A influência da cultura organizacional no processo de profissionalização da gestão em uma empresa familiar

Este artigo teve como propósito verificar como a cultura organizacional influencia no processo de profissionalização da gestão em uma empresa familiar. A metodologia utilizada foi o estudo de caso, e a coleta dos dados realizada por meio dos seguintes instrumentos qualitativos: observação, análise documental e entrevistas semi-estruturadas. Os resultados da pesquisa revelaramque a cultura organizacional da empresa objeto de estudo foi moldada conforme os valores e as crenças do seu fundador e que a cultura desta organização vem influenciando de forma positiva o seu processo de profissionalização da gestão, ainda em transição

Novos significados para velhas palavras

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Mycobacteria em queijos tipo Minas comercializados em feiras-livres de São Paulo, Brasil

Mycobacterium bovis is the causative agent of bovine tuberculosis, a disease that affects dairy herds throughout the Brazilian territory, constituting a neglected zoonosis transmitted by raw milk and its derivatives. In this study, we evaluated the presence of M. bovis and other mycobacteria in Minas cheese obtained from open fairs in the city of São Paulo between 2012 and 2013. Samples (n = 133) were decontaminated using hexa-cetylpyridinium chloride and seeded on Stonebrink–Leslie medium. The isolates were submitted to molecular identification by TB Multiplex PCR targeting the 16S rRNA gene and amplicon nucleotide sequencing. From 16 cheese samples (12%), we obtained 26 putative colonies of Mycobacterium spp., none of which belonged to any of the Mycobacterium tuberculosis, Mycobacterium avium, or Mycobacterium intracellulare complexes. Phylogenetic analysis showed that sample sequences were grouped in a clade that includes only non-tuberculous mycobacteria with proximity to sequences obtained from Mycobacterium novocastrense (3 sequences), Mycobacterium holsaticum (1 sequence), andMycobacterium elephantis (2 sequences). Although no epidemiological evidence was found regarding the importance of oral transmission of mycobacteria in healthy people, their importance in the immunosuppressed population remains uncertain.Mycobacterium bovis é o agente da tuberculose bovina, doença que acomete o rebanho em todo território brasileiro e é uma negligenciada zoonose transmitida pelo leite e seus derivados. Este trabalho avaliou a presença de M. bovis e outras micobactérias, em queijo minas meia-cura, obtidos em feiras-livres na cidade de São Paulo, entre os anos de 2012 e 2013. As amostras (n = 133) foram descontaminadas pelo método HPC (hexa-cetyl-pyridinium chloride) e semeadas em meio Stonebrink Leslie. Os isolados foram submetidos à identificação molecular por PCR TB multiplex, pesquisando-se o gene 16S rRNA, e ao sequenciamento nucleotídico. Dezesseis amostras (12%) possuiam 26 colônias sugestivas de Mycobacterium spp., mas nenhuma delas pertencia aos complexos Mycobacterium tuberculosis, Mycobacterium avium e Mycobacterium intracellulare. A análise filogenética mostrou que todas as amostras estavam agrupadas em clados que incluem apenas micobactérias não tuberculosas (MNT), sendo que algumas possuiam proximidade com sequências obtidas de Mycobacterium novocastrense (3 sequências), Mycobacterium hosaticum (1 sequência) e Mycobacterium elephantis (2 sequências). Embora no momento não haja evidência epidemiológica da importância da transmissão oral das micobactérias pra indivíduos saudáveis, sua importância na população imunossuprimida ainda é incerta

Hemophagocytic syndrome: a dilemma chasing the intensivists

Hemophagocytic lymphohistiocytosis or hemophagocytic syndrome is represented by an uncontrolled inflammatory response characterized by marked histiocyte activation and a cytokine storm. The entity may present a primary or genetic type, and the secondary type is usually triggered by infectious diseases of any kind, autoimmune disease, or neoplasia. This entity, although well described and with definite diagnostic criteria, still remains misdiagnosed because of the overlap presentation with other inflammatory processes. The authors present the case of a 13-year-old girl who was submitted to an appendicectomy complicated with a pericolic abscess, which required a second operation in order to be drained surgically. During the postoperative period of this second surgical procedure, the patient remained febrile, developing cytopenias, and multiple organ failure. Unfortunately, she died despite the efforts of the intensive care. The autopsy findings were characteristic of hemophagocytic syndrome. The authors report the case to call attention to this diagnosis whenever unexpected outcomes of infections are experienced

Carbapenem stewardship: positive impact on hospital ecology

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility

Menor incidência de hipoglicemia noturna com o uso de insulina lispro comparada à insulina humana regular no tratamento de pacientes com diabetes do tipo 1

Insulin lispro is a human insulin analog of rapid onset of action and duration, which mimics the physiological insulin profile after a meal. We have evaluated the safety and efficacy of lispro insulin in comparison with human regular insulin in a crossover, multicenter, randomized trial in 25 type 1 diabetic patients in use of human NPH and regular insulin (median age = 16 years). After administration of lispro or regular insulin for 2 months, the patients were transferred for the other insulin for two more months, maintaining the basal NPH insulin regimen. There was no difference in the postprandial glucose excursion and glycated hemoglobin A1c comparing the 2 groups (lispro and regular). The relative percentage decrease in glycemia was significantly greater with lispro insulin after lunch, in the first phase of the study (p<0.02). The total number of hypo-glycemic episodes was not different comparing both groups. However, there was a significant difference in the nocturnal hypoglycemia incidence with initial administration of lispro (p<0.05). With initial administration of regular insulin, there was an increase in the incidence of nocturnal hypoglycemia (p=0.038), with a subsequent reduction of hypoglycemia with insulin lispro (p=0.04). In the end of the study, 68% of the patients referred preference and better feeling with lispro, compared to regular insulin. Insulin lispro was a safe and efficacious option, with lower incidence of nocturnal hypoglycemia in type 1 diabetics. An optimization of the basal insulin regimen is necessary to improve glucose control with the use of rapid-action insulin.Insulina lispro é um análogo da insulina humana de ação e duração rápida, que mimeíiza o perfil fisiológico da insulina após uma refeição. Avaliamos a segurança e eficácia da insulina lispro em comparação com a insulina humana regular em um estudo multicêntrico, randomizado e cruzado em 27 diabéticos tipo 1 em uso de insulina humana NPH e regular (idade mediana = 16 anos). Após uso de insulina lispro ou regular por 2 meses, fez-se a transferência para a outra insulina por mais 2 meses mantendo-se a insulina NPH basal. Não houve diferença em relação à excursão prandial da glicemia da hemoglobina glicosilada A1C, comparando-se os 2 grupos (lispro e regular). O decréscimo percentual relativo da glicemia foi significantemente maior com insulina lispro no período do almoço, na primeira fase do estudo (p<0,02). O número total de episódios hipoglicêmicos não foi diferente, comparando os 2 grupos. Houve, porém, uma redução significante na incidência de hipoglicemia noturna e na madrugada com o uso inicial de lispro (p<0,05). Com o uso inicial de insulina regular, houve incremento na incidência de hipoglicemia noturna (p=0,038), com redução posterior na incidência da hipoglicemia com insulina lispro (p=0,04). Ao final do estudo, 68% dos pacientes referiram preferência e maior comodidade com insulina lispro em relação à insulina regular. A insulina lispro se mostrou uma opção segura e eficaz, com menor incidência de hipoglicemia noturna em diabéticos tipo 1. Uma otimização do regime de insulina basal é necessária para melhora do controle glicêmico, quando em uso de uma insulina de ação rápida.Universidade Federal do CearáUniversidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)Laboratório Eli Lilly do BrasilUNIFESPSciEL

Efeito de um programa de treinamento funcional no equilíbrio postural de idosas da comunidade

Functional training programs may help reduce elderly disabilities, falls, and emotional and social problems. The aim of this study was to assess the impact of an eight-week functional exercise program on aged women's instrumental activities of daily living (IADL) and one-foot stance balance. Irrespective of race and/or social condition, 7 community-dwelling elderly women (aged 71±8.1) were selected, being excluded those with cognitive impairment, acute or neurological diseases, spine or joint pain, labyrinth inflammatory disease, visual impairment, fractures in the previous year, and use of gait aid. All subjects were assessed by the Lawton IADL scale and the one-foot stance balance test, before and after the program. Exercises were performed three times a week and consisted of gait exercises in plantar flexion, dorsiflexion, alternation of sustained one-foot stance, sideways gait, gait with increased hip flexion, and tandem gait. Results show a functional improvement in IADL (p=0.042) as measured by the Lawton scale, and a trend towards better static one-foot stance balance, though not significant (p>;0.105). The proposed program of functional exercises may thus be said to bring about improvement in older women's functional performance and a trend towards improvement on static balance, suggesting its relevance to increase elderly women's autonomy.Programas de treino funcional podem colaborar na redução de incapacidades, quedas, problemas emocionais e sociais em idosos. O objetivo do estudo foi verificar o efeito de um programa de oito semanas de exercícios funcionais em idosas da comunidade, avaliando o impacto nas atividades instrumentais de vida diária (AIVD) e no equilíbrio unipodálico. Deste estudo quasi-experimental participaram sete idosas da comunidade (71±8,1 anos), sem distinção de raça e/ ou condição social, excluindo-se aquelas com alterações cognitivas, doenças agudizadas ou neurológicas, quadro álgico na coluna ou articulações, labirintite, distúrbios visuais não-compensados, fratura prévia no último ano e utilização de apoio para a marcha. Todas responderam ao questionário de Lawton e se submeteram ao teste de apoio unipodálico antes e depois do programa, administrado três vezes por semana. O programa consistia em exercícios de marcha em flexão plantar, dorsiflexão, permanência em alternância de apoio unipodálico, marcha lateral com flexão de quadril aumentada e marcha tandem. Os resultados indicam melhora (p=0,042) no nível funcional (índice de Lawton) após o programa e uma tendência à melhora no equilíbrio unipodálico, embora não-significante (p>;0,105). O programa de exercícios proposto produziu pois melhora no desempenho das AIVD e uma tendência à melhora do equilíbrio estático, sugerindo ser relevante para aprimorar a autonomia das idosas

Effect of Basic Promoters on Porous Supported Alumina Catalysts for Acetins Production

A facile strategy for the design of porous supports was obtained by modifying the sol-gel method followed by the wet impregnation technique. In this respect, herein, the acidity of the γ-Al2O3 phase was modulated by adding basic MgO, La2O3 or ZnO promoters to form binary supported catalysts. The Ni and Co dispersion on the supports associated with their tunable acidity and morphologies resulted in highly porous supported alumina-based catalysts. The physicochemical properties of the solids were comprehensively investigated by XRD, textural properties, Raman and FTIR spectroscopy, SEM-EDS, TEM, EPR and XPS analyses. The catalytic performances in the esterification of glycerol in the presence of acetic acid (EG) for the acetins production were evaluated. The highly dispersed NiO and Co3O4 active species on binary porous supports produced synergistic effects appearing to be the reason for the activity of the solids in the EG reaction. Under the optimized reaction conditions, NiCo/MgO-Al2O3 was found to be a robust solid with superior catalytic performance and improved stability in four reaction cycles with 65.0% of glycerol conversion with an exclusive selectivity of 53% for triacetin. The presence of Co2+/Co3+ and Ni2+ strongly interacting with the spinel γ-Al2O3 and MgAl2O4 phases, the latter having a large number of lattice oxygen species, was considered another active component besides those of Ni and Co in the esterification of glycerol.This work is supported by Funcap (Grant n° PS1-0186-00346.01.00/21). Financial assistance received from Ministerio de Ciencia e Innovación, Junta de Andalucía and FEDER is also thankfully acknowledged for funding project n° PID2021-126235OB-C32, UMA18-FEDERJA-126 and P20_00375. Partial funding for open access charge: Universidad de Málag