Cidadão e comunidade : que relevância no processo de contratualizaç

RESUMO - Nas últimas décadas, a especialização dos cuidados médicos tem conduzido a uma fragmentação do sistema de prestação, que, associada a uma deficiente coordenação entre serviços, cuidados e prestadores, torna a navegabilidade dos utentes nos sistemas de saúde uma tarefa complexa. Um novo modelo de organização, assente na procura de valor para os cidadãos, deve adoptar uma abordagem sistémica, que tenha subjacente uma coordenação integrada de serviços, numa perspectiva de ciclo de cuidados. Reorientar a prestação de cuidados para a obtenção de resultados e valor em saúde, exige uma reengenharia em torno da estrutura, organização e avaliação1 dos cuidados, requerendo, nomeadamente: i) instrumentos e ferramentas que auxiliem e estruturem este novo modelo; ii) assumpção dos papéis definidos para cada um dos actores do sistema, nomeadamente ao nível da coordenação; iii) encorajamento à adopção de modelos de contratualização, pagamento e competição, que responsabilizem os actores envolvidos não só pela prática que desenvolvem, mas pelos resultados em saúde. Estes mecanismos constituem uma oportunidade para expandir e sustentar abordagens, programas e intervenções integradas. Investir num sistema de pagamento por valor em saúde — P4V — payment for value, traduz uma aposta na relação entre diagnóstico, tratamento, resultados clínicos e custos, enquanto estratégia para assegurar ganhos em qualidade dos cuidados, eficiência dos processos e valor em saúde para o cidadão. Neste contexto, a gestão da doença enquanto modelo direccionado para o reforço da perspectiva e participação activa do cidadão, e avaliação compreensiva de novas formas de organização e gestão do sistema de prestação, constitui um instrumento para informar e sustentar esse processo de reengenharia do sistema. Um modelo que procura assegurar o encontro entre o estado da arte na prestação de cuidados e um nível óptimo, garantindo a qualidade de vida expectável para a pessoa com doença crónica. ----------------- ---------ABSTRACT – In the last decades advanced medical sciences trend to specialized care and fragmented health systems, leaving patients with a challenge on navigating services and care, requiring them to see a sequence of specialists each delivering discrete interventions. To overcome these challenges, every health system must redefine health care delivery to use its resources more efficiently and improve quality of care through an organization of the system as a whole. A system currently organized around value for patients, entails a framework that comprises the entire set of activities needed to address a patient´s medical condition, over the full cycle of care. Value- based care delivery therefore requires an integrated practice, both across services and time, and implies a movement through new structures, organization models, evaluation efforts and payment systems that enables, catalyze and reinforces the extension and sustainability of the steps needed to the change required. A shift from a payment for performance to a payment for value focuses attention on maximizing the overall value of care, and encourages coordination and integration between components of care that extends from screening, diagnoses, all the way through treatment, outcomes and costs, and ensuring an incentive for potentially high value types of care as well as innovation. These leave the actors of the system with the task of best allocating and valuing components of care. Disease management as a model designed to structure patient engagement and involvement in their care, and assure a comprehensive evaluation and monitoring of new organization and care delivery strategies align an opportunity as a source of information and sustainability for the progress of a growing number of likeminded efforts now underway across care delivery for chronic diseases. This framework will allow the fulfillment of the gap between sta

A framework for robustness assessment in the context of corroded RC structures

Structural robustness is an emergent concept related to the structural response to damage. At the present time, robustness is not well defined and much controversy still remains around this subject. Even if robustness has seen growing interest as a consequence of catastrophic consequences due to extreme events, the fact is that the concept can also be very useful when considered on more probable exposure scenarios such as deterioration, among others. This paper intends to be a contribution to the definition of structural robustness, especially in the analysis of reinforced concrete structures subjected to corrosion. To achieve this, first of all, several proposed robustness definitions and indicators and misunderstood concepts will be analyzed and compared. From this point and regarding a concept that could be applied to most type of structures and dam-age scenarios, a robustness definition is proposed. To illustrate the proposed concept, an example of corroded reinforced concrete structures will be analyzed using nonlinear analysis numerical methods based on a contin-uum strong discontinuities approach and isotropic damage models for concrete. Finally the robustness of the presented example will be assessed.

Fractional Order Generalized Information

This paper formulates a novel expression for entropy inspired in the properties of Fractional Calculus. The characteristics of the generalized fractional entropy are tested both in standard probability distributions and real world data series. The results reveal that tuning the fractional order allow an high sensitivity to the signal evolution, which is useful in describing the dynamics of complex systems. The concepts are also extended to relative distances and tested with several sets of data, confirming the goodness of the generalization.

Protein glycosylation of exosomes from ovarian carcinoma cells: structures and biological roles

Dissertation presented to obtain the Ph.D. degree in Biology

RoutesMobilityModel: easy realistic mobility simulation using external information services

Workshop on ns-3 (WNS '15). 13, May, 2015. Castelldefels, Spain.

Robustness of corroded reinforced concrete structures

Short Term Scienti c Mission, COST ACTION TU-0601

A reliability-based measure of robustness for concrete structures subjected to corrosion

This work is a contribution to the definition and assessment of structural robustness. Special emphasis is given to reliability of reinforced concrete structures under corrosion of longitudinal reinforcement. On this communication several authors’ proposals in order to define and measure structural robustness are analyzed and discussed. The probabilistic based robustness index is defined, considering the reliability index decreasing for all possible damage levels. Damage is considered as the corrosion level of the longitudinal reinforcement in terms of rebar weight loss. Damage produces changes in both cross sectional area of rebar and bond strength. The proposed methodology is illustrated by means of an application example. In order to consider the impact of reinforcement corrosion on failure probability growth, an advanced methodology based on the strong discontinuities approach and an isotropic continuum damage model for concrete is adopted. The methodology consist on a two-step analysis: on the first step an analysis of the cross section is performed in order to capture phenomena such as expansion of the reinforcement due to the corrosion products accumulation and damage and cracking in the reinforcement surrounding concrete; on the second step a 2D deteriorated structural model is built with the results obtained on the first step of the analysis. The referred methodology combined with a Monte Carlo simulation is then used to compute the failure probability and the reliability index of the structure for different corrosion levels. Finally, structural robustness is assessed using the proposed probabilistic index.

Autonomous Surface Vehicle Docking Manoeuvre with Visual Information

This work presents a hybrid coordinated manoeuvre for docking an autonomous surface vehicle with an autonomous underwater vehicle. The control manoeuvre uses visual information to estimate the AUV relative position and attitude in relation to the ASV and steers the ASV in order to dock with the AUV. The AUV is assumed to be at surface with only a small fraction of its volume visible. The system implemented in the autonomous surface vehicle ROAZ, developed by LSA-ISEP to perform missions in river environment, test autonomous AUV docking capabilities and multiple AUV/ASV coordinated missions is presented. Information from a low cost embedded robotics vision system (LSAVision), along with inertial navigation sensors is fused in an extended Kalman filter and used to determine AUV relative position and orientation to the surface vehicle The real time vision processing system is described and results are presented in operational scenario.

Information professionals in business context: new professionals, old skills

This communication aims to present some reflections regarding the importance of information in organizational context, especially in business context. The ability to produce and to share expertise and knowledge among its employees is now a key factor in the success of any organization. However, it’s also true that workers are increasingly feeling that too much information can hurt their performance. The existence of skilled professionals able to organize, evaluate, select and disseminate information in organizations appears to be a prerequisite for success. The skills necessary for the formation of a professional devoted to the management of information and knowledge in the context of business organizations will be analysed. Then data collected in two focus group discussion with students from a graduate course in Business Information, from Polytechnic Institute of Porto, Portugal, a will be examined.

Fractional Analysis of the DNA Information

Proceedings of the 12th Conference on 'Dynamical Systems -Theory and Applications'

Towards a Mobile Three-dimensional Modelling System for Underground Structures

Robotica 2012: 12th International Conference on Autonomous Robot Systems and Competitions April 11, 2012, Guimarães, Portugal

Reconstrução de Superfícies usando um Scanner 3D de Luz Estruturada

Ao longo dos últimos anos, os scanners 3D têm tido uma utilização crescente nas mais variadas áreas. Desde a Medicina à Arqueologia, passando pelos vários tipos de indústria, ´e possível identificar aplicações destes sistemas. Essa crescente utilização deve-se, entre vários factores, ao aumento dos recursos computacionais, à simplicidade e `a diversidade das técnicas existentes, e `as vantagens dos scanners 3D comparativamente com outros sistemas. Estas vantagens são evidentes em áreas como a Medicina Forense, onde a fotografia, tradicionalmente utilizada para documentar objectos e provas, reduz a informação adquirida a duas dimensões. Apesar das vantagens associadas aos scanners 3D, um factor negativo é o preço elevado. No âmbito deste trabalho pretendeu-se desenvolver um scanner 3D de luz estruturada económico e eficaz, e um conjunto de algoritmos para o controlo do scanner, para a reconstrução de superfícies de estruturas analisadas, e para a validação dos resultados obtidos. O scanner 3D implementado ´e constituído por uma câmara e por um projector de vídeo ”off-the-shelf”, e por uma plataforma rotativa desenvolvida neste trabalho. A função da plataforma rotativa consiste em automatizar o scanner de modo a diminuir a interação dos utilizadores. Os algoritmos foram desenvolvidos recorrendo a pacotes de software open-source e a ferramentas gratuitas. O scanner 3D foi utilizado para adquirir informação 3D de um crânio, e o algoritmo para reconstrução de superfícies permitiu obter superfícies virtuais do crânio. Através do algoritmo de validação, as superfícies obtidas foram comparadas com uma superfície do mesmo crânio, obtida por tomografia computorizada (TC). O algoritmo de validação forneceu um mapa de distâncias entre regiões correspondentes nas duas superfícies, que permitiu quantificar a qualidade das superfícies obtidas. Com base no trabalho desenvolvido e nos resultados obtidos, é possível afirmar que foi criada uma base funcional para o varrimento de superfícies 3D de estruturas, apta para desenvolvimento futuro, mostrando que é possível obter alternativas aos métodos comerciais usando poucos recursos financeiros.

Maturity models in the hospital information systems management initial research

Os modelos de maturidade são instrumentos facilitadores da gestão das organizações, incluindo a gestão da sua função sistemas de informação, não sendo exceção as organizações hospitalares. Neste artigo apresenta-se uma investigação inicial que visa o desenvolvimento de um abrangente modelo de maturidade para a gestão dos sistemas de informação hospitalares. O desenvolvimento deste modelo justifica-se porque os modelos de maturidade atuais no domínio da gestão dos sistemas informação hospitalares ainda se encontram numa fase embrionária de desenvolvimento, sobretudo porque são pouco detalhados, não disponibilizam ferramentas para determinação da maturidade e não apresentam as características dos estágios de maturidade estruturadas por diferentes fatores de influência.

Access and information behaviour of European Documentation Centres users in Portugal and Spain: a comparative study

The aim of this study was to undertake a comparative analysis of the practices and information behaviour of European information users who visit information units specialising in European information in Portugal and Spain. The study used a quantitative methodology based on a questionnaire containing closed questions and one open question. The questions covered the general sociological profile of the respondents and their use of European Document Centres, in addition to analysing aspects associated with information behaviour relating to European themes. The study therefore examined data on the preferred means and sources for accessing European information, types of documents and the subjects investigated most. The use of European databases and the Internet to access material on Europe was also studied, together with the reasons which users considered made it easy or difficult to access European information, and the aspects they valued most in accessing this information. The questionnaire was administered in European Document Centres in 2008 and 2010.