Adequação ao modelo de negócio sustentável: um estudo de caso na pousada Mar de Jurerê Ltda

TCC (graduação) - Universidade Federal de Santa Catarina, Centro Sócio Econômico, Curso de Administração.Este estudo objetiva analisar a situação empresa estudada e propor mudanças buscando atingir a sustentabilidade do negócio, agregando diferenciais competitivos com base no desenvolvimento sustentável. Para tal foi realizado um estudo descritivo intervencionista, com a coleta de dados baseada em análise documental, entrevistas não estruturadas e observação participante, no intuito de avaliar os processos realizados em todos os setores da pousada Mar de Jurerê, propondo mudanças na dinâmica organizacional, com o foco na eficiência econômica aliada a eficácia ambiental. 0 estudo identifica padrões em um negócio sustentável, que servem como base para o planejamento, procedimentos gerenciais e operacionais da empresa. Isto resulta em uma série de mudanças físicas estruturais baseadas em novas tecnologias e uma forte mudança na cultura da empresa, com valores voltados para o controle de resultados financeiros e disseminação da consciência ambiental. Desta forma, se constatou uma maior estabilidade na gestão de um negócio sustentável, com a implantação de um sistema integrado de gestão para auxilio à tomada de decisão e otimização dos processos gerenciais e produtivos, foram reduzidas as vulnerabilidades tanto na questão financeira quanto ambiental, obtendo um resultado mais limpo e perene

Educomunicação e alfabetização midiática: conceitos, práticas e interlocuções

O livro organizado por Ismar de Oliveira Soares, Claudemir Edson Viana e Jurema Brasil Xavier apresenta uma série de artigos sobre o tema divididos em quatro partes: 1-Atualizando conceitos e práticas; 2-A educação midiática em diálogo com o currículo escolar; 3-A Educomunicação em interlocução com as políticas públicas; e, 4-A Educomunicação em interlocução com as políticas públicas. A obra dedica seus 24 artigos especificamente aos saberes e às práticas inerentes ao tema da alfabetização midiática. Numa perspectiva multidisciplinar, os leitores aqui encontrarão experiências alimentadas tanto pelos referenciais da mídia-educação quanto pelo paradigma da Educomunicação, que emerge dos movimentos sociais da América Latina, na confluência entre a comunicação alternativa e a educação popular freiriana, a partir dos anos de 1960 e 1970

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Contaminação bacteriana da bile após colédoco-duodenostomia com ou em ligadura da ampola hepatopancreática

As atuais controversias, sobre a coledoco-duodenostomia latero-lateral (CD L-L), estao relacionadas com as possiveis complicacoes tardias, principalmente a sindrome do coto coledocociano distal. Alem de se evitar a estenose da anastomose, a perviedade da ampola hepatopancreatica, parece ser fator importante na prevencao do aparecimento das complicacoes infecciosas apos CD-LL. Para avaliar qual a importancia da perviedade do coledoco distal na contaminacao bacteriana da via biliar principal apos CD-LL foram utilizados 21 caes adultos, da raca Beagle, fornecidos pelo Bioterio da (UFSC). Os animais foram divididos em 3 grupos, com 7 caes cada: Grupo 1 (controle) - Colecistectomia e cateterizacao do coledoco atraves do cistico. Grupo 2 - Coledoco-duodenostomia latero-lateral e colecistectomia com cateterizacao do coledoco atraves do cistico. Grupo 3 - Coledoco-duodenostomia latero-lateral, oclusao da ampola hepatopancreatica e colecistectomia com cateterizacao do coledoco atraves do cistico. Com 15, 30, e 60 dias os animais foram submetidos a estudos microbiologicos e colangiograficos. Os resultados mostraram que o modelo proposto para realizacao da CD-LL em caes, sem dilatacao previa da via biliar e viavel e nao determina estenose da anastomose. Ocorreu uma dilatacao do coledoco maior nos grupo 2 e 3 em relacao ao grupo 1, mas todas as anastomoses eram pervias. A CD-LL em caes levou ao aumento progressivo da contaminacao bacteriana da bile. Foram identificadas as bacterias Escherichia coli (53,2 %), Klebsiela (21,3 %), Enterococcus (13 %), Proteus (8,5 %) e Streptococcus fecalis (4 %). A oclusao da ampola hepatopancreatica aumenta a contaminacao bacteriana da bileThe today controversy about the side-to-side choledochoduodenostomy (CDD L-L) is relationed with the possible later complications, principally the sump syndrome. Besides avoiding the stenosis of the anastomosis, the patency of the terminal common bile duct, seems to be a very important factor in preventing the appearance of infection complications after the CDD L-L. Twenty-one full-blooded beagle family adult male dogs, were used to evaluate the importance of the patency of the terminal common bile duct in the bacterial contamination of the main bile ducts after CDD L-L. The animals were divided in 3 groups of 7 dogs each: Group 1 (Control) - cholecystectomy and drainage of the common bile duct by the cystic duct. Group 2 – side-to-side choledochoduodenostomy e cholecystectomy with drainage of the common bile duct by the cystic duct. Group 3 – side-to-side choledochoduodenostomy, occlusion of the terminal common bile duct and cholecystectomy with drainage of the common bile duct by the cystic duct. The animals were submitted to microbiological and roentgenographic studies in 15, 30 and 60 days. The results showed that the proposed model to the realization of the CDD L-L in dogs, without the prior dilatation of the common bile duct is passable and does not determines estenose of the anastomosis. A dilatation of the major common bile duct occurred in-groups 2 and 3 in relation to group 1, but all the anastomosis were pervious. The CDD L-L in dogs developed a progressive increase in the contamination of the bile. The bacteriologic studies identified Escherichia coli (53,2 %), Klebsiella sp. (21,3 %), Enterococcus sp. (13 %), Proteus sp. (8,5 %) and Streptococcus fecalis (4%). The occlusion of the distal common bile duct increased the bacterial contamination of the bile.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BV UNIFESP: Teses e dissertaçõe

Avaliação da maturidade pulmonar fetal pela contagem dos corpos lamelares no líquido amniótico Evaluation of fetal lung maturity by lamellar bodies counting in amniotic fluid

OBJETIVO: comparar o teste de contagem de corpos lamelares (CCL) no líquido amniótico com o teste da polarização fluorescente (PF) como parâmetro diagnóstico para avaliação da maturidade pulmonar fetal. MÉTODO: estudo transversal, analítico e controlado realizado com 60 gestantes atendidas no período de março de 2002 a dezembro de 2007. Foram colhidas amostras de líquido amniótico e realizados os testes de CCL e PF (TDxFLM II), considerados de referência, e comparados à presença ou ausência da Síndrome do Desconforto Respiratório (SDR). Foram estabelecidos valores de corte para maturidade de 30 mil corpos lamelares/µL para o teste da CCL e 55 mg/g de albumina para o PF. Foram avaliadas as características maternas e perinatais, a evolução neonatal e o desempenho dos testes diagnósticos para predição da maturidade pulmonar fetal. Na análise estatística, foram utilizadas medidas descritivas e calculados os valores referentes à sensibilidade, especificidade, valor preditivo positivo e negativo dos testes, considerando-se significativos valores de p<0,05. RESULTADOS: a idade materna variou entre 15 e 43 anos, com média de 26,6 anos. A idade gestacional variou entre 24,3 e 41,6 semanas, com média de 35,1 semanas. A Síndrome do Desconforto Respiratório foi diagnosticada em 13,3% dos neonatos. As características perinatais, como peso, índice de Apgar, incidência de SDR, foram comparadas aos resultados dos testes de CCL e PF, sendo observada uma correspondência, estatisticamente significativa (p<0,05), entre os grupos de neonatos clinicamente classificados como imaturos e maduros em ambos os testes. Os testes foram concordantes em 68,3% dos casos. Quando se comparou o teste da PF com o teste da CCL, a sensibilidade foi de 100% para ambos, e a especificidade do teste da CCL foi superior (73,1%), quando comparado com o teste de PF (51,9%). O padrão-ouro para determinação da maturidade fetal é a ocorrência da SDR. O valor preditivo positivo do teste da CCL foi superior (36,4%) quando comparado ao teste da PF (24,2%) (p<0,05), sendo que o valor preditivo negativo foi de 100% para ambos os testes. CONCLUSÕES: este estudo demonstrou que o teste da CCL apresenta 100% de sensibilidade e especificidade superior ao teste de referência (PF). Além disso, a CCL é considerada um teste rápido, acessível, barato e factível em nossa realidade, podendo ser utilizado como teste confiável na predição da maturidade pulmonar fetal.<br>PURPOSE: to compare the lamellar body number density (LBND) count in amniotic fluid using the fluorescent polarization (FP) test as a diagnostic parameter for the assessment of fetal pulmonary maturity. METHOD: this was an analytical, controlled cross-sectional study conducted on 60 pregnant women from March 2002 to December 2007. Amniotic fluid specimens were obtained by amniocentesis or at the time of caesarean section, and submitted to the LBND and FP tests (TDxFLM®, Abbott Laboratories), the latter considered to be a reference test, and compared in terms of the presence or absence of respiratory distress syndrome (RDS). Cut-off values for maturity were established at 30,000 lamellar bodies/µL for the LBND test and 55 mg/g albumin for the FP test. Maternal and perinatal characteristics and neonatal evolution were evaluated, and the performance of the diagnostic tests regarding fetal pulmonary maturity was determined. In the statistical analysis, descriptive measures were used and the sensitivity, specificity and positive and predictive values of the tests were determined with the level of significance set at p<0.05. RESULTS: maternal age ranged from 15 to 34 years (mean: 26.6 years) and gestational age ranged from 24.3 to 41.6 weeks (mean: 35.1 weeks). RDS was diagnosed in 35.1% of neonates. Perinatal characteristics such as weight, Apgar score, and RDS incidence were compared to the results of the LBND and FP tests and a significant correspondence (p<0.05) was observed between the groups of neonates clinically classified as mature and immature in both tests. The tests were concordant in 68.3% of the cases. Comparison of the PF and LBND tests revealed 100% specificity for both and a higher specificity for the LBND test (73.1% as opposed to 51.9% for the PF test). The gold standard for the determination of fetal maturity is the occurrence of RDS. The positive predictive value of the LBND test was higher (36.4%) than that of the FP test (24.2%) (p<0.05) and the negative predictive value was 100% for both tests. CONCLUSIONS: the present study demonstrated that the LBND test has 100% sensitivity and higher specificity than the reference test (FP). In addition, the LBND test is considered to be rapid, accessible, inexpensive and feasible for the Brazilian reality, and it can be used as a reliable test for the prediction of fetal pulmonary maturity