Proposta de estratégia de implantação da filosofia Lean em hospitais

TCC(graduação) - Universidade Federal de Santa Catarina. Centro Tecnológico. Engenharia de ProduçãoApesar do pensamento Lean ter suas origens na manufatura, com o tempo ele foi expandindo para diferentes setores, visando adquirir os resultados advindos da implementação. Neste cenário, iniciaram-se relatos de aplicações enxutas nos ambientes hospitalares. Contudo, a grande maioria das aplicações focaram em objetivos operacionais, e não possuem visão sistemática, limitando seu desempenho. Logo, o objetivo deste trabalho é propor uma estratégia de implantação da filosofia Lean para hospitais, de modo a caracterizar os fatores facilitadores a uma jornada sustentável a longo prazo. Por meio de uma revisão sistemática da literatura, propõe-se um quadro com 23 obstáculos identificados e categorizados a partir das práticas enxutas em hospitais. Em seguida, foi desenvolvido um mapa mental de forma a sintetizar fatores facilitadores identificados nestas aplicações, contribuindo para o desenvolvimento da estratégia proposta. Posteriormente, foram realizadas entrevistas semiestruturadas com especialistas de modo a validar na prática os estudos desenvolvidos e adquirir críticas perante a estratégia exposta. Por fim a pesquisa também aponta sinergias entre a estratégia elaborada e o método do fluxo de valor desenvolvido pelo Lean InstituteDespite the fact that Lean thinking has its origins in manufacturing, over time it has been expanding to different sectors, aiming to acquire the results of implementation. In this scenario, reports of lean applications in hospital environments began. However, the vast majority of applications focused on operational objectives, and do not have a systematic view, limiting their performance. Therefore, the objective of this research is to propose a a strategy for implementing the Lean philosophy in hospitals, in order to characterize the factors that facilitate a long-term sustainable journey. Through a systematic review of the literature, a table with 23 obstacles identified and categorized based on lean practices in hospitals is proposed. Then, a mind map was developed in order to synthesize the facilitating factors identified in these applications, contributing to the development of the proposed strategy. Subsequently, semi-structured interviews were carried out with specialists in order to validate in practice the studies developed and acquire criticism regarding the exposed strategy. Finally, the research also points out synergies between the elaborated strategy and the value flow method developed by the Lean Institute

Analyzing complexities in the Brazilian soybean supply chain: a systems thinking and modeling approach

Purpose This study aims to analyze the complexities of the Brazilian soybean supply chain (SSC) and develop strategic interventions to improve the origin system’s performance. Design/methodology/approach This study used stakeholder interviews to identify the SSC bottlenecks and determine and assess drivers of competitiveness. A methodological framework based on the systems thinking approach for developing long-term structural changes was used. The problem was structured using behavior over time graph and causal loop modeling to propose three investment strategies to solve the logistics problem in SSC. Findings This study highlights the gaps in coordination between stakeholders and the public sector regarding the public policy for infrastructure investment. Three strategic interventions were developed to address the agro-industrial logistical problem, namely, investment in storage, multimodal transport systems and improvements in existing transport infrastructure. To overcome transport and storage logistics limitations, the authors suggest different forms of partnerships, including public-private partnerships. Research limitations/implications This research is limited to evaluating an agricultural commodity (soybean) and does not include its by-products. The sample of stakeholders was limited and the boundary of analysis was Brazil. Nevertheless, the study showed how strategic interventions could be developed following a holistic analysis. Practical implications The proposed integrated approach illustrates the development of three strategic initiatives. It can be implemented by stakeholders, including the public sector, which is the basis for providing assertive long-term investments in Brazilian logistics. Social implications The SSC analysis could promote the implementation of systemically determined interventions and strategies. It could significantly improve the performance of agricultural systems and help the formulation of public policies aimed at rural development. Originality/value The use of system dynamics to identify intervention points is an essential contribution to mitigating the SSC’s hindrances. Moreover, the combining methodologies resulted in comprehensive intervention strategies

Major cellular and molecular processes and clinical outcomes in bone regeneration for successful dental implantation: a systematic review

Introduction: In the context of bone regeneration, bone defects still represent a major challenge in oral and maxillofacial clinical and surgical treatment. The biomimetic design of biomaterials by simulating the natural structure and composition of bone tissue has gradually become a point of research interest due to its advantages of simplicity and efficiency. Objective: It was to carry out a systematic review on cellular and molecular processes, as well as to present the main clinical approaches of bone regeneration for dental implants. Methods: The present study followed a systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 142 articles were found. A total of 84 articles were fully evaluated and 33 were included in this study. Literary findings have shown that the lack of bone in the alveolar ridges has been a major problem in functional aesthetic recovery in patients who have suffered dentoalveolar trauma. The osteoinduction process is influenced by several factors, requiring the presence of inducers, which include β-glycerolphosphate, ascorbic acid, and dexamethasone. Mesenchymal stem cells acquire the morphology and components of osteoblastic membranes and begin to express alkaline phosphatase to deposit extracellular matrix rich in calcium and certain proteins, such as osteopontin and osteocalcin. The Bio Oss® (Geistlich) biomaterial, because it is biodegradable, biocompatible, non-toxic, and has low immunogenicity and bio stimulators, can act in the regeneration of bone tissue. Application of FRP and implant placement provides stable clinical results for severely atrophic maxilla 2-4 mm. Bovine xenograft alone and in combination with liquid FRP are both successful in achieving bone augmentation around implants and produce a small change in marginal bone level and a high implant survival rate after loading. Conclusion: Through the results of the present study, it was evidenced that the success of the dental implant is directly related to successful osseointegration

Modelos de negócio e vantagem competitiva: uma abordagem dinâmica

Objective: Demonstrate how the Canvas business model can become dynamic from a conceptual perspective. Methodology/approach: This study is qualitative, descriptive and exploratory, with a theoretical approach, based on the foremost theorists. Originality /Relevance: This study presupposes the importance of strengthening the business model literature on the competitive dynamic perspective. It defines the assumptions of a DMB and differentiates it from a static model. That enables the evaluation of the factors that cause a BMC to become static and thus not equipped to allow a business logic that creates value and generates a competitive advantage. Main results: At the end of the present essay, it is possible to understand, from a theoretical perspective, how the DBM contributes to value creation and the generation of sustainable advantage in high-change environments. Theoretical/methodological contributions: The present study has identified three conceptual assumptions that constitute the DBM. First, there is the design of the business models – interdependence and connection between their constitutive elements. Second, the business models linked to dynamic capabilities. Finally, the search for the capture of value and generation of sustainable competitive advantages by the companies. By those assumptions, it was possible to introduce a conceptual model for DBM and BMC evaluation from the perspective of a dynamic model.Objetivo: Demostrar cómo el modelo de negocio Canvas puede convertirse en dinámico desde una perspectiva conceptual. Metodología / enfoque: El presente estudio es de naturaleza cualitativa, descriptiva y exploratoria, con enfoque teórico, basada en los principales teóricos. Originalidad / Relevancia: Este estudio presupone el fortalecimiento de la literatura de modelo de negocio en la perspectiva de la competitividad dinámica. Se define el modelo de negocio dinámico y lo diferencia de un modelo estático. Esto permite evaluar los factores que hacen que un modelo de negocio se vuelva estático y, por lo tanto, no esté preparado para una lógica de negocios que crea valor y genere una ventaja competitiva. Principales resultados: Al final del ensayo, fue posible entender, desde una perspectiva teórica, que el Modelo de Negocio Dinámico contribuye a la creación de valor y la generación de ventaja sostenible en ambientes de alto cambio. Contribuciones teórico-metodológicas: El presente estudio identificó tres supuestos conceptuales que constituyen el modelo de negocio dinámico. Primero, el diseño de los modelos de negocios - interdependencia y conexión entre sus elementos constitutivos. En segundo lugar, los modelos de negocio vinculados a las capacidades dinámicas. Y por último, la búsqueda por la captura de valor y la generación de ventajas competitivas sostenibles por las empresas. A partir de estas conclusiones, fue posible evaluar el modelo de negocio Canvas en la perspectiva de un modelo dinámico. Palabras clave: Modelos de Negocio; Ventaja Competitiva; Canvas; Enfoque DinámicoObjetivo: Demonstrar como o modelo de negócio Canvas pode se tornar dinâmico a partir de uma perspectiva conceitual. Metodologia / abordagem: Este estudo é de natureza qualitativa, descritiva e exploratória, com abordagem teórica, baseada nos principais teóricos. Originalidade / Relevância: Este estudo pressupõe o fortalecimento da literatura de modelo de negócio na perspectiva da competitividade dinâmica. Ele define modelo de negócio dinâmico e o diferencia de um modelo estático. Isso permite avaliar os fatores que fazem com que um modelo de negócio se torne estático e, portanto, não esteja preparado para uma lógica de negócios que crie valor e gere vantagem competitiva. Principais resultados: No final do ensaio, foi possível entender, a partir de uma perspectiva teórica, que o Modelo de Negócio Dinâmico contribui para a criação de valor e a geração de vantagem sustentável em ambientes de alta mudança. Contribuições teórico-metodológicas: Este estudo identificou três pressupostos conceituais que constituem o modelo de negócio dinâmico. Primeiro, o desenho dos modelos de negócios - interdependência e conexão entre seus elementos constitutivos. Em segundo lugar, os modelos de negócios ligados a capacidades dinâmicas. E por fim, a busca pela captura de valor e geração de vantagens competitivas sustentáveis pelas empresas. A partir dessas conclusões, foi possível avaliar o modelo de negócio Canvas na perspectiva de um modelo dinâmico.Palavras-chave: Modelos de negócio; Vantagem Competitiva; Canvas; Abordagem Dinâmic

Watertightness of wound closure in lumbar spine-a comparison of different techniques

Background: Since a primary watertight dural suture after incidental durotomies has a failure rate of 5-10%, a watertight closure technique of the overlying layers (fascia, subcutis and skin) is essential. The purpose of this cadaveric study was to find the most watertight closure technique for fascia, subcutis and skin. Methods: Different suturing techniques were tested for each layer in a sheep cadaveric model by measuring the leakage pressure. The specimens were mounted on a pressure chamber connected to a manometer and a water tube system. Subsequently, the leakage was over-sewed with a cross stitch and the experiment was repeated. Results: Cross stitch suturing [median =180 mbar (43; 660)] performed best compared to continuous [median =16 mbar (6; 52)] (P=0.003) but not to single knot [median =118 mbar (21; 387)] (P=1.0) or locking stitch suturing [median =109 mbar (3; 149)] (P=0.93) for fascia closure. Continuous suture [median =9 mbar (3; 14)] resulted in a higher leakage pressure than single knot [median =1 mbar (1; 6)] (P=0.017) for subcutaneous closure. No significant differences were found between intracutaneous, Donati-continuous, single knot and locking stitch for skin closures (P=0.075). However, the Donati-continuous stitch closure resulted in higher pressures in tendency. Over-sewing increased median leakage pressure from 8.0 to 11.0 mbar (P=0.068) and from 4.0 to 13.0 mbar (P=0.042) for single knot and for locking stitch skin closures, respectively. Conclusions: Cross stitches for the fascia, continuous suturing technique for the subcutis and Donati-continuous stitch for the skin resulted in the most watertight closure within this experimental setting. If leakage occurs, over-sewing might relevantly improve the watertightness of the wound

Portal Vein Thrombosis and Thrombocytopenia in Eosinophilic Granulomatosis with Polyangiitis: A Paradox?

A 36-year-old woman with eosinophilic granulomatosis with polyangiitis (EGPA) presented with necrotic skin lesions and pulmonary infiltrates. There was eosinophilic vasculitis on skin biopsy, and substantial tissue eosinophilia in her bone marrow. She had unexplained worsening thrombocytopenia, which prompted a thrombophilia work-up. However, abnormalities in liver enzymes led to the extraordinary finding of portal vein thrombosis. Thrombocytopenia resolved with treatment with low molecular weight heparin. This case highlights the risk of hypercoagulability in eosinophilia specifically, and in EGPA. We suggest that thrombosis should be ruled out in all cases of EGPA

Enzimatic polycondensation of 1,4-butanediol and diethyl succinate

Please click Additional Files below to see the full abstrac

Perda de glicosaminoglicanas da cartilagem após ruptura do ligamento cruzado anterior: influência do tempo de ruptura e da lesão condral

OBJECTIVE: To quantify the concentration of sulfated glycosaminoglycans (GAGs) concentration in the synovial fluid (SF) of knees with chronic anterior cruciate ligament (ACL) rupture and to identify possible associations between GAG concentration in SF and the time elapsed since rupture and degree of chondral injury. METHOD: Fourteen adult male subjects with total unilateral ACL rupture, which had occurred between 5 and 144 months earlier, were assessed. All subjects underwent joint aspiration; it was possible to collect SF from ten individuals. The samples were quantified to determine the GAG concentration using dimethylmethylene blue (DMMB) staining. The degree of chondral injury was macroscopically evaluated using the modified Mankin histological scale. Spearman correlation test (< 0.05) was used to evaluate the association between GAG concentration and chondral injury, and Pearson correlation test (< 0.05) was used to evaluate the association between GAG concentration and the time elapsed since rupture. RESULTS: The GAG concentration in SF showed a mean variation of 73.84 ± 40.75 µg/ml, with a mean time of 40.4 ± 40.3 months since the rupture. There was no correlation between GAG concentration and time since the rupture (r= -0.09, p= 0.81). The chondral injury grades found were 0, 1, 4 and 5. There was no correlation between chondral injury grade and GAG concentration in SF (r= -0.41, p= 0.24). CONCLUSION: After at least 5 months, the GAG concentration in SF from knees with ACL rupture is independent of the time elapsed since rupture and/or the severity of chondral injury.OBJETIVO: Quantificar a concentração de glicosaminoglicanas sulfatadas (GAGs) no líquido sinovial (LS) de joelhos com ruptura crônica do ligamento cruzado anterior (LCA) e identificar uma possível correlação entre a concentração de GAGs no LS e o tempo pós-ruptura e grau de lesão condral. MÉTODOS: Foram avaliados 14 indivíduos adultos do sexo masculino com ruptura total unilateral do LCA, ocorrida entre cinco a 144 meses. Todos os sujeitos foram puncionados, sendo possível a coleta de LS em dez indivíduos. As amostras foram quantificadas para determinar a concentração de GAGs usando a coloração azul de dimetilmetileno, método descrito por Farndale21. O grau de lesão condral foi macroscopicamente avaliado pela escala histológica de Mankin modificada por Messner14. As correlações entre concentração de GAGs e lesão condral foram feitas pelo teste de correlação de Sperman (p< 0,05) e a concentração de GAGs e tempo pós-ruptura pelo teste de correlação de Pearson (p< 0,05). RESULTADOS: Concentração de GAGs no LS apresentou variação média de 73,84 ± 40,75µg/mL, sendo o tempo médio pós-ruptura de 40,4 + 40,3 meses. Não houve correlação entre concentração de GAGs e o tempo pós-ruptura (r= -0,09, p= 0,81). Os graus de lesão condral encontrados foram de 0, 1, 4 e 5. Não houve correlação entre grau de lesão condral e a concentração de GAGs no LS (r= -0,41, p= 0,24). CONCLUSÕES: Após no mínimo cinco meses, a concentração de GAGs no LS de joelhos com ruptura do LCA independe do tempo pós-ruptura e/ou do grau de lesão condral.Universidade Federal de São Carlos Department of PhysiotherapyUniversidade Federal de São Carlos Department of Morphology and PathologyUniversidade Federal de São Paulo (UNIFESP) Department of Orthopedics and TraumatologyUniversidade Estadual de Campinas Department of Cell BiologyUNIFESP, Department of Orthopedics and TraumatologySciEL

Cloning approach and functional analysis of anti-intimin single-chain variable fragment (scFv)

<p>Abstract</p> <p>Background</p> <p>Intimin is an important virulence factor involved in the pathogenesis of enteropathogenic <it>Escherichia coli </it>(EPEC) and enterohemorrhagic <it>Escherichia coli </it>(EHEC). Both pathogens are still important causes of diarrhea in children and adults in many developing and industrialized countries. Considering the fact that antibodies are important tools in the detection of various pathogens, an anti-intimin IgG2b monoclonal antibody was previously raised in immunized mice with the conserved sequence of the intimin molecule (int_388-667). In immunoblotting assays, this monoclonal antibody showed excellent specificity. Despite good performance, the monoclonal antibody failed to detect some EPEC and EHEC isolates harboring variant amino acids within the 338-667 regions of intimin molecules. Consequently, motivated by its use for diagnosis purposes, in this study we aimed to the cloning and expression of the single-chain variable fragment from this monoclonal antibody (scFv).</p> <p>Findings</p> <p>Anti-intimin hybridoma mRNA was extracted and reversely transcripted to cDNA, and the light and heavy chains of the variable fragment of the antibody were amplified using commercial primers. The amplified chains were cloned into <it>pGEM-T Easy </it>vector. Specific primers were designed and used in an amplification and chain linkage strategy, obtaining the scFv, which in turn was cloned into pAE vector. <it>E. coli </it>BL21(DE3)pLys strain was transformed with pAE scFv-intimin plasmid and subjected to induction of protein expression. Anti-intimin scFv, expressed as inclusion bodies (insoluble fraction), was denatured, purified and submitted to refolding. The protein yield was 1 mg protein per 100 mL of bacterial culture. To test the functionality of the scFv, ELISA and immunofluorescence assays were performed, showing that 275 ng of scFv reacted with 2 mg of purified intimin, resulting in an absorbance of 0.75 at 492 nm. The immunofluorescence assay showed a strong reactivity with EPEC E2348/69.</p> <p>Conclusion</p> <p>This study demonstrated that the recombinant anti-intimin antibody obtained is able to recognize the conserved region of intimin (Int_388-667) in purified form and the EPEC isolate.</p

Modelos de negócio e vantagem competitiva: uma abordagem dinâmica

Objective: Demonstrate how the Canvas business model can become dynamic from a conceptual perspective. Methodology/approach: This study is qualitative, descriptive and exploratory, with a theoretical approach, based on the foremost theorists. Originality /Relevance: This study presupposes the importance of strengthening the business model literature on the competitive dynamic perspective. It defines the assumptions of a DMB and differentiates it from a static model. That enables the evaluation of the factors that cause a BMC to become static and thus not equipped to allow a business logic that creates value and generates a competitive advantage. Main results: At the end of the present essay, it is possible to understand, from a theoretical perspective, how the DBM contributes to value creation and the generation of sustainable advantage in high-change environments. Theoretical/methodological contributions: The present study has identified three conceptual assumptions that constitute the DBM. First, there is the design of the business models – interdependence and connection between their constitutive elements. Second, the business models linked to dynamic capabilities. Finally, the search for the capture of value and generation of sustainable competitive advantages by the companies. By those assumptions, it was possible to introduce a conceptual model for DBM and BMC evaluation from the perspective of a dynamic model.Objetivo: Demostrar cómo el modelo de negocio Canvas puede convertirse en dinámico desde una perspectiva conceptual. Metodología / enfoque: El presente estudio es de naturaleza cualitativa, descriptiva y exploratoria, con enfoque teórico, basada en los principales teóricos. Originalidad / Relevancia: Este estudio presupone el fortalecimiento de la literatura de modelo de negocio en la perspectiva de la competitividad dinámica. Se define el modelo de negocio dinámico y lo diferencia de un modelo estático. Esto permite evaluar los factores que hacen que un modelo de negocio se vuelva estático y, por lo tanto, no esté preparado para una lógica de negocios que crea valor y genere una ventaja competitiva. Principales resultados: Al final del ensayo, fue posible entender, desde una perspectiva teórica, que el Modelo de Negocio Dinámico contribuye a la creación de valor y la generación de ventaja sostenible en ambientes de alto cambio. Contribuciones teórico-metodológicas: El presente estudio identificó tres supuestos conceptuales que constituyen el modelo de negocio dinámico. Primero, el diseño de los modelos de negocios - interdependencia y conexión entre sus elementos constitutivos. En segundo lugar, los modelos de negocio vinculados a las capacidades dinámicas. Y por último, la búsqueda por la captura de valor y la generación de ventajas competitivas sostenibles por las empresas. A partir de estas conclusiones, fue posible evaluar el modelo de negocio Canvas en la perspectiva de un modelo dinámico. Palabras clave: Modelos de Negocio; Ventaja Competitiva; Canvas; Enfoque DinámicoObjetivo: Demonstrar como o modelo de negócio Canvas pode se tornar dinâmico a partir de uma perspectiva conceitual. Metodologia / abordagem: Este estudo é de natureza qualitativa, descritiva e exploratória, com abordagem teórica, baseada nos principais teóricos. Originalidade / Relevância: Este estudo pressupõe o fortalecimento da literatura de modelo de negócio na perspectiva da competitividade dinâmica. Ele define modelo de negócio dinâmico e o diferencia de um modelo estático. Isso permite avaliar os fatores que fazem com que um modelo de negócio se torne estático e, portanto, não esteja preparado para uma lógica de negócios que crie valor e gere vantagem competitiva. Principais resultados: No final do ensaio, foi possível entender, a partir de uma perspectiva teórica, que o Modelo de Negócio Dinâmico contribui para a criação de valor e a geração de vantagem sustentável em ambientes de alta mudança. Contribuições teórico-metodológicas: Este estudo identificou três pressupostos conceituais que constituem o modelo de negócio dinâmico. Primeiro, o desenho dos modelos de negócios - interdependência e conexão entre seus elementos constitutivos. Em segundo lugar, os modelos de negócios ligados a capacidades dinâmicas. E por fim, a busca pela captura de valor e geração de vantagens competitivas sustentáveis pelas empresas. A partir dessas conclusões, foi possível avaliar o modelo de negócio Canvas na perspectiva de um modelo dinâmico.Palavras-chave: Modelos de negócio; Vantagem Competitiva; Canvas; Abordagem Dinâmic