Absenteísmo na equipe de enfermagem e suas implicações para a assistência prestada em unidades de urgência e emergência

Trata-se de um estudo descritivo e exploratório, com abordagem qualitativa dos dados. Objetivou-se analisar a percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo e suas implicações na assistência nas unidades de Urgência e Emergência (UE) das cinco distritais de saúde no município de Ribeirão Preto/SP. Os sujeitos foram profissionais da equipe de enfermagem (enfermeiro, auxiliar e técnico de enfermagem) que atuam nestas unidades. Foram selecionados 2 profissionais de cada categoria, a partir dos critérios de inclusão do estudo, sem considerar sexo, faixa etária e tempo de trabalho no serviço, totalizando 30 participantes. Os dados foram coletados por meio de entrevistas individuais semiestruturadas, conduzidas a partir de um roteiro norteador composto pelas variáveis (Processo de Gestão de Recursos Humanos (RH); Condição de Trabalho em Equipe e Qualidade do Cuidado Prestado) abordadas no estudo. Para análise dos dados utilizou-se análise de conteúdo, modalidade temática. Após análise dos dados, as categorias encontradas foram: TEMA 1 - Gerenciamento, organização e enfrentamento para a operacionalização do trabalho de enfermagem (Subtema 1 - Operacionalização da escala de trabalho frente ao desafio do quantitativo da equipe de enfermagem na unidade de UE; Subtema 2 - Reorganização do trabalho e a perspectiva dos trabalhadores frente à mudança para as 30h/semanais e a terceirização do serviço; Subtema 3 - Tempo de permanência do profissional no serviço; Subtema 4 - Comunicação como ferramenta para desenvolver o trabalho em equipe e gerenciar conflitos); TEMA 2 - Condições impostas ao trabalhador e sua influência no desenvolvimento do trabalho (Subtema 1 - Plano de carreira e salário como estimulantes para desenvolvimento do trabalho; Subtema 2 - Vínculo empregatício: vantagens e desvantagens; Subtema 3 - Educação permanente e sua importância para desenvolvimento do trabalho; Subtema 4 - Influência da estrutura física, materiais e equipamentos no cuidado) e TEMA 3 - Avaliação do serviço e da assistência prestada. No que diz respeito ao quantitativo de enfermagem disposto nas unidades, todos os entrevistados relatam que é um quantitativo razoável e que, em alguns momentos, se sentem sobrecarregados quando ocorrem ausências não previstas. Ao se tratar da terceirização das unidades estatutárias, relata-se que não houve comunicação prévia do evento e é visível a insegurança e frustração por parte dos entrevistados. Ressalta-se que a unidade terceirizada não sofreu mudanças em sua rotina. A rotatividade é presente nestas unidades de UE, sendo maior em determinada unidade e ocorre por inúmeros motivos, dentre eles, aposentadoria, transferência para Unidade Básica de Saúde (UBS), conflitos na equipe e/ou com pacientes, dentre outros. Todos os entrevistados sugerem que a comunicação é fundamental para o desenvolvimento do trabalho em equipe e é através dela que os conflitos possam vir a ser resolvidos. Neste momento, percebe-se, a partir das falas, que a comunicação é diferente entre as unidades e, portanto, existem níveis diferentes de conflitos entre as unidades. O município não possui um plano de carreira efetivo, portanto os entrevistados demonstram desmotivação para buscar novos conhecimentos. Quanto ao salário, estes têm a visão de que é razoável, sendo considerado elevado em relação às demais instituições de saúde do município, porém, defasado em relação à categoria profissional. Os profissionais terceirizados relatam uma certa insatisfação por trabalhar da mesma forma que os estatutários, recebendo um menor salário e sem os mesmos benefícios, o que nos leva à categoria vínculo empregatício, onde a estabilidade é abordada com visões positivas e negativas. Ao se tratar da visão negativa, os entrevistados sugerem que muitos colegas não sabem lidar com esse benefício, se ausentando do trabalho ou trabalhando de uma forma não adequada, prejudicando a rotina do serviço. No que tange à educação permanente, temos a diferença mais gritante do estudo, visto que os entrevistados estatutários relatam que não possuem a disponibilização, através da prefeitura, de cursos de atualização, capacitação e constante aprendizado enquanto que os terceirizados relatam atualizações constantes e apoio por parte da instituição com a qual eles estão vinculados. É unânime que todos os entrevistados consideram que a estrutura física, materiais e equipamentos interferem diretamente no cuidado. Ao serem questionados em relação à avaliação do cuidado prestado, eles o consideram bom, podendo ser melhor caso fossem disponibilizadas condições de trabalho mais adequadas. Considera-se o estudo como um possível instrumento de avaliação dos serviços prestados em unidade de UE, bem como das condições de trabalho fornecidas ao trabalhador e sua satisfação profissional

Estratégia de manutenção de equipamentos elétricos em unidades offshore de produção de petróleo e gás baseada na filosofia de operações integradas.

A função Manutenção é extremamente relevante para garantir o cumprimento do planejamento da produção de óleo e gás natural de uma unidade marítima de produção, pois impacta diretamente na eficácia do processo produtivo. Quando se trata de uma instalação offshore, a manutenção passa a ser ainda mais importante, pois falhas em equipamentos e sistemas industriais podem, além de causar perdas econômicas, causar graves acidentes às pessoas e ao meio ambiente. Gerir a manutenção de uma planta industrial flutuante, localizada a 300 quilômetros da costa, como no caso daquelas localizadas nos campos do pré-sal brasileiro, é uma tarefa que requer a aplicação das técnicas mais modernas de gerenciamento de manutenção e processos de trabalho ágeis e dinâmicos para garantir o suporte técnico adequado a partir de instalações localizadas em ambientes onshore. Neste contexto, esta tese tem como objetivo avaliar e propor uma metodologia para definição da estratégia de manutenção a ser implementada em novas unidades de produção de petróleo e gás natural destinadas a operar em ambiente offshore. Esta metodologia, pautada na manutenção centrada em confiabilidade, tem como objetivo garantir que a estratégia de manutenção, além de garantir a máxima disponibilidade e eficiência dos equipamentos e sistemas, também seja compatível com a filosofia das Operações Integradas, recentemente desenvolvida pela indústria norueguesa de exploração e produção de petróleo para otimizar a produção de seus campos que já estão em fase de amadurecimento. Dessa forma, este trabalho contribuirá para que, com base na metodologia proposta para definição da estratégia de manutenção, novas plataformas de petróleo e gás natural possam operar com ainda mais segurança e eficiência, garantindo o melhor aproveitamento possível das reservas de petróleo. Este trabalho inclui uma análise de custos simplificada para os estudos de caso propostos, não fazendo parte do escopo do trabalho uma análise de custos detalhada para toda instalação.

Visegrad development aid in the Eastern Partnership Region. OSW Report, February 2014

The international development cooperation systems of the Visegrad countries are all rather new, in most cases only about a decade old. They are still undergoing reforms and the countries are striving to strengthen their own profiles as development donors in the world by gradually increasing their bilateral ODA. Although their resources are limited and were further cut due to the financial and economic crisis, the bilateral ODA ratio of the Visegrad countries as a group spent in the EaP region gradually increased after 2009. Given that the individual systems are still developing and the countries are focusing on creating their own brand, it is highly unlikely that in the near future it would be in their interest to set up a common development fund – either for the EaP region or in general. Instead of creating new institutions, however, a rationalization of the current cooperation systems and a consolidation of existing resources is feasible and should be considered.

Mutual Recognition: economic and regulatory logic in goods and services. Bruges European Economic Research (BEER) Papers 24/June 2012

Mutual recognition is one of the most appreciated innovations of the EU. The idea is that one can pursue market integration, indeed "deep' market integration, while respecting 'diversity' amongst the participating countries. Put differently, in pursuing 'free movement' for goods, mutual recognition facilitates free movement by disciplining the nature and scope of 'regulatory barriers', whilst allowing some degree of regulatory discretion for EU Member States. This BEER paper attempts to explain the rationale and logic of mutual recognition in the EU internal goods market, its working in actual practice for about three decades now, culminating in a qualitative cost/benefit analysis and its recent improvement in terms of 'governance' in the so-called New Legislative Framework (first denoted as the 2008 Goods package) thereby ameliorating the benefits/costs ratio. For new (in contrast to existing) national regulation, the intrusive EU procedure to impose mutual recognition is presented as well, with basic data so as to show its critical importance to keep the internal goods market free. All this is complemented by a short summary of the scant economic literature on mutual recognition. Subsequently, the analysis is extended to the internal market for services. This is done in two steps, first by reminding the debate on the origin principle (which goes further than mutual recognition EU-style) and how mutual recognition works under the horizontal services directive. This is followed by a short section on how mutual recognition works in vertical (i.e. sectoral) services markets.

Travellers returning ill from the tropics – a descriptive retrospective study

nternational travel continues to increase in frequency. Health care providers need a wide understanding of the spectrum of travel related diseases and their management. This retrospective study analyses the demographic and clinical data of 360 travellers returning from the tropics presenting to an outpatient clinic at a tertiary hospital between 2003 - 2007. The aim of this study was to analyse the frequency of presenting symptoms and diseases in ill returning travellers and to correlate them to the areas visited and the duration and purpose of travel. The main symptoms during travel were diarrhoea (n = 200, 56 %) and fever (n = 124, 34 %). Travellers not visiting friends and relatives but with close contact to the local population were at more than two-fold increased risk of diarrhoea (Odds Ratio [OR] 2.5; 95 % confidence interval [CI] 1.1-6.0, p = 0.03) and fever (OR 2.4; 95 % CI 1.1-5.3; p = 0.02) compared to tourist travellers. Travellers visiting friends and relatives (VFR) were not at increased risk for diarrhoea (OR 0.6; 95 % CI 0.3-1.3; p = 0.17), or fever (OR 1.5; 95 % CI 0.7-3.4; p = 0.28). Thirty-two percent of all travellers (n = 115) were diagnosed with a specific pathogen. Malaria (6 %), giardiasis (6 %) and amebiasis (4 %) were the most frequently detected pathogens. The odds of malaria as a cause of the presenting illness was lower among travellers reporting pre-travel advice. Specific antimicrobial treatment was required in around one third of the patients.

The effect of hormone replacement therapy and/or exercise on skeletal muscle attenuation in postmenopausal women: a yearlong intervention

Hormone replacement therapy (HRT) has been reported to exert a positive effect on preserving muscle strength following the menopause, however, the mechanism of action remains unclear. We examined whether the mechanism involved preservation of muscle composition as determined by skeletal muscle attenuation. Eighty women aged 50-57 years were randomly assigned to either: HRT, exercise (Ex), HRT + exercise (ExHRT), and control (Co) for 1 year. The study was double-blinded with subjects receiving oestradiol and norethisterone acetate (Kliogest) or placebo. Exercise included progressive high-impact training for the lower limbs. Skeletal muscle attenuation in Hounsfield units (HU) was determined by computed tomography of the mid-thigh. Areas examined were the quadriceps compartment (includes intermuscular adipose tissue), quadriceps muscles, the posterior compartment and posterior muscles. Muscle performance was determined by knee extensor strength, vertical jump height, and running speed over 20 m. Fifty-one women completed the intervention. Vertical jump height and running speed improved in the HRT and ExHRT groups compared with Co (interaction, P < 0.01). For both the quadriceps compartment and quadriceps muscles, HU significantly increased (interaction, P <= 0.005) for HRT, Ex, and ExHRT compared with Co. For the posterior compartment, HU for the HRT and ExHRT were significantly increased compared with Co, while for posterior muscles, ExHRT was significantly greater than Co. Although the effects were modest, the results indicate that HRT, either alone or combined with exercise, may play a role in preserving/improving skeletal muscle attenuation in early postmenopausal women and thereby exert a positive effect on muscle performance.

A comparative study of 'joined-up' working in three regeneration programme case studies

This research concerns the development of coordination and co-governance within three different regeneration programmes within one Midlands city over the period from 1999 to 2002. The New Labour government, in office since 1997, had an agenda for ‘joining-up’ government, part of which has had considerable impact in the area of regeneration policy. Joining-up government encompasses a set of related activities which can include the coordination of policy-making and service delivery. In regeneration, it also includes a commitment to operate through co-governance. Central government and local and regional organisations have sought to put this idea into practice by using what may be referred to as network management processes. Many characteristics of new policies are designed to address the management of networks. Network management is not new in this area, it has developed at least since the early 1990s with the City Challenge and Single Regeneration Budget (SRB) programmes as a way of encouraging more inclusive and effective regeneration interventions. Network management theory suggests that better management can improve decision-making outcomes in complex networks. The theories and concepts are utilised in three case studies as a way of understanding how and why regeneration attempts demonstrate real advances in inter-organisational working at certain times whilst faltering at others. Current cases are compared to the historical case of the original SRB programme as a method of assessing change. The findings suggest that: The use of network management can be identified at all levels of governance. As previous literature has highlighted, central government is the most important actor regarding network structuring. However, it can be argued that network structuring and game management are both practised by central and local actors; Furthermore, all three of the theoretical perspectives within network management (Instrumental, Institutional and Interactive), have been identified within UK regeneration networks. All may have a role to play with no single perspective likely to succeed on its own. Therefore, all could make an important contribution to the understanding of how groups can be brought together to work jointly; The findings support Klijn’s (1997) assertion that the institutional perspective is dominant for understanding network management processes; Instrumentalism continues on all sides, as the acquisition of resources remains the major driver for partnership activity; The level of interaction appears to be low despite the intentions for interactive decision-making; Overall, network management remains partial. Little attention is paid to the issues of accountability or to the institutional structures which can prevent networks from implementing the policies designed by central government, and/or the regional tier.

Using min-sum loopy belief propagation for decentralised supply chain formation

Modern business trends such as agile manufacturing and virtual corporations require high levels of flexibility and responsiveness to consumer demand, and require the ability to quickly and efficiently select trading partners. Automated computational techniques for supply chain formation have the potential to provide significant advantages in terms of speed and efficiency over the traditional manual approach to partner selection. Automated supply chain formation is the process of determining the participants within a supply chain and the terms of the exchanges made between these participants. In this thesis we present an automated technique for supply chain formation based upon the min-sum loopy belief propagation algorithm (LBP). LBP is a decentralised and distributed message-passing algorithm which allows participants to share their beliefs about the optimal structure of the supply chain based upon their costs, capabilities and requirements. We propose a novel framework for the application of LBP to the existing state-of-the-art case of the decentralised supply chain formation problem, and extend this framework to allow for application to further novel and established problem cases. Specifically, the contributions made by this thesis are: • A novel framework to allow for the application of LBP to the decentralised supply chain formation scenario investigated using the current state-of-the-art approach. Our experimental analysis indicates that LBP is able to match or outperform this approach for the vast majority of problem instances tested. • A new solution goal for supply chain formation in which economically motivated producers aim to maximise their profits by intelligently altering their profit margins. We propose a rational pricing strategy that allows producers to earn significantly greater profits than a comparable LBP-based profitmaking approach. • An LBP-based framework which allows the algorithm to be used to solve supply chain formation problems in which goods are exchanged in multiple units, a first for a fully decentralised technique. As well as multiple-unit exchanges, we also model in this scenario realistic constraints such as factory capacities and input-to-output ratios. LBP continues to be able to match or outperform an extended version of the existing state-of-the-art approach in this scenario. • Introduction of a dynamic supply chain formation scenario in which participants are able to alter their properties or to enter or leave the process at any time. Our results suggest that LBP is able to deal easily with individual occurences of these alterations and that performance degrades gracefully when they occur in larger numbers.

Using the max-sum algorithm for supply chain emergence in dynamic multiunit environments

Supply chain formation (SCF) is the process of determining the set of participants and exchange relationships within a network with the goal of setting up a supply chain that meets some predefined social objective. Many proposed solutions for the SCF problem rely on centralized computation, which presents a single point of failure and can also lead to problems with scalability. Decentralized techniques that aid supply chain emergence offer a more robust and scalable approach by allowing participants to deliberate between themselves about the structure of the optimal supply chain. Current decentralized supply chain emergence mechanisms are only able to deal with simplistic scenarios in which goods are produced and traded in single units only and without taking into account production capacities or input-output ratios other than 1:1. In this paper, we demonstrate the performance of a graphical inference technique, max-sum loopy belief propagation (LBP), in a complex multiunit unit supply chain emergence scenario which models additional constraints such as production capacities and input-to-output ratios. We also provide results demonstrating the performance of LBP in dynamic environments, where the properties and composition of participants are altered as the algorithm is running. Our results suggest that max-sum LBP produces consistently strong solutions on a variety of network structures in a multiunit problem scenario, and that performance tends not to be affected by on-the-fly changes to the properties or composition of participants.

Using Physical Quantities in Applied Mathematical Problems with Maple

The present article discusses units of measure and their base units, work environments built in the Units package of the computer algebra system Maple. An analysis is drawn of the tools of the application in connection with the use of physical quantities and their features. Maple’s main commands are arranged in groups depending on the function. Some applied mathematical problems are given as examples making use of derivative, integral and differential equations.

Post Crisis Lessons for Open Economies: Are They All New?

This paper will argue that the American economy could and will absorb the recent shocks, and that in the longer run (within a matter of years), it will somehow convert the revealed weaknesses to its advantage. America has a long record of learning from its excesses to improve the working of its particular brand of capitalism, dating back to the imposition of antitrust controls on the robber barons in the late 1800s and the enhancement of investor protection after the 1929 crash. The American economy has experienced market imperfections of all kinds but it almost always has found, true, not perfect, but fairly reliable regulatory answers and has managed to adapt to change, (e. g. Dodd-Frank Act on financial stability). The U.S. has many times pioneered in the elaboration of both theoretical and policy oriented solutions for conflicts between markets and government to increase economic welfare (Bernanke, 2008, p. 425). There is no single reason why it should not turn the latest financial calamities to its advantage. At the same time, to regain confidence in capitalism as a global system, global efforts are indispensable. To identify some of the global economic conflicts that have a lot to do with U.S. markets in particular, we seek answers to global systemic questions.

Knowledge creation in dynamic learning environments

Researchers have extensively discussed using knowledge management to achieve sustainable competitive advantages; however, the successful implementation of knowledge management programs in organizations remains challenging. Problems with knowledge management arise primarily from issues related to inter-subjective creation of meaning by diverse individuals in a dynamic learning environment. ^ The first part of this dissertation examined the concepts of shared interpretive resources referring to background assumptions, shared language, and symbolic resources upon which individuals draw in their interactions in the community. The discussion adopted an interpretive research approach to underscore how community members develop shared interpretive resources over time. The second part examined how learners' behaviors influence knowledge acquisition in the community, emphasizing the associations between learners' learning approaches and learning contexts. An empirical survey of learners provided significant evidence to demonstrate the influences of learners' learning approaches. The third part examined an instructor's strategy—namely, advance organizer—to enhance learners' knowledge assimilation process. Advance organizer is an instructor strategy that refers to a set of inclusive concepts that introduce and sum up new material, and refers to a method of bridging and linking old information with something new. In this part, I underscore the concepts of advance organizer, and the implementations of advance organizer in one learning environment. A study was conducted in one higher educational environment to show the implementation of advance organizer. Additionally, an advance organizer instrument was developed and tested, and results from learners' feedback were analyzed. The significant empirical evidence showed the association between learners' learning outcomes and the implementation of advance organizer strategy. ^

O olhar das instituições de previdência sobre a casa e a cidade: promoção, financiamento e avaliação de imóveis

The investments of Caixas and Institutos de Aposentadoria e Pensões (CAP and IAP) in homes of Natal, between the decades of 1930-60, helped to boost up the local real estate market in consolidation at the time. Inserted in the first national policy on social housing in the country, these operations have demanded the creation of a wide qualified organizational structure, which would be from the "Central Offices" of Rio de Janeiro to the decentralized units of the federal states. The professionals linked to the Local Agencies have developed, on this matter, from activities related to the design and construction of residential complexes, to the daily study of financing proposals in isolated units. As from these studies, the evaluation of shelters was essential to the effectiveness of the policy, resulting in the production of data on the market value of the properties by observing and issuing judgments upon the living quarters of different social groups. Given these considerations, the aim here is to contribute to the understanding on how to operate these real estate actions in the legitimization of boundaries about the urban space and dwellings available to workers in Natal. Therefore, the views of the city and constructions expressed by the evaluating engineers in their technical reports have been taken as the focus. Being the main primary sources of work, these reports are part of the edifices process of CAP/IAP regarding Natal, whose content is systematized in the database "Enterprises", the HCUrb Research Group. In addition, there were used local newspapers at the time and interviews with professionals as complementary sources. It was found that, in general, the evaluations have configured – in a more everyday dimension of bureaucratic routines - a vehicle, among others, circulating ideas about "home" within the social security institutions, being imbued with assumptions historically constructed about the "modern habitat". Filled in loco, the reports expose the clash between modernizing ideals in vogue and clear limitations in the city scenario at the time. Fragmented images of the town are given to read through the labels assigned to the evaluated sites – these being coated of certain "scientific" character - which both legitimated and contributed to the dynamics of appreciation/depreciation of the soil and to the socio-spatial differentiation. Contradictions were evident in the endorsement given by the technicians when financing of admittedly precarious homes for insured disadvantaged categories at the local level - such as industrial workers - while strict regulations were imposed to new construction, designed, above all, to better paid categories. By identifying raters engineers as urban agents, members of a technical-focused operating system for safety and efficiency in the real estate investments of those authorities corporatist, it is desired the usefulness of further studies on these characters, their training, professional activity and participation in the construction of discourses and practices of intervention about the city and its buildings, discussing individual and grouped interests that were left behind.

Does market upgrading benefit farmers? : market differentiation, contract farming, and professional cooperatives in China's pork processing industry

This study tested whether contract farming or farmers professional cooperatives (FPCs) improved the social benefit of pork production and income of breeding farmers in China. The main concern of this study is whether institutional arrangement like contract farming or FPCs actually improved the welfare of farmers as expected. To answer this question accurately, we estimated the differentiated market demand of pork products in order to quantify the benefit by transaction types. Our study finds that contract farming or FPCs improved the benefits of pork products, but farmer's income remained lower than that of traditional transaction types. This finding is new in terms of quantifying distribution of the economic values among sales outlets, agro-firms and farmers. It is more reliable because it explicitly captures impacts from both demand side and supply side by structural estimation. In practice, we need to keep it mind the bargaining power of small farmers will not improve instantly even when the contract farming or FPCs are introduced.

Data on the biogeochemical cycle of methane in the ocean

Geological, mineralogical and microbiological aspects of the methane cycle in water and sediments of different areas in the oceans are under consideration in the monograph. Original and published estimations of formation- and oxidation rates of methane with use of radioisotope and isotopic methods are given. The role of aerobic and anaerobic microbial oxidation of methane in production of organic matter and in formation of authigenic carbonates is considered. Particular attention is paid to processes of methane transformation in areas of its intensive input to the water column from deep-sea hydrothermal sources, mud volcanoes, and cold methane seeps.