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Der akute Myokardinfarkt ist eine der Haupttodesursachen weltweit. Nach aktueller Studienlage reduziert eine schnelle perkutane Koronarintervention (PCI) die Sterblichkeit und verbessert das Outcome bei Patienten mit ST-Hebungsinfarkten (STEMI). Gleichwohl ist es in vielen Fällen schwierig, die von den nationalen und internationalen Gesellschaften geforderten Zeitintervalle einzuhalten. In der vorliegenden prospektiven Erhebung wurde untersucht, ob sich durch den Aufbau eines Infarktnetzwerkes und durch systematische Datenerfassung und Feedback, Behandlungszeiten bei Patienten mit STEMI verkürzen und somit die Behandlungsqualität verbessern lassen. Die hier ausgewerteten Daten wurden im Rahmen des deutschlandweiten, multizentrischen „Feedback-Intervention and Treatment-Times“ (FITT STEMI)-Projektes erhoben. Therapie- und Behandlungszeiten wurden bei Patienten mit STEMI (n=465) in einem Zeitraum von 18 Monaten standardisiert erfasst und systematisch analysiert. Nach einer Analyse des Status-quo in den ersten drei Monaten wurde durch Interventionsmaßnahmen versucht, eine Prozessoptimierung in der Behandlung von ST-Hebungsinfarkten zu erreichen. Zu den Interventionsmaßnahmen zählten: 1. die Einführung eines Herznotrufhandys für eine direkte Kommunikation der einweisenden (Not-)Ärzte und umliegenden peripheren Krankenhäuser mit dem diensthabenden Interventionskardiologen 2. ein systematischer Bypass der Notaufnahme im Interventionskrankenhaus zugunsten eines direkten Transportes in das Herzkatheterlabor 3. der direkte Transport von Patienten in das Interventionszentrum unter Umgehung von peripheren Krankenhäusern (Primärtransport) 4. die quartalsweise Rückkoppelung von Ergebnissen der Datenerhebung im Rahmen von Feedbackrunden an alle Beteiligten des Herzinfarktnetzwerkes. Es zeigte sich, dass die durchgeführten Interventionsmaßnahmen zu einer Reduzierung der Transport- und Behandlungszeiten und einer Prozessoptimierung führten. Die Rate der Primärtransporte in das Interventionszentrum war deutlich erhöht - auf über 70% im letzten Quartal. Die durchschnittlichen „door-to-balloon“ (D2B)-Zeiten konnten global um 13 min reduziert werden, die „contact-to-balloon“ (C2B)-Zeiten von 182 min zu Beginn der Erhebung um 50 min auf 132 min gesenkt werden. Auch der Anteil der Patienten, die innerhalb der von den Leitlinien formulierten Zeitintervalle therapiert wurden, konnte gesteigert werden. Nach Beginn des Projektes wurden doppelt so viele Patienten innerhalb der geforderten C2B-Zeit von < 90 bzw. <120 min therapiert, der Anteil der Patienten mit einer D2B-Zeit < 30 min konnte signifikant gesteigert werden. In der weiteren Analyse der Daten zeigte sich, dass insbesondere die telefonische Anmeldung der Patienten und die Umgehung der Notaufnahme wesentliche Faktoren in der Verbesserung des Behandlungsprozesses darstellen. Auffällig waren die langen Prähospitalzeiten (S2C). Diese Zeitspanne birgt erhebliches Verbesserungspotential, gerade im Hinblick auf die zeitliche Dringlichkeit in der Therapie. Ein direkter Einfluss der S2C auf die Mortalitätsraten konnte in dieser Erhebung allerdings nicht festgestellt werden. Zum Ende der Erhebung stiegen in einigen Bereichen die Behandlungszeiten wieder an. Es bleibt im weiteren Verlauf des Projektes abzuwarten, ob diese Beobachtung ein zufälliges Ereignis oder einen langfristigen Trend darstellt. Unbestritten ist, dass ein bestmöglicher Therapieprozess eine hohes Engagement aller Beteiligten, eine ständige Reevaluation und das kontinuierliche Bestreben, Prozesse zu verbessern, erfordert.

Dans une perspective de réalisation du marché unique européen, la libéralisation des différents secteurs d'activités en Europe dont celui des transports au courant des années 1990, entraîne le développement des différents modes et une surcroissance du transport routier avec certes de réels avantages en terme de développement économique, de compétitivité et d'emploi, mais aussi de sérieux inconvénients : congestion des grands axes routiers et augmentation du taux d'émissions de C02. Encourager l'intermodalité et promouvoir le développement des modes alternatifs à la route, rééquilibrer les différents modes de transport, constituent désormais l'une des principales priorités de l'Europe. Sous les auspices du Livre Blanc de 2001 relatif à la politique européenne des transports, les autoroutes de la mer naquirent sous un jour insuffisamment éclairé, et, actuellement, elles essaient de se frayer un véritable chemin. Elles présentent néanmoins des caractéristiques essentielles : considérées à la fois comme des infrastructures et des services de transport, elles constituent des lignes régulières de transport maritime à haute fréquence et à haute qualité de service, assurant des liaisons entre deux ou plusieurs ports d'au moins deux États membres de l'Union Européenne. Issues de la nouvelle politique européenne des transports, elles répondent aux impératifs de décongestion des grands axes routiers saturés, de sécurité routière, de développement durable et de protection de l'environnement, favorisant ainsi le développement et la croissance du marché intérieur. Or, l'absence d'un statut juridique initial applicable aux autoroutes de la mer a de réels impacts sur l'émergence de ce concept, qui évolue en s'adaptant aux nouvelles contraintes, en relevant de nombreux défis. Le bilan actuellement mitigé des autoroutes de la mer en Europe conduit à s'interroger sur les perspectives de leur pérennisation. Dès lors, notre réflexion est orientée vers deux aspects juridiques essentiels. D'une part l'impact réel de l'absence d'un régime juridique initial sur l'émergence des autoroutes de la mer et sur les mécanismes de financement qui l'accompagnent. D'autre part, la détermination d'un cadre juridique favorable au développement des autoroutes de la mer dans une perspective d'assurer leur meilleure intégration dans la chaîne logistique globale, et leur émergence comme véritable alternative durable, crédible et efficace à la route intégrale. / With the prospect to achieve the European single market, liberalization of various sectors in Europe including transport in the 1990s decade, leads to the development of different means of transport and the increase of road transport activities, certainly with real benefits such as economic development, competitiveness and employment; but also serious drawbacks : congestion of highways and increase in C02 emissions. Encouraging intermodality and promote the development of road alternatives, adjusting the balance between means of transport, is considered as one of European Union key priorities. Under the auspices of 2001 White Paper European transport policy, Motorways of the Sea concept were insufficiently informed, and currently, looking for his own way. Nevertheless they do present essential characteristics: both transport infrastructures and services, Shipping line services which are regular, frequent and of good quality , inbound to two or more sea ports to at least two states member of European Union. From the new European transport policy, they meet the requirements : road safety, sustainable development, safe environment, promoting growth in European Union internal market. However, the absence of an initial legal status applicable to the Motorways of the Sea has a real impact on the emergence of this concept, which evolves by adapting to new constraints, raising many challenges. The current mixed picture of Motorways of the Sea in Europe raises questions about the prospects for their sustainability. Our focus is directed towards two key legal aspects. On one hand the real impact of the absence of an initial legal status on the emergence of motorways of the sea and the funding mechanisms that accompany it. On the other hand, the determination of legal framework favourable to the development of Motorways of the sea which will contribute to a better integration into the global Supply Chain and emerge as truly sustainable alternative, credible and effective to the integral road transport.

Submitted by Guilherme Takamine Correia (gtakamine@gmail.com) on 2014-09-17T20:23:35Z No. of bitstreams: 1 Guilherme_Takamine_0830714_FINAL.pdf: 2537049 bytes, checksum: 8b19bdd2ebff97340ff7de1e8792701c (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2014-10-23T19:00:55Z (GMT) No. of bitstreams: 1 Guilherme_Takamine_0830714_FINAL.pdf: 2537049 bytes, checksum: 8b19bdd2ebff97340ff7de1e8792701c (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2014-10-29T17:36:30Z (GMT) No. of bitstreams: 1 Guilherme_Takamine_0830714_FINAL.pdf: 2537049 bytes, checksum: 8b19bdd2ebff97340ff7de1e8792701c (MD5) / Made available in DSpace on 2014-10-29T17:36:58Z (GMT). No. of bitstreams: 1 Guilherme_Takamine_0830714_FINAL.pdf: 2537049 bytes, checksum: 8b19bdd2ebff97340ff7de1e8792701c (MD5) Previous issue date: 2014-04-28 / Por que a maior empresa de cosmético do mundo não entra no canal de vendas da maior empresa de cosméticos do Brasil? O trabalho a seguir tem o objetivo de analisar a L’Oréal Brasil e entender os motivos de ela não atuar no canal de vendas door-to-door, principal canal de vendas da Natura, a maior empresa de cosméticos do Brasil. Com base no método do Estudo do Caso, foram feitas 23 entrevistas tendo como amostra o corpo executivo da L’Oréal Brasil, bem como seu CEO. O estudo abrangeu diversas áreas da organização: marketing, suprimentos, fabricação, recursos humanos, vendas e logística. Com base na teoria da Lógica Dominante, notou-se que apesar de o canal de vendas door-to-door ser atrativo, existem diversas razões estratégicas/crenças que impedem que a L’Oréal entre no canal, são elas: a desconfiança no futuro do canal, a operação logística e o paradigma histórico da L’Oréal. / Why does the largest cosmetics company in the world does not enter the channel of the largest cosmetic company in Brazil? The main objective of this work is to analyse the L'Oréal Brazil’s case and understand its motivations or reasons not to act in the door-to-door channel today dominate by Natura, the largest cosmetic company in Brazil. The method of case study included 23 interviews, among them the executive body of L'Oréal Brazil and its CEO. Several areas of the organization have been studied: marketing, supply chain, manufacturing, human resources, sales, among others. Based on the theory of Dominant Logic, it was noted that despite being attractive the is door-to-door channel, is not a strategic option for L'Oréal due to by: a lack of confidence about the future of the channel-door to-door, the operational logistics and mismatch paradigm of L'Oréal with the channel.

Made available in DSpace on 2016-06-02T20:00:46Z (GMT). No. of bitstreams: 1 4668.pdf: 1300864 bytes, checksum: 47714fffabd94cd02784d632c827ebcd (MD5) Previous issue date: 2010-12-15 / The collection of solid waste generated in urban areas is a growing concern for governments, health professionals and environmentalists. Among these concerns is the disposal of vegetable oil used in homes, which requires a more appropriate final allocation. For this to be attained, it is necessary, in addition to public awareness, the planning for the collection, with pre-defined routes. This study simulates alternative systems to collect waste oil in some sectors of the city of São Carlos SP using a Geographic Information System GIS. Using this system, routes to be travelled by the collectors from door to door, are defined. The program used was the TransCAD, which is a GIS specific for transportation planning, transport professionals, enabling the development routes using algorithms that include a procedure for arc routing. For this study it was assumed that a collector truck would be parked at some defined points and the collection would be performed by collecting agents with carts following pre-defined routes. Several simulations were made, aiming at minimizing the length of the routes and the number of agents necessary for the task. The results obtained with the simulations demonstrated that it is possible to define sets of routes that minimize the cost and the manpower required for the door to door collection of discarded frying oil. / A coleta dos resíduos sólidos gerados no meio urbano é uma preocupação crescente para governantes, profissionais da saúde e ambientalistas. Dentre estas preocupações, encontra-se o descarte do óleo vegetal utilizado nas residências, que exige uma destinação final mais adequada. Para isto se faz necessário, além da conscientização da população, um planejamento de coleta, com rotas pré-definidas. Este estudo simula sistemas alternativos para coleta do óleo residual em alguns setores da cidade de São Carlos SP, usando um Sistema de Informações Geográficas SIG. Com o uso desse sistema são definidas rotas a serem percorridas pelos agentes coletores no processo de coleta seletiva para o óleo residual de fritura através do sistema porta-aporta. O programa utilizado foi o TransCAD, que é um SIG específico para planejamento de transportes, permitindo desenvolver rotas utilizando-se algoritmos que incluem um procedimento de roteirização em arco (Rotina Arc Routing). Para este estudo considerou-se que um caminhão coletor ficaria estacionado em pontos determinados e o serviço de coleta seria realizado por agentes coletores com carrinhos manuais seguindo percursos de coleta a pé. Foram feitas diversas simulações procurando minimizar os percursos de coleta e o número de agentes coletores necessários para a execução do serviço. Os resultados obtidos com as simulações demonstraram que é possível se obter conjuntos de rotas que minimizam o custo e a mão de obra necessária para a coleta porta a porto do óleo residual de fritura.

[pt] O contínuo processo de transformação do mercado faz com que as empresas não pensem unicamente em si mesmas, mas em toda a cadeia de suprimentos, na qual estão inseridas. Atualmente, a principal meta é a redução dos seus diversos custos de distribuição, fazendo uso de novas tecnologias ou melhores sistemas, sem esquecer de manter ou melhorar o seu nível de serviço. Este trabalho considera um sistema de distribuição física constituído por um centro de distribuição (CD) e 44 furgões. A partir do CD os furgões atendem diariamente todos os clientes situados na Região Metropolitana do Rio de Janeiro. Nesta dissertação serão examinadas algumas propostas de configuração da rede de distribuição porta-a-porta de uma grande empresa industrial, na Região Metropolitana do Rio de Janeiro, para se chegar a menores custos, desperdícios e maior eficiência. O sistema atual é avaliado e diversas configurações de modificação na estrutura do sistema são examinadas, incluindo a colocação de um ou mais depósitos regionalizados, dentro da Região Metropolitana do Rio de Janeiro, auxiliando o depósito central (CD Principal), de modo a reduzir as distâncias percorridas, reduzir a frota e melhorar o atendimento aos clientes. Após a montagem das configurações, são feitas três análises para examinar as variações dos custos logísticos, dependendo da evolução da demanda e de congestionamentos resultantes nas vias da Região Metropolitana. O trabalho conclui mostrando que o aumento de custos das estruturas propostas, com mais um único depósito avançado, pode ser recompensado com ganhos operacionais e mercadológicos. A consideração de cenários futuros, com maiores custos de combustíveis e maiores congestionamentos reforça a proposta, sem chegar a viabilizar a proliferação dos depósitos avançados. / [en] The continuous process of transformation of the market forces the companies to think not only on themselves, but on the whole supply chain, in which they are inserted. Currently, the main goal is the reduction of their diverse costs of distribution, making use of new technologies or better systems, without forgetting to keep or improving its level of service. This study considers a physical distribution system that operates with one distribution center (DC) and 44 small trucks. Departing everyday from the DC the trucks supply all customers that belong to the Metropolitan Region of Rio de Janeiro. In this thesis some proposals for the door-to-door configuration of the distribution network of a great industrial company will be examined, in the Metropolitan Area of Rio de Janeiro, to reach lower costs, less waste and greater efficiency. The current system is evaluated and diverse configurations of modification in the system`s structure are examined, including the introduction of one or more deposits, in the Metropolitan Area, assisting the central deposit, in order to reduce the traveled distances, to reduce the fleet and to improve the customer`s attendance. After the assembly of the configurations, and considering various scenarios of evolution of demand and increase of traffic congestion, analyses are made to examine the variations of the logistics costs. The thesis goes to showing that the increase in the costs of an additional advanced warehouse, can be paid with operational and marketing profits. The consideration of future scenarios with larger fuel costs and more dramatic traffic congestion shall reinforce the proposal of one warehouse but yet do not recommend the proliferation of them.

This thesis examines the influence of the intensity of pressure strain of structures printed on the value of air permeability. The measurement is carried out using Blower Door Test on six variants using OSB boards as airtightening layers in the building. Part of the research was to verify the suitability of the test chamber and measuring devices for similar purposes and adjustment chamber

Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.

This dissertation explores the concept of shi manifested in traditional Chinese architecture by examining the efficacy of the traditional Chinese house doors. Three connotations of the concept of shi derived from different philosophical schools of thought during the Warring States Period: the advantageous shi, the authoritative shi and the self-so-doing shi, are re-engaged as the theoretical framework for this study. The three categories of shi correspondingly shed light on the understanding of the craftiness in architectural constructions, the embodied cultural meanings in building elements and the aesthetics achieved by the artful arrangement of building elements. This study also further reveals the essential nature of shi as weak and amorphous in parallel with the weak ontology proposed by Gianni Vattimo. It is this weak and amorphous nature of shi that results in the complexity, diversity and richness of traditional Chinese house doors. This new perspective of examining architecture through the lens of shi also provides a way for looking at the future development of Chinese architecture beyond the limitations of internationalism yet within the realm of a critical local modernity. / Ph. D.

The voices of eleven Aboriginal and ten non-Aboriginal adult social work educators who volunteered to participate in this qualitative research study represent a diverse range of practice and teaching experiences. Participants with experience teaching social work courses that included the enrollment of Aboriginal students were interviewed to gain knowledge about their self-location, lived experiences, their insight, and their perceptions of the ways in which they have and continue to support and influence the retention of Aboriginal post-secondary students. This study utilized phenomenology as a philosophical approach. The interview process was guided by a phenomenological investigation to identify and explore themes that emerged from the data. The major findings of the study revealed the the many facets to the social work educator-student relationship. The major findings of the study revealed the ways social work educators with experience teaching Aboriginal social work students from northern and remote communities, are involved in providing personal and academic support. Examples of the support provided includes the daily maintenance of an open door policy, reaching out and providing offers of help to students, and assuming roles as advocates, resource brokers, mentors, advisors and counsellors. / October 2016