Reconfiguração do sistema único de saúde e suas relações intersetoriais no município do Rio Grande: contribuições do enfermeiro

Objetivou-se conhecer o Sistema Único de Saúde e suas relações intersetoriais no município do Rio Grande frente a demanda das necessidades da população em relação à saúde provocadas pelo desenvolvimento socioeconômico previsto e, consequente crescimento populacional; construir uma proposta de reconfiguração do Sistema Único de Saúde no município do Rio Grande, com contribuições do enfermeiro capaz de atender a demanda produzida pelo desenvolvimento socioeconômico e, consequente crescimento populacional e elevar o nível de saúde da população riograndina. Tem-se como Tese: O estudo do Sistema Único de Saúde e suas relações intersetoriais do município do Rio Grande, possibilita a construção de uma proposta de reconfiguração do Sistema Único de Saúde, com contribuições do enfermeiro, capaz de atender a demanda produzida pelo desenvolvimento socioeconômico e consequente crescimento populacional e elevar o nível de saúde da população riograndina. O tema se justifica pelas contribuições que a pesquisa busca apresentar com a finalidade de oferecer subsídios capazes de auxiliar nas escolhas a serem realizadas de forma coletiva em benefício da saúde da população do município do Rio Grande. Alicerçado no conceito ampliado de saúde é indispensável envolver todos os setores, seus serviços e ações, do município do Rio Grande e apreendê-los como pilares essenciais para a efetivação do Sistema Único de Saúde em benefício da população. A visão sistêmica possibilita conhecer e identificar as relações dos setores e seus serviços e ações que contribuem para atender a demanda em saúde produzida pelo desenvolvimento socioeconômico do município, e assim, entender as necessidades desse ecossistema. O referencial teórico-filosófico construído com base em autores sistêmicos, entre eles: Prigogine, Stengers (1997), Santos, Siqueira, Silva (2009), Prigogine (2009, 2011), Capra (2012), Bertalanffy (2013), foi capaz de dar sustentabilidade a pesquisa com enfoque ecossistêmico. Como caminho metodológico foi empregado o método de análise de conteúdo (AC) ancorado em Bardin (2011). A pesquisa foi do tipo descritivo, exploratório, com abordagem qualitativa. A coleta de dados, envolvendo o contexto do município do Rio Grande/RS, foi realizada por meio de entrevista semi- estruturada, buscando fundamentar a questão de pesquisa, pressupostos, objetivos e especialmente a TESE. O lócus do estudo foi o município do Rio Grande/ RS, mais especificamente, junto aos setores produtivos (secretarias municipais) que compõem a comuna e órgãos integrantes da saúde que oferecem atendimento à população por meio do Sistema Único de Saúde. Os dados evidenciaram que o município encontra-se em estado de alerta, preocupado e até mesmo assustado com as modificações e transformações que estão acontecendo, produzidas pelo desenvolvimento socioeconômico e crescimento populacional como conseqüência da implantação do pólo naval. Na tentativa de equacionar os impactos nos diferentes segmentos criaram diversas estratégias, destacando-se a criação do Grupo de Trabalho e Desenvolvimento, como fórum de discussão. A intersetorialidade entre os setores do município despontou como estratégia importante alcançando bons resultados. A enfermagem, com base nos dados, encontra-se inserida nesse contexto, qualificada e pronta a exercer a sua função e enfrentar os desafios da demanda em saúde.

Do acesso clássico à comercialização: especificidades do mercado imobiliário informal na área especial de interesse social de Mãe Luiza, Natal/ RN.

This study presents research regarding affordable housing and their effects on the spatial reconfiguration of Natal/ RN, aiming to identify the specificities of the informality of urban land. This study aims to understand how informal housing market operates housing provision for the population located in popular informal settlements, through buying and selling market and rental market of residential properties irregular / illegal. This understanding will be through the neighborhood of Mãe Luisa, Special Area of Social Interest (SASI), located between neighborhoods with a population of high purchasing power and inserted into the tourist shaft of seaside of town. The characterization of informal housing market in Mãe Luiza, from buyers, sellers and renters, will help to understand how these informal transactions operate on SASI and housing provision for public policy development and implementation of housing programs and land regularization for low-income population, adequate to dynamic and reality of housing of informal areas

Impact of Thresholds and Load Patterns when Executing HPC Applications with Cloud Elasticity

Elasticity is one of the most known capabilities related to cloud computing, being largely deployed reactively using thresholds. In this way, maximum and minimum limits are used to drive resource allocation and deallocation actions, leading to the following problem statements: How can cloud users set the threshold values to enable elasticity in their cloud applications? And what is the impact of the application’s load pattern in the elasticity? This article tries to answer these questions for iterative high performance computing applications, showing the impact of both thresholds and load patterns on application performance and resource consumption. To accomplish this, we developed a reactive and PaaS-based elasticity model called AutoElastic and employed it over a private cloud to execute a numerical integration application. Here, we are presenting an analysis of best practices and possible optimizations regarding the elasticity and HPC pair. Considering the results, we observed that the maximum threshold influences the application time more than the minimum one. We concluded that threshold values close to 100% of CPU load are directly related to a weaker reactivity, postponing resource reconfiguration when its activation in advance could be pertinent for reducing the application runtime.

Etudes sanitaires pour le classement de zones conchylicoles en Charente Maritime : Rivière de la Seudre (coquillages fouisseurs), Banc de Ronce-Perquis (coquillages fouisseurs), Bouchots des Saumonards (coquillages filtreurs)

Trois études de zones ont été conduites en 1997/1998 dans le bassin de Marennes-Oléron (Charente-Maritime). Deux concernaient la contamination des coquillages fouisseurs de la Seudre et du banc de Ronce-Perquis. La troisième concernait la contamination des coquillages filtreurs des bouchots à moules des Saumonards (Ile d'Oléron). Ces études avaient pour objet d'évaluer les niveaux de contamination microbiologique et chimique de ces zones de production de coquillages afin que l'Administration puisse en effectuer le classement sanitaire conformément à l'arrêté du 21 juillet 1995. La Seudre, à l'aval de la rivière, a montré, pour les fouisseurs, une qualité microbiologique de catégorie B et une qualité microbiologique de catégorie C pour la partie amont. De son côté, le Banc de Ronce-Perquis a présenté, pour les fouisseurs, une qualité microbiologique de catégorie B. Enfin, la catégorie microbiologique des moules des bouchots des Saumonards est de type A. Le suivi du mercure total, du cadmium et du plomb dans la chair des coquillages a mis en évidence des teneurs inférieures aux valeurs seuil.

Sequential Morphological Changes in the CNV Net after Intravitreal Anti-VEGF Evaluated with OCT Angiography

PURPOSE: To assess and describe sequential morphological changes in the choroidal neovascularization (CNV) net using optical coherence tomography angiography (OCTA) in patients undergoing treatment with intravitreal antivascular endothelial growth factor (VEGF). METHODS: Prospective cohort study. OCTA was performed sequentially: before (t0), 1 h (t1), 1 week (t2) and 1 month after the injection (t3), using Avanti RTVue XR equipped with the AngioVue® software (Optovue, Calif., USA). All images were classified by two independent graders. RESULTS: Ten eyes of 10 patients, with a mean age of 72.4 ± 10.5 years, were included. CNV morphology was described as tree-like in 5 eyes, glomerular in 1 and fragmented in 4. A fibrovascular capsule surrounding the CNV net was found in 4 eyes and a feeder trunk was noticed in 6. No changes were observed at t1. Loss of peripheral capillaries, vessel fragmentation and decreased vessel density were evident in 8 eyes at t2. The CNV capillary density and the peripheral anastomosis increased in all of these at t3. Two eyes remained unchanged through the whole length of follow-up. CONCLUSIONS: Significant changes in the CNV net can be observable in OCTA at least 1 week after intravitreal anti-VEGF. The safety of frequent examinations may provide a method of gauging treatment effects.

Reuse and integration of specification logics: the hybridisation perspective

Hybridisation is a systematic process along which the characteristic features of hybrid logic, both at the syntactic and the semantic levels, are developed on top of an arbitrary logic framed as an institution. It also captures the construction of first-order encodings of such hybridised institutions into theories in first-order logic. The method was originally developed to build suitable logics for the specification of reconfigurable software systems on top of whatever logic is used to describe local requirements of each system’s configuration. Hybridisation has, however, a broader scope, providing a fresh example of yet another development in combining and reusing logics driven by a problem from Computer Science. This paper offers an overview of this method, proposes some new extensions, namely the introduction of full quantification leading to the specification of dynamic modalities, and exemplifies its potential through a didactical application. It is discussed how hybridisation can be successfully used in a formal specification course in which students progress from equational to hybrid specifications in a uniform setting, integrating paradigms, combining data and behaviour, and dealing appropriately with systems evolution and reconfiguration.

Double Coronary Artery Fistulae: Clinical and Imaging Concerns, and a Review of the Literature

Coronary artery fistulae (CAF) are a rare entity describing abnormal communication between a coronary artery and cardiac chamber or a large intrathoracic vessel and are seldom described in the literature[1]. These fistulae can be either congenital or acquired. Often incidental in finding, CAFs can have serious clinical sequelae, and should be duly reported and discussed with the cardiac team. More than 50% of patients with CAFs may be asymptomatic; 34% may report chest pain; 13% may have symptoms of heart failure, and a minority of 2% may suffer from endocarditis and arrhythmias[2]. The largest series to our knowledge was reported by the Cleveland Clinic, which found 225 patients with incidental CAF out of 126,595 coronary catheterizations (incidence of 0.18%), performed during a span of 28 years [3]. Multiple CAFs are an even rarer entity and only a handful of cases have been reported in the literature to date. Few cases of double CAFs have been reported that describe two different feeder coronary arteries giving rise to separate drainage sites[3]. In our report, however, we describe a new entity: a single-feeder coronary vessel communicated with two drainage sites. Our case is curiously unique, in which we report a single artery, originating from the right coronary artery (RCA) with double drainage sites – one to the left pulmonary artery and the second to the left bronchial artery.

Las posibilidades de internet en la reconfiguración de la red social primaria del adulto mayor, fracturada por efecto de la migración* El caso de los adultos mayores con parientes migrantes en 6 municipios del departamento del Quindío

El presente artículo muestra cómo Internet se convierte en una herramienta de comunicación importante para reconfigurar la red social primaria del adulto mayor, fracturada por efecto de la migración. En la investigación que le da origien, se pudo constatar que hoy esta red se encuentra dividida en red primaria natural, conformada por los parientes y amigos con los que comparte el día a día, y red primaria virtual, integrada por los parientes migrantes. El escrito centra su interés en presentar las características de la red primaria virtual en la que el adulto mayor se vio impelido a participar para satisfacer sus necesidades comunicacionales. Esta red cumple la función de mantener, pero no de extender, su red social primaria. Los resultados dan cuenta de 4 aspectos: las competencias digitales desarrolladas por el adulto mayor, la estructura, las funciones y los atributos de vínculo de la red primaria virtual. Para ello se acudió a autores como Cabrera, Castell; Madarriaga, Abello & Sierra; Narváez A.; Soto, Navarro & Sánchez; Tovar & Villarraga. La investigación fue de tipo etnográfico, con enfoque cualitativo. Se aplicaron entrevistas semi-estructuradas. Para el tratamiento de la información se utilizó la teoría Fundamentad, de Strauss & Corbin (2002).

Implications of retaining woody regrowth for carbon sequestration for an extensive grazing beef business: a bio-economic modelling case study

A bio-economic modelling framework (GRASP-ENTERPRISE) was used to assess the implications of retaining woody regrowth for carbon sequestration on a case study beef grazing property in northern Australia. Five carbon farming scenarios, ranging from 0% to 100% of the property regrowth retained for carbon sequestration, were simulated over a 20-year period (1993–2012). Dedicating regrowth on the property for carbon sequestration reduced pasture (up to 40%) and herd productivity (up to 20%), and resulted in financial losses (up to 24% reduction in total gross margin). A net carbon income (income after grazing management expenses are removed) of $2–4 per t CO2-e was required to offset economic losses of retaining regrowth on a moderately productive (~8 ha adult equivalent–1) property where income was from the sale of weaners. A higher opportunity cost ($ t–1 CO2-e) of retaining woody regrowth is likely for feeder steer or finishing operations, with improved cattle prices, and where the substantial transaction and reporting costs are included. Although uncertainty remains around the price received for carbon farming activities, this study demonstrated that a conservatively stocked breeding operation can achieve positive production, environmental and economic outcomes, including net carbon stock. This study was based on a beef enterprise in central Queensland’s grazing lands, however, the approach and learnings are expected to be applicable across northern Australia where regrowth is present.

Virtual-Build-to-Order as a Mass Customization Order Fulfilment Model

Virtual-build-to-order (VBTO) is a form of order fulfilment system in which the producer has the ability to search across the entire pipeline of finished stock, products in production and those in the production plan, in order to find the best product for a customer. It is a system design that is attractive to Mass Customizers, such as those in the automotive sector, whose manufacturing lead time exceeds their customers' tolerable waiting times, and for whom the holding of partly-finished stocks at a fixed decoupling point is unattractive or unworkable. This paper describes and develops the operational concepts that underpin VBTO, in particular the concepts of reconfiguration flexibility and customer aversion to waiting. Reconfiguration is the process of changing a product's specification at any point along the order fulfilment pipeline. The extent to which an order fulfilment system is flexible or inflexible reveals itself in the reconfiguration cost curve, of which there are four basic types. The operational features of the generic VBTO system are described and simulation is used to study its behaviour and performance. The concepts of reconfiguration flexibility and floating decoupling point are introduced and discussed.

Stable isotope ratios in bentho-demersal biota along a depth gradient in the bay of biscay: A multitrophic study

Although stable isotope ratios are increasingly used to investigate the trophic ecology of marine organisms, their spatial variations are still poorly understood in the coastal environment. In this study, we measured the stable isotope composition (δ13C, δ15N) of suspended particulate organic matter (SPOM) (primary producer), a suspension feeder, the great scallop Pecten maximus (primary consumer), megabenthic decapods and benthic fishes (secondary consumers) along a depth gradient (from 5m to 155m depth) across the continental shelf of the Bay of Biscay. Although the three trophic levels exhibited similar δ13C patterns along the gradient, the δ15N patterns varied between SPOM, scallops and carnivores. The δ15N difference between SPOM and scallops decreased with increasing depth, suggesting that non trophic factors may affect the stable isotope composition of scallops at deepest sampling stations. An opposed trend was found between scallops and carnivores, suggesting that the trophic level of these carnivores increased at higher depth, possibly as an adaptation to lower prey abundances. Although our results suggest that primary consumers are suitable to establish isotopic baselines in coastal environments, we stress the need for further studies aiming at characterizing the variability of stable isotopes in coastal biota, and the respective effects of baseline, trophic and metabolic factors in their isotopic composition.

Monitorização das condições de operação de uma caldeira a biomassa

A reduzida informação e o pouco trabalho científico desenvolvido na área de sistemas de combustão de biomassa de média potência, faz dos objectivos propostos neste trabalho elementos importantes. O trabalho científico a seguir apresentado, vai permitir obter as bases para o desenvolvimento de condições apropriadas de operação de sistemas de combustão a biomassa, aumentando a eficiência e a rentabilidade económica deste tipo de sistema energético. O principal objetivo do presente trabalho consistiu na aplicação de metodologias de monitorização que permitam caracterizar e melhorar a eficiência do sistema de combustão, na implementação dos métodos escolhidos e na monitorização das condições de operação de uma caldeira industrial de combustão de biomassa, destacando-se: (i) monitorização dos caudais de alimentação de biomassa à caldeira realizada por sistemas de alimentação sem-fim; (ii) análise e monitorização de temperaturas e pressão; (iii) monitorização do caudal de ar de combustão; (iv) monitorização do caudal de gases de exaustão; (v) monitorização da potência térmica; (vi) monitorização da composição do efluente gasoso. A caracterização físicas de amostras de biomassa, o teste a diferentes tipos de biomassa com diferentes condições de operação e a recolha de amostras de cinzas de combustão para a caracterização físico-química são outros métodos de monitorização e caracterização aplicados. Também foi desenvolvido e aplicado um ensaio de controlo do sistema de alimentação em modo de operação manual e comparado com o sistema de controlo do sistema de alimentação em modo de operação automático. O estudo realizado permite concluir que deve ser desenvolvido e implementado um algoritmo de controlo e operação da fornalha que permita um doseamento mais adequado dos caudais de combustível e ar de combustão com vista a melhorar o desempenho do sistema combustão.

Diurnal temporal patterns of the diversity and the abundance of reef fishes in a branching coral patch in New Caledonia

Small-scale spatial and temporal variability in animal abundance is an intrinsic characteristic of marine ecosystems but remains largely unknown for most animals, including coral reef fishes. In this study, we used a remote autonomous unbaited video system and recorded reef fish assemblages during daylight hours, 10 times a day for 34 consecutive days in a branching coral patch of the lagoon of New Caledonia. In total, 50 031 fish observations belonging to 114 taxa, 66 genera and 31 families were recorded in 256 recorded videos. Carnivores and herbivore-detritus feeders dominated the trophic structure. We found significant variations in the composition of fish assemblages between times of day. Taxa richness and fish abundance were greater in the early morning and in the late afternoon than during the day. Fourteen taxa displayed well-defined temporal patterns in abundance with one taxon influenced by time of day, six influenced by tidal state and seven influenced by both time of day and tidal state. None of these 14 taxa were piscivores, 10 were herbivore-detritus feeders, three were carnivores and one was plankton feeder. Our results suggest a diel migration from feeding grounds to shelter areas and highlight the importance of taking into account small-scale temporal variability in animal diversity and abundance when studying connectivity between habitats and monitoring communities.

The interaction between two oppositely travelling, horizontally offset, antisymmetric quasi-geostrophic hetons

We investigate numerically the nonlinear interactions between hetons. Hetons are baroclinic structures consisting of two vortices of opposite sign lying at different depths. Hetons are long-lived. They most often translate (they can sometimes rotate) and therefore they can noticeably contribute to the transport of scalar properties in the oceans. Heton interactions can interrupt this translation and thus this transport, by inducing a reconfiguration of interacting hetons into more complex baroclinic multipoles. More specifically, we study here the general case of two hetons, which collide with an offset between their translation axes. For this purpose, we use the point vortex theory, the ellipsoidal vortex model and direct simulations in the three-dimensional quasi-geostrophic contour surgery model. More specifically, this paper shows that there are in general three regimes for the interaction. For small horizontal offsets between the hetons, their vortices recombine as same-depth dipoles which escape at an angle. The angle depends in particular on the horizontal offset. It is a right angle for no offset, and the angle is shallower for small but finite offsets. The second limiting regime is for large horizontal offsets where the two hetons remain the same hetonic structures but are deflected by the weaker mutual interaction. Finally, the intermediate regime is for moderate offsets. This is the regime where the formation of a metastable quadrupole is possible. The formation of this quadrupole greatly restrains transport. Indeed, it constrains the vortices to reside in a closed area. It is shown that the formation of such structures is enhanced by the quasi-periodic deformation of the vortices. Indeed, these structures are nearly unobtainable for singular vortices (point vortices) but may be obtained using deformable, finite-core vortices.

Why are some companies more successful than others? An exploration into organizational culture and dynamic capabilities

Why are some companies more successful than others? This thesis approaches the question by enlisting theoretical frameworks that explain the performance with internal factors, deriving from the resource-based view, namely the dynamic capabilities approach. To deepen the understanding of the drivers and barriers towards developing these higher order routines aiming at improving the operational level routines, this thesis explores the organisational culture and identity research for the microfoundational antecedents that might shed light on the formation of the dynamic capabilities. The dynamic capabilities framework in this thesis strives to take the theoretical concept closer to practical applicability. This is achieved through creation of a dynamic capabilities matrix, consisting of four dimensions often encountered in dynamic capabilities literature. The quadrants are formed along internal-external and resources-abilities axes, and consist of Sensing, Learning, Reconfiguration and Partnering facets. A key element of this thesis is the reality continuum, which illustrates the different levels of reality inherent in any entity of human individuals. The theoretical framework constructed in the thesis suggests a link between the collective but constructivist understanding of the organisation and both the operational and higher level routines, evident in the more positivist realm. The findings from three different case organisations suggest that the constructivist assumptions inherent to an organisation function as a generative base for both drivers and barriers towards developing dynamic capabilities. From each organisation one core assumption is scrutinized to identify its connections to the four dimensions of the dynamic capabilities. These connections take the form of drivers or barriers – or have the possibility to develop into one or the other. The main contribution of this thesis is to show that one key for an organisation to perform well in a turbulent setting, is to understand the different levels of realities inherent in any group of people. Recognising the intangible levels gives an advantage in the tangible ones.