O objetivo deste trabalho foi examinar a prática adotada para disponibilização de leitos para internação pelos hospitais públicos da cidade de Taubaté - SP. Os hospitais-foco desse estudo foram escolhidos por acessibilidade não probabilística e os entrevistados selecionados por interesse dentro do perfil de caráter Público. O estudo possibilitou identificar eventuais lacunas e oportunidades de melhoria na gestão pública hospitalar, observar fatores e variáveis socioeconômicos e demográficos como, por exemplo, receitas Estaduais e Municipais, renda per capita, taxas Estaduais e Municipais e Dados Territoriais, além do número de internações por especialidades. O método utilizado foi a pesquisa de natureza exploratório-descritiva e documental. Foi utilizada uma entrevista semi-estruturada junto aos gestores dos hospitais pesquisados. Após a coleta, por meio de documentos fornecidos por órgãos reguladores e entrevistas com os respectivos gestores, os dados foram examinados e comparados com os parâmetros da Portaria MS n 1101/GM. Diante dos resultados encontrados concluiu-se que os hospitais públicos dessa cidade atendem parcialmente aos parâmetros estabelecidos pela Portaria 1101/GM. Em particular, no que diz respeito às internações por especialidades médicas, há um cenário de muitas oportunidades para os gestores hospitalares, a começar pela expertise na gestão pública profissionalizada, arraigada no processo de melhoria contínua na qual há a necessidade de mudanças no sistema de administração hospitalar, devido à complexidade dessa organização. Enfim, é imprescindível que haja a inter-relação dos saberes interdisciplinares eivados na busca do conhecimento do todo da organização hospitalar e também em partes devido à pluralidade de profissionais de diferentes formações e de serviços. Há oportunidades na gestão da saúde por meio de ações preventivas, não tardias ou dispendiosas, com diagnósticos precisos e tratamento multidisciplinar. Essa mudança seria um alvo a ser atingido. / The aim of this paper is to examine the practice adopted for the provision of beds for public hospitals by the city of Taubaté - SP. The hospitals focused on this study were chosen for non-probabilistic accessibility, and the interviewees selected by interest in the public character profile. The study enabled to identify possible gaps and opportunities for improvement in public hospital management, observe socioeconomic factors and demographic variables such as, for example, state and local income, per capita income, state and local taxes, territorial data, besides the number of hospitalizations for specialties. The method used was the exploratory-descriptive and documentary research. Data were collected through a semi-structured interviews with the managers of the hospitals surveyed and through the documents provided by regulatory agency. Afterwards, the corpora were examined and compared with the parameters of Ordinance No. 1101 G / M MS. Considering the results, it was concluded that public hospitals in this city partially meet the parameters established by this ordinance. Consequently, regarding the admissions to medical specialties, there are many opportunities for hospital managers, starting with expertise in professionalized public administration ingrained in the process of continuous improvement, which there is a need for changes in the hospital administration system, due the complexity of the organization. Finally, it is crucial that the interrelationship of interdisciplinary knowledge riddled in the pursuit of knowledge of the whole hospital organization, and also the parts, due to the plurality of different backgrounds and professional services. In short, there are opportunities in health management through preventive actions, not late or expensive, with precise diagnosis and multidisciplinary treatment, in other words, a change to be conquered.

Die vorangegangen Darstellungen haben gezeigt, auf welchen Art und Weise verschiedene Unternehmen zu Größe und Macht gelangen können. Dabei verdeutlichen die gewählten Fallbeispiele sehr genau, wie unterschiedlich die Wege zum Erfolg beschrieben werden können. Auf der einen Seite sehen wir die General Motors Corporation, die schon seit den ersten Tagen des Automobils eine Strategie der Expansion durch externen Unternehmenszukauf betreibt. Ihr gegenüber steht Toyota, ein Automobilhersteller der seinen Erfolg hauptsächlich der Nutzung des eigenen internen Entwicklungspotentials verdankt. Beide zusammen repräsentieren die zwei größten Automobilkonzerne der Welt.

No description available.

Interferon (IFN)τ is the luteotrophic signal in ruminants and is secreted by bovine blastocysts both in vivo and in vitro. IFNτ secretion is highly variable and its control is only partly understood. Most studies on the effects of environmental factors on IFNτ production have evaluated IFNτ production during the time of embryo elongation and attachment. There is less knowledge of how IFNτ production at the blastocyst stage is modulated. Therefore, the hypothesis of this thesis was that the amounts of IFNτ expressed and/or secreted by bovine blastocysts produced in vitro were modulated by environmental factors. In the first set of experiments, bovine embryos were incubated with a cytokine (granulocyte macrophage colony stimulating factor, GM-CSF). GM-CSF had been shown previously to promote embryo viability in a range of species and to modulate IFNτ secretion by ovine blastocysts and thus was classified as a beneficial environmental factor. Three experiments were conducted to test whether GM-CSF stimulated bovine blastocyst development and IFNτ secretion. Embryos were incubated with a range of different concentrations of GM-CSF (2, 5, 10 and 50 ng mL-1) and at different stages of development (1 to 3 and 1 to 9 days post-insemination). Bovine embryos were unresponsive to GM-CSF in terms of IFNτ secretion, pyruvate oxidation, rate of development, blastocyst yield, morphological quality and apoptotic index, irrespective of timing of exposure and/or concentration of GM-CSF. In the second part of the thesis, bovine blastocysts were exposed to a mild heat treatment (42°C for four h) to determine whether heat stress affected IFNτ expression by bovine blastocysts. A novel multiplex reverse-transcription polymerase chain reaction methodology was validated to detect IFNτ and heat shock protein (HSP)70 mRNA in individual bovine embryos relative to an endogenous gene (YWHAZ) and an exogenous mRNA (α-globin) and results were expressed both in absolute terms and in relation to the endogenous control. Heat treatment upregulated IFNτ mRNA expression, suggesting that detrimental environmental factors may influence IFNτ expression. Heat treatment also caused an increase in HSP70 mRNA expression but did not affect blastocyst morphology, suggesting that the level of stress caused by the heat treatment was great enough to activate the cellular stress response, but mild enough not to cause a change in morphology. In addition, the positive correlation between HSP70 and IFNτ transcript levels and the higher IFNτ expression by embryos which showed signs of degeneration and collapse compared to those which progressed in development suggested that IFNτ expression may be indicative of stress. The relationship between IFNτ expression and secretion in vitro with morphology, pyruvate metabolism, apoptotic index and cell number was inconsistent, suggesting that IFNτ production did not correlate with ‘quality’ (defined as an index of viability). Blastocyst yield, day of blastulation and change in morphology index did account for at least part of the variation in IFNτ production, suggesting that some intrinsic factors may regulate IFNτ secretion. These intrinsic factors, however, did not explain all the variation in IFNτ secretion between blastocysts. Therefore, the amount of IFNτ secreted by bovine blastocysts is modulated by both intrinsic and environmental factors. A model was proposed where different levels of stress affect survivability to different extents, and the ability to respond to mild levels of stress may be indicative of improved survivability.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

<div>The space around the Earth is becoming increasingly populated with a growth in number of launches and proliferation of debris. Currently, there are around 44,000 objects (with a minimum size of 10cm) orbiting the Earth as per the data made publicly available by the US strategy command (USSTRATCOM). These objects include active satellites and debris. The number of these objects are expected to increase rapidly in future from launches by companies in the private sector. For example, SpaceX is expected to deploy around 12000 new satellites in the LEO region to develop a space-based internet communication system. Hence in order to protect active space assets, tracking of all the objects is necessary. Probabilistic tracking methods have become increasingly popular for solving the multi-target tracking problem in Space Situational Awareness (SSA). This thesis studies one such technique known as the GM-PHD filter, which is an algorithm which estimates the number of objects and its states when non-perfect measurements (noisy measurements, false alarms) are available. For Earth orbiting objects, especially those in Geostationary orbits, ground based optical sensors are a cost-efficient way to gain information.In this case, the likelihood of gaining target-generated measurements depend on the probability of detection (p_D) of the target.An accurate modeling of this quantity is essential for an efficient performance of the filter. p_D significantly depends on the amount of light reflected by the target towards the observer. The reflected light depends on the relative position of the target with respect to the Sun and the observer, the shape, size and reflectivity of the object and the relative orientation of the object towards Sun and the observer. The estimation of the area and reflective properties of the object is in general, a difficult process. Uncontrolled objects, for example, start tumbling and no information regarding the attitude motion can be obtained. In addition, the shape can change because of disintegration and erosion of the materials. For the case of controlled objects, given that the object is stable, some information on the attitude can be obtained. But materials age in space which changes the reflective properties of the materials. Also, exact shape models for these objects are rare. Moreover,, area can never be estimated with optical measurements or any other measurements, as it is always albedo-area i.e., reflectivity times area that can be measured.</div><div> The purpose of this work is to design a variation of the GM-PHD filter which accounts for the uncertainty in p_D as the original GM-PHD filter designed by Vo and Ma assumes p_D as a constant. It is validated that the proposed method improves the filter performance when there is an uncertainty in area(hence uncertainty in p_D) of the targets. In the tested cases, the uncertainty in p_D was modeled as an uncertainty in area while assuming that the targets are spherical and that the reflectivity of the targets is constant. It is seen that a model mismatch in p_D affects the filter performance significantly and the proposed method improves the performance of the filter in all cases.</div>

Genetically modified (GM) foods technology is a novel idea for improving food and crop production, but the supposed health risk of GM foods, such as possible negative long-term health effects to humans, animals and the environment, have provoked the European Union to create assessment protocols to monitor and regulate the safety of GM foods and crops. This research investigates the perception and attitudes of unlabeled GM foods of the WKU faculty and staff. A survey was administered via WKU Qualtrics, and chi-square tests were performed to see how the benefits and disadvantages of GM foods may affect the purchasing decisions of the educated consumer, and to see if the WKU faculty and staff wants GM foods to be labeled or not. The research confirms that the benefits and disadvantages of GM foods do affect the purchasing decisions of the educated consumer. The survey revealed that about 60% of the WKU faculty and staff buys GM foods, and 40% do not buy GM foods, and approximately 92% of the WKU faculty and staff wants GM foods to have proper labeling and information. The research provides information about how the educated consumer of Kentucky may feel about unlabeled GM foods. The research also recommends some trade-off benefits of GM foods, including that approximately 35% of the WKU faculty and staff reported that they would buy GM foods if it helps to lower cholesterol and fight diabetes, and 20% say they would buy GM foods if it is cheaper than other foods. Some of the disadvantages of GM foods are that the pesticide chemicals used in the production methods of GM foods are toxic to humans, animals, and the environment. Approximately 54% of the participants say they would not buy GM foods because they are concerned about how it may affect their long-term health, and about 35% reported that they don’t buy GM foods because of improper labeling and information.

The Plasma Impedance Probe (PIP) is an electronic instrument that measures the impedance of a dipole antenna immersed in a plasma environment. Measurements made by the PIP provide valuable information regarding the plasma environment. Knowledge of ionospheric plasma density and density disturbances is required to understand radio frequency communication with satellites. The impedance curve provides us with significant plasma characteristics such as the electron-neutral collision frequency and plasma electron density. The work proposed here is a transistor-level implementation of the analog front-end, the non-inverting amplifier that is used to drive the antenna. The antenna immersed in plasma is excited with a sinusoidal/pulse stimulus and the output from the non-inverting configuration is fed into the difference amplifier. In the difference amplifier the output signal from the non- inverting amplifier is subtracted from the original stimulus and then fed into a high-speed pipeline data converter. The entire analog and mixed signal components are integrated on a single chip. The obvious advantages with this design are that it eliminates several sources of analog signal processing errors, thereby improving stability. A Fast Fourier Transform (FFT) is then applied on the sampled input stimulus as well as the processed signal. The input voltage FFT is then divided by the current FFT to obtain the antenna impedance. The FFT method helps in reducing transient errors and improves noise immunity of the system. The antenna impedance span curves over the frequency range from 100 kHz to 20MHz. The approach for the tranistor-level design is implementing short-channel design tech- niques using the gm/ID method. This is the primary focus of the thesis where the emphasis has been on using a simple and intuitive method to design the front-end amplifier in the TSMC .35 um technology. The design specifications for this amplifier are derived from the system-level simulations. The transition from a Printed Circuit Board (PCB)-based design to System on Chip (SOC) implementation is explored. This makes the design components highly specific to the application. The following are the design approaches used for the analog front-end design. * A detailed study of the various factors affecting the PIP instrument measurement capabilities from the previous works. * System-level simulation of the the entire PIP system to completely characterize the analog front-end. * Exploration of the possible design topologies for the transistor-level implementation. * A novel method of analog amplifier design using the gm/ID methodology. Miniaturization of the instrument and using a pulse-based measurement scheme also offer an immediate benefit to sounding rocket missions. The reduction of power, mass, and volume will enable the instrument to be flown on many more sounding rockets than at present. The faster measurement is especially valuable since the ionospheric plasma changes in character most rapidly with altitude.

<p>The current research is directed towards dissection of host genetic factors involved in host immune response and the malaria disease outcome. A possible association between FcγRIIa polymorphism and anti-malarial antibody (A.M.A) responses were investigated in Sudanese patients in relation to clinical outcome of falciparum malaria. The frequency of the R/R131 genotype was significantly higher in patients with severe malaria as compared with mild malaria. A.M.A IgG3 was shown to be associated with reduced risk of clinical malaria in individuals carrying the H/H131 genotype. Low levels of IgG2 reactive with the Pf332-C231 antigen were associated with lower risk of severe malaria in individuals carrying the H131 allele. </p><p>Fulani and Masaleit, two sympatric ethnic groups in Sudan, are characterized by marked differences in susceptibility to falciparum malaria. We investigated whether the two populations differ in the frequency of GM/KM allotypes. The distribution of GM/KM phenotypes differed significantly among the two groups, with Gm 6 being significantly lower among the Fulani, and the combined frequency of Km 1,3 and Gm 1,17 5,6,13,14 phenotypes was found to be higher among Masaleit.</p><p> In interethnic study we investigated whether the two groups differ in the frequency of FcγRIIa and HbAS genotypes. The frequency of the H/H131, R/R13 and HbAS genotypes differed significantly among the two groups. Moreover, the Fulani showed higher levels of A.M.A IgG2 and lower IgG1 and IgG3 when compared to their sympatric non-Fulani neighbours.</p><p>A tri-allelic SNP (C/T/A) in the CRP gene was investigated for possible ethnic associations. The A allele, which is associated with higher basal CRP levels, was found to be less frequent in the Fulani compared with non-Fulani ethnic groups both in Sudan and Mali. </p><p>In conclusion, our results suggest possible associations between FcγRIIa, CRP genotypes, GM/KM allotypes, and anti-malarial antibody responses and the clinical outcome of falciparum malaria.</p>

<p>In this thesis, two different vaccines were evaluated as adjuvant therapy for patients with colorectal cancer. The ability of the two candidate vaccines to generate antigen-specific cellular and humoral responses, respectively, was studied. The effectiveness of granulocyte colony stimulating factor (GM-CSF) as a cytokine adjuvant to augment the immune response was also examined.</p><p>The first vaccination strategy involved immunization with the recombinant tumor-associated protein, carcinoembryonic antigen (CEA). Recombinant CEA was administered at 4 different dose levels 7 times during one year. Peripheral blood samples were regularly analyzed during 36 months. This vaccination regimen induced a strong immunoglobulin 1 (IgG1) and IgG4 response, a moderate IgG2 response and a weak IgG3 response against CEA. GM-CSF markedly augmented the effect on IgG1 and IgG4 as well as the T cell response. In contrast, dose of rCEA had no or modest effect on induced immune responses. The response gradually increased during the 12 months immunization period. Responses of all three IgG subclasses and of T cells were protracted up to 36 months. The anti-CEA IgG titers related significantly to survival. Functional HLA-DR epitopes of CEA could be defined. These major histocompatibility class II epitopes may serve as putative components of a peptide-based vaccination strategy. </p><p>The other vaccine strategy consisted of the tumor-associated antigen epithelial cell adhesion molecule (Ep-Cam) expressed as a transgene in a viral vector, ALVAC. Patients were immunized subcutaneously/intradermally 3 times over 6 weeks and monitored for immune responses for 46 weeks. No anti-Ep-Cam specific humoral response was induced, but Ep-Cam specific type 1 T cells (interpheron-gamma production) were induced, mainly in the GM-CSF group. The cytotoxic cellular response appeared late, or a few months after the last immunization.</p><p>Both vaccines were well tolerated. Since GM-CSF was an important component for both regimens, immungenicity of this cytokine was assessed. Multiple immunizations with low dose GM-CSF were associated with a low incidence of GM-CSF antibodies that did not neutralize the biological effect of GM-CSF. </p><p>In conclusion, both vaccines are promising candidate vaccines. GM-CSF is necessary to induce a strong humoral and cellular immune response. Large clinical trials are urgently warranted to evaluate the clinical efficacy.</p>