e Mieloblástica Aguda. Bases Clínico-Laboratoriais no Contributo para o Diagnóstico Diferencial Entre Estas Duas Patologias

Os autores apresentam um trabalho onde se pretende avaliar a utilidade dos índices plaquetários — volume plaquetário médio (VPM) e o coeficiente de variação do diâmetro plaquetário (CVDP ou PDW = Platelet Distribution Width) — e do número de plaquetas (PLAQ) no diagnóstico diferencial da trombocitopénia na púrpura trombocitopénica aguda (PTI) e na leucémia linfoblástica ou mieloblástica aguda (LLAULMA). Do mesmo modo, estudam comparativamente os dados clínicos e laboratoriais nestes dois grupos de doentes. Caracterizam 59 casos de doentes em idade pediátrica com PTI e 19 casos com LLA/LMA, seguidos na Unidade de Hematologia Infantil do Hospital de Dona Estefânia. Concluem não existir diferenças significativas entre as variáveis VPM e PDW entre os dois grupos de doentes. Com base nas três variáveis (VPM, PDW, PLAQ) foi construída uma regra de discriminação que fornece uma boa separação entre os grupos. Da caracterização clínico-laboratorial ressaltaram diferenças significativas entre as duas entidades nosológicas, o que permitiria prescindir a realização do mielograma para exclusão do diagnóstico de LLA/LMA numa criança com trombocitopénia significativa isolada

O balanced scorecard aplicado à administração pública

A modernização da Administração Pública e a melhoria dos índices de eficiência, eficácia e economia são objectivos que se têm colocado à generalidade dos países desenvolvidos nos últimos anos. Com as iniciativas introduzidas pela New Public Management, defende-se a adopção de mecanismos de mercado no sector público, maior transparência das contas públicas, maior responsabilização, maior qualidade nos serviços prestados, com uma gestão de recursos mais eficiente (value for money). A implementação deste novo modelo de gestão pública exige uma mudança nos sistemas de informação contabilística existentes que devem priveligiar a informação estratégica, fundamental ao processo de tomada de decisão. Assim, com a modernização da gestão pública, assiste-se à necessidade de um sistema de informação que integre, para além da contabilidade orçamental e financeira, a contabilidade de gestão. O Balanced Scorecard, apesar de inicialmente ter sido desenvolvido para avaliar o desempenho de organizações com fins lucrativos, revelou-se um instrumento dinâmico e flexível, com utilidade para as organizações onde o lucro não constitui o principal objectivo. A sua aplicação ao sector público começa a ser significativa, essencialmente no contexto internacional, onde a implementação e a comunicação da estratégia, em todos os níveis organizacionais, se revela fudamental. A aplicabilidade do Balanced Scorecard às organizações públicas é defendida por vários autores, desde que a sua implementação se adapte à realidade concreta de cada instituição, sendo necessário, por vezes, alterar o modelo original de Kaplan e Norton. Dada a importância e a utilidade do Balanced Scorecard para o sector público, este livro revela-se pertinente e actual, tendo como objectivos colmatar a falta de literatura existente sobre a aplicabilidade do Balanced Scorecard na Administração Pública e, por outro lado, proporcionar um instrumento de trabalho útil para os profissionais que desejam implementar o Balanced Scorecard, ou um modelo com caracteríticas semelhantes, na gestão da sua organização. Deste modo, o livro apresentado revela-se útil quer para profissionais quer para académicos que têm interesse no estudo da Administração Pública. Face aos objectivos propostos, este livro apresenta-se estruturado em seis capítulos. Num primeiro capítulo é feita a abordagem acerca dos princípios e das características do modelo da New Public Management e das reformas que têm sido introduzidas em Portugal. O segundo capítulo introduz a necessidade de um novo sistema de informação contabilística para as organizações públicas, face à mudança nas características, objectivos e utilizadores da contabilidade pública; é ainda analisada a reforma do sistema de contabilidade pública em Portugal. Segue-se o terceiro capítulo onde se analisa a importância e a justificação da contabilidade gestão no sector público, bem como as novas técnicas e práticas contabilísticas que têm sido implementadas nas organizações públicas. No quarto capítulo é feito o enquadramento teórico do Balanced Scorecard, desde a caracterização do modelo original desenvolvido por Kaplan e Norton, as perspectivas de desempenho utilizadas, a importância da definição das relações de causa-efeito e as dificuldades no desenvolvimento deste modelo. O quinto capítulo aborda a aplicabilidade do Balanced Scorecard à realidade da Administração Pública, as alterações ao modelo original, as dificuldades na definição da estratégia, bem como a metodologia a seguir na implementação do modelo. Por último, no sexto capítulo são apresentados alguns exemplos de organizações públicas onde o Balanced Scorecard está a ser utilizado como instrumento de gestão estratégica; os casos apresentados abordam diferentes tipos de organizações, como organizações policiais, hospitais, municípios e instituições de ensino superior

Long-Term Survival (>25 Years) of Deceased Donor Kidney Transplant Recipients: a Single-Center Experience

INTRODUCTION: The aim of this preliminary work is to analyze the clinical features of 52 patients with a functional transplanted kidney for >25 years (all first transplant and all deceased donor recipients) and to compare with a similar though more complete study from Hôpital Necker-Paris 2012. METHODS: The mean graft survival at 25 years is 12.7% and at 30 years is 10%. The actual mean serum creatinine concentration is 1.3 mg/L. We analyzed recipient age (mean, 35.9 years) and gender (29 men and 23 women). Donor age was 26.7 ± 10.3 years. Seven patients (13.4%) were transplanted with 1 HLA mismatch, 42.3% with 2 mismatches, and 44.2% with 3 mismatches. Mean cold ischemia time was 15.45 ± 7.7 hours. Of the recipients, 76% had immediate graft function; 38% experienced 1 acute rejection episode and 4 patients had 2 rejection crises. The initial immunosuppressive regimen was azathioprine (AZA) + prednisolone (Pred) in 14 patients, cyclosporin (CSA) + Pred in 13 patients, and CSA + AZA + Pred in 25 patients. Of these patients, 19% maintained their initial regimen, and 54% (28 patients) were very stable on a mixed CSA regimen for >25 years. RESULTS: We present the major complications (diabetes, neoplasia, and hepatitis C virus positivity). CONCLUSION: Our results in deceased donor kidney recipients for >25 years are similar to the mixed population (deceased donors and living donors) presented by the Necker group, although 54% of our patients remain on CSA immunosuppression, contradicting the idea that its use is not compatible with good long-term kidney function in transplant recipients

Partial safety factors for prestressed concrete girders 2 strengthened with CFRP laminates

This paper provides a framework for the calibration of partial safety factors in prestressed concrete (PC) girders strengthened in flexure with carbon fiber-reinforced polymer (CFRP) laminates. A hybrid approach was proposed to take advantage of comprehensive nonlinear numerical models in reliability analysis using a first-order reliability method (FORM) in conjunction with the response surface method (RSM). The PC girders selected for analyses were taken from real structures designed and built in the 1980s based on old standards that now require strengthening and upgrade due to partial corrosion of the prestressing strands. Using the proposed approach, a sensitivity analysis was performed to identify the most relevant variables and assess the area of CFRP laminates needed to restore capacity up to new design standards. A partial safety factor was proposed for strengthening PC girders using CFRP laminates. Sensitivity analysis showed that traffic loads and model uncertainties are the most important variables for calibration. (C) 2019 American Society of Civil Engineers.Portuguese Science and Technology Foundation (FCT)Portuguese Foundation for Science and Technology [SFRH/BD/76345/2011]Australian Research CouncilAustralian Research Council [DE150101703, LP140100591]FCT, within Institute for Sustainability and Innovation in Structural Engineering (ISISE) [UID/ECI/04029/2013]info:eu-repo/semantics/publishedVersio

Partial safety factors for prestressed concrete girders strengthened with CFRP laminates

This paper provides a framework for the calibration of partial safety factors in prestressed concrete (PC) girders strengthened in flexure with carbon fibre-reinforced polymer (CFRP) laminates. A hybrid approach was proposed to take advantage of comprehensive non-linear numerical models in reliability analysis using a first order reliability method (FORM) in conjunction to the response surface method (RSM). The PC girders selected for analyses were taken from real structures designed and built since the 1980s, based on old standards, now requiring strengthening and upgrade due to partial corrosion of prestressing strands. Using the proposed approach, a sensitivity analysis was performed to identify the most relevant variables and assess the area of CFRP laminates needed to restore the capacity to new design standards. Following this study, a partial safety factor was proposed for strengthening PC girders using CFRP laminates. A sensitivity analysis also showed the traffic loads and model uncertainties to be the most important variables for calibration

Evaluation in Health: Reflections Inscribed in the Paradigm of Contemporary Health

Objectives: To analyze the methods of health evaluation from the point of view of users\u27 needs and the care perspective

Feedlot pen surface greenhouse gases emissions from Nellore or Brangus bulls finished on diets with contrating fat levels.

The objective of this study was to evaluate greenhouse gases (GHG) emissions from a feedlot pen surface where Nellore and Brangus bulls were fed diets with low or high fat

Genomic structure, promoter activity, and developmental expression of the mouse homologue of the Machado–Joseph disease (MJD) gene

Machado–Joseph disease (MJD) is a neurodegenerative disorder, caused by the expansion of the (CAG)n tract in the MJD gene. This encodes the protein ataxin-3, of unknown function. The mouse Mjd gene has a structure similar to that of its human counterpart and it also contains a TATA-less promoter. Its 5V flanking region contains conserved putative binding regions for transcription factors Sp1, USF, Arnt, Max, E47, and MyoD. Upon differentiation of P19 cells, the Mjd gene promoter is preferentially activated in endodermal and mesodermal derivatives, including cardiac and skeletal myocytes; and less so in neuronal precursors. Mouse ataxin-3 is ubiquitously expressed during embryonic development and in the adult, with strong expression in regions of the CNS affected in MJD. It is particularly abundant in all types of muscle and in ciliated epithelial cells, suggesting that it may be associated with the cytoskeleton and may have an important function in cell structure and/or motility.Fundação Luso-Americana para o Desenvolvimento - (Proc. 3.L./A.II/P.582/99Fundação para a Ciência e a Tecnologia (FCT) - (Project POCTI/MGI 33759/99), BD/9759/ 2003).Fundo Social Europeu (FSE) - Fundo Europeu de Desenvolvimento Regional (FEDER)

Novel insights into biomass delignification with acidic deep eutectic solvents: a mechanistic study of β-O-4 ether bond cleavage and the role of the halide counterion in the catalytic performance

The development of innovative technologies for an efficient, yet eco-friendly, biomass delignification is required to achieve higher sustainability than traditional processes. In this context, the use of deep eutectic solvents (DES) for the delignification process could fulfil these requirements and stands today as a promising alternative. This work focus on understanding the fundamental chemistry behind the cleavage of B-O-4 ether bond present in 2-phenoxy-1-phenylethanol (PPE), a lignin model compound, with three acidic DES, including Propionic acid/Urea (PA:U), Lactic acid/Choline Chloride (LA:ChCl) and p-Toluenesulphonic acid/Choline chloride (pTSA:ChCl). The acidic nature of each DES influenced the efficiency of PPE cleavage and determined the extent of further side reactions of cleavage products. Although PA:U (2:1) demonstrated ability to dissolve lignin, it is unable to cleave B-O-4 ether linkage in PPE. On the other hand, LA:ChCl (10:1) allowed PPE cleavage, but an esterification between the PPE and lactic acid as well as oligomerization of lactic acid were detected. Among examined solvents, pTSA:ChCl (1:1) demonstrated the highest performance on the PPE cleavage, although the high acidity of this system lead to condensation of cleavage products at prolonged time. The presence of water decreases the ability of DES for the cleavage, but the extension of undesired side reactions was also reduced. Finally, the analysis of intermediates and products of the reactions allowed the identification of a chlorinated species of PPE that precedes the cleavage reaction. A kinetic study using pTSA:ChCl (1:1) and pTSA:ChBr (1:1) was performed to unveil the role of the halide counterion present in DES on the cleavage of <2=2 ether bond and a new reaction mechanism was herein proposed and supported by density functional theory (DFT) calculations.Altri ñ Celbi, Buckman, Crown Van Gelder, CTP, DS Smith Paper, ESKA, Essity, Holmen, ISPT, Mayr-Melnhof Eerbeek, Mets‰ Fibre, Mid Sweden University, Mondi, Omya, The Navigator Company, Sappi, Essity, Smurfit Kappa, Stora Enso, Eindhoven University of Technology, University of Aveiro, University of Twente, UPM, Valmet Technologies Oy, Voith Paper, VTT Technical Research Centre of Finland Ltd, WEPA and Zellstoff Pols.in publicatio