A contribuição do Programa Saúde da Família (PSF) para o Sistema Público de Saúde do município de Araraquara

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo de práticas adotadas por empresas que utilizam a Produção Enxuta em paralelo ao Seis Sigma no processo de melhoria

As empresas estão utilizando diversos processos de melhoria para adequarem seus negócios às necessidades dos clientes, à maior concorrência, a uma necessidade de flexibilização e de redução dos custos de seus processos de manufatura. O seis sigma e a produção enxuta são dois processos utilizados por empresas no Brasile no mundo. Atualmente a integração destes processos é um desafio para essas empresas, que buscam uma maneira mais eficiente de reduzir seus desperdícios e se adaptarem às necessidades de seus mercados consumidores. Surge, assim, o Lean Sigma aplicado nas empresas de diversas formas. O objetivo deste trabalho é estruturar, por meio de dois estudos de caso, como as empresas estão utilizando o seis Sigma e a Produção Enxuta em seus processos de melhoria. Verificou-se que existem diferentes formas de utilizar os processos em paralelo: na primeira empresa o processo iniciou em conjunto e depois foi separado em dois processos paralelos de melhoria. A segunda empresa foi ao contrário, começando de forma paralela, desagregada, e posteriormente se unindo em um único processo de melhoria, denominado Lean Sigma. O trabalho apresenta uma sistematização do processo de melhoria de duas empresas, dividido em Visão Geral e Objetivos, Estrutura Organizacional e Métodos de Melhoria. Foram verificadas as formas gerais de utilização dos processos de melhoria e que uma abordagem integrada, que contemple as peculiaridades de cada processo, se demonstra como uma melhor opção para um processo de melhoria que utiliza a Produção Enxuta e o Seis Sigma paralelamente. A pesquisa traz, também, como resultado, uma proposta de sistematização do Lean Sigma, considerando o conhecimento adquirido nos estudos de caso e na literatura consultada.

Managing healthcare quality in project management framework

Healthcare professionals routinely deploy various quality management tools and techniques in order to improve performance of healthcare delivery. However, they are characterised by fragmented approach i.e., they are not linked with the strategic intent of the organisation. This study introduces a holistic quality improvement method, which integrates all quality improvement projects with the strategic intent of the healthcare organisations. It first identifies a healthcare system and its environment. The Strengths, Weaknesses, Opportunities and Threats (SWOT) of the system are then derived with the involvement of the concerned stakeholders. This leads to developing the strategies in order to satisfy customers in line with the organisation's competitive position. These strategies help identify a few projects, the implementation of which ensures achievement of desired quality. The projects are then prioritised with the involvement of the concerned stakeholders and implemented in order to improve the system performance. The effectiveness of the method has been demonstrated using a case study of an intensive care unit at the Eric Williams Medical Sciences Complex Hospital in Trinidad. Copyright © 2007 Inderscience Enterprises Ltd.

Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda’s National Referral Hospital.

Objectives: To identify reasons for neonatal admission and death with the aim of determining areas needing improvement. Method: A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1st November 2013 to 31st January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians. Results: A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001). Neither place of birth nor delayed and after hour admissions were independently associated with mortality. Conclusion and recommendations: Mortality rate in SCBU is high. Prematurity and its complications were major contributors to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable at risk neonates is needed in order to decongest SCBU.

Adsorption in slit-like pores of activated carbons: Improvement of the Horvath and Kawazoe method

Anew thermodynamic approach has been developed in this paper to analyze adsorption in slitlike pores. The equilibrium is described by two thermodynamic conditions: the Helmholtz free energy must be minimal, and the grand potential functional at that minimum must be negative. This approach has led to local isotherms that describe adsorption in the form of a single layer or two layers near the pore walls. In narrow pores local isotherms have one step that could be either very sharp but continuous or discontinuous benchlike for a definite range of pore width. The latter reflects a so-called 0 --> 1 monolayer transition. In relatively wide pores, local isotherms have two steps, of which the first step corresponds to the appearance of two layers near the pore walls, while the second step corresponds to the filling of the space between these layers. All features of local isotherms are in agreement with the results obtained from the density functional theory and Monte Carlo simulations. The approach is used for determining pore size distributions of carbon materials. We illustrate this with the benzene adsorption data on activated carbon at 20, 50, and 80 degreesC, argon adsorption on activated carbon Norit ROX at 87.3 K, and nitrogen adsorption on activated carbon Norit R1 at 77.3 K.

Improvement of a filters method in a derivative free optimization

Constraints nonlinear optimization problems can be solved using penalty or barrier functions. This strategy, based on solving the problems without constraints obtained from the original problem, have shown to be e ective, particularly when used with direct search methods. An alternative to solve the previous problems is the lters method. The lters method introduced by Fletcher and Ley er in 2002, , has been widely used to solve problems of the type mentioned above. These methods use a strategy di erent from the barrier or penalty functions. The previous functions de ne a new one that combine the objective function and the constraints, while the lters method treat optimization problems as a bi-objective problems that minimize the objective function and a function that aggregates the constraints. Motivated by the work of Audet and Dennis in 2004, using lters method with derivative-free algorithms, the authors developed works where other direct search meth- ods were used, combining their potential with the lters method. More recently. In a new variant of these methods was presented, where it some alternative aggregation restrictions for the construction of lters were proposed. This paper presents a variant of the lters method, more robust than the previous ones, that has been implemented with a safeguard procedure where values of the function and constraints are interlinked and not treated completely independently.

Analysis and selection of indicators for a sustainability assessment method for school buildings based on SBTool ‐ PT

Nowadays, the sustainability of buildings has an extreme importance. This concept goes towards the European aims of the Program Horizon 2020, which concerns about the reduction of the environmental impacts through such aspects as the energy efficiency and renewable technologies, among others. Sustainability is an extremely broad concept but, in this work, it is intended to include the concept of sustainability in buildings. Within the concept that aims the integration of environmental, social and economic levels towards the preservation of the planet and the integrity of the users, there are, currently, several types of tools of environmental certification that are applicable to the construction industry (LEED, BREEAM, DGNB, SBTool, among others). Within this context, it is highlighted the tool SBTool (Sustainable Building Tool) that is employed in several countries and can be subject to review in institutions of basic education, which are the base for the formation of the critical masses and for the development of a country. The main aim of this research is to select indicators that can be used in a methodology for sustainability assessment (SBTool) of school buildings in Portugal and in Brazil. In order to achieve it, it will also be analyzed other methodologies that already incorporate parameters directly related with the schools environment, such as BREEAM or LEED.

Pediatric patient classification system: improvement of an instrument

Objective Improve the content validity of the instrument for classification of pediatric patients and evaluate its construct validity. Method A descriptive exploratory study in the measurement of the content validity index, and correlational design for construct validation through exploratory factor analysis. Results The content validity index for indicators was 0.99 and it was 0.97 for graded situations. Three domains were extracted in the construct validation, namely: patient, family and therapeutic procedures, with 74.97% of explained variance. The instrument showed evidences of content and construct validity. Conclusion The validation of the instrument occurred under the approach of family-centered care, and allowed incorporating some essential needs of childhood such as playing, interaction and affection in the content of the instrument.


Therapeutic benefits of body percussion using the BAPNE method

Body percussion using to the BAPNE method is a means of cognitive stimulation with multiple applications. The aim of this research is to assess their full potential as a source of therapy. The methodology used is theoretical in nature and makes use of a wide bibliography to find evidence for its therapeutic effect. In essence, body percussion can be seen to lead to improvements in three areas. the Physical, as it stimulates awareness of the body, control of movement and muscular strength, coordination and balance; the Mental, as it improves concentration, memory and perception; and finally Socio-affective, as it helps to build egalitarian relationships and leads to a decrease in anxiety in social interactions. This means of therapy has several different uses and it is targeted at different groups. In the present investigation we categorise them into five main groups: individuals with neurodegenerative diseases like Alzheimer's or Parkinson's disease; individuals with learning disorders such as dyslexia or ADHD; patients affected by diseases of the spinal cord, cranial neuropathies and trauma (Neurorehabilitation); and for the treatment of addictive behavior (addiction); and depressive disorders or anxiety disorders.After thorough analysis, we have found scientific evidence that the therapeutic body percussion using the BAPNE method improves the quality of life of patients and it is an important factor in stabilizing the development of different diseases.In addition, evidence involving certain biological indicators (in control and experimental groups, and through a pre-test and post-test) show its effect on levels of stress and anxiety (reduction of cortisol), as well as improvement of social relations as a result of working as a group (increased levels of oxytocin), and improvements seen in self-esteem and in a variety of personal aspects through the Aspects of Identity questionnaire.

A method of weighting indicators in building energy efficiency assessment

This paper identifies the indicators of energy efficiency assessment in residential building in China through a wide literature review. Indicators are derived from three main sources: 1) The existing building assessment methods; 2)The existing Chinese standards and technology codes in building energy efficiency; 3)Academia research. As a result, we proposed an indicator list by refining the indicators in the above sources. Identified indicators are weighted by the group analytic hierarchy process (AHP) method. Group AHP method is implemented following key steps: Step 1: Experienced experts are selected to form a group; Step 2: A survey is implemented to collect the individual judgments on the importance of indicators in the group; Step 3: Members’ judgments are synthesized to the group judgments; Step 4: Indicators are weighted by AHP on the group judgments; Step 5: Investigation of consistency estimation shows that the consistency of the judgment matrix is accepted. We believe that the weighted indicators in this paper will provide important references to building energy efficiency assessment.

Detection of pressed hazelnut oil in virgin olive oil by analysis of polar components: improvement and validation of the method

An improved method for the detection of pressed hazelnut oil in admixtures with virgin olive oil by analysis of polar components is described. The method. which is based on the SPE-based isolation of the polar fraction followed by RP-HPLC analysis with UV detection. is able to detect virgin olive oil adulterated with pressed hazelnut oil at levels as low as 5% with accuracy (90.0 +/- 4.2% recovery of internal standard), good reproducibility (4.7% RSD) and linearity (R-2: 0.9982 over the 5-40% adulteration range). An international ring-test of the developed method highlighted its capability as 80% of the samples were, on average, correctly identified despite the fact that no training samples were provided to the participating laboratories. However, the large variability in marker components among the pressed hazelnut oils examined prevents the use of the method for quantification of the level of adulteration. (C) 2003 Elsevier Ltd. All rights reserved.

Towards a method for the economic evaluation of environmental indicators in UK Integrated Arable Farming Systems

Integrated Arable Farming Systems (IAFS), which involve a reduction in the use of off-farm inputs, are attracting considerable research interest in the UK. The objectives of these systems experiments are to compare their financial performance with that from conventional or current farming practices. To date, this comparison has taken little account of any environmental benefits (or disbenefits) of the two systems. The objective of this paper is to review the assessment methodologies available for the analysis of environmental impacts. To illustrate the results of this exercise, the methodology and environmental indicators chosen are then applied to data from one of the LINK - Integrated Farming Systems experimental sites. Data from the Pathhead site in Southern Scotland are used to evaluate the use of invertebrates and nitrate loss as environmental indicators within IAFS. The results suggest that between 1992 and 1995 the biomass of earthworms fell by 28 kg per hectare on the integrated rotation and rose by 31 kg per hectare on the conventional system. This led to environmental costs ranging between £2.24 and £13.44 per hectare for the integrated system and gains of between £2.48 and £14.88 for the conventional system. In terms of nitrate, the integrated system had an estimated loss of £72.21 per hectare in comparison to £149.40 per hectare on the conventional system. Conclusions are drawn about the advantages and disadvantages of this type of analytical framework. Keywords: Farming systems; IAFS; Environmental valuation; Economics; Earthworms; Nitrates; Soil fauna

A holistic method to assess building energy efficiency combining D-S theory and the evidential reasoning approach

The assessment of building energy efficiency is one of the most effective measures for reducing building energy consumption. This paper proposes a holistic method (HMEEB) for assessing and certifying building energy efficiency based on the D-S (Dempster-Shafer) theory of evidence and the Evidential Reasoning (ER) approach. HMEEB has three main features: (i) it provides both a method to assess and certify building energy efficiency, and exists as an analytical tool to identify improvement opportunities; (ii) it combines a wealth of information on building energy efficiency assessment, including identification of indicators and a weighting mechanism; and (iii) it provides a method to identify and deal with inherent uncertainties within the assessment procedure. This paper demonstrates the robustness, flexibility and effectiveness of the proposed method, using two examples to assess the energy efficiency of two residential buildings, both located in the ‘Hot Summer and Cold Winter’ zone in China. The proposed certification method provides detailed recommendations for policymakers in the context of carbon emission reduction targets and promoting energy efficiency in the built environment. The method is transferable to other countries and regions, using an indicator weighting system to modify local climatic, economic and social factors.