Universalização do acesso à saúde e regulação dos planos privados de assistência à saúde: a atuação regulatória da ANS como instrumento de harmonia contratual e viabilização do papel suplementar da iniciativa privada na efetivação do direito social à saúde

While essential to human nature, health and life have been protected since ancient times by various areas of knowledge, particularly by the Law, given its dynamics within the regulation of social interactions. In Brazil, health has been granted major importance by the Federal Constitution of 1988, which, disrupting the dictatorial authoritarianism, inaugurating a Social State and focusing on the values of freedom and human dignity, raises health to the condition of a social right, marked predominantly by an obligational bias directed, primarily, to the State, through the enforcement of public policies. Although, given the limitation of the State action to the reserve for contingencies, it turns clear that an universalizing access to public health is impossible, seen that the high cost of medical provisions hinders the State to meet all the health needs of the rightholders. As a result of the inefficiency of the State, the effort of the Constituent Assembly of 1988 in creating a hybrid health system becomes nuclear, which, marked by the possibility of exploration of healthcare by the private initiative, assigns to the private enterprise a key role in supplementing the public health system, especially through the offer of health insurance plans. At this point, however, it becomes clear that health provisions rendered by the private agents are not unlimited, which involves discussions about services and procedures that should be excluded from the contractual coverage, for purposes of sectoral balance, situation which draws the indispensability of deliberations between Fundamental Rights on one hand, related to the protection of health and life, and contractual principles on the other hand, connected to the primacy of private autonomy. At this point, the importance of the regulation undertaken by the ANS, Brazilian National Health Agency, appears primordial, which, by means of its seized broad functions, considerable autonomy and technical discretion, has conditions to implement an effective control towards the harmonization of the regulatory triangle, the stability and development of the supplementary health system and, consequently, towards the universalization of the right to health, within constitutional contours. According to this, the present essay, resorting to a broad legislative, doctrinal and jurisprudential study, concludes that economic regulation over the private healthcare sector, when legitimately undertaken, provides progress and stability to the intervening segment and, besides, turns healthcare universalization feasible, in a way that it can not be replaced efficiently by any other State function.

Adults with autism spectrum disorders exhibit decreased sensitivity to reward parameters when making effort-based decisions.

BACKGROUND: Efficient effort expenditure to obtain rewards is critical for optimal goal-directed behavior and learning. Clinical observation suggests that individuals with autism spectrum disorders (ASD) may show dysregulated reward-based effort expenditure, but no behavioral study to date has assessed effort-based decision-making in ASD. METHODS: The current study compared a group of adults with ASD to a group of typically developing adults on the Effort Expenditure for Rewards Task (EEfRT), a behavioral measure of effort-based decision-making. In this task, participants were provided with the probability of receiving a monetary reward on a particular trial and asked to choose between either an "easy task" (less motoric effort) for a small, stable reward or a "hard task" (greater motoric effort) for a variable but consistently larger reward. RESULTS: Participants with ASD chose the hard task more frequently than did the control group, yet were less influenced by differences in reward value and probability than the control group. Additionally, effort-based decision-making was related to repetitive behavior symptoms across both groups. CONCLUSIONS: These results suggest that individuals with ASD may be more willing to expend effort to obtain a monetary reward regardless of the reward contingencies. More broadly, results suggest that behavioral choices may be less influenced by information about reward contingencies in individuals with ASD. This atypical pattern of effort-based decision-making may be relevant for understanding the heightened reward motivation for circumscribed interests in ASD.

designing + (dis)assembling disputes: an ethnography of disputes & lawyers in the construction industry

The UK construction industry is notorious for the sheer amount of disputes which are likely to arise on each building and engineering project. Despite numerous creative attempts at “dispute avoidance” and “dispute resolution”, this industry is still plagued with these costly disputes. Whilst both academic literature and professional practices have investigated the causes of disputes and the mechanisms for avoidance/resolution of these disputes, neither has studied in any detail the nature of the construction disputes and why they develop as they do once a construction lawyer is engaged. Accordingly, this research explores the question of what influences the outcome of a construction dispute and to what extent do construction lawyers control or direct this outcome? The research approach was ethnographic. Fieldwork took place at a leading construction law firm in London over 18 months. The primary focus was participant observation in all of the firm’s activities. In addition, a database was compiled from the firm’s files and archives, thus providing information for quantitative analysis. The basis of the theoretical framework, and indeed the research method, was the Actor‐Network Theory (ANT). As such, this research viewed a dispute as a set of associations – an entity which takes form and acquires its attributes as a result of its relations with other entities. This viewpoint is aligned with relational contract theories, which in turn provides a unified platform for exploring the disputes. The research investigated the entities and events which appeared to influence the dispute’s identity, shape and outcome. With regard to a dispute’s trajectory, the research took as its starting point that a dispute follows the transformation of “naming, blaming, claiming…”, as identified by Felstiner, Abel and Sarat in 1980. The research found that construction disputes generally materialise and develop prior to any one of the parties approaching a lawyer. Once the lawyer is engaged, we see the reverse of the trajectory “naming, blaming, claiming…” this being: “claiming, blaming, naming…” The lawyers’ role is to identify or name (or rename) the dispute in the best possible light for their client in order to achieve the desired outcome – the development of which is akin to the design process. The transformation of a dispute and the reverse trajectory is by no means linear, but rather, iterative and spatial as it requires alliances, dependencies and contingencies to assemble and take the shape it does. The research concludes that construction disputes are rarely ever completely “resolved” as such. Whilst an independent third party may hand down a judgment, or the parties may reach a settlement agreement, this state is only temporal. Some construction disputes dissipate whist others reach a state of hibernation for a period of time only to pick up momentum and energy some years later. Accordingly, this research suggests that the concept of “dispute resolution” does not exist in the UK construction industry. The ultimate goal should be for parties to reach this ultimate and perpetual state of equilibrium as quickly and as cost effectively as possible: “dispute dissolution”, the slowing down of the dispute’s momentum. Rather than focusing on the design and assemblage of the dispute, the lawyers’ role therein is, or should be, to assist with the “disassembling” of the dispute.

Understandings of transnational families in debates on Migration and development

International migration sets in motion a range of significant transnational processes that connect countries and people. How migration interacts with development and how policies might promote and enhance such interactions have, since the turn of the millennium, gained attention on the international agenda. The recognition that transnational practices connect migrants and their families across sending and receiving societies forms part of this debate. The ways in which policy debate employs and understands transnational family ties nevertheless remain underexplored. This article sets out to discern the understandings of the family in two (often intermingled) debates concerned with transnational interactions: The largely state and policydriven discourse on the potential benefits of migration on economic development, and the largely academic transnational family literature focusing on issues of care and the micro-politics of gender and generation. Emphasizing the relation between diverse migration-development dynamics and specific family positions, we ask whether an analytical point of departure in respective transnational motherhood, fatherhood or childhood is linked to emphasizing certain outcomes. We conclude by sketching important strands of inclusions and exclusions of family matters in policy discourse and suggest ways to better integrate a transnational family perspective in global migration-development policy.

Temor, silencio y deliberación: la inhibición de la opinión en Tucídides

Tucídides es una de nuestras mejores fuentes de información para conocer la práctica argumentativa de la deliberación democrática. En este trabajo se analiza uno de los vicios que, según el historiador, haría su aparición en la escena política ateniense a la muerte de Pericles: la instrumentalización del miedo para obtener la victoria momentánea en la asamblea. El temor prudente, que fuera una arma periclea para conducir la deliberación racional en aras del bien común, habría desaparecido siendo sustituido por el amedrentamiento del rival, la calumnia, el obstruccionismo y la parálisis de la confrontación dialéctica. Instauradas en la ciudad la desconfianza y la sospecha de ocultación, los golpistas del 411 hallaron el terreno abonado para callar las voces contrarias y, gracias al silencio, instaurar el terror.

La congruence des valeurs : un facteur à considérer pour rehausser le leadership transformationnel et son efficacité ?

Les théories sous-tendant le leadership transformationnel suggèrent que la congruence des valeurs personnelles et organisationnelles est au cœur du fonctionnement du leadership transformationnel. Or, l’examen de cette proposition soulève certaines questions. Par exemple, il y a lieu de s’interroger quant à l’importance du type (subjective ou objective) et de la cible (équipe, organisation) de congruence considérés, du contenu des valeurs utilisées pour juger de la congruence, des contingences situationnelles modulant l’importance de la congruence, et du rôle de la congruence des valeurs des leaders eux-mêmes. Ainsi, afin d’enrichir les connaissances sur le rôle des valeurs en regard du leadership transformationnel, cette thèse propose trois articles dans lesquels ce rôle des valeurs et de leur congruence est abordé sous trois angles. Les données utilisées dans cette thèse proviennent d’une grande organisation canadienne, et des sous-ensembles de données sont créés pour répondre aux objectifs de chaque article. Le premier article s’intéresse aux liens qu’ont a) les valeurs personnelles des gestionnaires, b) les valeurs qu’ils perçoivent dans leur organisation et c) la congruence de ces deux ensemble de valeurs avec l’émission de comportements de leadership transformationnel tel que perçus par leurs subordonnés. Les résultats suggèrent que la congruence des valeurs n’a pas de lien avec le leadership transformationnel, mais que c’est le cas pour certaines valeurs au niveau personnel et organisationnel qui présentent effectivement un lien. Le deuxième article porte sur le potentiel rôle modérateur de la congruence des valeurs personne-organisation des subordonnés dans la relation entre le leadership transformationnel et les comportements d’habilitation. Les résultats montrent que la congruence des valeurs peut effectivement modérer cette relation, et que la forme de la modération peut dépendre de l’ancienneté des employés. Le troisième article traite du rôle modérateur de la présence de valeurs et de leur congruence au niveau de l’équipe dans la relation entre le leadership transformationnel et les comportements d’habilitation. Les résultats suggèrent que les valeurs et leur congruence dans les équipes peuvent modérer l’efficacité du leadership transformationnel en regard des comportements d’habilitation. De façon générale, la présence et la congruence de cinq valeurs, parmi les sept testées, semblent rehausser la relation entre le leadership transformationnel et les comportements d’habilitation. Ainsi, la présente thèse, en ajoutant des considérations quant aux questions qui avaient été soulevées par l’examen de la proposition théorique du rôle des valeurs et de leur congruence dans le leadership transformationnel, permet d’améliorer la compréhension de ce rôle. Spécifiquement, les résultats de cette thèse suggèrent que globalement, la congruence des valeurs peut être plus importante pour l’efficacité du leadership transformationnel lorsque les valeurs considérées sont plus importantes dans l’équipe de l’individu, et lorsque l’individu a peu d’ancienneté dans son organisation. De plus, en ce qui a trait aux leaders, il semble que la présence de valeurs de bien-être collectif et d’ouverture au changement ait un lien avec l’émission de comportements de leadership transformationnel. Une discussion traite de ces résultats et indique les limites de la thèse ainsi que des pistes de recherche future.

Les stratégies syndicales face aux restructurations d’entreprises : une étude comparative des contre-pouvoirs syndicaux dans le secteur des équipementiers automobiles en France et au Canada

Cette thèse tente de comprendre l’impact des restructurations des entreprises multinationales sur les stratégies syndicales. Les acteurs syndicaux locaux sont-ils déterminés par l’appartenance à des régimes nationaux et à des contingences organisationnelles ou peuvent-ils influencer des décisions objectives comme les restructurations ? Cette recherche s’insère dans une problématique large qui fait la jonction entre la mondialisation économique sur une base continentale, la réorganisation productive des entreprises multinationales et l’action syndicale. Au plan théorique, nous confrontons trois grandes approches analytiques, à savoir : le néo-institutionnalisme et les structures d’opportunités ; l’économie politique critique et la question du pouvoir syndical ; la géographie économique critique mettant de l’avant les contingences, l’encastrement et l’espace concurrentiel. Sur la base de ces trois familles, nous présentons un modèle d’analyse multidisciplinaire. Au plan méthodologique, cette thèse est structurée autour de quatre études de cas locales qui ont subi des menaces de restructurations. Cette collecte a été effectuée dans deux pays (la France et le Canada) et dans un secteur particulier (les équipementiers automobiles). Trois sources qualitatives forment le cœur empirique de cette thèse : des statistiques descriptives, des documents de sources secondaires et des entretiens semi-dirigés (44), principalement avec des acteurs syndicaux. L’analyse intra et inter régime national éclaire plusieurs aspects de la question des stratégies syndicales en contexte de restructurations. Les principales contributions de cette thèse touchent : 1. l’impact des facteurs relationnels et des ressources de pouvoir développées par les syndicats locaux sur les structures d’opportunités institutionnelles; 2. l’importance des aspects « cognitifs » et d’envisager le pouvoir de manière multi-niveaux; 3. l’importance de l’encastrement social et des dynamiques relationnelles entre syndicats et patronats; 4. l’influence de la concurrence internationale/nationale/régionale/locale dans le secteur des équipementiers automobiles; et 5. l’importance des arbitrages et des relations entre les acteurs de l’entreprise par rapport à la théorie de la contingence pour comprendre les marges structurelles des syndicats locaux. Notre recherche invite les acteurs sociaux à repenser leur action dans le cadre des restructurations. En particulier, les syndicats locaux se doivent d’explorer de nouveaux répertoires stratégiques pour répondre aux nombreux défis que posent le changement économique et les restructurations.

A representação social do papel de gestores em organizações não governamentais

The discussions concerning the absence of a management model appropriate to the peculiarities of third sector organizations have not been impeditive to their emphasized expansion in the last decades. In the attempt of understanding this phenomenon from the perspective of those who manage social organizations, this work based on the theory of social representations to understand the notion that organization managers of the third sector - based in Fortaleza CE - have of the part that they play and how this notion influences the direction of their activities. Social representations of managers of four different categories of non-governmental organizations have been investigated, each category composed of two unities. The categories researched were: social integration through art and education, prevention and treatment of alcohol and drug abuse, children s health assistance and community action. By using Doise s Societal Approach, the role of social managers translated in intraindividual, interindividual and situational processes of their actions, has been analysed within the social representations, focusing on beliefs, values, symbols and stories that give meaning to the existence of non-governmental organizations. Analysis and discussion of data displayed the existence of diversity in the understanding of managers within their practice, in other words, the management profile is also its own manager s. The branch where an organization acts is also preponderant in the shaping of a management style. It could be deduced, from to the organizations researched, that professional formation and the manager s social insertion mainly, are determinative factors in the outlining of a management model of its own. It was concluded that, due to heterogeneity of interests and action segments, there is no systematic process for social management among organizations. Management styles are supported by their director s own perception of achievement, who model organizations according to their contingencies

Ulisses e o feminino: eros e epos

Na Odisseia, as errâncias de um homem à procura de um destino e em luta sem tréguas pela sobrevivência, contra as contingências naturais da vida, constituem um dos motores da narrativa da viagem de regresso de Ulisses. No relato das suas aventuras aparecem um conjunto de estadias localizadas em sítios fantásticos e de encontros com figuras não humanas, geralmente representadas no feminino. Com base numa leitura dos célebres episódios eróticos de Circe, de Calipso e de Nausícaa, pretende-se neste artigo analisar como a díade epos-eros contribuiu para uma caracterização mais humanizada das experiências de vida de um herói astucioso e versátil, que foi capaz de resistir a todos os perigos e nunca se deixou iludir pelas tentações que punham em risco o seu nostos.

The Relation between Substance Use and Medication Adherence among HIV Positive Substance Users in Residential Treatment

Poor medication adherence is problematic among HIV positive, low-income African-American substance users. Substance use has been shown to be associated with poor medication adherence, though we do not know the mechanism that underlies this relationship. Lack of positive environmental rewards and the propensity to discount delayed rewards may be possible mechanisms to explain this relationship. Using baseline data from a randomized controlled trial, we examined the relationships between substance use and medication adherence, testing both environmental rewards and delay discounting as independent mediators. There was a main effect of substance use on adherence, such that high frequency of substance use predicted poor adherence. There was also a main effect of environmental rewards on adherence, such that a lack of environmental reinforcement predicted poor adherence. This study shed light on the processes that contribute to low adherence, namely substance use and lack of environmental contingencies, and suggests important targets for intervention.

A representação social do papel de gestores em organizações não governamentais

The discussions concerning the absence of a management model appropriate to the peculiarities of third sector organizations have not been impeditive to their emphasized expansion in the last decades. In the attempt of understanding this phenomenon from the perspective of those who manage social organizations, this work based on the theory of social representations to understand the notion that organization managers of the third sector - based in Fortaleza CE - have of the part that they play and how this notion influences the direction of their activities. Social representations of managers of four different categories of non-governmental organizations have been investigated, each category composed of two unities. The categories researched were: social integration through art and education, prevention and treatment of alcohol and drug abuse, children s health assistance and community action. By using Doise s Societal Approach, the role of social managers translated in intraindividual, interindividual and situational processes of their actions, has been analysed within the social representations, focusing on beliefs, values, symbols and stories that give meaning to the existence of non-governmental organizations. Analysis and discussion of data displayed the existence of diversity in the understanding of managers within their practice, in other words, the management profile is also its own manager s. The branch where an organization acts is also preponderant in the shaping of a management style. It could be deduced, from to the organizations researched, that professional formation and the manager s social insertion mainly, are determinative factors in the outlining of a management model of its own. It was concluded that, due to heterogeneity of interests and action segments, there is no systematic process for social management among organizations. Management styles are supported by their director s own perception of achievement, who model organizations according to their contingencies

Redes elétricas inteligentes: desenvolvimento de modelos computacionais e aplicações para a gestão do lado da procura

Esta tese incide sobre o desenvolvimento de modelos computacionais e de aplicações para a gestão do lado da procura, no âmbito das redes elétricas inteligentes. É estudado o desempenho dos intervenientes da rede elétrica inteligente, sendo apresentado um modelo do produtor-consumidor doméstico. O problema de despacho económico considerando previsão de produção e consumo de energia obtidos a partir de redes neuronais artificiais é apresentado. São estudados os modelos existentes no âmbito dos programas de resposta à procura e é desenvolvida uma ferramenta computacional baseada no algoritmo de fuzzy-clustering subtrativo. São analisados perfis de consumo e modos de operação, incluindo uma breve análise da introdução do veículo elétrico e de contingências na rede de energia elétrica. São apresentadas aplicações para a gestão de energia dos consumidores no âmbito do projeto piloto InovGrid. São desenvolvidos sistemas de automação para, aquisição monitorização, controlo e supervisão do consumo a partir de dados fornecidos pelos contadores inteligente que permitem a incorporação das ações dos consumidores na gestão do consumo de energia elétrica; SMART GRIDS - COMPUTATIONAL MODELS DEVELOPMENT AND DEMAND SIDE MANAGMENT APPLICATIONS Abstract: This thesis focuses on the development of computational models and its applications on the demand side management within the smart grid scope. The performance of the electrical network players is studied and a domestic prosumer model is presented. The economic dispatch problem considering the production forecast and the energy consumption obtained from artificial neural networks is also presented. The existing demand response models are studied and a computational tool based on the fuzzy subtractive clustering algorithm is developed. Energy consumption profiles and operational modes are analyzed, including a brief analysis of the electrical vehicle and contingencies on the electrical network. Consumer energy management applications within the scope of InovGrid pilot project are presented. Computational systems are developed for the acquisition, monitoring, control and supervision of consumption data provided by smart meters allowing to incorporate consumer actions on their electrical energy management.

O impacto das medidas da Troika no desempenho económico-financeiro das empresas portuguesas

Os efeitos despoletados com a crise financeira de 2008 marcaram uma mudança radical de pensamentos e políticas entre as várias economias mundiais. Esta crise ficou marcada pelo enorme esforço que as economias tiveram que suportar, obrigando todos mercados a moldarem-se em função das contingências implementadas. Após análise e leitura de diversa literatura é consensual a referência ao início da crise financeira nos Estados Unidos da América (EUA) com o chamado subprime, percebendo-se também que muito rapidamente atingiria a Europa e todo o mundo. Desta forma, a Europa e inevitavelmente Portugal, acabaria por ser atingido e sofrer diversas consequências resultantes desta crise financeira. Na verdade, fruto da enorme turbulência dos mercados mundiais e da globalização, Portugal (incapaz de por si só sair da crise em que se viu envolvido) vê-se na necessidade de recorrer a ajuda externa por parte da Troika. Neste sentido, a presente dissertação tem como objetivo relatar resumidamente o início da crise financeira mundial, analisando o impacto das políticas de combate à crise implementadas em Portugal, no desempenho económico-financeiro das empresas portuguesas. Este estudo recaiu sobre a análise e perceção de comportamento de alguns indicadores económico financeiros entre os anos de 2010 a 2014, período durante o qual a Troika esteve presente em Portugal, implementando uma serie de reformas e políticas de combate à crise. Assim, debruçamo-nos sobre quatro setores de atividade (Construção Civil, Restauração, Hotelaria e Indústria do Calçado), observando os dados financeiros extraídos da base de dados SABI (Sistema de análise de Balanços Ibéricos) sobre empresas inseridas nos respetivos setores de atividade. Com base nos resultados do estudo realizado podemos concluir que o desempenho dos indicadores económico financeiros foram mais penalizados nos setores da Construção Civil e da Hotelaria.

Diretrizes para o gerenciamento de riscos em contratos de obras públicas : estudo de caso da contratação integrada

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Civil e Ambiental, 2015.

La congruence des valeurs : un facteur à considérer pour rehausser le leadership transformationnel et son efficacité ?

Les théories sous-tendant le leadership transformationnel suggèrent que la congruence des valeurs personnelles et organisationnelles est au cœur du fonctionnement du leadership transformationnel. Or, l’examen de cette proposition soulève certaines questions. Par exemple, il y a lieu de s’interroger quant à l’importance du type (subjective ou objective) et de la cible (équipe, organisation) de congruence considérés, du contenu des valeurs utilisées pour juger de la congruence, des contingences situationnelles modulant l’importance de la congruence, et du rôle de la congruence des valeurs des leaders eux-mêmes. Ainsi, afin d’enrichir les connaissances sur le rôle des valeurs en regard du leadership transformationnel, cette thèse propose trois articles dans lesquels ce rôle des valeurs et de leur congruence est abordé sous trois angles. Les données utilisées dans cette thèse proviennent d’une grande organisation canadienne, et des sous-ensembles de données sont créés pour répondre aux objectifs de chaque article. Le premier article s’intéresse aux liens qu’ont a) les valeurs personnelles des gestionnaires, b) les valeurs qu’ils perçoivent dans leur organisation et c) la congruence de ces deux ensemble de valeurs avec l’émission de comportements de leadership transformationnel tel que perçus par leurs subordonnés. Les résultats suggèrent que la congruence des valeurs n’a pas de lien avec le leadership transformationnel, mais que c’est le cas pour certaines valeurs au niveau personnel et organisationnel qui présentent effectivement un lien. Le deuxième article porte sur le potentiel rôle modérateur de la congruence des valeurs personne-organisation des subordonnés dans la relation entre le leadership transformationnel et les comportements d’habilitation. Les résultats montrent que la congruence des valeurs peut effectivement modérer cette relation, et que la forme de la modération peut dépendre de l’ancienneté des employés. Le troisième article traite du rôle modérateur de la présence de valeurs et de leur congruence au niveau de l’équipe dans la relation entre le leadership transformationnel et les comportements d’habilitation. Les résultats suggèrent que les valeurs et leur congruence dans les équipes peuvent modérer l’efficacité du leadership transformationnel en regard des comportements d’habilitation. De façon générale, la présence et la congruence de cinq valeurs, parmi les sept testées, semblent rehausser la relation entre le leadership transformationnel et les comportements d’habilitation. Ainsi, la présente thèse, en ajoutant des considérations quant aux questions qui avaient été soulevées par l’examen de la proposition théorique du rôle des valeurs et de leur congruence dans le leadership transformationnel, permet d’améliorer la compréhension de ce rôle. Spécifiquement, les résultats de cette thèse suggèrent que globalement, la congruence des valeurs peut être plus importante pour l’efficacité du leadership transformationnel lorsque les valeurs considérées sont plus importantes dans l’équipe de l’individu, et lorsque l’individu a peu d’ancienneté dans son organisation. De plus, en ce qui a trait aux leaders, il semble que la présence de valeurs de bien-être collectif et d’ouverture au changement ait un lien avec l’émission de comportements de leadership transformationnel. Une discussion traite de ces résultats et indique les limites de la thèse ainsi que des pistes de recherche future.