Práticas de inclusão com alunos com multideficiência no 2º e 3º ciclo

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de mestre em Ciências da Educação Especialidade Educação Especial

Fusão de hospitais em centros hospitalares : impacto no seu desempenho operacional e financeiro

Mestrado em Contabilidade e Análise Financeira

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Optimization of the Pultrusion process

Manufacturing processes need permanently to innovate and optimize because any can be susceptible to continuous improvement. Innovation and commitment to the development of these new solutions resulting from existing expertise and the continuing need to increase productivity, flexibility and ensuring the necessary quality of the manufactured products. To increase flexibility, it is necessary to significantly reduce set-up times and lead time in order to ensure the delivery of products ever faster. This objective can be achieved through a normalization of the pultrusion line elements. Implicitly, there is an increase of productivity by this way. This work is intended to optimize the pultrusion process of structural profiles. We consider all elements of the system from the storehouse of the fibers (rack) to the pultrusion die. Particular attention was devoted to (a) the guidance system of the fibers and webs, (b) the resin container where the fibers are impregnated, (c) standard plates positioning of the fibers towards the entrance to the spinneret and also (d) reviewed the whole process of assembling and fixing the die as well as its the heating system. With the implementation of these new systems was achieved a significant saving of time set-up and were clearly reduced the unit costs of production. Quality assurance was also increased.

A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminolevulinic Acid Compared With White-Light Surgery

BACKGROUND: High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA). OBJECTIVE: To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service. METHODS: We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, lifeyears, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed. RESULTS: The incremental cost-effectiveness ratios are below €10 000 in all evaluated outcomes, being around €9100 per quality-adjusted life-year gained, €6700 per life-year gained, and €8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of €20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year. CONCLUSION: 5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.

Public enterprise reforms and efficiency in regulated environments: the case of the postal sector

Purpose - This paper focuses on analyzing the effect that public reforms have on the efficiency of state-owned enterprises in regulated environments. Design/methodology/approach - The research is focused in the postal sector where public and private companies must obey a legal framework related to provide a universal service. The analysis is carried out using a panel of 7 European postal operators for the period 1997-2003. The activity analyzed was the letter mail division; we take as key variable the unit cost of a letter and use a translog cost function where as independent variables we include traffic levels, labor cost per employee, quality and availability of the service as well as the type of ownership (public or private). Additionally, in a second stage the geographical differences among countries are considered. Findings - Results indicate that postal operators that experienced organizational changes without being privatized, such as the Spanish and Greek operators, do not have higher unit costs than privatized postal operators like the one of Germany and the Netherlands. Moreover, we find that in all cases the operator of Ireland appear to be the most efficient. In this case restructuring process has been carried out giving an important leadership role to workers. This suggests us that labor culture could be a key variable to study when analyzing reform processes in public enterprises. Originality/value - Our findings show that in a regulated environment like in the postal sector, public and private companies can obtain similar efficiency levels in term of unit costs.

Different approaches to modelling the cost-effectiveness of schistosomiasis control

This paper reviews three different approaches to modelling the cost-effectiveness of schistosomiasis control. Although these approaches vary in their assessment of costs, the major focus of the paper is on the evaluation of effectiveness. The first model presented is a static economic model which assesses effectiveness in terms of the proportion of cases cured. This model is important in highlighting that the optimal choice of chemotherapy regime depends critically on the level of budget constraint, the unit costs of screening and treatment, the rates of compliance with screening and chemotherapy and the prevalence of infection. The limitations of this approach is that it models the cost-effectiveness of only one cycle of treatment, and effectiveness reflects only the immediate impact of treatment. The second model presented is a prevalence-based dynamic model which links prevalence rates from one year to the next, and assesses effectiveness as the proportion of cases prevented. This model was important as it introduced the concept of measuring the long-term impact of control by using a transmission model which can assess reduction in infection through time, but is limited to assessing the impact only on the prevalence of infection. The third approach presented is a theoretical framework which describes the dynamic relationships between infection and morbidity, and which assesses effectiveness in terms of case-years prevented of infection and morbidity. The use of this model in assessing the cost-effectiveness of age-targeted treatment in controlling Schistosoma mansoni is explored in detail, with respect to varying frequencies of treatment and the interaction between drug price and drug efficacy.

Services in disadvantaged areas: Statins report

NICE report: Proactive case finding and retention and improving access to services in disadvantaged areas (Health Inequalities). The National Institute for Health and Clinical Excellence was asked by the Department of Health to produce guidance for the NHS on public health interventions aimed at reducing the rate of premature death (defined by ONS as death

Improving Health and Reducing Inequalities: A Practical Guide to Health Impact Assessment

(WHIASU) A basic guide to conducting a HIA. 1. Health impact assessment is a tool that can help organisations to assess the possible consequences of their decisions on people۪s health and well-being, thereby helping to develop more integrated policies and programmes. 2. This document has been developed as a practical guide to health impact assessment. It is designed to meet the needs of a variety of organisations by explaining the concept, the process and its flexibility, and by providing templates that can be adjusted to suit. 3. The Welsh Assembly Government is committed to developing the use of health impact assessment in Wales as a part of its strategy to improve health and wellbeing and to reduce health inequalities. This practical guide has been prepared by the Welsh Health Impact Assessment Support Unit, which was established by the Welsh Assembly Government to encourage and support organisations and groups in Wales to use the approach. 4. The development and use of health impact assessment will contribute to the ongoing development and implementation of local health, social care and wellbeing strategies, which is a joint statutory responsibility for Local Health Boards and local authorities. It can also contribute to Community Strategies which, given their overarching nature and breadth and depth, can address social, economic and environmental determinants of health, and to the implementation of Communities First, the Welsh Assembly Government۪s crosscutting regeneration programme. 5. The development of Health Challenge Wales as the national focus for improving health in Wales reinforces efforts to prevent ill health. Tools such as health impact assessment can help organisations and groups in all sectors to identify ways in which they can help people to improve their health.

Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme: a report from the EORTC 26981/22981 NCI-C CE3 Intergroup Study.

BACKGROUND: The study aimed to compare the cost-effectiveness of concomitant and adjuvant temozolomide (TMZ) for the treatment of newly diagnosed glioblastoma multiforme versus initial radiotherapy alone from a public health care perspective. METHODS: The economic evaluation was performed alongside a randomized, multicenter, phase 3 trial. The primary endpoint of the trial was overall survival. Costs included all direct medical costs. Economic data were collected prospectively for a subgroup of 219 patients (38%). Unit costs for drugs, procedures, laboratory and imaging, radiotherapy, and hospital costs per day were collected from the official national reimbursement lists based on 2004. For the cost-effectiveness analysis, survival was expressed as 2.5 years restricted mean estimates. The incremental cost-effectiveness ratio (ICER) was constructed. Confidence intervals for the ICER were calculated using the Fieller method and bootstrapping. RESULTS: The difference in 2.5 years restricted mean survival between the treatment arms was 0.25 life-years and the ICER was euro37,361 per life-year gained with a 95% confidence interval (CI) ranging from euro19,544 to euro123,616. The area between the survival curves of the treatment arms suggests an increase of the overall survival gain for a longer follow-up. An extrapolation of the overall survival per treatment arm and imputation of costs for the extrapolated survival showed a substantial reduction in ICER. CONCLUSIONS: The ICER of euro37,361 per life-year gained is a conservative estimate. We concluded that despite the high TMZ acquisition costs, the costs per life-year gained are comparable to accepted first-line treatment with chemotherapy in patients with cancer.

Economies of Feedlot Scale, Biosecurity, Investment, and Endemic Livestock Disease, September 2006

Infectious livestock disease creates externalities for proximate animal production enterprises. The distribution of production scale within a region should influence and be influenced by these disease externalities. Taking the distribution of the unit costs of stocking an animal as primitive, we show that an increase in the variance of these unit costs reduces consumer surplus. The effect on producer surplus, total surplus, and animal concentration across feedlots depends on the demand elasticity. A subsidy to smaller herds can reduce social welfare and immiserize the farm sector by increasing the extent of disease. While Nash behavior involves excessive stocking, disease effects can be such that aggregate output declines relative to first-best. Disease externalities can induce more adoption of a cost-reducing technology by larger herds so that animals become more concentrated across herds. For strategic reasons, excess overall adoption of the innovation may occur. Larger herds are also more likely to adopt biosecurity innovations, explaining why larger herds may be less diseased in equilibrium.

El paper del joc en el desenvolupament d'infants amb TEA

Jugar no és només un sinònim de diversió, sinó que darrera d’aquesta acció s’amaguen molts elements que són imprescindible per al desenvolupament infantil, ja que l’afavoreix en tots els àmbits de la seva vida. Un nen amb Necessitats Educatives Especial té el mateix dret de gaudir d’una estona de joc, i desenvolupar-­‐se com a persona. De fet, el joc és considerat una eina d’aprenentatge a l’edat infantil. Per això, el present treball de grau té com objectiu principal analitzar la importància del joc com a eina educativa amb infants amb un Trastorn de l’Espectre Autista. S’utilitza una metodologia qualitativa, i a través de l’observació, s’analitza com el joc ajuda a un infant amb Trastorn de l’Espectre Autista a adquirir determinades habilitats i capacitats que li permeten tenir certa autonomia. Els resultats obtinguts, permeten afirmar que la Unitat de Suport a l’Educació Especial utilitza el joc com un recurs didàctic per a treballar amb infants amb Autisme. Per això, es planteja una proposta d’intervenció dins d’aquesta unitat.

Timing of Capacity Change: Models for Capital Intensive Industry

The suitable timing of capacity investments is a remarkable issue especially in capital intensive industries. Despite its importance, fairly few studies have been published on the topic. In the present study models for the timing of capacity change in capital intensive industry are developed. The study considers mainly the optimal timing of single capacity changes. The review of earlier research describes connections between cost, capacity and timing literature, and empirical examples are used to describe the starting point of the study and to test the developed models. The study includes four models, which describe the timing question from different perspectives. The first model, which minimizes unit costs, has been built for capacity expansion and replacement situations. It is shown that the optimal timing of an investment can be presented with the capacity and cost advantage ratios. After the unit cost minimization model the view is extended to the direction of profit maximization. The second model states that early investments are preferable if the change of fixed costs is small compared to the change of the contribution margin. The third model is a numerical discounted cash flow model, which emphasizes the roles of start-up time, capacity utilization rate and value of waiting as drivers of the profitable timing of a project. The last model expands the view from project level to company level and connects the flexibility of assets and cost structures to the timing problem. The main results of the research are the solutions of the models and analysis or simulations done with the models. The relevance and applicability of the results are verified by evaluating the logic of the models and by numerical cases.

Naudan lietelannan käsittelymenetelmien taloudellinen vertailu

Maataloudessa syntyvä lanta on arvokas lannoite ja maanparannusaine, jonka käsittelystä aiheutuu sekä kustannuksia että ympäristövaikutuksia. Muita haasteita ovat esimerkiksi lannan mikrobit, lannan levitykseen soveltuvan ajankohdan lyhyys, lannan ravinteiden sovittaminen kasvien tarpeisiin ja lannan ravinteiden määrä suhteessa levityskelpoisen peltoalan määrään. Tutkimuksen tavoitteena oli tunnistaa naudan lietelannan käsittelyketjuihin liittyvät kustannukset ja osoittaa eri käsittelyketjujen kustannusten eroavaisuudet. Tavoitteena oli myös tunnistaa ja osoittaa käsittelyketjujen laadulliset erot. Kustannukset selvitettiin kustannuslaskelmin ja laadulliset erot SWOT-menetelmällä. Tutkimuksen kohteeksi valittiin 6 tilakokoluokkaa ja käsittelyketjuiksi lietelanta-, kompostointi- ja mädätysketju. Tutkimuksessa alhaisimmat kustannukset olivat lietelantaketjulla, jonka kustannukset 25 – 250 naudan tilalla olivat 5 200 – 6 600 €/a ja yksikkökustannukset 1 – 9 €/m3. Mädätysketjun kustannukset vastaavissa tilakokoluokissa olivat noin 33 000 – 50 000 €/a ja yksikkökustannukset 8 – 55 €/m3. Kompostointiketjun kustannukset olivat 35 000 – 143 000 €/a ja yksikkökustannukset 24 – 58 €/m3. Lietelantaketjun edullisuus johtui vähäisistä laite- ja rakennusinvestoinneista ja pienistä työmääristä ja kompostointiketjun kalleus suurista tukiaine- ja investointikustannuksista. Käsittelyketjujen asettaminen paremmuusjärjestykseen oli hankalaa. Työn määrä oli pienin lietelantaketjussa ja toiseksi pienin suurilla tiloilla mädätysketjussa. Kompostointiketjulla itse levitykseen kuluva aika oli pienin. Ravinteiden osalta mädätysketju oli parhain ja kompostointiketju huonoin. Ympäristövaikutuksiltaan ja hajuhaitoiltaan kompostointi- ja mädätysketju olivat parhaimmat. Mikrobien osalta parhain oli kompostointiketju.

Tietotekniikan liiketoiminnalle tuomien hyötyjen kuvaaminen ja ohjaaminen

Tämän työn tavoitteena on arvioida hyödyt, jotka tietotekniikka mahdollistaa liiketoiminnalle ja löytää keino ohjata tietojärjestelmäkehitystä tavoiteltavien hyötyjen suuntaan. Työn teoriaosuudessa esitetään ongelmia, joita tietotekniikan liiketoiminnallisten hyötyjen arvioinnissa on esiintynyt. Teoriaosuudessa käsitellään prosessiajattelun perusteita ja prosessin suorituskyvyn arviointia yleisellä tasolla ja tarkastellaan tietotekniikan vaikutusta liiketoiminnan prosesseihin. Lisäksi todetaan tietotekniikan roolit ja hyödyt liiketoimintaan nähden ja esitellään EEM -menetelmä (Enabler-Effect Map), jolla hyödyt voidaan kartoittaa. EEM menetelmälle hahmotetaan käyttöympäristö ja tarkastellaan EEM:n käyttöä osana ohjelmistotuotantoprosessia. Työn käytännön osuudessa aloitetaan Mikrotukiyksikön kehitysprojektin toteutus esitetyn teorian mukaan. Projektissa määritellään uusi toimintaa tukeva tietojärjestelmä liiketoimintalähtöisesti. Määrittelyn tulokset esitetään työn loppuosassa, mutta tietojärjestelmän toteutus on jätetty tämän työn ulkopuolelle.Projektin määrittelyn perusteella tehdään johtopäätökset ja kehittämisehdotukset menetelmälle ja työn teettävälle yritykselle Tietoleonia Oy:lle