Análise dos fundamentos do modelo value-based health care delivery à luz das teorias de estratégia

O setor de saúde, globalmente, apresenta problemas relacionados aos seus custos, qualidade e acesso. Porter e Teisberg (2004, 2006) propuseram modelo de gestão específico para a administração estratégica na área, o Value-Based Health Care Delivery (VBHCD). O modelo teve relativa repercussão e vem influenciando muitos atores no setor. Contudo, o modelo vem sendo aceito sem o devido questionamento de seus fundamentos e consistência com a teoria em estratégia. O presente trabalho busca, por meio de um ensaio teórico, analisar o modelo proposto à luz de paradigmas gerais da estratégia empresarial como, por exemplo, o modelo de Porter e a Visão Baseada em Recursos (RBV). Inicialmente, o artigo sintetiza as explicações teóricas do modelo porteriano clássico e da RBV. Em seguida, o VBHCD é examinado comparado a essas explicações, buscando-se relações e, eventualmente, contradições. Conclui-se que o modelo VBHCD não se alinha integralmente a nenhum corpo teórico isoladamente. Mesmo sendo proposto por Porter, parte de seus fundamentos advém, na verdade, de outras correntes teóricas. Esta abordagem integradora de teorias concorrentes, apesar de presente na literatura, ainda apresenta dificuldades e barreiras, um aspecto que não está explícito no modelo

Non-asymptotic confidence bounds for the optimal value of a stochastic program

We discuss a general approach to building non-asymptotic confidence bounds for stochastic optimization problems. Our principal contribution is the observation that a Sample Average Approximation of a problem supplies upper and lower bounds for the optimal value of the problem which are essentially better than the quality of the corresponding optimal solutions. At the same time, such bounds are more reliable than “standard” confidence bounds obtained through the asymptotic approach. We also discuss bounding the optimal value of MinMax Stochastic Optimization and stochastically constrained problems. We conclude with a small simulation study illustrating the numerical behavior of the proposed bounds.

Influência da vermiculita expandida na formulação de pastas leves para evitar a migração de gás em cimentação de poços petrolíferos

The gas migration during the cementing of wells is one of the main problems of oil wells engineering. Its occurrence can cause severe problems since shortly to loss of control of the well after cementation. Recently, 20/04/2010 In an accident of major proportions in the Gulf of Mexico, among other factors, faulty cementing operation provided the gas migration, causing the accident, in which 11 people died and 17 were injured occurred. Besides the serious consequences that can be caused by gas migration, remediation of the problem, which is made by injecting cement in damaged areas, usually involves additional costs and is not always effective. Therefore, preventing gas migration to be preferred. Some methods are used to prevent the migration of the pressurized gas as the annular space, application of pressure pulses, reducing the height of the cement column compressible cement pastes of low permeability, pastes and to control free filtered water, and binders of thixotropic cement expandable and flexible. Thus, the cement pastes used to prevent gas migration must meet the maximum these methods. Thus, this study aimed to formulate a cement paste to prevent gas migration, using the expanded vermiculite, and evaluate the behavior of the folder trials necessary for use in oil wells. Free water content, rheological properties, compressive strength, loss of liquid phase sedimentation of solids, specific weight, thickening time and gas migration: The following tests were performed. The results show that meets the specifications paste formulated for use in oil wells and the use of expanded vermiculite contribute to the absorption of free water, thixotropy and low density. The absorption of free water is proven to result in zero percentage test free water content, thixotropy is observed with the high value of the initial gel strength (Gi) in testing rheological properties and low density is proven in test weight specific

Dynamic stationary response of reinforced plates by the boundary element method

A direct version of the boundary element method (BEM) is developed to model the stationary dynamic response of reinforced plate structures, such as reinforced panels in buildings, automobiles, and airplanes. The dynamic stationary fundamental solutions of thin plates and plane stress state are used to transform the governing partial differential equations into boundary integral equations (BIEs). Two sets of uncoupled BIEs are formulated, respectively, for the in-plane state ( membrane) and for the out-of-plane state ( bending). These uncoupled systems are joined to formamacro-element, in which membrane and bending effects are present. The association of these macro-elements is able to simulate thin-walled structures, including reinforced plate structures. In the present formulation, the BIE is discretized by continuous and/or discontinuous linear elements. Four displacement integral equations are written for every boundary node. Modal data, that is, natural frequencies and the corresponding mode shapes of reinforced plates, are obtained from information contained in the frequency response functions (FRFs). A specific example is presented to illustrate the versatility of the proposed methodology. Different configurations of the reinforcements are used to simulate simply supported and clamped boundary conditions for the plate structures. The procedure is validated by comparison with results determined by the finite element method (FEM).

Artificial neural networks: A novel approach to analysing the nutritional ecology of a blowfly species, Chrysomya megacephala

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

On exact boundary controllability for linearly coupled wave equations

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Short-wave instabilities in the Benjamin-Bona-Mahoney-Peregrine equation: theory and numerics

In this paper we discuss the nonlinear propagation of waves of short wavelength in dispersive systems. We propose a family of equations that is likely to describe the asymptotic behaviour of a large class of systems. We then restrict our attention to the analysis of the simplest nonlinear short-wave dynamics given by U-0 xi tau, = U-0 - 3(U-0)(2). We integrate numerically this equation for periodic and non-periodic boundary conditions, and we find that short waves may exist only if the amplitude of the initial profile is not too large.

Dynamical properties of a particle in a wave packet: Scaling invariance and boundary crisis

Some dynamical properties present in a problem concerning the acceleration of particles in a wave packet are studied. The dynamics of the model is described in terms of a two-dimensional area preserving map. We show that the phase space is mixed in the sense that there are regular and chaotic regions coexisting. We use a connection with the standard map in order to find the position of the first invariant spanning curve which borders the chaotic sea. We find that the position of the first invariant spanning curve increases as a power of the control parameter with the exponent 2/3. The standard deviation of the kinetic energy of an ensemble of initial conditions obeys a power law as a function of time, and saturates after some crossover. Scaling formalism is used in order to characterise the chaotic region close to the transition from integrability to nonintegrability and a relationship between the power law exponents is derived. The formalism can be applied in many different systems with mixed phase space. Then, dissipation is introduced into the model and therefore the property of area preservation is broken, and consequently attractors are observed. We show that after a small change of the dissipation, the chaotic attractor as well as its basin of attraction are destroyed, thus leading the system to experience a boundary crisis. The transient after the crisis follows a power law with exponent -2. (C) 2011 Elsevier Ltd. All rights reserved.

Phase Transition in Dynamical Systems: Defining Classes of Universality for Two-Dimensional Hamiltonian Mappings via Critical Exponents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Energy gain induced by boundary crisis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tolerance to the air exposition test of Hoplias lacerdae larvae and juvenile during its initial development

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Lap number properties for p-Laplacian problems investigated by Lyapunov methods

In this work we consider a one-dimensional quasilinear parabolic equation and we prove that the lap number of any solution cannot increase through orbits as the time passes if the initial data is a continuous function. We deal with the lap number functional as a Lyapunov function, and apply lap number properties to reach an understanding on the asymptotic behavior of a particular problem. (c) 2006 Published by Elsevier Ltd.

An alternative approach to solve convergence problems in the backpropagation algorithm

The multilayer perceptron network has become one of the most used in the solution of a wide variety of problems. The training process is based on the supervised method where the inputs are presented to the neural network and the output is compared with a desired value. However, the algorithm presents convergence problems when the desired output of the network has small slope in the discrete time samples or the output is a quasi-constant value. The proposal of this paper is presenting an alternative approach to solve this convergence problem with a pre-conditioning method of the desired output data set before the training process and a post-conditioning when the generalization results are obtained. Simulations results are presented in order to validate the proposed approach.

Exact boundary control for the wave equation in a polyhedral time-dependent domain

We establish exact boundary controllability for the wave equation in a polyhedral domain where a part of the boundary moves slowly with constant speed in a small interval of time. The control on the moving part of the boundary is given by the conormal derivative associated with the wave operator while in the fixed part the control is of Neuman type. For initial state H-1 x L-2 we obtain controls in L-2. (C) 1999 Elsevier B.V. Ltd. All rights reserved.

Non-linear boundary element analysis of floor slabs reinforced with rectangular beams

In this work, a numerical model to perform non-linear analysis of building floor structures is proposed. The presented model is derived from the Kirchhoff-s plate bending formulation of the boundary element method (BENI) for zoned domains, in which the plate stiffness is modified by the presence of membrane effects. In this model, no approximation of the generalized forces along the interface is required and the compatibility and equilibrium conditions along interfaces are imposed at the integral equation level. In order to reduce the number of degrees of freedom, the Navier Bernoulli hypothesis is assumed to simplify the strain field for the thin sub-regions (rectangular beams). The non-linear formulation is obtained from the linear formulation by incorporating initial internal force fields, which are approximated by using the well-known cell sub-division. Then, the non-linear solution of algebraic equations is obtained by using the concept of the consistent tangent operator. The Von Mises criterion is adopted to govern the elasto-plastic material behaviour checked at points along the plate thickness and along the rectangular beam element axes. The numerical representations are accurately obtained by either computing analytically the element integrals or performing the numerical integration accurately using an appropriate sub-elementation scheme. (C) 2007 Elsevier Ltd. All rights reserved.