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PurposeThis research aims to evaluate the impact of barriers experienced by Brazilian companies in adopting Industry 4.0 (I4.0).Design/methodology/approachAs a methodological approach, the survey method was used, adopting the use of the questionnaire for data collection. From the feedback of 99 companies (with an index of 80%), quantitative analyzes of the data were carried out with the aid of factor analysis and linear regression to validate the proposed structural model.FindingsThe barriers construct does not impact the I4.0 adoption construct. Directly evaluating the effect of the variables that make up the barriers construct in the I4.0 adoption construct, it was observed that three barriers affect effectively the adoption of I4.0: technological infrastructure; financial constraint and lack of understanding of the benefits of I4.0.Research limitations/implicationsAs a limitation, the research was conducted only in the Brazilian context, requiring the development of future studies in other countries that can strengthen the findings of this research.Practical implicationsIn addition, the results achieved provide relevant insights into public policymakers and business managers, helping them to deeply understand the barriers that impact the adoption of I4.0. This facilitates the propagation of I4.0 concepts in the context of Brazilian companies and in the formulation of public policies adapted to each sector, allowing a more assertive action in the face of the types of barriers experienced by organizations during the adoption of I4.0.Social implicationsThe findings can help practitioners and policymakers to understand in detail this new industrial model and the difficulties that prevent its implementation.Originality/valueFrom an extensive literature review, no studies were identified that statistically validate which barriers effectively affect the adoption of I4.0. This research is a pioneer in proposing a structural model to analyze the barriers experienced by workers during the adoption of I4.0, exploring Brazilian companies, from different economic sectors and sizes. It is noteworthy that the literature still focuses efforts on manufacturing companies.

Inappropriate consumption patterns and the harmful effects on the environment have challenged public institutions to constantly improve the public value to be added to society and the environment through eco-efficient results in the services provided to society. In this context, the Executive Secretary is inserted in the Public Administration as a strategic agent with executives and subordinates. However, such changes must come materialized in the development of pro-environmental awareness and behavior of the servers that compose it, in order to develop skills that make them able to contribute to organizational sustainability. Thus, the objective of this research is to analyze the sustainable awareness, the ecological behavior at work and the mastery of competencies for organizational sustainability of the Executive Secretaries of a Federal Institution of Higher Education. To this end, a descriptive survey research was conducted, with data obtained through the application of closed questionnaires, analyzed by means of descriptive statistics. The results found indicated that there is an ecological awareness among executive secretaries, but that it does not materialize in the same intensity in relation to behavior at work. It was observed that the competencies for sustainability identified in these professionals were the normative and the preventive, but that they need to develop the systemic and interpersonal competencies, due to their capacity and scope of intervention in the institution. &nbsp, Los patrones de consumo inadecuados y los efectos nocivos causados al medio ambiente han desafiado a las Instituciones Públicas a mejorar constantemente el valor público que se añade a la sociedad y al medio ambiente mediante resultados ecoeficientes en los servicios prestados a la sociedad. En este contexto, el Secretario Ejecutivo se inserta en la Administración Pública como un agente estratégico con ejecutivos y subordinados. Sin embargo, tales cambios deben venir materializados en el desarrollo de la conciencia y el comportamiento pro-ambiental de los servidores que la componen, con el fin de desarrollar habilidades que los hagan capaces de contribuir a la sostenibilidad organizacional. Así, el objetivo de esta investigación es analizar la conciencia sostenible, el comportamiento ecológico en el trabajo y el dominio de las competencias para la sostenibilidad organizativa de los secretarios ejecutivos de una institución federal de educación superior. Para ello, se llevó a cabo una investigación descriptiva por encuesta, con datos obtenidos mediante la aplicación de cuestionarios cerrados, analizados a través de la estadística descriptiva. Los resultados indicaron que las secretarias ejecutivas tienen conciencia ecológica, pero que ésta no se materializa con la misma intensidad en relación con su comportamiento laboral. Se observó que las competencias para la sostenibilidad identificadas en estos profesionales fueron las normativas y las preventivas, pero que necesitan desarrollar las competencias sistémicas e interpersonales, por su capacidad y alcance de intervención en la Institución &nbsp, Os padrões inadequados de consumo e os efeitos nocivos acarretados ao meio ambiente têm desafiado as Instituições Públicas a melhorarem constantemente o valor público a ser agregado à sociedade e ao meio ambiente por meio de resultados ecoeficientes nos serviços prestados à sociedade. Nesse contexto, está inserido o Secretário Executivo na Administração Pública como agente estratégico junto a executivos e subordinados. Todavia, tais mudanças devem vir materializadas no desenvolvimento da consciência e de comportamento pró-ambiental dos servidores que a compõem, de modo a desenvolver competências que os tornem aptos a contribuir com a sustentabilidade organizacional. Assim, o objetivo desta pesquisa é analisar a consciência sustentável, o comportamento ecológico no trabalho e o domínio das competências para a sustentabilidade organizacional dos Secretários-Executivos de uma Instituição Federal de Ensino Superior. Para isso, foi realizada uma pesquisa descritiva, tipo survey, com dados obtidos por meio da aplicação de questionários fechados, analisados por meio da estatística descritiva. Os resultados encontrados indicaram que há uma consciência ecológica nos secretári-os executivos, mas que ela não se materializa na mesma intensidade em relação ao comportamento no trabalho. Observou-se que as competências para a sustentabilidade identificadas nesses profissionais, foram a normativa e a preventiva, mas, que necessitam desenvolver as competências sistêmica e interpessoal, pela sua capacidade e abrangência de intervenção na Instituição.

OBJETIVO: relacionar as Doenças Falciformes com a terapia gênica, tendo em vista a possibilidade da correção genética dessas hemoglobinopatias hereditárias. MÉTODOS: o delineamento consistiu em uma revisão integrativa a partir de artigos publicados nas bases de dados PubMed, Lilacs, e da Biblioteca Virtual em Saúde (BVS), combinando os seguintes descritores: Genetic therapy AND Anemia, Sickle Cell e Beta-thalassemia AND Anemia, Sickle Cell. Após busca e aplicações dos critérios de inclusão e exclusão restaram assim oito artigos, os quais compõem esta revisão. RESULTADOS E DISCUSSÕES: a maioria dos artigos utilizados faziam uma abordagem geral sobre a terapia genética em pacientes beta-talassêmicos, comparando as características destes com as dos indivíduos falciformes, ressaltando as grandes chances de controle e até mesmo da cura destas através da inserção ou edição de genes como também transplante das células hematopoiéticas. Estudos atuais apostam em avanços científicos no ramo da biologia da manipulação para que haja uma modificação genética com transfusão de células em crianças pré-diagnosticadas com alguma hemoglobinopatia, impedindo assim que ocorram as manifestações clínicas da doença. CONSIDERAÇÕES FINAIS: sabendo-se do grande número de nascidos portando algum tipo de Doença Falciforme, a modificação genética do sangue do cordão umbilical e o desenvolvimento de células estaminais hematopoiéticas seria, portanto uma terapia ideal para a diminuição dos casos de recém-nascidos portadores de Anemia Falciforme ou de Beta-talassemia. Já nos casos já existentes, a abordagem terapêutica que mostra maior eficiência e facilidade de acesso seria àquela que combina o aumento do volume celular com a diminuição da hemoglobina intracelular.

O presente artigo é proveniente do trabalho de conclusão de curso da Autora (2017), que teve como objetivo investigar o movimento de Ocupação das Escolas no ano de 2016, com ênfase no Instituto Federal da Paraíba (IFPB) campus Cabedelo. O percurso metodológico refere-se ao acesso inicial à pesquisa realizada durante a ocupação do campus através do Projeto de Extensão intitulado Universidade e Juventude: passarela cidadã. Tal pesquisa foi realizada pelos discentes XX e XX, vinculados ao grupo acima citado, sob a responsabilidade professora XX. O segundo momento foi a realização de um grupo focal com os alunos e alunas que fizeram parte da ocupação, para desta forma, entender como se dá a relação escola-alunos após o movimento de ocupação. Com a mobilização de alguns teóricos como Castells (2013), Gohn (2011), Poerner (2004) Foracchi (1972), Ianni (1963), Sposito (2000), Pais (1993), pode-se compreender a trajetória dos movimentos sociais da juventude e a sua dinâmica na contemporaneidade. Nesse sentido, com os resultados, torna-se perceptível uma maior quantidade de participação de alunos mais jovens, concentrados no primeiro ano, e, a partir dos relatos, demonstra-se uma mudança na relação com a escola mediante uma maior apropriação do espaço escolar pelos alunos participantes desta pesquisa.

Este ensaio tem como objetivo abordar a atuação dos movimentos sociais no período pandêmico do novo coronavírus. Elaborando um recorte específico no uso das ferramentas digitais e no engajamento do ativismo político de jovens através das redes sociais, utilizados pelo movimento estudantil em atos virtuais. Partindo de uma reflexão socioantropológica enquanto pesquisadoras no campo da juventude e dos movimentos sociais, percebemos a internet como um meio de organização desses movimentos. Promovendo ciberespaços para a mobilização dos militantes, os movimentos que antes ocupavam as ruas, hoje ocupam as redes sociais e disputam o campo virtual.

Objectives: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. Methods: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p

Objectives. Endoscopic gastrostomy occasionally presents limitations such as costs, availability of equipment and special materials, and difficult access to the gastric cavity in the setting of obstructive esophageal tumors. Open jejunostomies present high rates of postoperative complications and limited capacity for abdominal evaluation due to reduced incision size. Thus, to reduce procedure-related complications and overall costs and provide a thorough intraoperative evaluation of the peritoneal cavity, we present the following simplified technique. Methods. Video-assisted jejunostomy in ten steps. Results. The use of this Video-assisted laparoscopic technique proves to be a safe, viable alternative, with cost reduction, decreased use of disposable materials, shortened operative time, and accelerated recovery, in addition to increased technical ease and wide applicability across a variety of hospital settings.

Cavernous hemangiomas are congenital hamartomatous lesions that originate from mesodermal tissue composed of dilated blood vessels. Abdominal pain and palpable mass are the most common presenting symptoms. The different types of treatment for symptomatic patients remain controversial. However, surgical resection is always the most preferred method when possible. To date, there are no reports of endoscopic ultrasound-guided (EUS-guided) absolute ethanol injection as a treatment for such disease when surgery is not an option. A 19-year-old girl with giant cavernous intra-abdominal hemangioma extending to the hepatic hilum, also affecting the gastric wall and occupying the entire supra-mesocolic cavity, initially presents with upper gastrointestinal bleeding and loss of 20 kg in 1 year (BMI = 18 kg/m2). Percutaneous angiography identified a mass with arterial blood supply by the left gastric artery that was embolized. After re-bleeding, an alternative treatment with EUS-guided injection of alcohol was proposed once resection was not feasible without major risks to a young patient. This procedure was repeated 15 and 45 days after the initial treatment, with the ethanol injection of 25 cc and 15 cc, respectively. On the second and third procedure dates, there was evident regression of the hemangioma. On the third procedure, it was possible to identify all anatomic structures that were not clear on the first EUS. After 45 days of last injection, abdominal CT and EUS showed notorious regression of the lesion. Eight months later, abdominal CT showed only a remnant lesion in the hepatogastric ligament with 129 cm3 on volumetry (87% lower in comparison to the initial image), and the patient remains asymptomatic with BMI of 26. In the most recent follow-up CT, 4 years and 2 months after first treatment, the patient presents with a slight increase in the hemangioma—now with 183 cm3 on volumetry. Transgastric EUS-guided ethanol injection in the treatment of giant intra-abdominal cavernous hemangioma can provide good outcomes without major complications and can be repeated if necessary.

Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.

Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor, with more than 800,000 new cases diagnosed each year and with high mortality, ranking fourth in the world in cancer deaths. The worst prognosis is related to the late diagnosis, in which the tumor is at an advanced stage and curative treatments are not efficient in terms of increasing overall survival. Currently, screening and monitoring tests based on current guidelines have limited accuracy, which points to the need for the development of new biomarkers that improve HCC detection as well as its early diagnosis. This review will discuss the five phases of development of a biomarker, from its discovery to its application in clinical practice, and indicate the main biomarkers per development phase. Potential emerging technologies such as "Radiomics", "Proteomics" and "Metabolomics" will also be discussed, which should serve as tools for the elucidation of tumor heterogeneity, as well as provide data for future studies on HCC biomarkers.

Pancreatic duct stones are direct sequelae of chronic pancreatitis (CP) and can occur in ∼50% of patients. Selection of the appropriate treatment method for pancreatic duct stones depends on location, size and number of stones. We present a patient with upper abdominal pain and weight loss for the previous 3 months. Diagnostic workup detected a chronic inflammation of the pancreas with stone in the main pancreatic duct and a nodular lesion in the head of the pancreas. Endoscopic retrograde cholangiopancreatography was performed without success. Given the rise in incidence and prevalence of CP, the potential complications and high mortality rate, it is imperative that physicians understand the risk factors, disease process and management of this disease. Pancreaticoduodenectomy in patients with CP is a feasible option for the treatment of focal cystic lesions to the head of the pancreas associated to pancreatic stone in selected cases.

Background Hepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications. Methods This retrospective comparative descriptive study aims to evaluate a series of 86 consecutive liver resections (LRs) performed for the treatment of metastatic liver tumors, comparing the results between patients undergoing major and minor LR. All patients submitted to LR from October 2010 to July 2015 at the Erasto Gaertner Hospital in Curitiba-PR were included. Quantitative numerical variables were analyzed with the Student t-test. The nonparametric Mann–Whitney U test was used for numerical variables of non-normal distribution. Categorical variables were analyzed with the Chi-square test with Fisher's correction. The data were analyzed with the SPSS 23.0 and STATA 15 programs, being p Results Eighty-six LR were performed, 56 cases by colorectal metastasis. The major LR corresponded to 68 cases, with 13.2% of Clavien-Dindo III–V complications and 2.9% of reoperation rate. Eighteen minor LR were performed and one patient had a postoperative complication requiring reoperation. Conclusion Preoperative elevation of transaminases and jaundice negatively influence surgical outcomes in patients undergoing LR. Tumors greater than 3 cm presented worse postoperative survival. Major LR did not significantly increase the surgical morbidity rate. Institutional Review Board registration 1.122.319/2015

Quality is a term used by various specialists, from different perspectives, having as a common point to identify focuses that promote their development in institutional management. Quality processes allow us to improve assistance, reducing complication and death rates and reducing costs. Currently, the positive experience of the patient is highly valued and should be sought by all institutions. The benefits of quality procedures are extensive. There is evidence of lower complication and mortality rates, cost reduction, uniformity of care, improved communication and opportunity for health education. There is a need for financial investment by the institutions, but they can be converted in the future. The idea that these are just bureaucratic steps must be fought because individualistic attitudes are no longer part of safe medicine. The success of a quality process requires interdisciplinarity, integration with quality offices for effective communication. The implementation of feasible attitudes should be sought, with a high adherence rate to seek patient satisfaction and safety. We will address historical aspects, the requirements for the implementation of a quality program, the concepts of indicators and the aspects that influence the quality in surgery, in addition to presenting benefits that such a program can offer to the surgeon and the institution.

Trauma systems are an integrated, hierarchical, and regionalized network of agencies, institutions, and resources aimed at full collaboration, trained, and dedicated to control, treat, and prevent deaths and permanent disability in a population, directly or indirectly related to trauma disease. The main objective of trauma systems is to maximize the effort and effectiveness of all human, material, and financial resources available. The main objective of trauma registries is to provide information for trauma systems, and that includes accurate and reliable information of the causes, circumstances, and type of injuries of the population.

Introduction: Pancreatic cancer is the fourth leading cause of cancer death in Western countries, with a more prevalent incidence in the elderly (1). It presents itself as a neoplasm with high lethality and low survival, surgical resection being the only treatment with curative potential. However, pancreatoduodenectomy (Kausch-Whipple technique) is one of the most difficult surgeries in the gastrointestinal system, due to the great difficulty in accessing the pancreas and its proximity to various delicate and vital structures, requiring advanced knowledge by the surgeon (6). Objective: Evaluate the profile of patients with pancreatic cancer and factors that contribute to the surgical outcome and survival after curative pancreatoduodenectomy. Method: A descriptive retrospective cross-sectional study was carried out through the analysis of records of pancreatoduodenectomy in the period May 2005 – July 2015 at Hospital Erasto Gaertner (HEG) in Curitiba/PR. Variables were analyzed using Student's t-test, non-parametric Mann-Whitney U test, and chi-squared test with Fisher's correction. Survival and disease-free survival rates were evaluated using the Kaplan-Maier method with the log-rank test and survival predictors identified with Cox regression. The SPSS 23.0 and STATA 15 programs were used, with p value being lower than 0.05 considered statistically significant. Results: 98 pancreatoduodenectomy were evaluated and 46 were in male patients and 30 were in patients aged

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p

RESUMO Objetivo: avaliar a viabilidade de abreviação do jejum em cirurgias colorretais oncológicas, bem como, o impacto no desfecho cirúrgico dos pacientes. Métodos: estudo prospectivo comparativo randomizado com pacientes submetidos à cirurgias eletivas colorretais, por câncer, no período de maio a setembro de 2017. Os pacientes foram randomizados eletronicamente em dois grupos de acordo com o jejum pré-operatório a ser adotado: convencional ou abreviado. Resultados: dos 33 pacientes incluídos, 15 seguiram o protocolo de jejum abreviado e 18 de jejum convencional. Ambos os grupos apresentaram perfis comparáveis. Nenhum paciente foi submetido a preparo mecânico do cólon. Em 69,7% dos casos, a cirurgia envolveu dissecção baixa do reto. Os procedimentos foram equivalentes em relação às variáveis intraoperatórias e complicações graves. O tempo para atingir realimentação plena foi menor para o jejum abreviado (10 versus 16 dias, p=0,001), assim como, o tempo de internação hospitalar (2 versus 4 dias, p=0,009). Os custos hospitalares foram menores no jejum abreviado (331 versus 682 reais, p