Política de humanização em serviços de saúde – contributos para a definição de indicadores

A reforma dos cuidados de saúde primários (CSP), iniciada em 2005, visa melhorar o desempenho dos centros de saúde através da reorganização dos serviços em várias unidades funcionais, no sentido de resolver os problemas tendo em conta as necessidades a satisfazer, complementando-se entre si e assumindo compromissos de acessibilidade e qualidade nos cuidados de saúde prestados. Ao mesmo tempo, são criados órgãos de gestão e governação clínica que nunca antes existiram nos CSP, envolvendo a participação da comunidade. A optimização da gestão e da governação clínica permitiu organizar os serviços de saúde em Agrupamentos de Centros de Saúde (AGES), dando-lhes poderes e responsabilidades para solucionarem problemas e tomarem as decisões acertadas e céleres, já que conhecem melhor as necessidades de saúde das populações. As relações burocráticas são substituídas por relações de contratualidade, orientadas para obter melhores resultados em saúde. Partindo destes pressupostos, o estudo realizado pretende analisar a percepção de profissionais de saúde quanto à política de humanização dos CSP, bem como, identificar/construir indicadores que avaliem essa política, sendo um estudo de carácter exploratório e descritivo, à luz de uma abordagem qualitativa. Participaram neste estudo cinco profissionais de saúde da Administração Regional de Saúde (ARS) do Norte, lP, do Departamento de Contratualização, Departamento de Estudos e Planeamento da ARS Norte e do AGES Tâmega 11 - Vale Sousa Sul, seleccionados por conveniência e inquiridos por entrevista semi-estruturada. Os dados foram tratados através da análise de conteúdo com o apoio informático NVivo9. Os resultados apresentados, com base nas entrevistas realizadas aos participantes no estudo, sustentam que os actuais indicadores quantitativos contratualizados com as unidades funcionais, expressam a política de humanização num serviço de saúde, não coincidindo totalmente com as definições internacionais expressas neste estudo.

An heuristic approach for optimal location of gas supply units in transportation system

The best places to locate the Gas Supply Units (GSUs) on a natural gas systems and their optimal allocation to loads are the key factors to organize an efficient upstream gas infrastructure. The number of GSUs and their optimal location in a gas network is a decision problem that can be formulated as a linear programming problem. Our emphasis is on the formulation and use of a suitable location model, reflecting real-world operations and constraints of a natural gas system. This paper presents a heuristic model, based on lagrangean approach, developed for finding the optimal GSUs location on a natural gas network, minimizing expenses and maximizing throughput and security of supply.The location model is applied to the Iberian high pressure natural gas network, a system modelised with 65 demand nodes. These nodes are linked by physical and virtual pipelines – road trucks with gas in liquefied form. The location model result shows the best places to locate, with the optimal demand allocation and the most economical gas transport mode: by pipeline or by road truck.

Optimal location of gas supply units in natural gas system network

Natural gas industry has been confronted with big challenges: great growth in demand, investments on new GSUs – gas supply units, and efficient technical system management. The right number of GSUs, their best location on networks and the optimal allocation to loads is a decision problem that can be formulated as a combinatorial programming problem, with the objective of minimizing system expenses. Our emphasis is on the formulation, interpretation and development of a solution algorithm that will analyze the trade-off between infrastructure investment expenditure and operating system costs. The location model was applied to a 12 node natural gas network, and its effectiveness was tested in five different operating scenarios.

Plataforma remota de gestão de um parque de GateBoxes

A monitorização de redes é um aspeto de elevada importância, principalmente em redes de média ou grande dimensão. A necessidade de utilização de uma ferramenta para realização dessa gestão facilita o trabalho e proporciona de uma forma mais rápida e eficaz a identificação de problemas na rede e nos seus sistemas. Neste sentido, o presente trabalho tem como objetivo o desenvolvimento de uma solução para a monitorização de GateBoxes, um dos produtos desenvolvidos e comercializados pela empresa NextToYou. A necessidade de monitorização das GateBoxes, por parte da NextToYou, é essencial para que possa detetar falhas no seu funcionamento ou realizar notificações aquando da deteção de problemas para uma rápida resolução. Neste contexto a empresa decidiu implementar uma ferramenta para a referida monitorização e propôs, no âmbito da tese, o desenvolvimento de uma aplicação que satisfizesse esses propósitos. Disponibilizou então, para o desenvolvimento uma plataforma, a WebForge, e definiu alguns requisitos funcionais dessa ferramenta, tais como, a monitorização remota de informação, gestão de alarmes, geração de avisos e notificações. Para a elaboração deste trabalho foram realizados estudos teóricos sobre o tema da gestão e monitorização remotas, realizando-se posteriormente o desenvolvimento de uma aplicação para a monitorização de GateBoxes. Após a implementação efetuou-se a validação do trabalho realizado através da execução de testes e demonstrações, de forma a poder validar e verificar o desempenho do sistema.

Multi-criteria design optimization study of solvent extraction in mixer–settler units

Solvent extraction is considered as a multi-criteria optimization problem, since several chemical species with similar extraction kinetic properties are frequently present in the aqueous phase and the selective extraction is not practicable. This optimization, applied to mixer–settler units, considers the best parameters and operating conditions, as well as the best structure or process flow-sheet. Global process optimization is performed for a specific flow-sheet and a comparison of Pareto curves for different flow-sheets is made. The positive weight sum approach linked to the sequential quadratic programming method is used to obtain the Pareto set. In all investigated structures, recovery increases with hold-up, residence time and agitation speed, while the purity has an opposite behaviour. For the same treatment capacity, counter-current arrangements are shown to promote recovery without significant impairment in purity. Recycling the aqueous phase is shown to be irrelevant, but organic recycling with as many stages as economically feasible clearly improves the design criteria and reduces the most efficient organic flow-rate.

Controllability results for impulsive mixed type functional integro-differential evolution equations with nonlocal conditions

In this paper, we establish the controllability for a class of abstract impulsive mixed-type functional integro-differential equations with finite delay in a Banach space. Some sufficient conditions for controllability are obtained by using the Mönch fixed point theorem via measures of noncompactness and semigroup theory. Particularly, we do not assume the compactness of the evolution system. An example is given to illustrate the effectiveness of our results.

How to integrate stories and ICT in content-based units of work for English learning

The aim of this article is to show how it is possible to integrate stories and ICT in Content Language Integrated Learning (CLIL) for English as a foreign language (EFL) learning in bilingual schools. Two Units of Work are presented. One, for the second year of Primary, is based on a Science topic, ‘Materials’. The story used is ‘The three little pigs’ and the computer program ‘JClic’. The other one is based on a Science and Arts topic for the sixth year of Primary, the story used is ‘Charlotte’s Web’ and the computer program ‘Atenex’.

The role of functional polymorphisms in immune response genes as biomarkers of BCG Immunotherapy outcome in bladder cancer: Establishment of a predictive profile in a Southern Europe population

OBJECTIVE: To evaluate the predictive value of genetic polymorphisms in the context of BCG immunotherapy outcome and create a predictive profile that may allow discriminating the risk of recurrence. MATERIAL AND METHODS: In a dataset of 204 patients treated with BCG, we evaluate 42 genetic polymorphisms in 38 genes involved in the BCG mechanism of action, using Sequenom MassARRAY technology. Stepwise multivariate Cox Regression was used for data mining. RESULTS: In agreement with previous studies we observed that gender, age, tumor multiplicity and treatment scheme were associated with BCG failure. Using stepwise multivariate Cox Regression analysis we propose the first predictive profile of BCG immunotherapy outcome and a risk score based on polymorphisms in immune system molecules (SNPs in TNFA-1031T/C (rs1799964), IL2RA rs2104286 T/C, IL17A-197G/A (rs2275913), IL17RA-809A/G (rs4819554), IL18R1 rs3771171 T/C, ICAM1 K469E (rs5498), FASL-844T/C (rs763110) and TRAILR1-397T/G (rs79037040) in association with clinicopathological variables. This risk score allows the categorization of patients into risk groups: patients within the Low Risk group have a 90% chance of successful treatment, whereas patients in the High Risk group present 75% chance of recurrence after BCG treatment. CONCLUSION: We have established the first predictive score of BCG immunotherapy outcome combining clinicopathological characteristics and a panel of genetic polymorphisms. Further studies using an independent cohort are warranted. Moreover, the inclusion of other biomarkers may help to improve the proposed model.

Remuneration Structure Definition for Distributed Generation Units and Demand Response Participants Aggregation

The implementation of competitive electricity markets has changed the consumers’ and distributed generation position power systems operation. The use of distributed generation and the participation in demand response programs, namely in smart grids, bring several advantages for consumers, aggregators, and system operators. The present paper proposes a remuneration structure for aggregated distributed generation and demand response resources. A virtual power player aggregates all the resources. The resources are aggregated in a certain number of clusters, each one corresponding to a distinct tariff group, according to the economic impact of the resulting remuneration tariff. The determined tariffs are intended to be used for several months. The aggregator can define the periodicity of the tariffs definition. The case study in this paper includes 218 consumers, and 66 distributed generation units.

Is There Sufficient Training of Health Care Staff on Noise Reduction in Neonatal Intensive Care Units? a Pilot Study From NeoNoise Project

Evidence indicates that exposure to high levels of noise adversely affects human health, and these effects are dependent upon various factors. In hospitals, there are many sources of noise, and high levels exert an impact on patients and staff, increasing both recovery time and stress, respectively. The goal of this pilot study was to develop, implement and evaluate the effectiveness of a training program (TP) on noise reduction in a Neonatal Intensive Care Units (NICU) by comparing the noise levels before and after the implementation of the program. A total of 79 health professionals participated in the study. The measurements of sound pressure levels took into account the layout of the unit and location of the main sources of noise. General results indicated that LAeq levels before implementation of the training program were often excessive, ranging from 48.7 ± 2.94 dBA to 71.7 ± 4.74 dBA, exceeding international guidelines. Similarly following implementation of the training program noise levels remained unchanged (54.5 ± 0.49 dBA to 63.9 ± 4.37 dBA), despite a decrease in some locations. There was no significant difference before and after the implementation of TP. However a significant difference was found for Lp, Cpeak, before and after training staff, suggesting greater care by healthcare professionals performing their tasks. Even recognizing that a TP is quite important to change behaviors, this needs to be considered in a broader context to effectively control noise in the NICU.

Brazilian fruit pulps as functional foods and additives: Evaluation of bioactive compounds

Eight tropical fruit pulps from Brazil were simultaneously characterised in terms of their antioxidant and antimicrobial properties. Antioxidant activity was screened by DPPH radical scavenging activity (126–3987 mg TE/100 g DW) and ferric reduction activity power (368–20819 mg AAE/100 g DW), and complemented with total phenolic content (329–12466 mg GAE/100 g DW) and total flavonoid content measurements (46–672 mg EE /100 g DW), whereas antimicrobial activity was tested against the most frequently found food pathogens. Acerola and açaí presented the highest values for the antioxidant-related measurements. Direct correlations between these measurements could be observed for some of the fruits. Tamarind exhibited the broadest antimicrobial potential, having revealed growth inhibition of Pseudomonas aeruginosa. Escherichia coli, Listeria monocytogenes, Salmonella sp. and Staphylococcus aureus. Açaí and tamarind extracts presented an inverse relationship between antibacterial and antioxidant activities, and therefore, the antibacterial activity cannot be attributed (only) to phenolic compounds.

Coalition of distributed generation units to Virtual Power Players - a game theory approach

Smart Grids (SGs) have emerged as the new paradigm for power system operation and management, being designed to include large amounts of distributed energy resources. This new paradigm requires new Energy Resource Management (ERM) methodologies considering different operation strategies and the existence of new management players such as several types of aggregators. This paper proposes a methodology to facilitate the coalition between distributed generation units originating Virtual Power Players (VPP) considering a game theory approach. The proposed approach consists in the analysis of the classifications that were attributed by each VPP to the distributed generation units, as well as in the analysis of the previous established contracts by each player. The proposed classification model is based in fourteen parameters including technical, economical and behavioural ones. Depending of the VPP strategies, size and goals, each parameter has different importance. VPP can also manage other type of energy resources, like storage units, electric vehicles, demand response programs or even parts of the MV and LV distribution network. A case study with twelve VPPs with different characteristics and one hundred and fifty real distributed generation units is included in the paper.

HRM specificities’ on Portugal hotel units

This paper presents the main Human Resources Management (HRM) specificities’ on Portuguese hotel units. We try to understand the role of HRM on behavior of co-workers and quality service in hotel units and to know the future tendency of human capital profile on Portuguese hotel units and the role of HRM function on management of their staff. We, also, try to explore if Portuguese culture has influence on HRM specificities’ of hotel units. This phenomenon has a special relevance in the Portuguese context, because this country is known a growing process of tourism industry in recent years. Furthermore, little is known about HRM department’ contributions to their human capital management and development. This paper is one of the first to focus specifically on Portuguese hotel units and it also seeks to present findings that stem from the Human Resources Managers’ perspective. The paper is based on qualitative case studies. The data were collected through semi-structured interviews of 12 human resource managers from 12 hotel units located in Portugal. The results show that although there is not an effective HRM, current HRM practices are enough to encouraging pro-environmental behavior in their staff and they have a direct effect on customer satisfaction and competitiveness of sector. However, managers recognize there is need introduce some change on short-term to promote a better performance of staff with effect on customers satisfaction and competitiveness on sector in Portugal. According to these results, the paper discusses the major theoretical and practical implications.