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Water is at the core of sustainable development, and its use for human activities, including vehicle washing, should be done in a sustainable way. There are several technical solutions for washing buses offering different performances, making it difficult to choose the one that best meets the requirements of each specific case. The literature on the topic hardly analyzes the choice of the best technical solution for washing buses and does not apply and compare the results of different multicriteria decision-making (MCDM) methods for the problem. The unique information available is from the different suppliers in the market. Whereby, this work intends to give a technical-scientific contribution to fulfill this gaps. Therefore, the main objectives of this work are (1) to select the best sustainable technical solutions for washing buses depending on the specific conditions for a case study and (2) to analyze how different multicriteria decision-making methods behave in the selection process. To achieve these objectives, the problem was approached as a case study in a public transport company in Portugal and the methodology followed the next steps: started with the identification of the different types of commercial technical solutions for washing buses; the company’s experts selected four main criteria: water consumption, operating costs, quality of washing, and time spent; the criteria weights were determined using the fuzzy-AHP method; then four representative MCDM methods were selected, namely, AHP, ELECTRE, TOPSIS, and SMART; the ranks obtained for the four methods were compared; and a sensitivity analysis was performed. Considering the input data for the criteria and their weights, the results for all the methods showed that the best and the worst solution was the same, mobile portico with a brush and porticoes with three brushes, respectively. Furthermore, the results of the sensitivity analysis performed with disturbances for the weights of each criterion presented that the results are slightly affected and the similarity in rankings for the four MCDM methods was validated by Spearman’s rank correlation coefficient (rs) and Kendall’s coefficient of concordance (W). Considering these results, the SMART method, the less complex one, showed no difference from the others. For that reason, simple methods, such as SMART, in line with other works in the literature perform well in most cases. As a final remark of this work, it can be said that the methodology employed in this project can also be deemed applicable to other similar companies seeking technical solutions for bus or truck washing. Furthermore, the application of the SMART method, the less complex one and the most understandable for people, showed no difference from the others, being able to be applied in similar situations.

Abstract Background Brazil is seeing rapid population ageing, which is leading to new demands on primary health care services. There is a need to develop and assess the effectiveness of new interventions to build the capacity of staff, including community health workers, to meet the needs of groups such as care-dependent older people and their care-givers. This study examines the feasibility of a small training intervention piloted in the Brazilian city of Fortaleza. Methods The study evaluated participants’ own assessments of key knowledge and skills related to the needs of care-dependent older people, both before and after the training intervention. It also assessed their capacity to implement a simple screening tool of geriatric risk factors. Results The participant self-assessments indicate significant improvements in their perceived knowledge and capacity in responding to the health needs of care-dependent older people. Additionally, participants were able to successfully conduct the home visits and screening for risk factors. Conclusions The study demonstrates the feasibility of developing interventions to enhance the capacity of community health workers to meet the needs of dependent older people in countries like Brazil. The evidence of effectiveness, though limited and subjective, provides justification for a larger, formally evaluated intervention. The experience of Fortaleza provides valuable lessons for other cities and countries in the region which are facing similar challenges.

In today’s competing business market, companies are constantly challenged to dynamically adapt to customer expectations by diminishing the time response that goes from the beginning of the business opportunity to the satisfaction of the customer need. Simultaneously, there is increased recognition of the advantages that companies obtain in focusing on their core business and seeking other competencies through partnerships with other partners by forming collaborative networks. These new collaborative organizational structures require a new set of methods and tools to support the management of manufacturing processes across the entire supply chain. The present paper addresses the collaborative production planning problem in networks of non-hierarchical, decentralized, and independent companies. By proposing a collaborative planning intelligent framework composed of a web-based set of methods, tools, and technologies, the present study intends to provide network stakeholders with the necessary means to responsively and efficiently address each one of the market business opportunities. Through this new holistic framework, the managers of the networked companies can address the challenges posed during collaborative network formation and supply chain production planning.

This paper presents a novel policy framework to support government responses to COVID-19 in long-term care facilities (LTCFs) in low and middle-income countries. It focuses on issues that are of specific relevance to Brazilian policy-settings, including examples of its local implementation. The CIAT Framework combines and summarizes broad elements for an emergency strategy to address the potential effects of COVID-19. The 4 steps of the Framework entail policies to coordinate, identify, assess, and target support. Those policies can be applied immediately to mitigate the impact of the COVID-19 pandemic in LTCFs. It is, however, essential to situate these responses within a more comprehensive and permanent strategy. Intersectoral collaboration must evolve into a fully institutionalized system.

In the last few years, the industrial, scientific, and technological fields have been subject to a revolutionary process of digitalization and automation called Industry 4.0. Its implementation has been successful mainly in the economic field of sustainability, while the environmental field has been gaining more attention from researchers recently. However, the social scope of Industry 4.0 is still somewhat neglected by researchers and organizations. This research aimed to study Industry 4.0 and sustainability themes using data science, by incorporating open data and open-source tools to achieve sustainable Industry 4.0. To that end, a quantitative analysis based on open data was developed using open-source software in order to study Industry 4.0 and sustainability trends. The main results show that manufacturing is a relevant value-added activity in the worldwide economy; that, foreseeing the importance of Industry 4.0, countries in America, Asia, Europe, and Oceania are incorporating technological principles of Industry 4.0 in their cities, creating so-called smart cities; and that the industries that invest most in technology are computers and electronics, pharmaceuticals, transport equipment, and IT (information technology) services. Furthermore, the G7 countries have a prevalent positive trend for the migration of technological and social skills toward sustainability, as it relates to the social pillar, and to Industry 4.0. Finally, on the global scale, a positive correlation between data openness and happiness was found.

Purpose: The study purpose was to analyse the excellence and operational efficiency of Portuguese industrial companies through the measurement of lean practices implementation. Additionally, it intended to propose a new model to assess the lean production system. Design/methodology/approach: The research presents an in-depth lean literature review that served as a basis for the creation of a questionnaire. The survey was addressed to Portuguese industrial companies to obtain data about their lean implementation success. Collected data were analysed, resorting descriptive and exploratory statistics. A principal component analysis was applied to reduce the amount of data and define a new model that characterizes the lean practices adoption level. Some Chi-square tests were used to assess the independence of some variables. Findings: The results indicate that a significant percentage of organizations use lean practices within their activity. Concerning the lean implementation maturity, a plus side revealed by the study concerns the adoption of the teamwork, internal information shared principles, increase of process capability to produce conforming products, and reduction in set up times. On the other hand, responsibilities decentralization, more employees acting as team leaders, implementation of employees’ suggestions, and interconnection with suppliers, are some of the principles that need to be given greater attention by the Portuguese industrial organizations. The key contribution consists of a new model for lean determinants based on three dimensions: work method, productive process elements, and work efficiency. Originality/value: The present research provides a new Lean determinants model that allows understanding the importance of the operational efficiency provided by a mature lean production system, being the key to the competitiveness in the global business market.

Desmoid tumors are rare benign neoplasms, with locally aggressive characteristics. Ongoing or previous pregnancy, antecedent trauma, and familial adenomatous polyposis are known risk factors. Still, the majority of cases are sporadic and its etiology is still unknown. These tumors may occur in any body site, but retroperitoneal and pelvic desmoid tumors are extremely rare. Nonspecific clinical and radiological findings lead to erroneous diagnosis in 50% of patients before surgery. We present a case of a young multiparous female with a deep infiltrative lesion adherent to the right pelvic sidewall leading to severe right hydroureteronephrosis and ipsilateral loss of renal function. Although deep endometriosis was suspected, malignancy features could not be excluded by imaging studies. The patient underwent an exploratory laparotomy for definite diagnosis and treatment, which led to right nephrectomy, hysterectomy, and right oophorectomy because of deep infiltration and difficult dissection. Definite histologic diagnosis revealed the presence of a pelvic desmoid tumor. Positive margins were encountered but, until this moment, no disease relapse occurred.

ABSTRACT Objectives: to assess factors associated with vulnerability and fragility in the elderly. Methods: crosssectional study with 384 elderly people in Fortaleza, Ceará. The Vulnerable Elders Survey and Clinical-Functional Vulnerability Index - 20 were used. Chi-square and Fisher’s exact tests were used for associations. In the analysis of the combined influence of risk factors, the stepwise logistic regression and multinomial regression methods were adopted. Results: 251 (65.4%) non-vulnerable and 133 (34.6%) vulnerable elders. From the vulnerable elders analyzed, 42 (30.9%) are at high risk for frailty. Factors associated with vulnerability: age, gender, presence of comorbidities, hypertension, diabetes, osteoporosis and use of polypharmacy. There is a 30% increase in the chance of vulnerability for each additional drug. Physical activity reduces the chance of vulnerability by 60%. Factors associated with frailty: educational level; self-perception of health; comorbidities; polypharmacy. Conclusions: it is important to pay attention to the presence of arterial hypertension, osteoporosis, polypharmacy, and encourage the practice of physical activity.

O trabalho por turnos pode ser definido como qualquer regime fora do horário laboral usual, cujo objetivo se centre no asseguramento de uma continuidade dos serviços prestados. O setor da saúde é particularmente afetado por este tipo de trabalho. O objetivo do presente estudo é rever a literatura corrente relativa aos efeitos do trabalho por turnos no sono e saúde psíquica dos trabalhadores, dando particular ênfase ao seu impacto nos profissionais de saúde. Foi revista a literatura em inglês entre 1984 e 2017 integralmente disponível no PubMed/MEDLINE que avaliasse o impacto do trabalho por turnos no sono e saúde psíquica dos trabalhadores, através das palavras‑chave: shiftwork disorder, sleep, mental health, medical errors, doctors. Foram identificados efeitos deletérios do trabalho por turnos ao nível do sono, saúde psíquica, desempenho cognitivo e laboral dos trabalhadores. Ao nível do sono, este regime laboral aumenta a sonolência excessiva diurna e a insónia. No que que diz respeito à saúde psíquica, o trabalho por turnos potencia o aparecimento de patologia ansiosa, depressão e abuso de substâncias, produzindo ainda alterações cognitivas significativas. Estas alterações cognitivas assumem particular relevância nos profissionais de saúde, podendo aumentar o número de erros médicos cometidos no horário por turnos. O trabalho por turnos produz efeitos significativos no sono, saúde psíquica e desempenho cognitivo dos trabalhadores. É importante a implementação de medidas institucionais e individuais que possam reduzir o impacto do trabalho por turnos nos trabalhadores, particularmente na área da saúde.

Abstract: The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of “avoidable displacement from home” (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.

In recent years electricity sectors worldwide have undergone major transformations, referred to as the “energy transition”. This has required energy planning to quickly adapt to provide useful inputs to the regulation activity so that a cost-effective electricity market emerges to facilitate the integration of renewables. This paper analyzes the role of system planning and regulations on two specific elements in the energy market design: the concept of firm capacity and the presence of distributed energy resources, both of which can be influenced by regulation. We assess the total cost of different regulatory mechanisms in the Brazilian and Mexican systems using optimization tools to determine optimal long-term expansion for a given regulatory framework. In particular, we quantitatively analyze the role of the current regulation in the total cost of these two electricity systems when compared to a reference “efficient” energy planning scenario that adopts standard cost-minimization principles and that is well suited to the most relevant features of the new energy transformation scenario. We show that two very common features of regulatory designs that can lead to distortions are: (i) renewables commonly having a lower “perceived cost” under the current regulations, either due to direct incentives such as tax breaks or due to indirect access to more attractive contracts or financing conditions; and (ii) requirements for reliability are often defined more conservatively than they should be, overstating the hardships imposed by renewable generation on the existing system and underestimating their potential to form portfolios.

The problem of selecting suppliers/partners is a crucial and important part in the process of decision making for companies that intend to perform competitively in their area of activity. The selection of supplier/partner is a time and resource-consuming task that involves data collection and a careful analysis of the factors that can positively or negatively influence the choice. Nevertheless it is a critical process that affects significantly the operational performance of each company. In this work, trough the literature review, there were identified five broad suppliers selection criteria: Quality, Financial, Synergies, Cost, and Production System. Within these criteria, it was also included five sub-criteria. Thereafter, a survey was elaborated and companies were contacted in order to answer which factors have more relevance in their decisions to choose the suppliers. Interpreted the results and processed the data, it was adopted a model of linear weighting to reflect the importance of each factor. The model has a hierarchical structure and can be applied with the Analytic Hierarchy Process (AHP) method or Simple Multi-Attribute Rating Technique (SMART). The result of the research undertaken by the authors is a reference model that represents a decision making support for the suppliers/partners selection process.