Does innovation make a difference? An analysis of the performance of micro and small enterprises in the foodservice industry

Purpose – This paper aims to identify and measure the impact of the types of innovation on micro and small enterprises’ performance in the foodservice industry. Design/methodology/approach – A sample of 55 micro and small enterprises located in the Recife Metropolitan Area in Pernambuco were considered for the purpose of the analysis. All the firms were registered in the Agente Local de Inovação (ALI) program during the period of 2015 and 2016. The innovations developed by the firms were identified and measured using the sectorial innovation index, and the firm’s performance was calculated by the annual revenue. The impact of the innovations on performance was measured using multiple linear regression and quantile regression. Findings – The regressions’ findings suggest that two innovation dimensions stand out concerning firm performance, that is, brand and customer experience are thought as to contribute to firm performance significantly. However, it has also been found that the contribution of the innovations may vary in the level of firm performance. Originality/value – The paper was distinguished by analyzing the relationship between innovation and firm performance in the context of micro and small enterprises. The research also allowed knowing the innovations that can contribute to the micro and small enterprises’ performance, allowing such organizations to identify and develop the innovations seen as necessary for their competitiveness

A contribuição da avicultura de corte para o desenvolvimento do Mato Grosso do Sul

O objetivo geral deste artigo é analisar a contribuição da avicultura na geração de emprego e massa salarial para os municípios de Mato Grosso do Sul. Com o intuito de embasar a discussão, utilizou-se a teoria de desenvolvimento multidimensional. A metodologia utilizada alicerçou-se no Índice de Concentração Normalizado (ICN), visando subsidiar a análise da geração de emprego e massa salarial na avicultura, assim como o desenvolvimento da economia estadual. Os resultados demonstram que o setor avícola de Mato Grosso do Sul é importante para a geração de emprego e massa salarial, principalmente para os municípios de Itaquiraí, Dourados, Sidrolândia, Caarapó e Aparecida do Taboado no abate, e Água Clara, Cassilândia, Dourados, Sidrolândia e Terenos na criação, localizados na região centro-sul do estado. A relevância da avicultura é indicada, principalmente, pelo grau de aglomeração nesses municípios e confirmada pelo índice que mede a especialização para 2015. Conclui-se que quaisquer fatores exógenos que incidirem sobre esse setor causarão impactos negativos nessas localidades

Hypofractionation as a solution to radiotherapy access in latin america: expert perspective

Background: Limited radiation therapy resources have resulted in an interest in developing time and cost-saving innovations to expand access to cancer treatment, in Latin America. Therefore, hypofractionated radiotherapy (HRT) is a possible solution, as this modality delivers radiation over a shorter period of time. Materials and methods: A selected panel of Latin American (LA) experts in fields related to HRT were provided with a series of relevant questions to address, prior to the multi-day conference. Within this meeting, each narrative was discussed and edited, through numerous rounds of discussion, until agreement was achieved. Results: The challenges identified in increasing the adoption of HRT in LA include a lack of national and regional clinical practice guidelines and cancer registries; a lack of qualified human resources and personnel education; high up-front costs of equipment; disparate resource distribution and scarce HRT research. An analysis for these overarching challenges was developed and answered with recommendations. Conclusion: Extending the adoption of HRT in LA can provide a path forward to increase access to radiotherapy and overcome the shortage of equipment. HRT has the potential to improve population health outcomes and patient centered care, while offering comparable local control, toxicity, palliation, and late effects for multiple indications, when compared to conventional RT. Concerted efforts from all involved stakeholders are needed to overcome the barriers in adopting this strategy in LA countries. The recommendations presented in this article can serve as a plan of action for HRT adoption in other countries in a similar situation

Trophic dynamics in two South American estuaries encompassing industrial development and a biodiversity hotspot

Estuaries are critical to the life histories and development of many marine species, and support some of the most productive aquatic ecosystems. However, owing to their geographic accessibility, many estuaries face considerable anthropogenic threats, which can be exacerbated in developing nations. Understanding the ecological implications of anthropogenic activities as a precursor to dedicated conservation activities requires comprehensive assessments of baseline trophic relationships. This study addresses a shortfall in such information for two tropical, coastal ecosystems globally identified as priority areas for biodiversity conservation: the Paranagua estuarine complex; and the Cananeia-Iguape estuarine lagoon system in southern Brazil. Ecological relationships were investigated through carbon and nitrogen stable isotope (delta C-13 and delta N-15) determination in sediments, plant fragments and the muscle tissues of marine species occupying different trophic levels, including benthic invertebrates, ichthyofauna (Stellifer rastrifer, Paralonchurus brasiliensis, and Isopisthus parvipinnis), and delphinids (Sotalia guianensis and Pontoporia blainvillei). Isotope ratios facilitated distinguishing plant fragments, sediments (which were terrestrially influenced) and biota (predominantly marine influenced). However, despite variation among anthropogenic stressors, isotope ratios did not vary between the studied estuaries, implying similar impacts on trophic relationships which might reflect some inter-estuary mixing. All ichthyofauna and the delphinids had similar generalist diets and shared the same trophic niche, which may reflect their consistent spatio-temporal distributions and habitat patterns in the estuaries. The data illustrate the utility of isotopically characterizing biodiversity-hotspot estuaries as a mechanism for rapidly assessing ecological relationships between key species and regional habitats. Such an approach can be used to evaluate ecological connectivity as a baseline for management and might be applied more broadly, embracing multiple regions as part of estuarine and coastal biome conservation efforts

RADIOATIVIDADE DAS AREIAS UTILIZADAS NA CONSTRUÇÃO CIVIL DA CIDADE DO NATAL/RN

O presente trabalho tem por desígnio identificar os minerais pesados encontrados nos aluviões que abastecem o mercado da construção civil da grande Natal, bem como medir a radioatividade provinda dessas areias, nas quais as pessoas estão em constante contato, a fim de alertá-las aos possíveis perigos. Para tal, escolheu-se a localidade de Jacobina, no município de Macaíba/RN pelo fato da existência de exploração de areia nas margens do rio Potengi, onde foram realizadas medições gamaespectométricas no solo e em afloramentos com o Cintilômetro RS-125 Super-SPEC, adquirido pelo CNPq (Processo nº 550307/2010-9). A partir dos resultados obtidos, foram criadas superfícies modeladas (em meio digital) através de mapas temáticos que proporcionaram uma simples interpretação das doses radioativas absorvidas

Sacubitril/Valsartan is useful and safe in elderly people with heart failure and reduced ejection fraction. Data from a real-word cohort

Background HF elderly patients are underrepresented in Sacubitril/Valsartan HF trials, and the effect of S/V in real-life patients with advanced age is unknown. The aim of this study was to evaluate the use and safety of S/V in a real-word cohort of elderly patients. Methods We performed a prospective registry of patients who started S/V in clinical practice. We compared baseline characteristics, adverse events during follow-up and causes of S/V withdrawal according to age. Results A total of 427 patients started treatment with S/V: 222 (52.0%)<70 years old, 140 (32.8%) between 70 and 79 and 65 (15.2%)≥80. During a mean follow-up of 7.0±0.1months S/V was well tolerated, with no age-related differences in adverse events (26.8%, 25.9%, 23.1% respectively; p=0.83). Symptomatic hypotension tended to be more frequent in the elderly (19.8%, 25.6%, 33.3% respectively; p=0.17). The withdrawal of S/V was more frequent in younger patients (14.4%, 10.0%, 4.6% respectively; p=0.05) and related to poor prognosis (HR 13.51, 95% CI 3.22–56.13, p<0.001). Conclusions Sacubitril/Valsartan is useful and safe in elderly people with HF-rEF in real-life clinical practice, and withdrawal is associated to poor prognosis. The doses achieved are lower in elderly people.Antecedentes Los pacientes ancianos con IC están sub-representados en los ensayos de IC sacubitril/valsartán (S/V), y se desconoce el efecto del S/V en pacientes de la vida real con edad avanzada. El objetivo de este estudio fue evaluar el uso y la seguridad del S/V en una cohorte de pacientes ancianos. Métodos Se realizó un registro prospectivo de los pacientes que iniciaron el S/V en la práctica clínica. Se compararon las características iniciales, los eventos adversos durante el seguimiento y las causas de la abstinencia del S/V según la edad. Resultados Un total de 427 pacientes iniciaron el tratamiento con S/V: 222 (52,0%)<70 años, 140 (32,8%) entre 70-79 años y 65 (15,2%)≥80 años. Durante un seguimiento medio de 7,0±0,1 meses, el S/V fue bien tolerado, sin diferencias en los eventos adversos relacionados con la edad (26,8, 25,9 y 23,1%, respectivamente; p=0,83). La hipotensión sintomática tendió a ser más frecuente en los ancianos (19,8, 25,6 y 33,3%, respectivamente; p=0,17). El retiro del S/V fue más frecuente en pacientes más jóvenes (14,4, 10,0 y 4,6%, respectivamente; p=0,05) y se relacionó con un pronóstico precario (CRI: 13,51; IC del 95%: 3,22-56,13; p<0,001). Conclusiones El sacubitril/valsartán es útil y seguro en personas de edad avanzada con HF-rEF en la práctica clínica de la vida real, y la abstinencia se asocia con un pronóstico deficiente. Las dosis alcanzadas son más bajas en las personas mayores.Sin financiaciónNo data JCR 20200.206 SJR (2020) Q4, 31/35 AgingNo data IDR 2020UE

Sacubitril/Valsartan in Daily Clinical Practice: Data From a Prospective Registry

Sacubitril/valsartan (SV) is a new therapy in heart failure with reduced ejection fraction. Our aim was to determine the efficacy and safety of this drug daily clinical practice. We performed a multicenter registry in 10 hospitals. All patients who started SV from October 2016 to March 2017 on an outpatient basis were included. A total of 427 patients started treatment with SV. Mean follow-up was 7.0 ± 0.1 months. Forty-nine patients (11.5%) discontinued SV, and 12 (2.8%) died. SV discontinuation was associated with higher cardiovascular (hazard ratio 13.22, 95% confidence interval, 6.71-15.73, P < 0.001) and all-cause mortality (hazard ratio 13.51, 95% confidence interval 3.22-56.13, P < 0.001). Symptomatic hypotension occurred in 71 patients (16.6%). Baseline N-terminal pro-B-type natriuretic peptide levels, functional class, and left ventricular ejection fraction improved at the end of follow-up in patients who continued with SV (all P values ≤0.001). This improvement was not significant in patients with SV discontinuation. SV has a good tolerability in patients from daily clinical practice. SV withdrawal in patients with heart failure and reduced ejection fraction was independently associated with increased all-cause mortality. Patients who continued with SV presented an improvement in functional class left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide levels.Sin financiación2.598 JCR (2019) Q2, 62/138 Cardiac & Cardiovascular Systems; Q3, 147/270 Pharmacology & Pharmacy0.800 SJR (2019) Q2, 110/362 Cardiology and Cardiovascular Medicine, 112/331 PharmacologyNo data IDR 2019UE

A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia)

<p>Abstract</p> <p>Background</p> <p>Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan.</p> <p>Methods and design</p> <p><it>Design</it>: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. </p> <p><it>Setting</it>: 18 PHCT in the Barcelona province (Spain). </p> <p><it>Sample</it>: all patients with a diagnosis of hypertension (population based study). Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. </p> <p><it>Intervention</it>: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. </p> <p><it>Measurements</it>: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. </p> <p><it>Dependent variable</it>: prevalence of hypertensive patients with poor BP control. </p> <p><it>Analysis</it>: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (α) will be set at < 0.05. Outcomes will be analysed on an intention-to-treat basis.</p> <p>Discussion</p> <p>The implementation of a quality improvement plan might benefit the coordination of different professionals of PHCTs and may also improve blood pressure control.</p> <p>Trial Registration</p> <p>This protocol has been registered at clinicaltrials.gov with the ID number MS: 1998275938244441.</p