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Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy.

Resumo Vivemos em um mundo inegavelmente digitalizado. Nele, compreender e implementar um processo de Transformação Digital tornaram-se fatores primordiais para a maioria das organizações. Devido à sua relevância e atualidade, a Transformação Digital surge como um tema de grande interesse. A academia destaca a necessidade de um melhor entendimento dos seus requisitos e orientações estratégicas. Nesse contexto, pesquisadores sinalizam a necessidade de construir uma abordagem centrada em como transformar digitalmente modelos de negócio, e de definir quais capacitadores, fases e instrumentos precisam ser considerados. Diante disso, foi desenvolvido este estudo, cujo objetivo foi definir dimensões base para a implementação da Transformação Digital considerando um conjunto de tecnologias aderentes ao conceito de Indústria 4.0. A abordagem metodológica escolhida para o desenvolvimento do estudo foi a pesquisa processual, o método foi a pesquisa descritiva, e de impacto. Ademais, o estudo foi desenvolvido por meio de uma pesquisa exploratória e descritiva, de caráter bibliográfico e documental, concretizado via revisão da literatura. Com a realização da pesquisa, identificaram-se três direcionadores e nove dimensões que podem servir como base para o processo de Transformação Digital em uma organização. Este estudo permitiu construir um modelo preliminar que poderá servir como base para um mapeamento do processo de implementação da Transformação Digital em estudos futuros e poderá auxiliar as organizações a aperfeiçoar seus processos e ações rumo a esta era de inovação.

BackgroundDespite the potential effectiveness of bariatric surgery in promoting weight loss, a considerable proportion of patients still face the challenge of achieving optimal post-surgery outcomes. The timing of eating, in addition to the content of what is eaten, as well as chronotype and social jetlag (a marker of circadian misalignment), have been implicated in weight regulation. However, the current understanding of these chrono-related behaviours in individuals undergoing bariatric surgery is still scarce. Thus, this study aims to evaluate the role of chrono-nutrition, chronotype, and circadian misalignment in the weight-loss trajectory among individuals living with severe obesity who underwent bariatric surgery.MethodsThe ChronoWise project is a prospective single-centre cohort study designed to follow patients experiencing bariatric surgery at the Santo António Local Health Unit (ULSSA), Porto, Portugal. Participants will be recruited and evaluated at pre-surgery and followed-up over 3 and 6 months after surgery. The baseline evaluation will be conducted face-to-face during the hospital stay and by telephone or video call on the subsequent evaluations, following standard procedures. Data collection includes sociodemographics, food intake, chrono-nutrition behaviours, sleep time behaviour, sleep quality, screen time, physical activity and exercise behaviours, anthropometric measurements, and biochemical parameters. The 'Munich Chronotype Questionnaire' will be used to assess chronotype and social jet lag. Chrono-nutrition dimensions will be measured by the 'Chrononutrition Profile-Questionnaire' in all evaluations. Weight and height will be self-reported and retrieved from medical registries. trajectories of weight-loss will be obtained.DiscussionThis study will add important evidence on the role of chrono-nutrition, chronotype and social jetlag profile in weight-loss outcomes after bariatric surgery. Identifying novel approaches to change the paradigm of post-surgical weight management towards a tailored treatment aligned with circadian rhythm may be useful to strengthen the existing treatments and improve patients' response to bariatric surgery.

In this study, novel surface engineering strategies to improve the wear performance of AISI 4340 were investigated. The strategies were as follows: (i) NiP deposition on a previously nitrided steel substrate, followed by NiP interdiffusion heat treatment at either 400 °C or 610 °C (referred to as duplex treatment); (ii) the deposition of AlCrN PVD coating on NiP layers on a previously nitrided steel substrate (referred to as triplex treatment). Prior to the deposition of AlCrN, the NiP was subjected to the interdiffusion heat treatment at either 400 °C or 610 °C. These strategies were compared with the performance of the AlCrN coating directly applied on nitrided steel. To characterize the microstructural features of each layer, X-ray diffraction (XRD) and scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDS) analysis were conducted. We also carried out mechanical and tribological behavior assessments. The tribological tests were carried out using a ball-on-disc tribometer under a constant load of 20 N and a tangential speed of 25 cm/s; cemented carbide spheres with a diameter of 6 mm were the counterpart body. The friction coefficient was continuously monitored throughout the tests. The results reveal that the wear mechanism for the AlCrN coating is predominantly oxidative. The most wear-resistant surface architecture was the one comprising AlCrN over the NiP layer subjected to interdiffusion heat treatment at either 400 °C or 610 °C.

Background: Magnesium sulphate (MgSO4) is routinely administered to pregnant women as a tocolytic and as a neuroprotective agent against cerebral palsy and motor impairment in preterm neonates. However, concerns have recently been arising regarding its effects in the neonate, including cardiovascular, intestinal, and neurological adverse effects. Our goal is to analyse prenatal MgSO4 administration and neonatal outcomes. Methods: We conducted a retrospective study that included all neonates born under 32 weeks of gestational age admitted to our Neonatal Intensive Care Unit between January 2016 and December 2019. Patients with life-threatening congenital malformations were excluded. Gestational, perinatal and outcome data were collected and statistically analysed. Results: One hundred and eighteen infants were included, of which 61 (51.7%) had been exposed to MgSO4 in utero. Mothers treated with MgSO4 were more likely also to have received corticosteroids for lung maturation and/or perinatal antibiotics. All but 5 (95.8%) infants needed post-natal resuscitation manoeuvres. Neonates that were prenatally exposed to MgSO4 were less likely to require such manoeuvres (p = 0.039), and immediate oxygen therapy (p = 0.015) was less frequently required. The median neonatal serum magnesium was higher in those exposed to MgSO4 (2.51 mEq/L) than in non-exposed (1.87 mEq/L) (p

Abstract: The Agile approach is focused on individuals and customer satisfaction, based on the dynamic and streamlined work of a team that is capable of adapting, and adapting the project to changing scenarios and demands. However, amidst the COVID-19 pandemic, Agile teams accustomed to in-person communication have encountered the challenges of working from home. The main objective of this research is to analyze the challenges generated by the pandemic context, and the consequent social distance, for the development of software projects that use Agile approaches within a large state-owned company and identify the effect it had on the course and results of the projects. The research was qualitative in nature and had two exploratory diagnostic stages. The findings indicate that there were no negative impacts of relevance on project deliveries. On the one hand, results indicated losses in socialization, in spontaneous exchanges of knowledge, and in interaction among teams, as well as a demand for greater engagement of professionals. Additionally, limitations were revealed for more complex discussions and knowledge management. The study highlights solutions that were found and/or suggested for many challenges, contributing to the literature on best practices for the Agile approach, and is focused on the unprecedented context of the COVID-19 pandemic. Our findings can contribute to other companies with a similar profile that work with Agile projects, besides contributing to building a dialogue between the academic and business environments.

Introduction: Patent ductus arteriosus (PDA) in preterm infants has been associated with increased mortality and comorbidities. This study aimed to characterize the population of preterm infants diagnosed with PDA and to identify predictive factors of response to medical treatment of PDA. Methods: An eight-year retrospective observational study was carried out, which included all preterm infants with a gestational age (GA) between 23 and 32 weeks diagnosed with PDA, admitted to the Neonatal Unit of the CHUSJ. Univariate comparative analysis was performed, and models for predicting the effectiveness of PDA treatment with ibuprofen were explored by multivariate logistic regression analysis. Results: 115 cases were included and 34 were excluded, with a final sample of 81 preterm infants with PDA. The univariate analysis revealed significant differences in the closure efficacy via medical treatment with ibuprofen in several variables, and a multivariate logistic regression model was obtained (discriminative capacity 72.2%, sensitivity 98.1%, specificity 57.1%), taking into account the effect of GA, type of delivery, need for diuretics treatment and platelet transfusion. Conclusion: This study enabled the population of preterm infants diagnosed with PDA to be characterized and the identification of a predictive model that can help predict the efficacy of medical treatment and thus contribute to optimizing the medical approach to the non-responders. Resumo: Introdução: A patência do canal arterial (PCA) nos recém-nascidos de pré-termo (RNPT) tem vindo a ser associada ao aumento de mortalidade e de comorbilidades. Este estudo objetivou caracterizar a população de RNPT diagnosticados com PCA e identificar fatores preditivos de resposta ao tratamento médico. Métodos: Foi realizado um estudo observacional retrospetivo de oito anos, que incluiu todos os RNPT com idade gestacional entre as 23 e as 32 semanas com diagnóstico de PCA, admitidos no Serviço de Neonatologia do Centro Hospitalar Universitário de São João (CHUSJ). Realizou-se análise comparativa univariada e foram explorados os modelos preditivos da eficácia do tratamento de PCA com ibuprofeno, por análise de regressão logística multivariável. Resultados: Cumpriram critérios de inclusão no estudo 115 casos e foram excluídos 34, obtendo-se a amostra final de 81 RNPT com PCA. A análise univariada revelou diferenças significativas na eficácia de encerramento pelo tratamento médico com ibuprofeno em diversas variáveis e obteve-se um modelo de regressão logístico multivariado (capacidade discriminativa 72,2%, sensibilidade 98,1%, especificidade 57,1%), considerando o efeito das variáveis: idade gestacional, tipo de parto, necessidade de tratamento com diuréticos e de transfusão de plaquetas. Conclusão: Este estudo permitiu caraterizar a população de RNPT com diagnóstico de PCA e a identificação de um modelo preditivo que poderá auxiliar na previsão da eficácia de resposta ao tratamento médico e deste modo contribuir para aprimorar a estratégia de abordagem aos não respondedores ao tratamento médico.

The Paris Agreement was signed to reduce greenhouse gas emissions, and Brazil is committed to increasing renewable energy participation in the electrical matrix. This study aims to evaluate how wind energy fulfils the goals determined in the agreement. Through a systematic literature review, 10 relevant studies were identified and together with the analysis of data available in the National Energy Balance report from the Energy Research Company. Comparing the data obtained in the period with the established targets was possible. The success of policies for the sector in reaching the goals above was also evaluated. The results show that wind energy is the renewable source that most benefited from tax incentives and, thus, contributed to the expansion of the share of renewable energy in the Brazilian electrical matrix.

Titanium and its alloys are commonly used to fabricate orthopedic implants due to their excellent mechanical properties, corrosion resistance, and biocompatibility. In recent years, orthopedic implant surgeries have considerably increased. This has also resulted in an increase in infection-associated revision surgeries for these implants. To combat this, various approaches are being investigated in the literature. One of the approaches is modifying the surface topography of implants and creating surfaces that are not only antifouling but also encourage osteointegration. Titania nanotube surfaces have demonstrated a moderate decrease in bacterial adhesion while encouraging mesenchymal stem cell adhesion, proliferation, and differentiation, and hence were used in this study. In this work, titania nanotube surfaces were fabricated using a simple anodization technique. These surfaces were further modified with copper using a physical vapor deposition technique, since copper is known to be potent against bacteria once in contact. In this study, scanning electron microscopy was used to evaluate surface topography; energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy were used to evaluate surface chemistry; contact angle goniometry was used to evaluate surface wettability; and X-ray diffraction was used to evaluate surface crystallinity. Antifouling behavior against a gram-positive and a gram-negative bacterium was also investigated. The results indicate that copper-modified titania nanotube surfaces display enhanced antifouling behavior when compared to other surfaces, and this may be a potential way to prevent infection in orthopedic implants.

Introdução e Objetivo: A magnitude e mecanismos induzidos pelo treinamento de força sobre o gasto energético e substratos utilizados não estão totalmente esclarecidos, sendo divergentes entre estudos. O objetivo deste caso singular, foi avaliar o gasto calórico, consumo de oxigênio pós exercí­cio (EPOC) e taxa de oxidação de substratos induzidos por um protocolo de alta intensidade e curto intervalo de descanso. Materiais e Métodos: Esta pesquisa é um estudo de caso, de um praticante de exercício de força do sexo masculino, com 32 anos, 177 cm de estatura, 86 quilogramas, 16,2 % de gordura e com metabolismo basal avaliado em 2250 kcal/dia. O voluntário apresentava experiência prévia de 4 anos e alta força relativa. Foram avaliados o gasto calórico e taxa de oxidação de substratos durante a intervenção e o gasto energético após a intervenção. Resultados: O gasto calórico aumentou em 6 vezes em relação ao repouso (1,57 kcal/min em repouso para 11,42 kcal/min em exercí­cio), gerando um gasto calórico total de 525,65 kcal. Foi observada uma taxa de oxidação de carboidrato de 3,75 g/min durante o esforço e 2,65 g/min durante o EPOC. Além disso, a taxa de oxidação de gordura foi de 0,20 g/min, gerando consumo total de 16,1 gramas durante o componente lento do EPOC. Conclusão: O protocolo de treinamento de força de alta intensidade e curto intervalo de descanso proporcionou alto gasto calórico em curto tempo, podendo ser utilizado pelo voluntário como estratégia para otimizar o gasto energético quando há limitação de tempo para prática da atividade em questão.

Abstract In extreme preterm infants, massive congenital sacrococcygeal teratomas with great hemodynamic commitment may be a situation for limitation of care.

Purpose: The article aims to show the viability of installing a precision-based approach system in Viseu airfield, in Portugal. This work looks to evidence to what extent the implementation of ILS (Instrument Landing System) or GBAS (Ground Based Augmentation System) in the airfield is viable, and which of the two would be the better option for this case, from a technical and economic view and as a way to increase safety levels. Design/methodology/approach: The article analyses the airfield’s evolution over time and forecasts its movements for the future, over a 10-year period, by utilising two different models: multiple linear regression and IATA traffic forecasts. The different types of airfield taxes were also reviewed and their values were estimated for the following years. The equipment’s technical aspects and individual prices were analysed to accurately determine the time needed for the airfield to recover the investment done, allied with an 80% funding European project. Findings: Approach systems are being modernized, and throughout the years more airports and airfields are starting to replace old approach systems for satellite-based new ones. When compared to ILS, GBAS offers more advantages at a technical and economic level, and even for smaller airfields with a low traffic volume, sometimes it can be technically and economically possible to have such systems implemented. Originality/value: Studies about the implementation of new radio aids are usually prepared for big airports by airport operators or ANSPs before major investment projects. However, for most small regional airports in the country, where traffic is not near as big, such studies don’t exist, and for that reason, investigating the possibility of installing such kind of equipment is very important, especially taking into consideration the safety they provide and other benefits that naturally come up with it.

Purpose – This empirical and exploratory study analyzed the role of interaction with the innovation environment and of the organizational learning capacity (OLC) development stage in startups in Northeast Brazil based on the perception of managers of these companies. Design/methodology/approach – This was a quantitative study. Questionnaires were sent electronically to the managers of startups in the nine states of Northeast Brazil. A total of 54 managers participated, composing a non-probabilistic sample. The data collected were analyzed by multiple linear regressions. Findings – The results obtained seek to evidence whether the interaction of startups in Northeast Brazil with the startup ecosystem and the development stage in which these companies are found are associated with OLC. The results confirmed the hypothesis that higher startup development stages are positively associated with higher levels of OLC in the sample. A negative association was identified between the manufacturing startup type and the OLC level, and the level of interaction with the innovation environment was still infrequent. Research limitations/implications – This study contributes to the literature on the determinants of organizational learning and to startup managers who wish to more effectively promote this learning. Implications of the findings are discussed. Practical implications – This study contributes to the literature on the determinants of organizational learning and to startup managers who wish to more effectively promote this learning. Implications of the findings are discussed. Originality/value – Studies on Brazilian startups are still relatively scarce, especially studies that focus on learning capacity. No other studies addressing the hypotheses tested here were found.

Introduction: It is our goal to analyze the neonatal data from a Level III Unit and compare them with the overall data from the Vermont Oxford Network (VON). Methods: It is an observational, retrospective study that included very low birth weight infants (VLBWI) born in this hospital or admitted in the first 24 hours of life between 2000 and 2013. Two periods, 2000-2006 and 2007-2013, were studied. Descriptive data and Chi-Square test were performed, and a value of p < 0.05 was considered statistically significant. Results: A total of 607 VLBWI were studied, 51.1% male, mean weight 1,120 g and gestational age 29.3 weeks. Non-invasive ventilation in the Neonatal Intensive Care Unit (NICU) of Centro Hospitalar Universitário de São João (CHUSJ) was 63.5% in the 2000-2006 period and 70.2% in the 2007-2013 period, but still less than in the VON. Late-onset sepsis was 18.4% and 9.9% in the first and the second period, respectively, and 7.7% and 4.9% in the VON. Regarding mortality, it was higher in both periods in our NICU with respect to the VON, with a difference of 46.0% and 58.7% in the first and the second period, respectively. Discussion: There were improvements regarding the use of mechanical ventilation and the incidence of late-onset sepsis. Both decreased between the two periods but were still having higher levels than those of the VON. Regarding morbidity and mortality, the difference may be explained by the fact that our NICU is Level III and a reference center for metabolic, oncological, cardiac and surgical pathologies. Conclusion: It is very important for a NICU to know the characteristics of its population to assess the quality of healthcare and compare its results with other NICUs. VON allows us to identify the more and less positive aspects in order to improve the latter ones, and to promote better practices of healthcare.

Titanium (Ti) is a popular biomaterial for orthopedic implant applications due to its superior mechanical properties such as corrosion resistance and low modulus of elasticity. However, around 10% of these implants fail annually due to bacterial infection and poor osseointegration, resulting in severe pain and suffering for the patients. To improve their performance, nanoscale surface modification approaches and doping of trace elements on the surfaces can be utilized which may help in improving cell adhesion for better osseointegration while reducing bacterial infection. In this work, at first, titania (TiO2) nanotube arrays (NT) were fabricated on commercially available pure Ti surfaces via anodization. Then zinc (Zn) doping was conducted following two distinct methods: hydrothermal and alkaline heat treatment. Scanning electron microscopic (SEM) images of the prepared surfaces revealed unique surface morphologies, while energy dispersive X-ray spectroscopy (EDS) revealed Zn distribution on the surfaces. Contact angle measurements indicated that NT surfaces were superhydrophilic. X-ray photoelectron spectroscopy (XPS) provided the relative amount of Zn on the surfaces and indicated that hydrothermally treated surfaces had more Zn compared to the alkaline heat-treated surfaces. X-ray crystallography (XRD) and nanoindentation techniques provided the crystal structure and mechanical properties of the surfaces. While testing with adipose-derived stem cells (ADSC), the surfaces showed no apparent cytotoxicity to the cells. Finally, bacteria adhesion and morphology were evaluated on the surfaces after 6 h and 24 h of incubation. From the results, it was confirmed that NT surfaces doped with Zn drastically reduced bacteria adhesion compared to the Ti control. Zn-doped NT surfaces thus offer a potential platform for orthopedic implant application.

This article uses the Newcomb-Benford(NB-Law), or Law of Anomalous Numbers, to analyze the values of Electronic Bidding Processes that occurred in the Purchasing Portal of the Brazilian Federal Government and contained in the newly created website “DadosAbertos.gov.br”. In the analysis, all services contracted in the period from 2014 to 2018 were considered. The objective of the research was to analyze the conformity of the Electronic Auction referred to the NB-Law, aiming to verify anomalies, which represent signs of fraud. It can be said that there was a statistically significant anomaly in the analysis of the first digit of the values bid in the Electronic Bidding Tenders. It is also noted that the trading sessions with the first digit of numbers 4, 8 and 9 are those with the largest differences between expected and observed values, strengthening the hypothesis that these represent the trading sessions with the highest incidence / probability of deviations, to be tested in future studies. The study, pioneer in this type of analysis in the Brazilian data source, aims to contribute to the literature focused on the detection of accounting or financial fraud in the public sector. The results collected here can also contribute to the practice of inspection in public management. It is recommended to deepen the studies based on the Economics of Corruption, on issues that involve the detection of fraud, so that corruption becomes unviable or inopportune.

Muitos estudos sobre o impacto ambiental em áreas urbanas estão relacionados ao ruído do tráfego rodoviário. O transporte é uma atividade essencial à vida urbana e à economia, seja ele de pessoas ou bens de consumo, os tipos de veículos para transporte são classificados em veículos leves ou pesados. Entretanto, o mau planejamento da roteirização das cidades ocasiona certa movimentação em demasia em alguns pontos, causando níveis excessivos de ruído gerados pelo tráfego rodoviário. Este estudo tem como objetivo apresentar um modelo matemático que represente a relação entre as grandezas Nível Equivalente Sonoro e Volume Veicular, utilizando o modelo de regressão logística não linear, a fim de facilitar a tomada de decisão em relação ao planejamento urbano. Os dados de pressão sonora e volume veicular foram coletados por dez dias durante cinco horas totalizando uma coleta de 50 horas, com um total de 180 mil dados de nível de pressão sonora e 124.316 veículos. O local de coleta de dados foi uma rodovia que passa pela cidade de Maringá, no Paraná, sendo uma rodovia de tráfego intenso. Os resultados mostram que as diferenças entre os níveis de ruído de tráfego medido e previsto variam de -0,3 dB (A) a +0,3 dB (A) e a diferença média foi de -0,006 dB (A). O modelo de previsão de ruído de tráfego rodoviário proposto pode ser utilizado como ferramenta de apoio à decisão no planejamento urbano, levando em consideração as mesmas condições de contorno da rodovia estudada.

This study aims to verify the effect of implementing a lean manufacturing (LM) system on operational performance in an industrial company’s production line. There are few studies that seek to quantitatively verify the effect of implementing an LM system on the operational performance of a company, and that is the main objective of this research. In this case-based study, the LM implementation in the company studied is compared with best practices and reference models, ascertaining the degree of adherence of the company’s program. The operational performance, in terms of three key dimensions of cost, quality and lead time, is compared before and after the implementation of the LM program. By comparing the means of quantitative indicators related to the three performance dimensions, evidence was found of significant gains in the operational performance, and it was demonstrated that the company followed many of the best practices of LM implementation found in the literature. This study contributes to managers and to the literature on LM by measuring its apparent impacts on operational performance.

Newborns are particularly susceptible to off-label and unlicensed (OLUL) drug treatments, especially in the intensive care setting, inferring from dosing regimens and indications supported in older populations and built on non-neonatal pathophysiology. This use leads to unpredictable drug effectiveness and safety and, therefore, an increased probability of medication errors and adverse drug reactions. An extensive literature search was conducted in MEDLINE, Scopus, and Web of Science for papers published from 2011 to 2020 considering OLUL drug use in Neonatal Intensive Care Units (NICUs). Of the 902 studies retrieved, 618 after duplicates were removed, 74 full texts were carefully assessed for eligibility and, in the end, 23 published studies were included, representing a total of 6,762 patients in 80 NICUs worldwide. Considering overall prescriptions, 43.5% were OL and 11.1% were UL. Most studies found that more than 50% of the newborns were exposed to at least 1 OLUL drug and 10 of them reported a rate higher than 90%. Most prescribed drug classes in an OL manner were anti-infectives for systemic use drugs, including ampicillin and gentamicin, followed by nervous system drugs such as fentanyl. The most prescribed drug class in a UL manner was nervous system drugs, being caffeine the most prescribed one. The main reasons for OL prescribing included age and dose, and for UL prescribing, modifications of licensed drugs, extemporaneous preparations, or changes in the pharmaceutical forms. Very preterm, lower birth weight, disease severity, and longer length of stay in the NICU were associated with higher OLUL prescribing. These findings show that despite recent attempts by international regulatory authorities to develop more clinical trials in the pediatric population, OLUL drug use is still widespread, particularly among newborns in NICUs. More efforts must be made by these regulatory entities to ensure the development of safer drugs for the neonatal period.

The atypical hemolytic uremic syndrome (aHUS) in the newborn is a rare disease, with high morbidity. Eculizumab, considered a first-line drug in older children, is not approved in neonates and in children weighing less than 5 kg. We present a 5-day-old female newborn, born at 36 weeks' twin gestation, by emergency cesarean section due to cord prolapse, with birth weight of 2,035 g and Apgar score of 7/7/7, who develops microangiopathic hemolytic anemia, thrombocytopenia, and progressive acute renal failure. In day 5, after diagnosis of aHUS, a daily infusion of fresh frozen plasma begins, with improvement of thrombocytopenia and very slight improvement in renal function. The etiologic study (congenital infection, Shiga toxin, ADAMTS13 activity, directed metabolic study) was normal. C3c was slightly decreased. On day 16 for maintenance of anemia and severe renal failure, she started 300 mg/dose eculizumab. Anemia resolves in 10 weeks and creatinine has normal values after 13 weeks of treatment. The genetic study was normal. In this case, eculizumab is effective in controlling microangiopathy and in the recovery of renal function. Diagnosis of neonatal aHUS can be challenging because of phenotypic heterogeneity and potential overlap with other manifestations that may confound it, such as perinatal asphyxia or sepsis/disseminated intravascular coagulation.

The objective of this study was to determine the critical success factors (CSFs), as well as respective best practices (BPs) associated with those factors, using a case survey of the employees of Ford Motor Company working in different development centers around the world. The company’s project managers were asked to respond to two structured questionnaires. The results confirm the study’s assumption that the order of importance of the CSFs of the automotive industry differ from those of other industries in general. The results also reflect the importance of the front end (FE) phase in the new product development process. Regional differences were also observed. Neglecting CSFs can lead to delayed decision-making, resulting in higher development costs or cancellations of projects.

Authors present a case report of a female patient, with 38-years-old, admitted with alithiasic acute pancreatitis. During the hospitalization on day 6 she referred migration of the pain to the lower right quadrant and had pain in decompression; she underwent a computed tomography scan that was compatible with acute appendicitis. She was admitted to the operating room and laparoscopic appendectomy was performed. Surgery and hospitalization were uneventful and she was discharged on the 10th day after admission. The purpose to present this case is related to need to draw doctors’ attention to do an accurate physical examination and a selective interpretation of diagnostic exams in order to make a correct differential diagnosis and guide treatment.

Background: Cardiomyopathies (CMs) are rare multifactorial diseases of the heart muscle. Neonatal forms present as a myocardial injury in the absence of primary valvular, great vessels or septal anomalies. Despite being uncommon diseases, CMs may lead to potentially severe sequelae and considerable risk of neonatal death. This study aimed to provide an overview of neonatal CM (NCM) and describe its aetiology, initial clinical findings, morbidity and mortality. Methods: Retrospective observational study of all newborns diagnosed with CM admitted to the Neonatal Intensive Care Unit (NICU) of Centro Hospitalar Universitário de S. João, in Porto, Portugal, between 1997 and 2017. Data collected included demographic and perinatal information, clinical presentation, CM type and aetiology, treatments, complications and outcome. Results: Twenty-eight newborns with CM diagnosis were selected: 26 neonates were considered to have primary CM forms and 2 secondary CMs. Of those 26 diagnosed with primary CMs, 16 had hypertrophic CM, 8 had dilated CM, and 2 had tachycardia-induced CM. Secondary CMs comprehended 1 case of infiltrative CM and another of CM due to corticosteroids toxicity. Cardiac murmur (57.1%) was the most common finding, followed by heart failure (HF, 28.6%), cyanosis (21.4%), arrhythmia and sepsis (17.9%, each), and hypertension (10.7%). Two newborns were placed on a heart transplant waiting list. Three neonates developed congestive HF and 1 had a sudden cardiac death event. A total of 4 (14.3%) newborns have deceased during the NICU stay. More than 90% of the neonates were prescribed more than one medicine at discharge. Conclusion: NCMs require critical intensive care management. Unspecific symptoms characterise clinical findings. The majority of newborns have idiopathic primary CMs, but rare heterogeneous aetiologies may be the underlying cause in some cases. Thus, a multidisciplinary approach is mandatory.

Cardiomyopathies are rare diseases of the heart muscle, of multiple causes, that manifest with various structural and functional phenotypes but are invariably associated with cardiac dysfunction. Dilated cardiomyopathy is the commonest cardiomyopathy in children, and the majority present before one year of age. Its etiology may be acquired or genetic. Myocarditis is an important cause and is responsible for the majority of acquired cases. Inherited (familial) forms of dilated cardiomyopathy may occur in 25-50% of patients. Echocardiographic and tissue Doppler studies are the basis for diagnosis of dilated cardiomyopathy in most patients. Marked dilatation of the left ventricle with global hypokinesis is the hallmark of the disease. This review will cover the classification, epidemiology and management of newborns with dilated cardiomyopathy. In particular, a comprehensive and up-to-date review of the genetic study of dilated cardiomyopathy and of detailed echocardiographic assessment of these patients will be presented. Resumo: As cardiomiopatias são doenças raras do músculo cardíaco, de múltiplas causas, que se manifestam com vários fenótipos estruturais e funcionais, mas invariavelmente associadas a disfunção cardíaca. A cardiomiopatia dilatada é a forma mais comum em crianças, apresentando-se maioritariamente antes do ano de idade. A sua etiologia pode ser adquirida ou genética. A miocardite é uma importante causa, responsável pela maioria dos casos adquiridos. As formas hereditárias (familiares) de cardiomiopatia dilatada podem ocorrer em 25-50% dos pacientes. Os estudos ecocardiográficos e Doppler são a base para o seu diagnóstico, caracterizando-se por uma acentuada dilatação do ventrículo esquerdo com hipocinesia global. Neste artigo serão abordadas a classificação, a epidemiologia e a abordagem dos recém-nascidos com cardiomiopatia dilatada. Em particular, será apresentada uma revisão abrangente e atualizada da avaliação genética desta entidade, bem como aspetos detalhados da ecocardiografia nestes pacientes. Keywords: Dilated cardiomyopathy, Neonatal, Genetic studies, Echocardiographic evaluation, Management, Palavras-chave: Cardiomiopatia dilatada, Neonatal, Estudo genético, Avaliação ecocardiográfica, Abordagem

Propósito – O artigo analisa a evolução do quadro regulatório do microcrédito produtivo orientado, a atuação de seus principais atores institucionais e apresenta os resultados dos estudos brasileiros de impacto desta modalidade de crédito na superação da pobreza. Metodologia/abordagem/design – O estudo apoia-se nas perspectivas histórica e institucional para analisar a regulação do microcrédito produtivo orientado e a atuação de suas instituições e nos trabalhos de pesquisa empírica para a análise de seus efeitos na superação da pobreza. Resultados – O microcrédito tem um impacto positivo, embora limitado, para a superação da pobreza pelos microempreendedores de baixa renda. Todavia, as características da operação de microcrédito e o quadro regulatório atual não propiciam os incentivos para a atuação da iniciativa privada na concessão de microcrédito, em especial para os segmentos de mais baixa renda. Implicações práticas – Espera-se que este artigo possa apoiar o trabalho de pesquisadores interessados na análise e formulação de propostas de políticas públicas ligadas ao microcrédito produtivo orientado e na inserção social e produtiva dos segmentos de baixa renda. Originalidade/relevância do texto – O artigo sintetiza a evolução normativa referente ao microcrédito produtivo orientado no Brasil e os estudos do impacto do microcrédito produtivo orientado na superação da pobreza realizados no Brasil.

Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn’s lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.

A poluição Sonora é consideradapelaOrganização Mundial da Saúde um problema de saúdepublica.Este artigo apresenta um estudo dos níveis de imissão sonora, a partir da análise espectral de frequências, no entorno dos edifícios do campus Centro Politécnico da Universidade Federal do Paraná (Campus III). A avaliação foi feita em concordância com o método apresentado na norma brasileira NBR 10151 de 2000, que dispõe sobre a Avaliação do Ruído em Áreas Habitadas, e os resultados obtidos foram comparados com os níveis limites constantes da norma e da Lei Municipal 10.625 de 2002 da cidade de Curitiba. O tempo de medição para cada ponto avaliado foi de 15 minutos. Foram utilizados quatro analisadores sonoros calibrados. Conclui-se, que, para uma área educacional, os valores dos níveis de pressão sonora estão acima dos limites estabelecidos pela NBR 10151 e pela legislação municipal. A análise do espectro de frequências do ruído no entorno do Campus, mostra que o mesmo é caracterizado por uma faixa larga de frequências, desde baixas até altas frequências. Considerando-se os níveis sonoros máximos LAmax e os espectros sonoros medidos e considerando o limite de 60 dB(A) estabelecido pela Lei Municipal de Curitiba 10.625, a faixa de frequências do ruído gerado está dominantemente entre 63 Hz e 12500 Hz.

Propósito – O artigo busca analisar a independência formal e a independência real das agências reguladoras no Brasil, nos diversos aspectos que a estruturam. Metodologia/abordagem/design – A análise apoia-se nas perspectivas histórica, doutrinária e institucional de direito comparado para a construção dos conceitos de regulação e agências reguladoras, abordando as questões da legitimidade e controle desses entes em um Estado Democrático de Direito. Resultados – O estudo conclui que o transplante das estruturas legais que dão suporte à independência das agências reguladoras tem baixa eficácia frente às culturas normativa e política pré-existentes, o que poderá levar à redução de sua independência real. Implicações Práticas – Espera-se que este artigo possa apoiar o trabalho de pesquisadores interessados nas relações das teorias da regulação com o histórico das agências reguladoras no Brasil. Originalidade/relevância do texto – O artigo sintetiza conceitos relativos à regulação e às agências reguladoras, e sua evolução nos Estados Unidos e no Brasil, com foco nas questões de sua independência formal e real. As recentes propostas de modificações normativas e o dilema que se estabelece entre a independência das agências reguladoras e a agenda do Governo Federal são também apresentados.

Background: Congenital anomalies (CAs) are a leading cause of fetal and infant mortality and morbidity worldwide. They may be identified prenatally, at the moment of birth or later in life. Purpose: To describe the cases of CAs registered over the last 15 years at a level III hospital, comparing individuals who were detected through prenatal (preN) diagnosis with those detected through postnatal (postN) diagnosis. Methods: All records were collected from the Registo Nacional de Anomalias Congénitas (RENAC) online platform between 1st January 2000 to 31st December 2014, in a level III hospital, where cases of CAs were notified voluntarily (n = 1,222). We tested differences for selected variables between the years in study. A multivariate analysis was performed to identify potential factors associated to preN diagnosis. Results: We observed a total of 1,510 anomalies, being 493 (40.3%) circulatory, 252 (20.6%) chromosomal, 187 (15.3%) musculoskeletal, 138 (11.3%) digestive, 133 (10.9%) urinary, 117 (9.6%) nervous, 37 (3.0%) respiratory, 35 (2.9%) genital, 25 (2%) anomalies of the eye, ear, face and neck, 20 (1.6%) cleft lip/cleft palate and 73 (6.0%) others. Time of diagnosis was known for all subjects: 770 (63.0%) were diagnosed prenatally and 452 (37.0%) were diagnosed at birth or during the first month of life. We found statistically significant differences between groups for several variables. Assisted reproduction techniques (p = 0.023), maternal medications during the first trimester of pregnancy (p = 0.004) and the number of anomalies per individual (p ≤ 0.001) had a statistically significant impact on receiving preN diagnosis. Conclusion: Our data confirm the importance of both RENAC national database and preN diagnosis in improving perinatal healthcare. However, in order to determine the national prevalence of CAs and understand any involved factors, it is desirable to enhance the notification in the whole country, facilitating the adjustment of national protocols to achieve a better perinatal counseling and surveillance.

Introduction: Cardiac arrhythmias are often diagnosed in fetuses and newborns. In the neonatal period, the incidence varies between 1% and 5%. There are three main types of rhythm disturbance: irregular heart rhythm, tachycardia and bradycardia. The prognosis changes with the nature of the arrhythmias and with timely diagnosis and management, but the majority have benign course, either spontaneously or after brief treatment, with life-threatening arrhythmias occurring rarely. Aim: To evaluate the morbidity and mortality of neonates with cardiac arrhythmia, at discharge from the Neonatal Intensive Care Unit (NICU). Methods: The study population included all newborns who were admitted with the diagnosis of cardiac arrhythmia between January 1, 2005 and December 31, 2014 at the NICU of “Centro Hospitalar de São João” (CHSJ), a level III unit. Data were collected retrospectively by reviewing patient’s clinical records. Results: Of a total of 66 patients with cardiac arrhythmia, at discharge from the NICU, 3% died and 9% showed sequelae. Adverse outcome was associated with preterm delivery, 1st and 5th minutes Apgar score < 7, resuscitation at birth, earlier prenatal diagnosis, gestation complications, postnatal therapy with electrical cardioversion, other reasons for hospitalization besides arrhythmia, inotropic support, longer hospital stay, oxygen therapy and mechanical ventilation and duration of both, transfusion support, parenteral nutrition and central vascular access. No arrhythmia type was associated to differences in outcome. Conclusion: Our study reports an overall good prognosis of neonates with cardiac arrhythmia at discharge from NICU. Nevertheless, we identified some factors related to the perinatal period and to NICU stay that were associated with adverse outcome.

Introduction: Hemodynamically significant patent ductus arteriosus (PDA) is a common condition in very low birth weight infants. Therapeutic options include medical therapy and surgical ligation. Medical treatment is based on non-selective inhibitors of cyclooxygenases 1 and 2 (indomethacin and ibuprofen). The debate on the most appropriate treatment for the closure of the PDA is far from being closed, in the light of the currently available evidence. Aim: The objective of this study was to compare efficacy and safety of indomethacin and ibuprofen. Methods: All infants < 32 weeks of gestational age or ≤ 1,500 g of birth weight born in “Centro Hospitalar São João” between January 2005 and December 2014 were included. Those with major malformations or genetic disorders, congenital TORCH infections, transferred or deceased before 72 hours of life, outborns, and those with severe pathologies at birth were excluded. The cohort of neonates treated with indomethacin from January 2005 to December 2009 was compared to those treated with ibuprofen from January 2010 to December 2014. Results: 328 newborns were included in the study: 99 (30.2%) with PDA and 229 (69.8%) without. The median gestational age was 30 weeks and the median birth weight was 1,231 grams. Among the 99 patients with PDA, 21 were treated with indomethacin and 41 received ibuprofen. There was no statistically significant difference in efficacy between groups. There was a higher incidence of thrombocytopenia in the indomethacin group compared to the ibuprofen group, but there was no significant difference in any other PDA-associated comorbidities between groups. Conclusion: Our study showed that indomethacin and ibuprofen have a similar effect in closing PDA in < 32 weeks preterm infants. We found no significant differences in safety, except for thrombocytopenia. Further studies are necessary to compare both efficacy and adverse events of ibuprofen and indomethacin to identify the optimal pharmacological agent for PDA.

The corrosion properties of a 22.5 wt. (%) Cr duplex stainless steel were investigated after long-term aging of 3000, 5000 and 7000 hours at 300 and 400 ºC. The corrosion resistance was measured based on mass loss in a FeCl3 10 wt. (%) solution and electrochemical measurements in a 0.1 M H2SO4 solution. The results indicate that the corrosion resistance decreased steadily up to 5000 hours of aging. However, the samples subjected to 7000 hours of aging showed better corrosion resistance than those aged for 3000 and 5000 hours. This effect is attributed to the phase transformation that occurs during aging, a finding which was confirmed by hardness, transmission electron microscopy and X-ray photoelectron spectroscopy measurements.

Neste trabalho, foram avaliados o desempenho e o rendimento de carcaça em juvenis de jundiá Rhamdia quelen, alimentados com farinha de silagem química de rejeitos de pescado em substituição à levedura de cana, em dietas à base de ingredientes vegetais (dieta controle). Os 135 animais (peso médio inicial de 48,11±5,54g) foram distribuídos em cinco tratamentos com três repetições ao acaso. Cada unidade de observação foi composta por um tanque circular (1000 litros) abastecido com 200 litros de água, com temperatura controlada, em um sistema fechado de criação contendo nove animais cada. Os peixes foram alimentados durante 75 dias, duas vezes ao dia, na proporção de 10% da biomassa total. Foram testadas dietas contendo: 0, 12,5, 25, 37,5 e 50% de farinha de silagem. Os resultados indicaram um efeito quadrático (PThis study evaluated the productive performance and carcass yield of jundiá (Rhamdia quelen) fed with different fish dregs chemical silage flour concentrations in substitution to the sugar cane yeast in a diet based on vegetable ingredients (control diet). Animals with initial weight of 48.11±5.54g were distributed in 5 treatments with 3 replicates, in a completely randomized design. Each observation unit consisted of a 1,000 liter polipropilene tank, with 200 liters of water, with 9 animals, in a thermo-regulated system with water recirculation. During 75 days, twice daily (9h and 17h) the following diets were offered, in the proportion of 7% total biomass: 0% (control), 12.5%, 25%, 37.5% and 50% of silage flour. Results showed a quadratic effect (P

Resumo: Introdução: Os derrames pleurais podem complicar as pneumonias na população pediátrica. Assumem especial importância pelas implicações na duração do internamento, geralmente prolongado, e pela morbilidade associada.Objectivos: Caracterizar uma população de doentes com pneumonia complicada de derrame; determinar os possíveis factores de prognóstico a partir de dados clínicos, radiológicos e analíticos na admissão; e avaliar a influência das intervenções terapêuticas na evolução da doença.Métodos: Revisão casuística dos doentes com idade inferior a 18 anos e derrame pleural parapneu mónico, internados de Julho de 1997 a Junho de 2004 (7 anos).Resultados: Foram estudados 118 casos, 60% do sexo masculino, com idade média 7 anos. A incidência de derrame pleural aumentou ao longo do período do estudo. Verificou-se maior incidência de casos no Outono e no Inverno. Na admissão, 60% dos doentes apresentavam sinais de dificuldade respiratória e 39% dor torácica. Em 40% dos doentes foram detectados septos pleurais na admissão, o que se associou a maior duração de internamento e de antibioticoterapia e mais frequente necessidade de cirurgia. Em 72% dos doentes foi efectuada toracocentese (pH médio: 7,24). Em 17% foi possível isolar o agente: Streptococcus pneumoniae (cinco), Staphylococcus aureus (quatro) e Streptococcus pyogenes (quatro). Foram submetidos a drenagem pleural 52% e necessitaram de cirurgia 18%. A mediana da duração de internamento foi de 15 dias e a média de 16,4 dias (2 a 51).Discussão: Associam-se a pior prognóstico a presença de: sinais de dificuldade respiratória; septos; empiema; baixo valor no líquido pleural de pH, glicose ou proteínas; desidrogenase láctica elevada no líquido pleural e proteína C-reactiva sanguínea aumentada. A drenagem pleural e/ou cirurgia mais precoces provavelmente diminuem o tempo de doença e de internamento.Conclusão: Os derrames parapneumónicos complicados são tratados com êxito em centros de referência com experiência nos diferentes tipos de intervenção que poderão ser necessários.Rev Port Pneumol 2009; XV (2): 241-259 Abstract: Introduction: Pleural effusions can complicate pneumonias in children and adolescents and are usually associated with a long hospital stay and increased morbidity.Aims: To characterise a population of patients with parapneumonic pleural effusion and to establish possible prognostic factors on admission based on clinical, imaging and analytical data. To correlate treatment options with the outcome.Methods: Case review of patients under 18 years old with parapneumonic pleural effusion, admitted between July 1997 â June 2004 (7 years).Results: 118 patients were included, 60% male, with mean age 7 years. The incidence of pleural effusion increased throughout the period of the study. The admissions occurred predominantly in autumn and winter. On admission 60% of patients had respiratory distress and 39% chest pain. In 40% loculations were found on admission and were associated with longer hospital stay, longer course of antibiotic therapy and more frequent need for surgery. Thoracentesis was performed in 72% of patients (mean pH pleural fluid 7.24). The aetiologic agent was identified in 17% of cases: Streptococcus pneumoniae (five), Staphylococcus aureus (four) and Streptococcus pyogenes (four). In our study, 52% of patients underwent pleural drainage and 18% surgery. Median length of hospital stay was 15 days with mean 16.4 days (2 â 51).Discussion: Factors associated with worse prognosis were respiratory distress, loculations, empyema, low pH in pleural fluid, glucose or proteins in pleural fluid, high lactic dehydrogenase level in pleural fluid and high serum C-reactive protein. Pleural drainage and/or surgery can shorten hospital stay and improve outcome.Conclusion: Complicated parapneumonic pleural effusions are managed successfully in centres with experience in the different types of procedure that might be necessary.Rev Port Pneumol 2009; XV (2): 241-259 Palavras-chave: Pneumonia, derrame pleural, drenagem, cirurgia, prognóstico, Key-words: Drainage, pleural effusion, pneumonia, prognosis, surgery

ABSTRACT: Objective: To describe a case of insulinoma in a patient with pre-existing type 2 diabetes mellitus.Methods: We report a case, with clinical, biochemical, and imaging findings, and give a literature review.Results: The most common causes of recurrent hypoglycemia in a patient with diabetes mellitus are insulin excess and use of insulin secretagogues. If these are completely ruled out, other causes must be considered. The co-existence of diabetes mellitus and insulinoma is very rare, with less than 40 cases reported in the literature. We report the case of a 66-year-old woman with obesity, hypertension, and type 2 diabetes mellitus treated with premixed insulin, who was diagnosed with an insulinoma in the setting of a 6-month history of severe recurrent hypoglycemia that persisted despite discontinuation of insulin therapy. A computed tomography of the abdomen revealed a 14-mm tumor in the pancreatic tail that was removed through laparoscopic distal pancreatectomy. Histopathologic examination confirmed the diagnosis. Postoperatively, the patient had to resume insulin therapy and is now being managed with premixed insulin with a total daily insulin dose of 40 units (0.6 U/kg), without hypoglycemic episodes.Conclusion: Although hypoglycemic agents are the most common cause of hypoglycemia in patients with diabetes, insulinomas may also occur in these patients. This case report stresses the importance of considering this diagnosis in patients with diabetes and recurrent hypoglycemic episodes that persist after antidiabetic treatment adjustment or discontinuation.Abbreviations: DM = diabetes mellitus; HbA1c = glycated hemoglobin; TDID = total daily insulin dose

Esta pesquisa propõe o desenvolvimento de metodologias para controle de qualidade da água de abastecimento público tanto pela operacionalização de mecanismos de avaliação e controle quanto pela significativa contribuição para a tomada de decisão na vigilância em saúde ambiental. Tais objetivos encontraram fundamento em dados de acometimento de doenças de veiculação hídrica registrados na Secretaria Estadual de Saúde. Foram selecionados os bairros da Posse (primeiro Distrito) e Caioaba (5º Distrito), os quais mostraram situações díspares, o que permitiu modelar a situação de cobertura no Município de Nova Iguaçu, no Rio de Janeiro. O trabalho tornou patente o comprometimento da qualidade da água dos distritos estudados, uma vez que 61% das amostras apresentaram positivação nos exames bacteriológicos, evidenciando os efeitos indesejáveis do saneamento diferenciado que desponta, sobretudo, nos países em desenvolvimento.This study proposes to develop methodologies for public water supply quality control by implementing evaluation and control mechanisms and enhancing environmental health surveillance decision-making. These objectives were based on data for waterborne diseases recorded at the Rio de Janeiro State Health Department. We selected the following neighborhoods: Posse (1st Township) and Caioaba (5th Township), with dissimilar situations, allowing us to produce a model of water supply coverage in the Municipality of Nova Iguaçu, Rio de Janeiro State. The study underscored the poor quality of the water supply in the two townships, since 61% of the samples were positive on bacteriological examination, showing the undesirable effects of differential sanitation, especially in developing countries.

O livro consiste em uma coletânea de 12 textos organizados por Adair Mendes Nacarato e Celi Espasandin Lopes, reunindo subsídios teóricos e práticos relativos às interfaces entre a educação matemática e as práticas em leituras e escritas, perpassando a escola básica e o ensino superior.

New product development (NPD) projects are typically managed through a series of screens, or gates, where ideas compete for resources. Ideas are carved into projects, and these projects are reviewed, and approved or terminated through the screening process so that only the best performing projects continue to subsequent stages of design, development and testing, and are released into the market place (Krishnan and Ulrich 2001; Terwiesch and Ulrich 2009). Most large innovative organizations deal with more than one NPD project at a time and typically engage in product pipeline management (PPM), where a set of active projects are evaluated together while they traverse through a sequence of such screens. Key decisions in a R&D pipeline are: screen thresholds, complexity of projects, resource allocation and capacity adjustment biases. We explore the impact of structural and behavioral aspects of these decisions through a simulation based analysis of a pharmaceutical dataset. Results establish concave relationships between value created at the end of pipeline and the resource allocation and complexity allocation biases, indicating optimizability and a limit for front loading practices.

No intuito de pesquisar sobre a adequação de equipamentos e sistemas domésticos, esse projeto foi elaborado tendo como objetivo principal avaliar a qualidade do sistema de abastecimento de água nessa comunidade, uma vez que há precarização desta infra-estrutura em áreas precárias das periferias urbanas. Foi observada a inexistência de uma ação governamental e comunitária específica e sistemática, orientando sobre as formas corretas de armazenamento e a utilização da água pelos moradores, originando grandes riscos à sua saúde; ressaltando, dessa forma, a importância da realização de estudos referentes à qualidade da água na habitação no loteamento irregular Parque Morada Anchieta. Como resultado da pesquisa foi possível co-relacionar a má qualidade da água, seja por forma de abastecimento ou de utilização, com a incidência de doenças de veiculação hídrica. Os dados de saúde da pesquisa foram obtidos no Hospital Carlos Chagas, que atende a população local. Elaborouse, então um diagnóstico da área em questão que serviu como subsídio na formulação de propostas de ações de melhorias físicas do sistema domiciliar e base para os trabalhos de educação em saúde e educação ambiental. Ressaltamos a relevância do referido projeto, no que concerne a um estudo detalhado do sistema hídrico intra e peridomiciliar em loteamento irregular como uma proposta metodológica da educação em saúde em áreas semelhantes e como subsídio ao gestor público para o planejamento e ação em futuras intervenções.