Planos de saúde e envelhecimento populacional: um modelo viável?

O presente trabalho versa sobre a relação presente e futura dos planos de saúde com os idosos. Tem como pressupostos iniciais a existência de uma janela demográfica de oportunidades que será encerrada, conforme estimativa do IBGE, em 2020 e o fato de o modelo de atenção à saúde por planos de saúde se encontrar em expansão. Diante da realidade de envelhecimento populacional, pergunta-se: Os planos de saúde são um modelo viável para a garantia da atenção à saúde dos idosos? As respostas a essa questão foram construídas adotando-se como método de trabalho a análise de doutrina, jurisprudência, legislação e, quando necessário, fontes não tradicionais do Direito como os dados de órgãos de pesquisa demográficos e econômicos, a imprensa e as associações setoriais. Inicialmente tratou-se do funcionamento do setor de planos de saúde, desde a sua origem, indicando-se que historicamente sempre manteve uma relação simbiótica com o Estado, em especial com os recursos públicos. Para tanto, foram explorados temas como o ressarcimento ao SUS, o uso da estrutura dos hospitais públicos pelos planos de saúde e a existência de subsídios, abatimentos e outras formas de financiamento público das atividades deste setor. No capítulo seguinte se detalhou a questão do envelhecimento populacional, apresentando-se a legislação pertinente, os dados que revelam a composição presente e estimada da população brasileira, os principais problemas de saúde que afetam os idosos e os impactos da mudança de perfil demográfico para a política de saúde. No capítulo 3 evidenciou-se a já problemática relação dos planos de saúde com os idosos, permeada por discriminações na contratação, cobrança de mensalidades proibitivas e reajustes expulsivos, presença de cláusulas abusivas em contratos antigos, judicialização dos reajustes por mudança de faixa etária e conflitos decorrentes da prevalência da contratação na forma coletiva. Por fim, no derradeiro capítulo concluiu-se que o modelo de planos de saúde não é viável para a garantia da atenção à saúde do idoso, sendo urgente que haja uma discussão sobre qual modelo de saúde o país deseja sob pena de que as conquistas decorrentes da afirmação da saúde como direito fundamental se percam. Há características inerentes ao setor que o aparta dos idosos e, portanto, da nova realidade demográfica do país, como a prática da seleção de risco, a cobrança de mensalidades com preços insustentáveis para os idosos, o foco no modelo curativo de atenção à saúde e o afastamento da prevenção. Por outro lado, o cenário se agrava por conta das recorrentes falhas na regulação e na regulamentação, e pelo tratamento cindido, na prática, da política de saúde como se não fosse una e não devesse funcionar em harmonia, independentemente da fonte de financiamento. Há, portanto, um alto risco de que a situação dos idosos nos planos de saúde se torne insustentável, dando margem a medidas imediatistas ampliadoras dos subsídios públicos aos planos de saúde. A contrarreforma sanitária, entendida como o retrocesso das ações e dos serviços de saúde ao modelo anterior à Constituição Federal, é um perigo a ser considerado e combatido.

Comparison of Wildlife Impacts Associated with Uranium In-Situ Recovery and Wind Farms in Wyoming

Wyoming has multiple resources including non-renewable sources, renewable sources, as well as its wildlife. Two of these resources are uranium and wind. Currently wind farms in Wyoming are generating approximately 5 million MW of power, with less of an impact on wildlife than in-situ facilities. In-situ facilities in 2007 produced an estimated 32 million MW of power from uranium, with a greater impact to wildlife than wind farms. Both resources have a great potential in Wyoming and both will have an impact on wildlife. Currently wind farms show less of an impact on wildlife but they are also producing fewer megawatts. The potential for wind-generated energy over the next century shows wildlife impacts will be greater than impacts from ISR facilities.

A Quantile-Based Probabilistic Mean Value Theorem

For non-negative random variables with finite means we introduce an analogous of the equilibrium residual-lifetime distribution based on the quantile function. This allows us to construct new distributions with support (0, 1), and to obtain a new quantile-based version of the probabilistic generalization of Taylor's theorem. Similarly, for pairs of stochastically ordered random variables we come to a new quantile-based form of the probabilistic mean value theorem. The latter involves a distribution that generalizes the Lorenz curve. We investigate the special case of proportional quantile functions and apply the given results to various models based on classes of distributions and measures of risk theory. Motivated by some stochastic comparisons, we also introduce the “expected reversed proportional shortfall order”, and a new characterization of random lifetimes involving the reversed hazard rate function.

Kyiv's gas strategy: closer cooperation with Gazprom or a genuine diversification. OSW Commentary No. 110, 2013-07-16

In recent months Kyiv has been intensifying its efforts to diversify Ukraine’s gas supply routes with a view to reducing the country’s dependence on imports from Russia. One of the steps which Kyiv has taken has been to make the unprecedented decision to start importing gas from its Western neighbours. In November 2012, Ukraine’s state-owned Naftogaz began importing gas through Poland under a two-month contract with RWE (the imports continued into 2013 under a separate deal), while in the spring of 2013 Ukraine started importing gas from Hungary. Kyiv is also currently looking into the possibility of purchasing gas from Slovakia. Furthermore, since 2010 the Ukrainian government has been working on the construction of an LNG terminal near Odesa. The authorities have declared that this will allow Ukraine to import up to 5 billion m3 of LNG a year by 2015. The government has also taken measures to increase domestic production, including from non-traditional sources, and it plans to replace gas-based with coal-based technologies in local power stations. Finally, in January 2013, the government signed a 50-year production sharing agreement with Shell. This paves the way for the development of Ukraine’s shale gas deposits.

Best management practices report : a compilation of individual reports submitted by Robert Walker ... [et al.]

Includes bibliographies.

Decompositions of complete graphs into triangles and Hamilton cycles

For all odd integers n greater than or equal to 1, let G(n) denote the complete graph of order n, and for all even integers n greater than or equal to 2 let G,, denote the complete graph of order n with the edges of a 1-factor removed. It is shown that for all non-negative integers h and t and all positive integers n, G, can be decomposed into h Hamilton cycles and t triangles if and only if nh + 3t is the number of edges in G(n). (C) 2004 Wiley Periodicals, Inc.

Multiple genotypes of Chlamydia pneumoniae identified in human carotid plaque

Chlamydia pneumoniae is an obligate intracellular respiratory pathogen that causes 10% of community-acquired pneumonia and has been associated with cardiovascular disease. Both whole-genome sequencing and specific gene typing suggest that there is relatively little genetic variation in human isolates of C. pneumoniae. To date, there has been little genomic analysis of strains from human cardiovascular sites. The genotypes of C. pneumoniae present in human atherosclerotic carotid plaque were analysed and several polymorphisms in the variable domain 4 (VD4) region of the outer-membrane protein-A (ompA) gene and the intergenic region between the ygeD and uridine kinase (ygeD-urk) genes were found. While one genotype was identified that was the same as one reported previously in humans (respiratory and cardiovascular), another genotype was found that was identical to a genotype from non-human sources (frog/koala).

Reactive oxygen and nitrogen species production in cardiomyoblasts during hypoxia and reoxygenation

Hypoxia is a stress condition in which tissues are deprived of an adequate O2 supply; this may trigger cell death with pathological consequences in cardiovascular or neurodegenerative disease. Reperfusion is the restoration of an oxygenated blood supply to hypoxic tissue and can cause more cell injury. The kinetics and consequences of reactive oxygen and nitrogen species (ROS/RNS) production in cardiomyoblasts are poorly understood. The present study describes the systematic characterization of the kinetics of ROS/RNS production and their roles in cell survival and associated protection during hypoxia and hypoxia/reperfusion. H9C2 cells showed a significant loss of viability under 2% O2 for 30min hypoxia and cell death; associated with an increase in protein oxidation. After 4h, apoptosis induction under 2% O2 and 10% O2 was dependent on the production of mitochondrial superoxide (O2-•) and nitric oxide (•NO), partly from nitric oxide synthase (NOS). Both apoptotic and necrotic cell death during 2% O2 for 4h could be rescued by the mitochondrial complex I inhibitor; rotenone and NOS inhibitor; L-NAME. Both L-NAME and the NOX (NADPH oxidase) inhibitor; apocynin reduced apoptosis under 10% O2 for 4h hypoxia. The mitochondrial uncoupler; FCCP significantly reduced cell death via a O2-• dependent mechanism during 2% O2, 30min hypoxia. During hypoxia (2% O2, 4h)/ reperfusion (21% O2, 2h), metabolic activity was significantly reduced with increased production of O2-• and •NO, during hypoxia but, partially restored during reperfusion. O2-• generation during hypoxia/reperfusion was mitochondrial and NOX- dependent, whereas •NO generation depended on both NOS and non-enzymatic sources. Inhibition of NOS worsened metabolic activity during reperfusion, but did not effect this during sustained hypoxia. Nrf2 activation during 2% O2, a sustained hypoxia and reperfusion was O2-•/•NO dependent. Inhibition of NF-?B activation aggravated metabolic activity during 2% O2, 4h hypoxia. In conclusion, mitochondrial O2-•, but, not ATP depletion is the major cause of apoptotic and necrotic cell death in cardiomyoblasts under 2% O2, 4h hypoxia, whereas apoptotic cell death under 10% O2, 4h, is due to NOS-dependent •NO. The management of ROS/RNS rather than ATP is required for improved survival during hypoxia. O2-• production from mitochondria and NOS is cardiotoxic during hypoxia/reperfusion. NF-?B activation during hypoxia and NOS activation during reperfusion is cardiomyoblast protective.

Evaluating productive efficiency:comparative study of commercial banks in Gulf countries

Financial institutes are an integral part of any modern economy. In the 1970s and 1980s, Gulf Cooperation Council (GCC) countries made significant progress in financial deepening and in building a modern financial infrastructure. This study aims to evaluate the performance (efficiency) of financial institutes (banking sector) in GCC countries. Since, the selected variables include negative data for some banks and positive for others, and the available evaluation methods are not helpful in this case, so we developed a Semi Oriented Radial Model to perform this evaluation. Furthermore, since the SORM evaluation result provides a limited information for any decision maker (bankers, investors, etc...), we proposed a second stage analysis using classification and regression (C&R) method to get further results combining SORM results with other environmental data (Financial, economical and political) to set rules for the efficient banks, hence, the results will be useful for bankers in order to improve their bank performance and to the investors, maximize their returns. Mainly there are two approaches to evaluate the performance of Decision Making Units (DMUs), under each of them there are different methods with different assumptions. Parametric approach is based on the econometric regression theory and nonparametric approach is based on a mathematical linear programming theory. Under the nonparametric approaches, there are two methods: Data Envelopment Analysis (DEA) and Free Disposal Hull (FDH). While there are three methods under the parametric approach: Stochastic Frontier Analysis (SFA); Thick Frontier Analysis (TFA) and Distribution-Free Analysis (DFA). The result shows that DEA and SFA are the most applicable methods in banking sector, but DEA is seem to be most popular between researchers. However DEA as SFA still facing many challenges, one of these challenges is how to deal with negative data, since it requires the assumption that all the input and output values are non-negative, while in many applications negative outputs could appear e.g. losses in contrast with profit. Although there are few developed Models under DEA to deal with negative data but we believe that each of them has it is own limitations, therefore we developed a Semi-Oriented-Radial-Model (SORM) that could handle the negativity issue in DEA. The application result using SORM shows that the overall performance of GCC banking is relatively high (85.6%). Although, the efficiency score is fluctuated over the study period (1998-2007) due to the second Gulf War and to the international financial crisis, but still higher than the efficiency score of their counterpart in other countries. Banks operating in Saudi Arabia seem to be the highest efficient banks followed by UAE, Omani and Bahraini banks, while banks operating in Qatar and Kuwait seem to be the lowest efficient banks; this is because these two countries are the most affected country in the second Gulf War. Also, the result shows that there is no statistical relationship between the operating style (Islamic or Conventional) and bank efficiency. Even though there is no statistical differences due to the operational style, but Islamic bank seem to be more efficient than the Conventional bank, since on average their efficiency score is 86.33% compare to 85.38% for Conventional banks. Furthermore, the Islamic banks seem to be more affected by the political crisis (second Gulf War), whereas Conventional banks seem to be more affected by the financial crisis.

Ownership characteristics and access to finance:evidence from a survey of large privatised companies in Hungary and Poland

We examine financial constraints and forms of finance used for investment, by analysing survey data on 157 large privatised companies in Hungary and Poland for the period 1998 - 2000. The Bayesian analysis using Gibbs sampling is carried out to obtain inferences about the sample companies' access to finance from a model for categorical outcome. By applying alternative measures of financial constraints we find that foreign companies, companies that are part of domestic industrial groups and enterprises with concentrated ownership are all less constrained in their access to finance. Moreover, we identify alternative modes of finance since different corporate control and past performance characteristics influence the sample firms' choice of finance source. In particular, while being industry-specific, the access to domestic credit is positively associated with company size and past profitability. Industrial group members tend to favour bond issues as well as sells-offs of assets as appropriate types of finance for their investment programmes. Preferences for raising finance in the form of equity are associated with share concentration in a non-monotonic way, being most prevalent in those companies where the dominant owner holds 25%-49% of shares. Close links with a leading bank not only increase the possibility of bond issues but also appear to facilitate access to non-banking sources of funds, in particular, to finance supplied by industrial partners. Finally, reliance on state finance is less likely for the companies whose profiles resemble the case of unconstrained finance, namely, for companies with foreign partners, companies that are part of domestic industrial groups and companies with a strategic investor. Model implications also include that the use of state funds is less likely for Polish than for Hungarian companies.

Decentralized supply chain formation using max-sum loopy belief propagation

Supply chain formation is the process by which a set of producers within a network determine the subset of these producers able to form a chain to supply goods to one or more consumers at the lowest cost. This problem has been tackled in a number of ways, including auctions, negotiations, and argumentation-based approaches. In this paper we show how this problem can be cast as an optimization of a pairwise cost function. Optimizing this class of energy functions is NP-hard but efficient approximations to the global minimum can be obtained using loopy belief propagation (LBP). Here we detail a max-sum LBP-based approach to the supply chain formation problem, involving decentralized message-passing between supply chain participants. Our approach is evaluated against a well-known decentralized double-auction method and an optimal centralized technique, showing several improvements on the auction method: it obtains better solutions for most network instances which allow for competitive equilibrium (Competitive equilibrium in Walsh and Wellman is a set of producer costs which permits a Pareto optimal state in which agents in the allocation receive non-negative surplus and agents not in the allocation would acquire non-positive surplus by participating in the supply chain) while also optimally solving problems where no competitive equilibrium exists, for which the double-auction method frequently produces inefficient solutions. © 2012 Wiley Periodicals, Inc.

Spectrum redistribution for cognitive radios using discriminatory spectrum double auction

With the reformation of spectrum policy and the development of cognitive radio, secondary users will be allowed to access spectrums licensed to primary users. Spectrum auctions can facilitate this secondary spectrum access in a market-driven way. To design an efficient auction framework, we first study the supply and demand pressures and the competitive equilibrium of the secondary spectrum market, considering the spectrum reusability. In well-designed auctions, competition among participants should lead to the competitive equilibrium according to the traditional economic point of view. Then, a discriminatory price spectrum double auction framework is proposed for this market. In this framework, rational participants compete with each other by using bidding prices, and their profits are guaranteed to be non-negative. A near-optimal heuristic algorithm is also proposed to solve the auction clearing problem of the proposed framework efficiently. Experimental results verify the efficiency of the proposed auction clearing algorithm and demonstrate that competition among secondary users and primary users can lead to the competitive equilibrium during auction iterations using the proposed auction framework. Copyright © 2011 John Wiley & Sons, Ltd.

Interval data without sign restrictions in DEA

Conventional DEA models assume deterministic, precise and non-negative data for input and output observations. However, real applications may be characterized by observations that are given in form of intervals and include negative numbers. For instance, the consumption of electricity in decentralized energy resources may be either negative or positive, depending on the heat consumption. Likewise, the heat losses in distribution networks may be within a certain range, depending on e.g. external temperature and real-time outtake. Complementing earlier work separately addressing the two problems; interval data and negative data; we propose a comprehensive evaluation process for measuring the relative efficiencies of a set of DMUs in DEA. In our general formulation, the intervals may contain upper or lower bounds with different signs. The proposed method determines upper and lower bounds for the technical efficiency through the limits of the intervals after decomposition. Based on the interval scores, DMUs are then classified into three classes, namely, the strictly efficient, weakly efficient and inefficient. An intuitive ranking approach is presented for the respective classes. The approach is demonstrated through an application to the evaluation of bank branches. © 2013.

Making hiring decisions:a grounded theory approach to a practise-based study of filtering in selection

This thesis objective is to discover “How are informal decisions reached by screeners when filtering out undesirable job applications?” Grounded theory techniques were employed in the field to observe and analyse informal decisions at the source by screeners in three distinct empirical studies. Whilst grounded theory provided the method for case and cross-case analysis, literature from academic and non-academic sources was evaluated and integrated to strengthen this research and create a foundation for understanding informal decisions. As informal decisions in early hiring processes have been under researched, this thesis contributes to current knowledge in several ways. First, it locates the Cycle of Employment which enhances Robertson and Smith’s (1993) Selection Paradigm through the integration of stages that individuals occupy whilst seeking employment. Secondly, a general depiction of the Workflow of General Hiring Processes provides a template for practitioners to map and further develop their organisational processes. Finally, it highlights the emergence of the Locality Effect, which is a geographically driven heuristic and bias that can significantly impact recruitment and informal decisions. Although screeners make informal decisions using multiple variables, informal decisions are made in stages as evidence in the Cycle of Employment. Moreover, informal decisions can be erroneous as a result of a majority and minority influence, the weighting of information, the injection of inappropriate information and criteria, and the influence of an assessor. This thesis considers these faults and develops a basic framework of understanding informal decisions to which future research can be launched.

On the Arithmetic of Errors

An approximate number is an ordered pair consisting of a (real) number and an error bound, briefly error, which is a (real) non-negative number. To compute with approximate numbers the arithmetic operations on errors should be well-known. To model computations with errors one should suitably define and study arithmetic operations and order relations over the set of non-negative numbers. In this work we discuss the algebraic properties of non-negative numbers starting from familiar properties of real numbers. We focus on certain operations of errors which seem not to have been sufficiently studied algebraically. In this work we restrict ourselves to arithmetic operations for errors related to addition and multiplication by scalars. We pay special attention to subtractability-like properties of errors and the induced “distance-like” operation. This operation is implicitly used under different names in several contemporary fields of applied mathematics (inner subtraction and inner addition in interval analysis, generalized Hukuhara difference in fuzzy set theory, etc.) Here we present some new results related to algebraic properties of this operation.