The impact of the economic crisis on the quality of health services

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Standardization of project management processes

Software development is a discipline that is almost as old as the history of computers. With the advent of the Internet and all of its related technologies, software development has been on high demand. But, and especially in SME (small and medium enterprise), this was not accompanied with a comparable effort to develop a set of sustainable and standardized activities of project management, which lead to increasing inefficiencies and costs. Given the actual economic situation, it makes sense to engage in an effort to reduce said inefficiencies and rising costs. For that end, this work will analyze the current state of software development’s project management processes on a Portuguese SME, along with its problems and inefficiencies in an effort to create a standardized model to manage software development, with special attention given to critical success factors in an agile software development environment, while using the best practices in process modeling. This work also aims to create guidelines to correctly integrate these changes in the existing IS structure of a company.

eHealth e a adoção da inovação em assisted living technologies : o caso das demências

RESUMO - Assistimos hoje a um contexto marcado (i) pelo progressivo envelhecimento das sociedades ocidentais, (ii) pelo aumento da prevalência das doenças crónicas, de que as demências são um exemplo, (iii) pelo significativo aumento dos custos associados a estas patologias, (iv) por orçamentos públicos fortemente pressionadas pelo controlo da despesa, (v) por uma vida moderna que dificulta o apoio intergeracional, tornando o suporte proporcionado pelos filhos particularmente difícil, (vi) por fortes expectativas relativamente à prestação de cuidados de saúde com qualidade. Teremos assim de ser capazes de conseguir melhorar os serviços de saúde, ao mesmo tempo que recorremos a menos recursos financeiros e humanos, pelo que a inovação parece ser crítica para a sustentabilidade do sistema. Contudo a difusão das Assistive Living Technologies, apesar do seu potencial, tem sido bastante baixa, nomeadamente em Portugal. Porquê? Hamer, Plochg e Moreira (2012), no editorial do International Journal of Healthcare Management, enquadram a Inovação como “podendo ser imprevisível e mesmo dolorosa, pelo que talvez possamos não ficar surpreendidos se surgirem resistências e que, inovações bastante necessárias, capazes de melhorar os indicadores de saúde, tenham sido de adoção lenta ou que tenham mesmo sido insustentáveis”. Em Portugal não há bibliografia que procure caracterizar o modelo de difusão da inovação em eHealth ou das tecnologias de vivência assistida. A bibliografia internacional é igualmente escassa. O presente projeto de investigação, de natureza exploratória, tem como objetivo principal, identificar barreiras e oportunidades para a implementação de tecnologias eHealth, aplicadas ao campo das demências. Como objetivos secundários pretendemse identificar as oportunidades e limitações em Portugal: mapa de competências nacionais, e propor medidas que possa acelerar a inovação em ALT, no contexto nacional. O projeto seguirá o modelo de um estudo qualitativo. Para o efeito foram conduzidas entrevistas em profundidade junto de experts em ALT, procurando obter a visão daqueles que participam do lado da Oferta- a Indústria; do lado da Procura- doentes, cuidadores e profissionais de saúde; bem como dos Reguladores. O instrumento utilizado para a recolha da informação pretendida foi o questionário não estruturado. A análise e interpretação da informação recolhida foram feitas através da técnica de Análise de Conteúdo. Os resultados da Análise de Conteúdo efetuada permitiram expressar a dicotomia barreira/oportunidade, nas seguintes categorias aqui descritas como contextos (i) Contexto Tecnológico, nas subcategorias de Acesso às Infraestruturas; Custo da Tecnologia; Interoperabilidade, (ii) Contexto do Valor Percecionado, nas subcategorias de Utilidade; Eficiência; Divulgação, (iii) Contexto Político, compreendendo a Liderança; Organização; Regulação; Recursos, (iv) Contexto Sociocultural, incluindo nomeadamente Idade; Literacia; Capacidade Económica, (v) Contexto Individual, incluindo como subcategorias, Capacidade de Adaptação a Novas tecnologias; Motivação; Acesso a equipamentos (vi) Contexto Específico da Doença, nomeadamente o Impacto Cognitivo; Tipologia Heterogénea e a Importância do Cuidador. Foi proposto um modelo exploratório, designado de Modelo de Contextos e Forças, que estudos subsequentes poderão validar. Neste modelo o Contexto Tecnológico é um Força Básica ou Fundamental; o Contexto do Valor Percecionado, constitui-se numa Força Crítica para a adoção de inovação, que assenta na sua capacidade para oferecer valor aos diversos stakeholders da cadeia de cuidados. Temos também o Contexto Político, com capacidade de modelar a adoção da inovação e nomeadamente com capacidade para o acelerar, se dele emitir um sinal de urgência para a mudança. O Contexto Sociocultural e Individual expressam uma Força Intrínseca, dado que elas são características internas, próprias e imutáveis no curto-prazo, das sociedade e das pessoas. Por fim há que considerar o Contexto Específico da Doença, nesta caso o das demências. Das conclusões do estudo parece evidente que as condições tecnológicas estão medianamente satisfeitas em Portugal, com evidentes progressos nos últimos anos (exceção para a interoperabilidade aonde há necessidade de maiores progressos), não constituindo portanto barreira à introdução de ALT. Aonde há necessidade de investir é nas áreas do valor percebido. Da análise feita, esta é uma área que constitui uma barreira à introdução e adoção das ALT em Portugal. A falta de perceção do valor que estas tecnologias trazem, por parte dos profissionais de saúde, doentes, cuidadores e decisores políticos, parece ser o principal entrave à sua adoção. São recomendadas estratégias de modelos colaborativos de Investigação e Desenvolvimento e de abordagens de cocriação com a contribuição de todos os intervenientes na cadeia de cuidados. Há também um papel que cabe ao estado no âmbito das prioridades e da mobilização de recursos, sendo-lhe requerida a expressão do sentido de urgência para que esta mudança aconteça. Foram também identificadas oportunidades em diversas áreas, como na prevenção, no diagnóstico, na compliance medicamentosa, na terapêutica, na monitorização, no apoio à vida diária e na integração social. O que é necessário é que as soluções encontradas constituam respostas àquilo que são as verdadeiras necessidades dos intervenientes e não uma imposição tecnológica que só por si nada resolve. Do estudo resultou também a perceção de que há que (i) continuar a trabalhar no sentido de aproximar a comunidade científica, da clínica e do doente, (ii) fomentar a colaboração entre centros, com vista à criação de escala a nível global. Essa colaboração já parece acontecer a nível empresarial, tendo sido identificadas empresas Portuguesas com vocação global. A qualidade individual das instituições de ensino, dos centros de investigação, das empresas, permite criar as condições para que Portugal possa ser país um piloto e um case-study internacional em ALT, desde que para tal pudéssemos contar com um trabalho colaborativo entre instituições e com decisões políticas arrojadas.

(Non) - Demand driven servitization: strategic implications for suppliers from incorporating their customers up front

Double Degree. A Work Project, presented as part of the requirements for the Award of a Master’s Degree in Management from NOVA – School of Business and Economics and a Masters Degree in International Business, Strategy and Innovation from Maastricht University

The effect of ownership concentration on management behavior in Belgian banks: A case study

Double Degree. A Work Project, presented as part of the requirements for the Award of a Master’s Degree in Finance from NOVA – School of Business and Economics and a Masters Degree in Management from Louvain School of Management

Smart machines in day-to-day financial management:

Starting from Novabase’s challenge to launch in the UK Millennials a personal financial advisor mobile application, this work project aims to build a planning model to frame a business side of a launch strategy for mobile application in similar market and category. This study culminates on the design of SPOSTAC planning model. The created framework is intended to effectively and efficiently plan a launch strategy, being structured based on seven sequential elements: Situation, Product, Objectives, Strategy, Tactics, Action, and Control.

Comparateive analysis: Public and private school management systems

The Portuguese educational system has counted, for many years, with the co-existence of both public and private schools. In fact, the country’s growth and development led, in the past, to an increasing demand for free of charge public education that could only be matched through the creation of “publicly-subsidized and privately owned and managed schools”. Still, the demographic evolution of Portugal recently generated a decrease on the demand for public educational services. This situation has raised doubts about the true contribution of this type of school for the public education system. This paper aims at answering this question by isolating the impact of different property and management schemes on the performance of students, resorting to cross-section data on 9th grade students from 2010. The results corroborate the well known result on the relevance of the family socio-economic background for students’ performance, but do also sustain the existence of a significant positive impact of private ownership and management schemes on the overall performance of students. These results suggest that there might be gains associated with the expansion of such schemes within the public education system.

Estimating demand for primary health care services

Primary health services exist with the purpose of providing basic health care to every person at a cost they can afford. But is it fully available to everyone? The objective of this work project is to estimate the demand for primary health care services having into account that in some regions the citizens are not using as much health care as they would like due to supply side constraints. Using the number of consultations as proxy for demand, and applying an econometric tool called switching regression, the demand for primary health care services will be estimated.

Project management under uncertainty: a study on solution methods

Project Management involves onetime endeavors that demand for getting it right the first time. On the other hand, project scheduling, being one of the most modeled project management process stages, still faces a wide gap from theory to practice. Demanding computational models and their consequent call for simplification, divert the implementation of such models in project management tools from the actual day to day project management process. Special focus is being made to the robustness of the generated project schedules facing the omnipresence of uncertainty. An "easy" way out is to add, more or less cleverly calculated, time buffers that always result in project duration increase and correspondingly, in cost. A better approach to deal with uncertainty seems to be to explore slack that might be present in a given project schedule, a fortiori when a non-optimal schedule is used. The combination of such approach to recent advances in modeling resource allocation and scheduling techniques to cope with the increasing flexibility in resources, as can be expressed in "Flexible Resource Constraint Project Scheduling Problem" (FRCPSP) formulations, should be a promising line of research to generate more adequate project management tools. In reality, this approach has been frequently used, by project managers in an ad-hoc way.

Optimal behavior of responsive residential demand considering hybrid phase change materials

Due to communication and technology developments, residential consumers are enabled to participate in Demand Response Programs (DRPs), control their consumption and decrease their cost by using Household Energy Management (HEM) systems. On the other hand, capability of energy storage systems to improve the energy efficiency causes that employing Phase Change Materials (PCM) as thermal storage systems to be widely addressed in the building applications. In this paper, an operational model of HEM system considering the incorporation of more than one type of PCM in plastering mortars (hybrid PCM) is proposed not only to minimize the customerâ s cost in different DRPs but also to guaranty the habitantsâ  satisfaction. Moreover, the proposed model ensures the technical and economic limits of batteries and electrical appliances. Different case studies indicate that implementation of hybrid PCM in the buildings can meaningfully affect the operational pattern of HEM systems in different DRPs. The results reveal that the customerâ s electricity cost can be reduced up to 48% by utilizing the proposed model.

Evaluación de la degradación del suelo en agroecosistemas del centro-sur de Córdoba mediante indicadores e índices. Assessment of soil degradation in agroecosystems of central-southern Córdoba by means of indicators and indices

Las actividades agropecuarias ejercen diferentes presiones sobre los recursos naturales. Esto ha llevado, en algunas áreas, a un deterioro del suelo que provoca un impacto sobre la sustentabilidad en los sistemas agropecuarios. Para evaluar la degradación del suelo se han propuesto listas de indicadores, sin embargo, se carece de una herramienta metodológica robusta, adaptada a las condiciones edafoclimáticas regionales. Además, existe una demanda de productores e instituciones interesados en orientar acciones para preservar el suelo. El objetivo de este proyecto es evaluar la degradación física, química y biológica de los suelos en agroecosistemas del centro-sur de Córdoba. Por ello se propone desarrollar una herramienta metodológica que consiste en un set de indicadores físicos, químicos y biológicos, con valores umbrales, integrados en índices de degradación, que asistan a los agentes tomadores de decisiones y productores, en la toma de decisiones respecto de la degradación del suelo. El área de trabajo será una región agrícola del centro-sur de Córdoba con más de 100 años de agricultura. La metodología comienza con la caracterización del uso del territorio y sistemas de manejo, su clasificación y la obtención de mapas base de usos y manejos, mediante sensores remotos y encuestas. Se seleccionarán sitios de muestreo mediante una metodología semi-dirigida usando un SIG, asegurando un mínimo de un punto de muestreo por unidad de mapeo. Se elegirán sitios de referencia lo más cercano a una condición natural. Los indicadores a evaluar surgen de listas propuestas en trabajos previos del grupo, seleccionados en base a criterios internacionales y a adecuados a suelos de la región. Se usarán indicadores núcleo y complementarios. Para la obtención de umbrales, se usarán por un lado valores provenientes de la bibliografía y por otro, umbrales generados a partir de la distribución estadística del indicador en suelos de referencia. Para estandarizar cada indicador se definirá una función de transformación. Luego serán ponderarán mediante análisis estadísticos mulivariados e integrados en índices de degradación física, química y biológica, y un índice general de degradación. El abordaje concluirá con el desarrollo de dos instrumentos para la toma de decisiones: uno a escala regional, que consistirá en mapas de degradación en base a unidades cartográficas ambientales, de uso del territorio y de sistemas de manejo y otro a escala predial que informará sobre la degradación del suelo de un lote en particular, en comparación con suelos de referencia. Los actores interesados contarán con herramientas robustas para la toma de decisiones respecto de la degradación del suelo tanto a escala regional como local. Agricultural activities exert different pressures on natural resources. In some areas this has led to soil degradation and has an impact on agricultural sustainability. To assess soil degradation a robust methodological tool, adapted to regional soil and climatic conditions, is lacking. In addition, there is a demand from farmers and institutions interested in direct actions to preserve the soil. The objective of this project is to assess physical, chemical and biological soil degradation in agroecosystems of Córdoba. We propose to develop a tool that consists of a set of physical, chemical and biological indicators, with threshold values, integrated in soil degradation indices. The study area is a region with more than 100 years of agriculture. The methodology begins with the characterization of land use and management systems and the obtaining of base maps by means of remote sensing and survey. Sampling sites will be selected through a semi-directed methodology using GIS, ensuring at least one sampling point by mapping unit. Reference sites will be chosen as close to a natural condition. The proposed indicators emerge from previous works of the group, selected based on international standards and appropriate for the local soils. To obtain the thresholds, we will use, by one side, values from the literature, and by the other, values generated from the statistical distribution of the indicator in the reference soils. To standardize indicators transformation functions will be defined. Indicators will be weighted by mans of multivariate analysis and integrated in soil degradation indices. The approach concluded with the development of two instruments for decision making: a regional scale one, consisting in degradation maps based on environmental, land use and management systems mapping units; and an instrument at a plot level which will report on soil degradation of a particular plot compared to reference soils.

The management of brain metastases

Brain metastases occur in 20-50% of NSCLC and 50-80% of SCLC. In this review, we will look at evidence-based medicine data and give some perspectives on the management of BM. We will address the problems of multiple BM, single BM and prophylactic cranial irradiation. Recursive Partitioning Analysis (RPA) is a powerful prognostic tool to facilitate treatment decisions. Dealing with multiple BM, the use of corticosteroids was established more than 40 years ago by a unique randomized trial (RCT). Palliative effect is high (_80%) as well as side-effects. Whole brain radiotherapy (WBRT) was evaluated in many RCTs with a high (60-90%) response rate; several RT regimes are equivalent, but very high dose per fraction should be avoided. In multiple BM from SCLC, the effect of WBRT is comparable to that in NSCLC but chemotherapy (CXT) although advocated is probably less effective than RT. Single BM from NSCLC occurs in 30% of all BM cases; several prognostic classifications including RPA are very useful. Several options are available in single BM: WBRT, surgery (SX), radiosurgery (RS) or any combination of these. All were studied in RCTs and will be reviewed: the addition of WBRT to SX or RS gives a better neurological tumour control, has little or no impact on survival, and may be more toxic. However omitting WBRT after SX alone gives a higher risk of cerebro-spinal fluid dissemination. Prophylactic cranial irradiation (PCI) has a major role in SCLC. In limited disease, meta-analyses have shown a positive impact of PCI in the decrease of brain relapse and in survival improvement, especially for patients in complete remission. Surprisingly, this has been recently confirmed also in extensive disease. Experience with PCI for NSCLC is still limited, but RCT suggest a reduction of BM with no impact on survival. Toxicity of PCI is a matter of debate, as neurological or neuro-cognitive impairment is already present prior to PCI in almost half of patients. However RT toxicity is probably related to total dose and dose per fraction. Perspectives : Future research should concentrate on : 1) combined modalities in multiple BM. 2) Exploration of treatments in oligo-metastases. 3) Further exploration of PCI in NSCLC. 4) Exploration of new, toxicity-sparing radiotherapy techniques (IMRT, Tomotherapy etc).

Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.

A comparison of results from MRIO and interregional computable general equilibrium (CGE) analyses of the impacts of a positive demand shock on the ‘CO2 trade balance’ between Scotland and the rest of the UK

In previous work we have applied the environmental multi-region input-output (MRIO) method proposed by Turner et al (2007) to examine the ‘CO2 trade balance’ between Scotland and the Rest of the UK. In McGregor et al (2008) we construct an interregional economy-environment input-output (IO) and social accounting matrix (SAM) framework that allows us to investigate methods of attributing responsibility for pollution generation in the UK at the regional level. This facilitates analysis of the nature and significance of environmental spillovers and the existence of an environmental ‘trade balance’ between regions. While the existence of significant data problems mean that the quantitative results of this study should be regarded as provisional, we argue that the use of such a framework allows us to begin to consider questions such as the extent to which a devolved authority like the Scottish Parliament can and should be responsible for contributing to national targets for reductions in emissions levels (e.g. the UK commitment to the Kyoto Protocol) when it is limited in the way it can control emissions, particularly with respect to changes in demand elsewhere in the UK. However, while such analysis is useful in terms of accounting for pollution flows in the single time period that the accounts relate to, it is limited when the focus is on modelling the impacts of any marginal change in activity. This is because a conventional demand-driven IO model assumes an entirely passive supply-side in the economy (i.e. all supply is infinitely elastic) and is further restricted by the assumption of universal Leontief (fixed proportions) technology implied by the use of the A and multiplier matrices. In this paper we argue that where analysis of marginal changes in activity is required, a more flexible interregional computable general equilibrium approach that models behavioural relationships in a more realistic and theory-consistent manner, is more appropriate and informative. To illustrate our analysis, we compare the results of introducing a positive demand stimulus in the UK economy using both IO and CGE interregional models of Scotland and the rest of the UK. In the case of the latter, we demonstrate how more theory consistent modelling of both demand and supply side behaviour at the regional and national levels affect model results, including the impact on the interregional CO2 ‘trade balance’.

The Export Base Model with a Supply-Side Stimulus to the Export Sector

Paper delivered at the Western Regional Science Association Annual Conference, Sedona, Arizona, February, 2010.