Estudo sobre o Grau de Integração de Organizações de Saúde – EGIOS II

RESUMO - O movimento de integração dos cuidados de saúde tem como objectivo a procura de modelos de prestação de cuidados mais compreensivos, integrados e continuados. A determinação do grau de integração de cuidados pode ser realizada a partir da percepção dos profissionais de saúde, sendo os inquéritos por questionários uma fonte comummente utilizada neste tipo de estudos. O presente estudo, designado por EGIOS II, tem como objetivos: a) determinar o grau de percepção de integração, dos profissionais das Unidades Locais de Saúde; b) comparar a percepção do grau de integração dos profissionais entre 2010 e 2015; c) comparar a percepção do grau de integração dos profissionais que trabalham nas Unidades Locais de Saúde e em instituições não organizadas em Unidades Locais de Saúde; e d) identificar as áreas de maior e menor percepção de integração. O instrumento de recolha de dados utilizado, foi um inquérito por questionário, que pretende avaliar a percepção do grau de integração dos profissionais de acordo com as dimensões clínica, informação, normativa, administrativa, financeira e sistémica, em 53 itens. O inquérito foi estruturalmente adaptado do Health System Integration Study, tendo apresentado validade e fiabilidade. O inquérito foi aplicado em 22 instituições, a nível nacional, Unidades Locais de Saúde e a Centros Hospitalares / Hospitais e Agrupamentos de Centros de Saúde. A caraterização EGIOS II dividiu-se em quatro fases: preparação e envio dos ofícios; identificação dos interlocutores; envio dos inquéritos; e avaliação dos resultados. O inquérito apresentou uma taxa de resposta de 27%, representando 2085 respostas ao inquérito. Pode afirmar-se que globalmente o estudo apresenta representatividade estatística, com um intervalo de confiança de 95%. Os resultados indicam que os profissionais das Unidades Locais de Saúde em 2015 reportam maiores níveis de percepção de integração, quando comparados os dados com o estudo de 2010. Acrescenta-se que os profissionais das Unidades Locais de Saúde têm um maior grau de percepção de integração, do que os profissionais dos Centros Hospitalares / Hospitais e Agrupamentos de Centros de Saúde, não organizados em ULS. As dimensões administrativa, financeira e clínica são as que apresentam um menor grau de percepção de integração e as dimensões normativa e informação uma maior percepção de integração. Os órgãos de administração e órgãos de gestão intermédia apresentam uma percepção de integração superior comparativamente aos médicos e enfermeiros dos serviços hospitalares e cuidados de saúde primários. Foram identificadas nove recomendações que poderão servir como base para um plano de ação subsequente do presente estudo ou para aplicação em futuros estudos. Este estudo pode auxiliar no diagnóstico de problemas e barreiras da integração de cuidados, em que serviços atuar e ainda, identificar quais as estratégias e processos a priorizar de forma a melhorar a integração de cuidados de saúde.

Rely-guarantee protocols for safe interference over shared memory

Mutable state can be useful in certain algorithms, to structure programs, or for efficiency purposes. However, when shared mutable state is used in non-local or nonobvious ways, the interactions that can occur via aliases to that shared memory can be a source of program errors. Undisciplined uses of shared state may unsafely interfere with local reasoning as other aliases may interleave their changes to the shared state in unexpected ways. We propose a novel technique, rely-guarantee protocols, that structures the interactions between aliases and ensures that only safe interference is possible. We present a linear type system outfitted with our novel sharing mechanism that enables controlled interference over shared mutable resources. Each alias is assigned separate, local roles encoded in a protocol abstraction that constrains how an alias can legally use that shared state. By following the spirit of rely-guarantee reasoning, our rely-guarantee protocols ensure that only safe interference can occur but still allow many interesting uses of shared state, such as going beyond invariant and monotonic usages. This thesis describes the three core mechanisms that enable our type-based technique to work: 1) we show how a protocol models an alias’s perspective on how the shared state evolves and constrains that alias’s interactions with the shared state; 2) we show how protocols can be used while enforcing the agreed interference contract; and finally, 3) we show how to check that all local protocols to some shared state can be safely composed to ensure globally safe interference over that shared memory. The interference caused by shared state is rooted at how the uses of di↵erent aliases to that state may be interleaved (perhaps even in non-deterministic ways) at run-time. Therefore, our technique is mostly agnostic as to whether this interference was the result of alias interleaving caused by sequential or concurrent semantics. We show implementations of our technique in both settings, and highlight their di↵erences. Because sharing is “first-class” (and not tied to a module), we show a polymorphic procedure that enables abstract compositions of protocols. Thus, protocols can be specialized or extended without requiring specific knowledge of the interference produce by other protocols to that state. We show that protocol composition can ensure safety even when considering abstracted protocols. We show that this core composition mechanism is sound, decidable (without the need for manual intervention), and provide an algorithm implementation.

Search for low-scale gravity signatures in multi-jet final states with the ATLAS detector at s√ = 8 TeV

We search for evidence of physics beyond the Standard Model in the production of final states with multiple high transverse momentum jets, using 20.3 fb−1 of proton-proton collision data recorded by the ATLAS detector at s√ = 8 TeV. No excess of events beyond Standard Model expectations is observed, and upper limits on the visible cross-section for non-Standard Model production of multi-jet final states are set. Using a wide variety of models for black hole and string ball production and decay, the limit on the cross-section times acceptance is as low as 0.16 fb at the 95% CL for a minimum scalar sum of jet transverse momentum in the event of about 4.3 TeV. Using models for black hole and string ball production and decay, exclusion contours are determined as a function of the production mass threshold and the gravity scale. These limits can be interpreted in terms of lower-mass limits on black hole and string ball production that range from 4.6 to 6.2 TeV.

Parental Leave and Mothers' Careers: The Relative Importance of Job Protection and Cash Benefits

Job protection and cash benefits are key elements of parental leave (PL) systems. We study how these two policy instruments affect return-to-work and medium-run labour market outcomes of mothers of newborn children. Analysing a series of major PL policy changes in Austria, we find that longer cash benefits lead to a significant delay in return-to-work, particularly so in the period that is job-protected. Prolonged parental leave absence induced by these policy changes does not appear to hurt mothers' labour market outcomes in the medium run. We build a non-stationary model of job search after childbirth to isolate the role of the two policy instruments. The model matches return-to-work and return to same employer profiles under the various factual policy configurations. Counterfactual policy simulations indicate that a system that combines cash with protection dominates other systems in generating time for care immediately after birth while maintaining mothers' medium-run labour market attachment.

Modelització i control d'un reactor de producció d'hidrogen per a l'alimentació de piles de combustible

Les piles de combustible permeten la transformació eficient de l’energia química de certs combustibles a energia elèctrica a través d’un procés electroquímic. De les diferents tecnologies de piles de combustible, les piles de combustible de tipus PEM són les més competitives i tenen una gran varietat d’aplicacions. No obstant, han de ser alimentades únicament per hidrogen. Per altra banda, l’etanol, un combustible interessant en el marc dels combustibles renovables, és una possible font d’hidrogen. Aquest treball estudia la reformació d’etanol per a l’obtenció d’hidrogen per a alimentar piles de combustible PEM. Només existeixen algunes publicacions que tractin l’obtenció d’hidrogen a partir d’etanol, i aquestes no inclouen l’estudi dinàmic del sistema. Els objectius del treball són el modelat i l’estudi dinàmic de reformadors d’etanol de baixa temperatura. Concretament, proposa un model dinàmic d’un reformador catalític d’etanol amb vapor basat en un catalitzador de cobalt. Aquesta reformació permet obtenir valors alts d’eficiència i valors òptims de monòxid de carboni que evitaran l’enverinament d’una la pila de combustible de tipus PEM. El model, no lineal, es basa en la cinètica obtinguda de diferents assaigs de laboratori. El reformador modelat opera en tres etapes: deshidrogenació d’etanol a acetaldehid i hidrogen, reformat amb vapor d’acetaldehid, i la reacció WGS (Water Gas Shift). El treball també estudia la sensibilitat i controlabilitat del sistema, caracteritzant així el sistema que caldrà controlar. L’anàlisi de controlabilitat es realitza sobre la resposta de dinàmica ràpida obtinguda del balanç de massa del reformador. El model no lineal és linealitzat amb la finalitat d’aplicar eines d’anàlisi com RGA, CN i MRI. El treball ofereix la informació necessària per a avaluar la possible implementació en un laboratori de piles de combustibles PEM alimentades per hidrogen provinent d’un reformador d’etanol.

The metaphysics of quantum gravity : a causal approach

The dissertation investigates some relevant metaphysical issues arising in the context of spacetime theories. In particular, the inquiry focuses on general relativity and canonical quantum gravity. A formal definition of spacetime theory is proposed and, against this framework, an analysis of the notions of general covariance, symmetry and background independence is performed. It is argued that many conceptual issues in general relativity and canonical quantum gravity derive from putting excessive emphasis on general covariance as an ontological prin-ciple. An original metaphysical position grounded in scientific essential- ism and causal realism (weak essentialism) is developed and defended. It is argued that, in the context of general relativity, weak essentialism supports spacetime substantivalism. It is also shown that weak essentialism escapes arguments from metaphysical underdetermination by positing a particular kind of causation, dubbed geometric. The proposed interpretive framework is then applied to Bohmian mechanics, pointing out that weak essentialism nicely fits into this theory. In the end, a possible Bohmian implementation of loop quantum gravity is considered, and such a Bohmian approach is interpreted in a geometric causal fashion. Under this interpretation, Bohmian loop quantum gravity straightforwardly commits us to an ontology of elementary extensions of space whose evolution is described by a non-local law. The causal mechanism underlying this evolution clarifies many conceptual issues related to the emergence of classical spacetime from the quantum regime. Although there is as yet no fully worked out physical theory of quantum gravity, it is argued that the proposed approach sets up a standard that proposals for a serious ontology in this field should meet.

Space-time within general relativity : a structural realist understanding

ABSTRACT This dissertation investigates the, nature of space-time as described by the theory of general relativity. It mainly argues that space-time can be naturally interpreted as a physical structure in the precise sense of a network of concrete space-time relations among concrete space-time points that do not possess any intrinsic properties and any intrinsic identity. Such an interpretation is fundamentally based on two related key features of general relativity, namely substantive general covariance and background independence, where substantive general covariance is understood as a gauge-theoretic invariance under active diffeomorphisms and background independence is understood in the sense that the metric (or gravitational) field is dynamical and that, strictly speaking, it cannot be uniquely split into a purely gravitational part and a fixed purely inertial part or background. More broadly, a precise notion of (physical) structure is developed within the framework of a moderate version of structural realism understood as a metaphysical claim about what there is in the world. So, the developement of this moderate structural realism pursues two main aims. The first is purely metaphysical, the aim being to develop a coherent metaphysics of structures and of objects (particular attention is paid to the questions of identity and individuality of these latter within this structural realist framework). The second is to argue that moderate structural realism provides a convincing interpretation of the world as described by fundamental physics and in particular of space-time as described by general relativity. This structuralist interpretation of space-time is discussed within the traditional substantivalist-relationalist debate, which is best understood within the broader framework of the question about the relationship between space-time on the one hand and matter on the other. In particular, it is claimed that space-time structuralism does not constitute a 'tertium quid' in the traditional debate. Some new light on the question of the nature of space-time may be shed from the fundamental foundational issue of space-time singularities. Their possible 'non-local' (or global) feature is discussed in some detail and it is argued that a broad structuralist conception of space-time may provide a physically meaningful understanding of space-time singularities, which is not plagued by the conceptual difficulties of the usual atomsitic framework. Indeed, part of these difficulties may come from the standard differential geometric description of space-time, which encodes to some extent this atomistic framework; it raises the question of the importance of the mathematical formalism for the interpretation of space-time.

Container productivity, daily survival rates and dispersal of Aedes aegypti mosquitoes in a high income dengue epidemic neighbourhood of Rio de Janeiro: presumed influence of differential urban structure on mosquito biology

Different urban structures might affect the life history parameters of Aedes aegypti and, consequently, dengue transmission. Container productivity, probability of daily survival (PDS) and dispersal rates were estimated for mosquito populations in a high income neighbourhood of Rio de Janeiro. Results were contrasted with those previously found in a suburban district, as well as those recorded in a slum. After inspecting 1,041 premises, domestic drains and discarded plastic pots were identified as the most productive containers, collectively holding up to 80% of the total pupae. In addition, three cohorts of dust-marked Ae. aegypti females were released and recaptured daily using BGS-Traps, sticky ovitraps and backpack aspirators in 50 randomly selected houses; recapture rate ranged from 5-12.2% within cohorts. PDS was determined by two models and ranged from 0.607-0.704 (exponential model) and 0.659-0.721 (non-linear model), respectively. Mean distance travelled varied from 57-122 m, with a maximum dispersal of 263 m. Overall, lower infestation indexes and adult female survival were observed in the high income neighbourhood, suggesting a lower dengue transmission risk in comparison to the suburban area and the slum. Since results show that urban structure can influence mosquito biology, specific control strategies might be used in order to achieve cost-effective Ae. aegypti control.

Experimental Modeling and Control Strategies on an Open Mobile Robot Platform PRIM

This research work deals with the problem of modeling and design of low level speed controller for the mobile robot PRIM. The main objective is to develop an effective educational tool. On one hand, the interests in using the open mobile platform PRIM consist in integrating several highly related subjects to the automatic control theory in an educational context, by embracing the subjects of communications, signal processing, sensor fusion and hardware design, amongst others. On the other hand, the idea is to implement useful navigation strategies such that the robot can be served as a mobile multimedia information point. It is in this context, when navigation strategies are oriented to goal achievement, that a local model predictive control is attained. Hence, such studies are presented as a very interesting control strategy in order to develop the future capabilities of the system

Modeling of hybrid systems by piecewise decomposition

Piecewise linear models systems arise as mathematical models of systems in many practical applications, often from linearization for nonlinear systems. There are two main approaches of dealing with these systems according to their continuous or discrete-time aspects. We propose an approach which is based on the state transformation, more particularly the partition of the phase portrait in different regions where each subregion is modeled as a two-dimensional linear time invariant system. Then the Takagi-Sugeno model, which is a combination of local model is calculated. The simulation results show that the Alpha partition is well-suited for dealing with such a system

Rapid prototyping of compliant human aortic roots for assessment of valved stents.

Adequate in-vitro training in valved stents deployment as well as testing of the latter devices requires compliant real-size models of the human aortic root. The casting methods utilized up to now are multi-step, time consuming and complicated. We pursued a goal of building a flexible 3D model in a single-step procedure. We created a precise 3D CAD model of a human aortic root using previously published anatomical and geometrical data and printed it using a novel rapid prototyping system developed by the Fab@Home project. As a material for 3D fabrication we used common house-hold silicone and afterwards dip-coated several models with dispersion silicone one or two times. To assess the production precision we compared the size of the final product with the CAD model. Compliance of the models was measured and compared with native porcine aortic root. Total fabrication time was 3 h and 20 min. Dip-coating one or two times with dispersion silicone if applied took one or two extra days, respectively. The error in dimensions of non-coated aortic root model compared to the CAD design was <3.0% along X, Y-axes and 4.1% along Z-axis. Compliance of a non-coated model as judged by the changes of radius values in the radial direction by 16.39% is significantly different (P<0.001) from native aortic tissue--23.54% at the pressure of 80-100 mmHg. Rapid prototyping of compliant, life-size anatomical models with the Fab@Home 3D printer is feasible--it is very quick compared to previous casting methods.

The role of population origin and microenvironment in seedling emergence and early survival in Mediterranean maritime pine (Pinus pinaster Aiton).

Understanding tree recruitment is needed to forecast future forest distribution. Many studies have reported the relevant ecological factors that affect recruitment success in trees, but the potential for genetic-based differences in recruitment has often been neglected. In this study, we established a semi-natural reciprocal sowing experiment to test for local adaptation and microenvironment effects (evaluated here by canopy cover) in the emergence and early survival of maritime pine (Pinus pinaster Aiton), an emblematic Mediterranean forest tree. A novel application of molecular markers was also developed to test for family selection and, thus, for potential genetic change over generations. Overall, we did not find evidence to support local adaptation at the recruitment stage in our semi-natural experiment. Moreover, only weak family selection (if any) was found, suggesting that in stressful environments with low survival, stochastic processes and among-year climate variability may drive recruitment. Nevertheless, our study revealed that, at early stages of recruitment, microenvironments may favor the population with the best adapted life strategy, irrespectively of its (local or non-local) origin. We also found that emergence time is a key factor for seedling survival in stressful Mediterranean environments. Our study highlights the complexity of the factors influencing the early stages of establishment of maritime pine and provides insights into possible management actions aimed at environmental change impact mitigation. In particular, we found that the high stochasticity of the recruitment process in stressful environments and the differences in population-specific adaptive strategies may difficult assisted migration schemes.

Tax reforms and inequality: theoretical and empirical implications

In this paper we examine the effect of tax policy on the relationship between inequality and growth in a two-sector non-scale model. With non-scale models, the longrun equilibrium growth rate is determined by technological parameters and it is independent of macroeconomic policy instruments. However, this fact does not imply that fiscal policy is unimportant for long-run economic performance. It indeed has important effects on the different levels of key economic variables such as per capita stock of capital and output. Hence, although the economy grows at the same rate across steady states, the bases for economic growth may be different.The model has three essential features. First, we explicitly model skill accumulation, second, we introduce government finance into the production function, and we introduce an income tax to mirror the fiscal events of the 1980¿s and 1990¿s in the US. The fact that the non-scale model is associated with higher order dynamics enables it to replicate the distinctly non-linear nature of inequality in the US with relative ease. The results derived in this paper attract attention to the fact that the non-scale growth model does not only fit the US data well for the long-run (Jones, 1995b) but also that it possesses unique abilities in explaining short term fluctuations of the economy. It is shown that during transition the response of the relative simulated wage to changes in the tax code is rather non-monotonic, quite in accordance to the US inequality pattern in the 1980¿s and early 1990¿s.More specifically, we have analyzed in detail the dynamics following the simulation of an isolated tax decrease and an isolated tax increase. So, after a tax decrease the skill premium follows a lower trajectory than the one it would follow without a tax decrease. Hence we are able to reduce inequality for several periods after the fiscal shock. On the contrary, following a tax increase, the evolution of the skill premium remains above the trajectory carried on by the skill premium under a situation with no tax increase. Consequently, a tax increase would imply a higher level of inequality in the economy

Tax reforms and inequality: theoretical and empirical implications

In this paper we examine the effect of tax policy on the relationship between inequality and growth in a two-sector non-scale model. With non-scale models, the longrun equilibrium growth rate is determined by technological parameters and it is independent of macroeconomic policy instruments. However, this fact does not imply that fiscal policy is unimportant for long-run economic performance. It indeed has important effects on the different levels of key economic variables such as per capita stock of capital and output. Hence, although the economy grows at the same rate across steady states, the bases for economic growth may be different.The model has three essential features. First, we explicitly model skill accumulation, second, we introduce government finance into the production function, and we introduce an income tax to mirror the fiscal events of the 1980¿s and 1990¿s in the US. The fact that the non-scale model is associated with higher order dynamics enables it to replicate the distinctly non-linear nature of inequality in the US with relative ease. The results derived in this paper attract attention to the fact that the non-scale growth model does not only fit the US data well for the long-run (Jones, 1995b) but also that it possesses unique abilities in explaining short term fluctuations of the economy. It is shown that during transition the response of the relative simulated wage to changes in the tax code is rather non-monotonic, quite in accordance to the US inequality pattern in the 1980¿s and early 1990¿s.More specifically, we have analyzed in detail the dynamics following the simulation of an isolated tax decrease and an isolated tax increase. So, after a tax decrease the skill premium follows a lower trajectory than the one it would follow without a tax decrease. Hence we are able to reduce inequality for several periods after the fiscal shock. On the contrary, following a tax increase, the evolution of the skill premium remains above the trajectory carried on by the skill premium under a situation with no tax increase. Consequently, a tax increase would imply a higher level of inequality in the economy

Classical motions from pseudoclassical spin-1/2 particle models

The classical trajectory and spin precessions of Bargmann, Michel, and Telegdi are deduced from a pseudoclassical model of a relativistic spin-(1/2) particle. The corresponding deduction from a non- relativistic model is also given.