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During scaling of fermentations, choosing a bioreactor is fundamental to ensure the product's quality. This study aims to produce bioherbicides using Trichoderma koningiopsis fermentation, evaluating process parameters in an Airlift bioreactor. As a response, we quantified the production of enzymes involved in the bioherbicide activity (amylase, cellulase, laccase, lipase, and peroxidase). In addition, it evaluated the agronomic efficiency of the fermented extract optimized through tests that promoted soybean growth and nodulation, soybean seed germination, and in vitro phytopathogen control. As a result of optimizing the scaling bioprocess, it was possible to obtain an adequate fermentation condition, which, when applied to soybean seeds, had beneficial effects on their growth. It allowed the production of an enzyme cocktail. These results add a crucial biotechnological potential factor for the success of the optimized formulation in the Airlift bioreactor, in addition to presenting relevant results for the scientific community.

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Resumo Fundamento: A identificação de fatores de riscos na cirurgia cardiovascular auxilia na previsibilidade resultando na otimização de desfechos e redução de custos. Objetivo: Identificação dos preditores de risco pré e intraoperatórios para internação prolongada após cirurgia de revascularização do miocárdio (CRM) no Estado de São Paulo. Métodos: Análise transversal no banco de dados REPLICCAR II, registro prospectivo, consecutivo, multicêntrico que incluiu cirurgias de revascularização miocárdica realizadas entre agosto de 2017 e julho de 2019. O desfecho principal foi o tempo de internação prolongado, definida como período de pós-operatório superior a 14 (quatorze) dias. Para a identificação dos preditores foram realizadas análises de regressão logística uni- e multivariada. Os valores de p menores de 0,05 foram considerados significativos. Resultados: A mediana de idade foi de 63 (57-70) anos e 26,55% eram do sexo feminino. Dos 3703 pacientes analisados, 228 (6,16%) apresentaram longa permanência hospitalar (LPH) após a CRM e a mediana da internação foi de 17 (16-20) dias. Foram preditores da LPH após a CRM: idade >60 anos (OR 2,05; IC95% 1,43 - 2,87; p<0,001); insuficiência renal (OR 1,73; IC95% 1,29 - 2,32; p<0,001) e transfusão de hemácias no intraoperatório (OR 1,32; IC 1,07 - 2,06; p=0,01). Conclusão: Nesta análise, a idade > 60 anos, insuficiência renal e a transfusão de hemácias no intraoperatório foram preditores independentes de LPH após a CRM. A identificação destas variáveis pode ajudar no planejamento estratégico multiprofissional visando melhoria de resultados e otimização de recursos no estado de São Paulo.

Abstract Background: Identifying risk factors in cardiovascular surgery assists in predictability, resulting in optimization of outcomes and cost reduction. Objective: This study aimed to identify preoperative and intraoperative risk predictors for prolonged hospitalization after coronary artery bypass grafting (CABG) surgery in the state of São Paulo, Brazil. Methods: A cross-sectional analysis using data from the REPLICCAR II database, a prospective, consecutive, multicenter registry that included CABG surgeries performed between August 2017 and July 2019. The primary outcome was a prolonged hospital stay (PHS), defined as a postoperative period exceeding 14 days. Univariate and multivariate logistic regression analyses were performed to identify the predictors with significance set at p <0.05. Results: The median age was 63 (57-70) years and 26.55% of patients were female. Among the 3703 patients analyzed, 228 (6.16%) had a PHS after CABG, with a median hospital stay of 17 (16-20) days. Predictors of PHS after CABG included age >60 years (OR 2.05; 95% CI 1.43-2.87; p<0.001); renal failure (OR 1.73; 95% CI 1.29-2.32; p <0.001) and intraoperative red blood cell transfusion (OR 1.32; 95% CI 1.07-2.06; p=0.01). Conclusion: Age >60 years, renal failure, and intraoperative red blood cell transfusion were independent predictors of PHS after CABG. The identification of these variables can help in multiprofessional strategic planning aimed to enhance results and resource utilization in the state of São Paulo.

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ABSTRACT Objective: to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects. Method: an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively. Results: the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod. Conclusion: three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.

RESUMEN Objetivo: investigar las contribuciones de la aplicación de la metodología Lean a la mejora de los procesos de trabajo en salud y enfermería y su impacto en los aspectos financieros asociados. Método: revisión integradora, realizada en seis bases de datos, cuya muestra de diez (100,0%) estudios fue analizada y resumida de forma descriptiva. Resultados: los resultados obtenidos se estratificaron en: beneficios/barreras para la implementación de Lean Healthcare; aspectos económicos que implican la implementación de Lean Healthcare; y mejoras de procesos mediante la implementación de Lean Healthcare. La mayoría de los estudios (60,0%) se realizaron en hospitales universitarios, contextos que necesitan mejorar continuamente la calidad de los servicios prestados, generalmente con recursos escasos y limitados, que sustentan la viabilidad de mantener el trípode de docencia, investigación y extensión. Conclusión: tres (30,0%) estudios destacaron los aspectos financieros asociados a la aplicación de la metodología Lean. Los demás solo mencionaron la posibilidad de obtener ganancias financieras mejorando los procesos y reduciendo el desperdicio.

RESUMO Objetivo: investigar as contribuições da aplicação da metodologia Lean para melhoria dos processos de trabalho em saúde e enfermagem e sua repercussão nos aspectos financeiros associados. Método: revisão integrativa, realizada em seis bases de dados, cuja amostra de dez (100,0%) estudos foi analisada e sintetizada descritivamente. Resultados: os desfechos obtidos foram estratificados em: benefícios/barreiras para implantação do Lean Healthcare; aspectos econômicos envolvendo a implantação do Lean Healthcare; e melhorias em processos por meio da implantação do Lean Healthcare. A maioria dos estudos (60,0%) foi realizada em hospitais universitários, contextos que precisam melhorar, continuamente, a qualidade dos serviços prestados, geralmente com recursos escassos e limitados, os quais sustentam a viabilidade da manutenção do tripé ensino, pesquisa e extensão. Conclusão: três (30,0%) estudos evidenciaram os aspectos financeiros associados à aplicação da metodologia Lean. Os demais apenas mencionaram a possibilidade de ganhos financeiros por meio da melhoria de processos e redução de desperdícios.

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ABSTRACT Objective: To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period. Methods: Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay. Results: The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes. Final considerations: Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.

RESUMEN Objetivo: Analizar las evidencias sobre la influencia del Lean y/o Six Sigma para optimizar los procesos en el periodo perioperatorio. Métodos: Es una revisión integradora llevada a cabo en las bases de datos MEDLINE/PubMed, Web of Science, EMBASE, CINAHL, Scopus y LILACS, sobre la utilización del Lean y/o Six Sigma para optimizar los procesos en el perioperatorio. Los estudios incluidos se analizaron en tres categorías temáticas: flujo de pacientes quirúrgicos, proceso de trabajo y tiempo de la estancia. Resultados: La muestra final estuvo formada por diez estudios, los cuales contemplaron todos los períodos operatorios. Lean y/o Six Sigma contribuyen grandemente para mejorar los procesos en el perioperatorio. Consideraciones finales: Lean y/o Six Sigma optimizan los procesos perioperatorios al maximizar el alcance de los indicadores de estabilidad de los sistemas, facilitando la identificación de problemas potenciales para reconocer y proponer soluciones que ayuden a instituir un cuidado más centrado en el paciente.

RESUMO Objetivo: Analisar as evidências acerca da influência do Lean e/ou Six Sigma para otimização de processos no período perioperatório. Métodos: Revisão Integrativa realizada nas bases de dados MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus e LILACS, a respeito do uso do Lean e/ou Six Sigma para otimização de processos no perioperatório. Os estudos incluídos foram analisados em três categorias temáticas: fluxo de pacientes cirúrgicos, processo de trabalho e tempo de permanência. Resultados: A amostra final foi composta por dez estudos, os quais contemplaram todos os períodos operatórios. Lean e/ou Six Sigma contribuem de forma expressiva para a otimização dos processos no perioperatório. Considerações finais: Lean e/ou Six Sigma otimizam processos perioperatórios em vista da maximização do alcance de indicadores de estabilidade dos sistemas, tornando possível a identificação de potenciais problemas para o reconhecimento e proposição de soluções que possam viabilizar a instituição de um cuidado centrado no paciente.

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In this work, the Honduras Mahogany (Swietenia macropnylla King, SMK) seed husk was used as a novel biomass resource for producing activated carbon by physical activation. The texture characteristics and chemical characterization of resulting products were investigated in correlation with the process parameters. Based on the thermochemical properties of the SMK biomass, the process conditions were set to a rate of about 10 °C/min under nitrogen (N2) flow of 500 cm3/min heated to 500 °C, then switched to carbon dioxide (CO2) flow of 100 cm3/min in the specified activation conditions (i.e., temperature of 700-850 °C for holding times of 0-60 min). Our findings showed that the texture characteristics (i.e., surface area and pore volume) increased with an activation temperature increase from 700 to 800 °C for a holding time of 30 min but gradually decreased as the temperature increased thereafter. Similarly, the texture characteristics also indicated an increasing trend with the residence time extending from 0 min to 30 min but slightly decreased as the time was extended to 60 min. Therefore, the optimal activation conditions for producing SMK-based activated carbon should be set at 800 °C for a holding time of 30 min to obtain the maximal texture characteristics (i.e., BET surface area of 966 m2/g and total pore volume of 0.43 cm3/g). On the other hand, the chemical characteristics were analyzed by energy dispersive X-ray spectroscopy (EDS) and Fourier Transform infrared spectroscopy (FTIR), showing oxygen complexes contained on the hydrophilic surface of the resulting activated carbon.

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Due to the high content of phenolics and anthocyanins of Hibiscus sabdariffa L. tea and the sensibility of these bioactive compounds, this work aimed to optimize the obtention of microcapsules by spray-drying, using inulin as a carrier agent. Using a Box-Behnken Design, the effects of inlet temperature (130, 150, and 170 °C), feed flow rate (5, 10, and 15 mL min-1), and inulin concentration (5, 10, and 15 g L-1) were evaluated. It was possible to obtain pale-rose, slightly sweet instant powders with good total polyphenol content (1.12 mgGAE g-1) and anthocyanins encapsulation efficiency (32.3-60.6%), besides moisture (4.61-17.79%) and water activity (0.221-0.501), indicating physico-chemical and microbiological stability of the microcapsules. A simultaneous optimization with the desirability function was performed to maximize all the response variables analyzed, and the optimum conditions of 5 g L-1 of inulin, inlet temperature of 170 °C, and feed flow rate of 83 mL min-1 were found.

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Curcumin (CUR) is one natural bioactive compound acknowledged for diverse therapeutic activities, but its use is hindered by its poor bioavailability, fast metabolism, and susceptibility to pH variations and light exposure. Thus, the encapsulation in poly(lactic-co-glycolic acid), or PLGA, has been successfully used to protect and enhance CUR absorption in the organism, making CUR-loaded PLGA nanoparticles (NPs) promising drug delivery systems. However, few studies have focused beyond CUR bioavailability, on the environmental variables involved in the encapsulation process, and whether they could help obtain NPs of superior performance. Our study evaluated pH (3.0 or 7.0), temperature (15 or 35 °C), light exposure, and inert atmosphere (N2) incidence in the encapsulation of CUR. The best outcome was at pH 3.0, 15 °C, without light incidence, and without N2 usage. This best nanoformulation showed NP size, zeta potential, and encapsulation efficiency (EE) of 297 nm, -21 mV, and 72%, respectively. Moreover, the CUR in vitro release at pH values 5.5 and 7.4 suggested different potential applications for these NPs, one of which was demonstrated by the effective inhibition of multiple bacteria (i.e., Gram-negative, Gram-positive, and multi-resistant) in the minimal inhibition concentration assay. Besides, statistical analyses confirmed a significant impact of temperature on the NP size; in addition, temperature, light, and N2 affected the EE of CUR. Thus, the selection and control of process variables resulted in higher CUR encapsulation and customizable outcomes, ultimately enabling more economical processes and providing future scale-up guidelines.

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BACKGROUND: Four commercial starter cultures containing Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus (S1, S2, S3 and S4; S3 also contained Limosilactobacillus fermentum) were compared for fermentation, volatile flavor compounds, physicochemical parameters and microbiology, in yogurt prepared from three milk base formulations with increased protein (B1, B2 and B3). RESULTS: The fermentation patterns differed among starters, with Yoflex Mild 1.0 (S4) and SLB95 (S2) showing the longest fermentation time, depending on the formulation. At 21 days, S. thermophilus counts were similar among starters and higher than 8.52 log CFU mL-1 , for all yogurts. The highest counts (6.86 log CFU mL-1 ) for L. delbrueckii subsp. bulgaricus was found for S2 yogurts made from whey protein hydrolysate (B3). Minor water-holding capacity was detected for YF-L811 (S1) yogurts. Yoflex Harmony 1.0 (S3) starter containing Lim. fermentum produced a distinctive volatile profile characterized by aldehydes with respect to yogurts prepared with S1, S2 and S4, which were characterized by ketones. CONCLUSION: Results indicate the usefulness of carrying out studies similar to the present one to select the most appropriate process conditions depending on the desired product. © 2022 Society of Chemical Industry.

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ABSTRACT Introduction: The genetic algorithm is one of the essential theoretical mathematical models for simulating biological development. It is widely used in many fields such as engineering, medicine, and economics. Objective: Use the genetic algorithm as a mathematical model basis for optimization in the high school students' aptitude program. Methods: The selection method by competition is adopted to elect the random crossover of male crossover probability with high similarity to generate a new population. A genetic algorithm was proposed to adjust the crossover probability and dynamic mutation according to fitness, aiming to solve the problem of dynamic changes. A comparative analysis is performed between the nonlinear differential equations and the Levenberg-Marquardt method algorithm. Results: The algorithm improvement was obtained after analyzing the operation process and structuring of the traditional genetic algorithm; the mathematical model application revealed improvement in the motion accuracy model established by the genetic algorithm. Conclusion: The physical enhancement optimization scheme was tested and verified by a genetic algorithm and proves the research results hold theoretical feasibility. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: O algoritmo genético é um dos mais importantes modelos matemáticos teóricos para simulação de desenvolvimento biológico. É amplamente utilizado em muitos campos, tais como engenharia, medicina e economia. Objetivo: Utilizar o algoritmo genético como base de um modelo matemático para otimização no programa de aptidão nos estudantes do ensino médio. Método: Adota-se o método de seleção por competição para eleger o cruzamento aleatório da probabilidade de crossover masculino com grande semelhança para gerar uma nova população. Um algoritmo genético foi proposto para ajustar a probabilidade de crossover e mutação dinâmica de acordo com a aptidão física, visando resolver o problema das alterações dinâmicas. Efetua-se uma análise comparativa entre os resultados das equações diferenciais não-lineares e o algoritmo de Levenberg-Marquardt de quarta ordem. Resultados: O aperfeiçoamento do algoritmo foi obtido após a análise do processo de operação e estruturação do algoritmo genético tradicional, a aplicação do modelo matemático revelou melhora na precisão do modelo de movimento estabelecido pelo algoritmo genético. Conclusão: O esquema de otimização do aprimoramento físico foi testado e verificado por um algoritmo genético provando que os resultados da pesquisa possuem praticabilidade teórica.Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: El algoritmo genético es uno de los modelos matemáticos teóricos más importantes para la simulación del desarrollo biológico. Se utiliza ampliamente en muchos campos como la ingeniería, la medicina y la economía. Objetivo: Utilizar el algoritmo genético como base de un modelo matemático de optimización en el programa de aptitud para estudiantes de secundaria. Método: Se adopta el método de selección por competencia para elegir el cruce aleatorio de probabilidad de crossover masculino con alta similitud para generar una nueva población. Se propuso un algoritmo genético para ajustar la probabilidad de cruce y la mutación dinámica en función de la aptitud, con el fin de resolver el problema de los cambios dinámicos. Se realiza un análisis comparativo entre los resultados de las ecuaciones diferenciales no lineales y el algoritmo de Levenberg-Marquardt de cuarto orden. Resultados: La mejora del algoritmo se obtuvo tras el análisis del proceso de funcionamiento y estructuración del algoritmo genético tradicional, la aplicación del modelo matemático reveló la mejora de la precisión del modelo de movimiento establecido por el algoritmo genético. Conclusión: El esquema de optimización de la mejora física se probó y verificó mediante un algoritmo genético, demostrando que los resultados de la investigación tienen viabilidad teórica. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

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With the evolution of percutaneous coronary intervention techniques and their greater safety, the use of radial access, the greater need to optimize resources in health management and the greater demand from patients for an agile service to solve their problems, the discharge on the same day after percutaneous coronary interventions have been gaining ground in the global scenario as a feasible strategy. The objective of this article was to demonstrate that there is already a scientific basis for this, which extends from the financial aspect, and the patient's experience, to the technical details related to the safety of the strategy. A structured protocol based on evidence and on the most recent recommendations from two major medical societies is also proposed. Selecting patients well, training the multidisciplinary team and educating the patient are fundamental parts for the success of the strategy.

Com a evolução das técnicas de intervenção coronária percutânea e sua maior segurança, o uso do acesso radial, a maior necessidade de otimização dos recursos na gestão em saúde e a maior cobrança por parte dos pacientes por um serviço ágil para resolução de seus problemas, a alta no mesmo dia após as intervenções coronárias percutâneas vem ganhando espaço no cenário global como uma estratégia factível. O objetivo deste artigo foi demonstrar que já há base científica para o assunto, a qual se estende desde a aspectos financeiros, à experiência do paciente até à questão técnica relacionada à segurança da estratégia. Propõe-se, ainda, um protocolo estruturado baseado em evidências e nas recomendações mais recentes de duas grandes sociedades médicas. Selecionar bem os pacientes, treinar a equipe multiprofissional e educar o paciente são partes fundamentais para o sucesso da estratégia.