Hepatitis E is the fifth known form of human viral hepatitis.Although not very common in our clinical practice,the incidence in Western countries is increasing.Infection with the hepatitis E virus(HEV)may be related t...Hepatitis E is the fifth known form of human viral hepatitis.Although not very common in our clinical practice,the incidence in Western countries is increasing.Infection with the hepatitis E virus(HEV)may be related to acute illness,liver failure,chronic hepatitis and cirrhosis.HEV itself is an RNA virus,with eight described genotypes(HEV 1-8),four of which more commonly affect humans and have,thus,been better studied.Besides liver manifestations,genotype 3 is also related to extra-hepatic manifestations,such as neurological,renal and rheumatological.Evolution to chronic disease occurs especially in patients who underwent transplantation,have hematological malignancies requiring chemotherapy,or have infection with the human immunodeficiency virus.The diagnosis may be difficult because of the low availability of tests and due to low sensibility and specificity.The acute form of illness does not have to be treated,but the chronic one does.We present here a literature review of hepatitis E and the relation between chronic hepatitis E and transplantation.展开更多
Three atmospheric boundary layer （ABL） schemes and two land surface models that are used in the Weather Research and Forecasting （WRF） model, version 3.4.1, were evaluated with numerical simulations by using data ...Three atmospheric boundary layer （ABL） schemes and two land surface models that are used in the Weather Research and Forecasting （WRF） model, version 3.4.1, were evaluated with numerical simulations by using data from the north coast of France （Dunkerque）. The ABL schemes YSU （Yonsei University）, ACM2 （Asymmetric Convective Model version 2）, and MYJ （Mellor-Yamada-Janjic） were combined with two land surface models, Noah and RUC （Rapid Update Cycle）, in order to determine the performances under sea-breeze conditions. Particular attention is given in the determination of the thermal internal boundary layer （TIBL）, which is very important in air pollution scenarios. The other physics parameterizations used in the model were consistent for all simulations. The predictions of the sea-breeze dynamics output from the WRF model were compared with observations taken from sonic detection and ranging, light detection and ranging systems and a meteorological surface station to verify that the model had reasonable accuracy in predicting the behavior of local circulations. The temporal comparisons of the vertical and horizontal wind speeds and wind directions predicted by the WRF model showed that all runs detected the passage of the sea-breeze front. However, except for the combination of MYJ and Noah, all runs had a time delay compared with the frontal passage measured by the instruments. The proposed study shows that the synoptic wind attenuated the intensity and penetration of the sea breeze. This provided changes in the vertical mixing in a short period of time and on soil temperature that could not be detected by the WRF model simulations with the computational grid used. Additionally, among the tested schemes, the combination of the local- closure MYJ scheme with the land surface Noah scheme was able to produce the most accurate ABL height compared with observations, and it was also able to capture the TIBL.展开更多
Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung...Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.展开更多
Objective：To present a model for autism showing that impairment of sensory and self-regulation is the core deficit that underlies delays in social/language skills and abnormal behavior in autism;and to demonstrate th...Objective：To present a model for autism showing that impairment of sensory and self-regulation is the core deficit that underlies delays in social/language skills and abnormal behavior in autism;and to demonstrate the efficacy of a treatment for autism based on Chinese medicine.Methods：Children with autism under 6 years of age were assigned to treatment or wait-list conditions.A total of 130 children were treated and the results compared with 45 wait-list controls.Treatment is a tuina methodology directed at sensory impairment——Kai Qiao Tuina.The treatment was a five-month protocol that was implemented daily by trained parents via trained support staff.The effects of treatment on the main symptoms,autistic behavior,social/ language delay,sensory and self-regulatory impairment,as well as on parenting stress,were observed and compared.Results：The treatment had a large effect size（P0.0001） on measures of sensory and self-regulation. The evaluations done by pre-school teachers demonstrated improvement in the measures of autism（P0.003）, and were confirmed by evaluations done by parents（P0.0001）.There was a large decrease（P0.0001） in parenting stress.Conclusions：Sensory and self-regulatory impairment is a main factor in the development and severity of autism.Treatment of young children with autism with Kai Qiao Tuina resulted in a decrease in sensory and self-regulatory impairment and a reduction in severity of measures of autism.展开更多
AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy(e RARP) vs transperitoneal robot-assisted radical prostatectomy(t RARP) in a single...AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy(e RARP) vs transperitoneal robot-assisted radical prostatectomy(t RARP) in a single centre.METHODS: A total of 120 consecutive patients underwent 50 e RARP and 70 e RARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications(Clavien grade), positive surgical margin(PSM) rates, continence and erectile function were compared. The performance of e RARP required several technical modifications. These included developmentof Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.RESULTS: Robotic console times were shorter with e RARP vs t RARP(145.1 min vs 198.3 min, P < 0.0001). There were no significant differences in blood loss, PSM rates(e RARP 17.7% vs t RARP 22%) or complications(e RARP 8.5% vs t RARP 8%). A drain was used in all patients after t RARP and in 25/70 e RARP cases. Length of hospital stay was shorter after e RARP(mean 1.94 d vs 3.6 d, P < 0.0002). There were no differences between techniques in continence or potency at 6 mo. e RARP required several technical modifications: development of Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.CONCLUSION: e RARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. e RARP is a useful alternative to t RARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendele展开更多
Nineteen fungal strains were isolated from a chicken slaughterhouse effluent and within those, only one showed high values of lipolytic activity in submerged cultures. This fungus was identified as Trametes hirsuta. T...Nineteen fungal strains were isolated from a chicken slaughterhouse effluent and within those, only one showed high values of lipolytic activity in submerged cultures. This fungus was identified as Trametes hirsuta. The crude extract was immobilized in chitosan/clay beads, with an immobilization yield of 80.9%. The analyses of the crude extract and the immobilized derivative at different temperatures, pH (s), solvents, metallic ions and storage showed that the immobilization process increased the enzyme life span. Ethyl esters were obtained in solvent free systems using chicken viscera oil and the enzyme crude extract. For effective comparison, a reaction using viscera oil and commercial lipase Novozym 435 was carried out. The result revealed 35% and 28% esters conversion in the reactions containing chicken viscera oil, using Novozym 435 and the crude extract respectively. The extract was also used in a reaction with soybean oil, traditionally used as starting substrate for biodiesel production.展开更多
Toxoplasma gondii is a protozoan of worldwide distribution and the agent of toxoplasmosis.It is estimated that 30%–50%of the world population could be infected with this parasite.Although the infection in immunocompe...Toxoplasma gondii is a protozoan of worldwide distribution and the agent of toxoplasmosis.It is estimated that 30%–50%of the world population could be infected with this parasite.Although the infection in immunocompetent individuals is mostly asymptomatic,the disease in immunosuppressed and pregnant is a risk condition.As a member of the phylum Apicomplexa,T.gondii has an obligatory intracellular lifestyle;therefore,invading a host cell and establishing it inside a parasitophorous vacuole(PV)are mandatories for the survival of this parasite.The construction of a perfect intracellular niche for T.gondii requires the secretion of an arsenal of proteins from unique secretory organelles.These proteins will remodel the vacuolar environment and the host cell organization and functions,allowing the parasite to access essential nutrients and stay“invisible”inside a host cell.In the present review,we will discuss the main steps involved in the PV formation and its differentiation to tissue cyst,focusing mainly on the strategies employed in the acquisition of nutrients and proteins involved in host cell modification.展开更多
Introduction: Cognitive impairment has been identified in 30% - 50% of the population with Amyotrophic Lateral Sclerosis (ALS). Among these patients, dysphagia is not only a very common symptom but also one of the mai...Introduction: Cognitive impairment has been identified in 30% - 50% of the population with Amyotrophic Lateral Sclerosis (ALS). Among these patients, dysphagia is not only a very common symptom but also one of the main bulbar symptoms. Objective: To correlate cognitive function and dysphagia in patients with ALS. Methods: a cross-sectional study. Criteria for inclusion were an ALS diagnosis and the signing of the consent form. Criteria for exclusion were patients who had undergone speech therapy, patients within sufficient oral language skills to participate in cognitive tests, patients receiving enteral feeding and patients who withdrew from the study before completing all the stages. Evaluations of cognition and dysphagia were performed. Results: The initial sample consisted of 86 participants, 69 of which fell under exclusion criteria. Seventeen patients were evaluated, with a mean age of 49.8 (±11.3) and a mean education period of 7.1 (±2.8) years. Disease evolution was analyzed in months, with a median of 24 (P25 = 10;P75 = 72) months. In this sample, 70.6% of patients were male (p = 0.019). Among the tests performed, those of executive functions were correlated with dysphagia: FAB (p = 0.019) and Trail Making Test A (p = 0.006). Conclusion: This pilot study suggests a correlation between executive functions and dysphagia.展开更多
Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer how...Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer.Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.展开更多
Objective:This study aims to discuss the caregiving practices developed by Long-term Care Facilities(LTCFs)during the COVID-19 pandemic and analyze the daily care practices in long-term institutions for older adults i...Objective:This study aims to discuss the caregiving practices developed by Long-term Care Facilities(LTCFs)during the COVID-19 pandemic and analyze the daily care practices in long-term institutions for older adults in Brazil,all in light of the PCC framework.Methods:This is a mixed methods study in which data were collected through interviews with managers from 10 LTCFs.The qualitative discussion was carried out through the PCC framework divided into 5 categories:leisure,accommodation,food,hygiene and comfort,and clinical care.The quantitative data collected were analyzed in a descriptive way,being discussed in the light of the literature.Results:Analyzed LTCFs are unaware of our present difficulties in the implementation of PCC,with a greater presence of the traditional biomedical model being recognized.Given the vulnerabilities that the LTCFs present,PCC is an important alternative for LTCFs to promote the quality of life and autonomy of residents.Deconstructing the vision of LTCFs as a last resort of care and investing in the quality of care is an urgent and essential imperative for dignified and comprehensive care.Conclusions:This study highlights the need for a change in culture and understanding of the LTCFs not only as a place to provide healthcare,but also as a residents’home that fosters their autonomy,and feeling of belonging.Thus,it is essential to ensure that healthcare teams in LTCFs know about PCC and that further studies investigate the impact on the costs of PCC for institutionalized older adults.展开更多
This study aimed to explore how processes of innovation are perceived and managed in micro and small service-oriented companies in Campinas, i.e., verifying how people in these companies understand, identify, and mana...This study aimed to explore how processes of innovation are perceived and managed in micro and small service-oriented companies in Campinas, i.e., verifying how people in these companies understand, identify, and manage innovation （what tools or methodologies）. Innovation is not a new concept, but its perception as a process, detached from randomness, is. This understanding is what allows its management as a tool to improve results and competitiveness, and to the perpetuation of the company. The research had a qualitative approach that consisted in the content analysis of structured interviews held with 10 respondents of five different companies, using eight innovation-focused questions, adapted from the Brazilian National Quality Foundation （FNQ）. After interviews, four categories were identified： innovation understanding, innovative ambience, innovation process management, and learning during the process--the first two regarding the subjective features of innovation and the latter two the objective features. Analysis outcome has shown that companies understand the concept and importance of innovation, but still do not see it as a process, which leads them to try isolated initiatives, usually executed by instinct only. Due to the fact that innovation is not considered as a process, most practices encourage generation of ideas, instead of goals, key performance indicators （KPIs）, and learning--this latter one, only occurs informally and over time.展开更多
文摘Hepatitis E is the fifth known form of human viral hepatitis.Although not very common in our clinical practice,the incidence in Western countries is increasing.Infection with the hepatitis E virus(HEV)may be related to acute illness,liver failure,chronic hepatitis and cirrhosis.HEV itself is an RNA virus,with eight described genotypes(HEV 1-8),four of which more commonly affect humans and have,thus,been better studied.Besides liver manifestations,genotype 3 is also related to extra-hepatic manifestations,such as neurological,renal and rheumatological.Evolution to chronic disease occurs especially in patients who underwent transplantation,have hematological malignancies requiring chemotherapy,or have infection with the human immunodeficiency virus.The diagnosis may be difficult because of the low availability of tests and due to low sensibility and specificity.The acute form of illness does not have to be treated,but the chronic one does.We present here a literature review of hepatitis E and the relation between chronic hepatitis E and transplantation.
基金Supported by National Council for Scientific and Technological Development(301591/2009-1)
文摘Three atmospheric boundary layer （ABL） schemes and two land surface models that are used in the Weather Research and Forecasting （WRF） model, version 3.4.1, were evaluated with numerical simulations by using data from the north coast of France （Dunkerque）. The ABL schemes YSU （Yonsei University）, ACM2 （Asymmetric Convective Model version 2）, and MYJ （Mellor-Yamada-Janjic） were combined with two land surface models, Noah and RUC （Rapid Update Cycle）, in order to determine the performances under sea-breeze conditions. Particular attention is given in the determination of the thermal internal boundary layer （TIBL）, which is very important in air pollution scenarios. The other physics parameterizations used in the model were consistent for all simulations. The predictions of the sea-breeze dynamics output from the WRF model were compared with observations taken from sonic detection and ranging, light detection and ranging systems and a meteorological surface station to verify that the model had reasonable accuracy in predicting the behavior of local circulations. The temporal comparisons of the vertical and horizontal wind speeds and wind directions predicted by the WRF model showed that all runs detected the passage of the sea-breeze front. However, except for the combination of MYJ and Noah, all runs had a time delay compared with the frontal passage measured by the instruments. The proposed study shows that the synoptic wind attenuated the intensity and penetration of the sea breeze. This provided changes in the vertical mixing in a short period of time and on soil temperature that could not be detected by the WRF model simulations with the computational grid used. Additionally, among the tested schemes, the combination of the local- closure MYJ scheme with the land surface Noah scheme was able to produce the most accurate ABL height compared with observations, and it was also able to capture the TIBL.
文摘Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.
基金Supported by the Curry Stone Foundation,Spririt Moutain Community Fund,and Northwest Health Foundation
文摘Objective：To present a model for autism showing that impairment of sensory and self-regulation is the core deficit that underlies delays in social/language skills and abnormal behavior in autism;and to demonstrate the efficacy of a treatment for autism based on Chinese medicine.Methods：Children with autism under 6 years of age were assigned to treatment or wait-list conditions.A total of 130 children were treated and the results compared with 45 wait-list controls.Treatment is a tuina methodology directed at sensory impairment——Kai Qiao Tuina.The treatment was a five-month protocol that was implemented daily by trained parents via trained support staff.The effects of treatment on the main symptoms,autistic behavior,social/ language delay,sensory and self-regulatory impairment,as well as on parenting stress,were observed and compared.Results：The treatment had a large effect size（P0.0001） on measures of sensory and self-regulation. The evaluations done by pre-school teachers demonstrated improvement in the measures of autism（P0.003）, and were confirmed by evaluations done by parents（P0.0001）.There was a large decrease（P0.0001） in parenting stress.Conclusions：Sensory and self-regulatory impairment is a main factor in the development and severity of autism.Treatment of young children with autism with Kai Qiao Tuina resulted in a decrease in sensory and self-regulatory impairment and a reduction in severity of measures of autism.
文摘AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy(e RARP) vs transperitoneal robot-assisted radical prostatectomy(t RARP) in a single centre.METHODS: A total of 120 consecutive patients underwent 50 e RARP and 70 e RARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications(Clavien grade), positive surgical margin(PSM) rates, continence and erectile function were compared. The performance of e RARP required several technical modifications. These included developmentof Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.RESULTS: Robotic console times were shorter with e RARP vs t RARP(145.1 min vs 198.3 min, P < 0.0001). There were no significant differences in blood loss, PSM rates(e RARP 17.7% vs t RARP 22%) or complications(e RARP 8.5% vs t RARP 8%). A drain was used in all patients after t RARP and in 25/70 e RARP cases. Length of hospital stay was shorter after e RARP(mean 1.94 d vs 3.6 d, P < 0.0002). There were no differences between techniques in continence or potency at 6 mo. e RARP required several technical modifications: development of Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.CONCLUSION: e RARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. e RARP is a useful alternative to t RARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendele
文摘Nineteen fungal strains were isolated from a chicken slaughterhouse effluent and within those, only one showed high values of lipolytic activity in submerged cultures. This fungus was identified as Trametes hirsuta. The crude extract was immobilized in chitosan/clay beads, with an immobilization yield of 80.9%. The analyses of the crude extract and the immobilized derivative at different temperatures, pH (s), solvents, metallic ions and storage showed that the immobilization process increased the enzyme life span. Ethyl esters were obtained in solvent free systems using chicken viscera oil and the enzyme crude extract. For effective comparison, a reaction using viscera oil and commercial lipase Novozym 435 was carried out. The result revealed 35% and 28% esters conversion in the reactions containing chicken viscera oil, using Novozym 435 and the crude extract respectively. The extract was also used in a reaction with soybean oil, traditionally used as starting substrate for biodiesel production.
文摘Toxoplasma gondii is a protozoan of worldwide distribution and the agent of toxoplasmosis.It is estimated that 30%–50%of the world population could be infected with this parasite.Although the infection in immunocompetent individuals is mostly asymptomatic,the disease in immunosuppressed and pregnant is a risk condition.As a member of the phylum Apicomplexa,T.gondii has an obligatory intracellular lifestyle;therefore,invading a host cell and establishing it inside a parasitophorous vacuole(PV)are mandatories for the survival of this parasite.The construction of a perfect intracellular niche for T.gondii requires the secretion of an arsenal of proteins from unique secretory organelles.These proteins will remodel the vacuolar environment and the host cell organization and functions,allowing the parasite to access essential nutrients and stay“invisible”inside a host cell.In the present review,we will discuss the main steps involved in the PV formation and its differentiation to tissue cyst,focusing mainly on the strategies employed in the acquisition of nutrients and proteins involved in host cell modification.
文摘Introduction: Cognitive impairment has been identified in 30% - 50% of the population with Amyotrophic Lateral Sclerosis (ALS). Among these patients, dysphagia is not only a very common symptom but also one of the main bulbar symptoms. Objective: To correlate cognitive function and dysphagia in patients with ALS. Methods: a cross-sectional study. Criteria for inclusion were an ALS diagnosis and the signing of the consent form. Criteria for exclusion were patients who had undergone speech therapy, patients within sufficient oral language skills to participate in cognitive tests, patients receiving enteral feeding and patients who withdrew from the study before completing all the stages. Evaluations of cognition and dysphagia were performed. Results: The initial sample consisted of 86 participants, 69 of which fell under exclusion criteria. Seventeen patients were evaluated, with a mean age of 49.8 (±11.3) and a mean education period of 7.1 (±2.8) years. Disease evolution was analyzed in months, with a median of 24 (P25 = 10;P75 = 72) months. In this sample, 70.6% of patients were male (p = 0.019). Among the tests performed, those of executive functions were correlated with dysphagia: FAB (p = 0.019) and Trail Making Test A (p = 0.006). Conclusion: This pilot study suggests a correlation between executive functions and dysphagia.
文摘Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer.Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.
基金supported by the Mentored Undergraduate Summer Experience and SEED Money Grant of The College of New Jersey.
文摘Objective:This study aims to discuss the caregiving practices developed by Long-term Care Facilities(LTCFs)during the COVID-19 pandemic and analyze the daily care practices in long-term institutions for older adults in Brazil,all in light of the PCC framework.Methods:This is a mixed methods study in which data were collected through interviews with managers from 10 LTCFs.The qualitative discussion was carried out through the PCC framework divided into 5 categories:leisure,accommodation,food,hygiene and comfort,and clinical care.The quantitative data collected were analyzed in a descriptive way,being discussed in the light of the literature.Results:Analyzed LTCFs are unaware of our present difficulties in the implementation of PCC,with a greater presence of the traditional biomedical model being recognized.Given the vulnerabilities that the LTCFs present,PCC is an important alternative for LTCFs to promote the quality of life and autonomy of residents.Deconstructing the vision of LTCFs as a last resort of care and investing in the quality of care is an urgent and essential imperative for dignified and comprehensive care.Conclusions:This study highlights the need for a change in culture and understanding of the LTCFs not only as a place to provide healthcare,but also as a residents’home that fosters their autonomy,and feeling of belonging.Thus,it is essential to ensure that healthcare teams in LTCFs know about PCC and that further studies investigate the impact on the costs of PCC for institutionalized older adults.
文摘This study aimed to explore how processes of innovation are perceived and managed in micro and small service-oriented companies in Campinas, i.e., verifying how people in these companies understand, identify, and manage innovation （what tools or methodologies）. Innovation is not a new concept, but its perception as a process, detached from randomness, is. This understanding is what allows its management as a tool to improve results and competitiveness, and to the perpetuation of the company. The research had a qualitative approach that consisted in the content analysis of structured interviews held with 10 respondents of five different companies, using eight innovation-focused questions, adapted from the Brazilian National Quality Foundation （FNQ）. After interviews, four categories were identified： innovation understanding, innovative ambience, innovation process management, and learning during the process--the first two regarding the subjective features of innovation and the latter two the objective features. Analysis outcome has shown that companies understand the concept and importance of innovation, but still do not see it as a process, which leads them to try isolated initiatives, usually executed by instinct only. Due to the fact that innovation is not considered as a process, most practices encourage generation of ideas, instead of goals, key performance indicators （KPIs）, and learning--this latter one, only occurs informally and over time.
