Uma comparação entre os custos atuais, custos por pacote e reembolso hospitalar para o procedimento de revascularização miocárdica

In Brazil, the supplemental healthcare system is going through a transition period from the traditional Fee-for-service reimbursement system to the Package reimbursement system, similar to the American model known as the Diagnoses Related Groups (DRG) system. Although the Package concept is nothing new to the hospital environment, it is still seldom used since this system calls for a level of control and analytical knowledge of hospital costs that are poorly developed in Brazilian institutions. This study focuses on determining how much the reimbursement for a Myocardial Revascularization Package actually covers of the current costs for patients submitted to this procedure. A prospective analysis method for determining the cost per patient has been developed and 13 patients were individually followed-up during all their hospitalization period. The expenses with intensive care unit and in-patient clinical care, as well as the type of admittance - whether elective or emergency - were determined for each patient. Additionally, all the resources and materials for the surgical procedure were included, comprising specialized personnel, surgical fees, procedures and tests, biomedical equipment, and all the materials and medication used during the hospital stay. Based on this data, the current total costs were calculated and compared to the reimbursement for the Package previously agreed upon by the institution and the healthcare carriers. The study found an average cost of BR$ 8,826 for a Myocardial Revascularization surgical procedure, while the respective reimbursement for the Package is of BR$ 7,476. Therefore, the reimbursement does not cover the current costs of the procedure.

Satisfação no trabalho e rotatividade dos médicos do Programa de Saúde da Família

Um dos problemas mais graves identificados na implantação do Programa de Saúde da Família no Brasil é a rotatividade do médico generalista. Já que o modelo se fundamenta no vínculo entre profissionais da equipe e população, a alta rotatividade dos médicos pode comprometer a efetividade do modelo. Pesquisa realizada no município de São Paulo para verificar a existência de correlação entre satisfação no trabalho dos médicos do programa e a rotatividade desses profissionais confirmou a hipótese da existência de correlação negativa. O prestígio da instituição parceira do município na implantação do programa foi o fator mais importante na determinação da rotatividade dos médicos. Outros fatores de satisfação no trabalho que apresentaram correlação com a rotatividade foram: capacitação, distância das unidades de saúde e disponibilidade de materiais e equipamentos para realização das atividades profissionais.

Análise de falhas em martelos oscilantes dos desfibradores da indústria sucroalcooleira da Região Norte-Nordeste

The failure of materials is always an unwelcome event for several reasons: human lives are put in danger, economic losses, and interference in the availability of products and services. Although the causes of failures and behaviour of materials can be known, the prevention of such a condition is difficult to be guaranteed. Among the failures, wear abrasion by the low voltage is the kind of failure that occurs in more equipment and parts industry. The Plants Sucroalcooleiras suffer significant losses because of such attrition, this fact that motivated their choice for the development of this work. For both, were considered failures in the swing hammers desfibradores stopped soon after the exchange provided in accordance with tonnage of cane processed, then were analyzed by the level of wear testing of rubber wheel defined by the standard ASTM G65-91.The failures were classified as to the origin of the cause and mechanism, moreover, were prepared with samples of welding procedures according to ASME code, sec. IX as well, using the technique of thermal spraying to analyze the performance of these materials produced in laboratories, and compares them with the solder used in the plant. It was observed that the bodies-of-proof prepared by the procedure described as welding, and the thermal spraying the results of losing weight have been minimized significantly compared to the preparations in the plant. This is because the use of techniques more appropriate and more controlled conditions of the parameters of welding. As for the thermal spraying, this technique has presented a satisfactory result, but requires the use of these coatings in the best condition for real affirmation of the results

Revestimentos a base de Ta/Al2O3 produzidos por aspersão térmica sobre substrato metálico

Metal substrates were coated by thermal spraying plasma torch, they were positioned at a distance of 4 and 5 cm from the nozzle exit of the plasma jet. The starting materials were used for deposition of tantalum oxide powder and aluminium. These two materials were mixed and ground into high-energy mill, then immersed in the torch for the production of alumina coating infused with particles of tantalum with nano and micrometric size. The spraying equipment used is a plasma torch arc not transferred, which operating in the range of 250 A and 80 V, was able to produce enough heat to ignite aluminothermic between Ta2O5 and aluminum. Upon reaching the plasma jet, the mixing powders react with the heat of the blaze, which provides sufficient energy for melting aluminum particles. This energy is transferred through mechanisms of self-propagating to the oxide, beginning a reduction reaction, which then hits on the surface of the substrate and forms a coating on which a composite is formed by a junction metal - ceramic (Ta +Al2O3). The phases and quantification of each were obtained respectively by X-ray diffraction and the Rietveld method. Morphology by scanning electron microscopy and chemical analysis by energy dispersive spectroscopy EDS. It was also performed measurements of the substrate roughness, Vickers microhardness measurements in sprays and determination of the electron temperature of the plasma jet by optical emission spectroscopy EEO. The results confirmed the expectation generated around the end product of spraying the mixture Ta2O5 + Al, both in the formation of nano-sized particles and in their final form. The electron excitation temperature was consistent with the purpose of work, in addition, the thermodynamic temperature was efficient for the reduction process of Ta2O5. The electron excitation temperature showed values of 3000, 4500 and 8000 K for flows10, 20 and 30 l / min respectively, these values were taken at the nozzle exit of the plasma jet. The thermodynamic temperature around 1200 ° C, was effective in the reduction process of Ta2O5

The locus coeruleus and central chemosensitivity

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

Acidez do solo e calagem em pomares de frutíferas tropicais

A produtividade agrícola nos trópicos é afetada, principalmente, pelos fatores ligados à acidez do solo (pH, saturação por bases, acidez potencial, disponibilidade de nutrientes). A calagem é uma prática bem conhecida para corrigir a acidez do solo em culturas anuais, ainda que não seja praticada com a regularidade necessária. Entretanto, em culturas perenes, a incorporação de corretivos é mais complexa, devido às características desse grupo de plantas e à carência de informações científicas sobre o assunto. em condições de acidez, a calagem promove a neutralização do Al3+, a elevação do pH e o fornecimento de Ca e Mg, possibilitando a proliferação de raízes, com reflexos positivos no crescimento da parte aérea das plantas. Contudo, devido à baixa solubilidade e à lenta movimentação do calcário ao longo do perfil do solo, há obrigatoriedade de se fazer distribuição uniforme e incorporação profunda, antecedendo a implantação do pomar, a fim de garantir o eficiente aproveitamento de água e de nutrientes contidos nessas camadas. A calagem deve ser considerada um investimento, pois seus benefícios perduram além de um ano ou de uma safra agrícola. Isso se deve ao efeito residual dos corretivos de acidez do solo, sendo o tempo de duração desse efeito dependente de vários fatores, entre os quais: condições edafoclimáticas, cultura, manejo da área e tipo de corretivo empregado. em geral, partículas maiores de calcário têm efeito residual mais prolongado, sendo empregadas na implantação dos pomares. No entanto, a relação entre o tamanho da partícula e o efeito residual tem sido pouco pesquisada, devido à necessidade de estudos de longa duração. em função das elevadas doses de adubos nitrogenados utilizadas nos pomares de altos rendimentos, a acidez do solo aumenta, como resultado do processo de nitrificação. em pomares já implantados, o procedimento atualmente utilizado pelos produtores é a incorporação superficial do calcário na área. As recomendações talvez fossem outras, caso houvesse maior subsídio da pesquisa, tendo em vista os diversos problemas fitossanitários que podem ocorrer, direta ou indiretamente da prática da incorporação do corretivo, tais como redução do sistema radicular, ferimento das raízes e consequente risco de infecções, com disseminação de pragas e doenças no pomar. O objetivo desta revisão é apresentar os principais resultados de pesquisas sobre o assunto, mostrando os efeitos da calagem sobre a fertilidade do solo, a nutrição e a produtividade de frutíferas de grande importância econômica para o Brasil, bem como discutir a duração do efeito residual dos corretivos e a dose mais ecônomica a ser aplicada nos pomares de frutas em implantação e em produção.

Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Uma metodologia para redução de incertezas em sistema de medição de vazão de óleo e gás

The objective of this research is to discuss about the need for implementation of new alternatives for the implementation on the metrological control: on the findings of initial and subsequent measurements, the control procedures of measurement uncertainty applied in assessing the loss or remains found in handling operations of bulk liquids, when used turbine meters used in measuring the tax on the business of Petrobras, due to the current environment of legal metrology and scientific, both domestic and international. We aim, with these alternatives: standardizing the minimization of random and systematic errors, the estimate of the remaining errors, as well as the management control of metrological calibration procedures, control of measurement uncertainty, and contribute to the change in the form of performance of legal metrology and scientific disseminating new information to change management of metrological control, objectively focused on aspects of supervision in implementing these activities in the control of the uncertainties of measurement used in our processes in the fiscal measurement system Petrobras. Results are presented, information and comments on the influence of measurement uncertainty in the current results of the fiscal and transfer of custody. This will emphasize the need, among other things, improvement and expansion of metrological control monitored by setting a better meet demand, calibration equipment and measuring instruments for Petrobras. Finally, we intend to establish the need for improving the method of evaluation of the data meter applied to the current management control of measurement uncertainty by proposing a methodology for addressing the problem, as well as highlighting the expected results.

Estudo da formulação de massas cerâmicas provenientes da região do Seridó-RN para fabricação de telhas

This work has for objective study compared the characteristics and technological properties of ceramic bodies from the region of Seridó-RN. The region under study has identified 23 cities where they were 80 ceramics industries. To define the universe of search, there was a survey of pottery that are part of APL Seridó next to the IEL. The characteristics and operating conditions of ceramics industries of the region were identified through a socio-economic questionnaire applied locally, which addressed issues such as: profiles of companies, production process etc. The analysis of information collected from 24 companies identified in seven cities shows that the vast majority of industries is small, with family structure, obsolete equipment and labo, little qualified. Most of the pottery works with low technical knowledge, poor control of the production process and product technology. The raw collected were submitted to analysis of X ray diffraction, chemical composition, termical analysis, particle size distribution and plasticity. Then were produced five formulations and made by uniaxial pressure at 25 MPa for firing in temperatures varying from 850 to 1050 °C. The firing technological properties evaluated were: mass loss to fire, lineal shrinkage, apparent density, apparent porosity, water absorption and flexural strength (3 points). The results indicated that the raw materials from the region have significant similarities in the composition chemical and mineralogical. Furthermore, it indicates the possibility of the use of cycles of firing faster and efficient than the current, limited to some clay mass burning of certain conditions

Efeitos da radiação uv, temperatura e vapor aquecido nos compósitos poliméricos: monitoramento, instabilidade estrutural e fratura

The application of composite materials and in particular the fiber-reinforced plastics (FRP) has gradually conquered space from the so called conventional materials. However, challenges have arisen when their application occurs in equipment and mechanical structures which will be exposed to harsh environmental conditions, especially when there is the influence of environmental degradation due to temperature, UV radiation and moisture in the mechanical performance of these structures, causing irreversible structural damage such as loss of dimensional stability, interfacial degradation, loss of mass, loss of structural properties and changes in the damage mechanism. In this context, the objective of this thesis is the development of a process for monitoring and modeling structural degradation, and the study of the physical and mechanical properties in FRP when in the presence of adverse environmental conditions (ageing). The mechanism of ageing is characterized by controlled environmental conditions of heated steam and ultraviolet radiation. For the research, it was necessary to develop three polymer composites. The first was a lamina of polyester resin reinforced with a short glass-E fiber mat (representing the layer exposed to ageing), and the other two were laminates, both of seven layers of reinforcement, one being made up only of short fibers of glass-E, and the other a hybrid type reinforced with fibers of glass-E/ fibers of curaua. It should be noted that the two laminates have the lamina of short glass-E fibers as a layer of the ageing process incidence. The specimens were removed from the composites mentioned and submitted to environmental ageing accelerated by an ageing chamber. To study the monitoring and modeling of degradation, the ageing cycles to which the lamina was exposed were: alternating cycles of UV radiation and heated steam, a cycle only of UV radiation and a cycle only of heated steam, for a period defined by norm. The laminates have already undergone only the alternating cycle of UV and heated steam. At the end of the exposure period the specimens were subjected to a structural stability assessment by means of the developed measurement of thickness variation technique (MTVT) and the measurement of mass variation technique (MMVT). Then they were subjected to the mechanical tests of uniaxial tension for the lamina and all the laminates, besides the bending test on three points for the laminates. This study was followed by characterization of the fracture and the surface degradation. Finally, a model was developed for the composites called Ageing Zone Diagram (AZD) for monitoring and predicting the tensile strength after the ageing processes. From the results it was observed that the process of degradation occurs Abstract Raimundo Nonato Barbosa Felipe xiv differently for each composite studied, although all were affected in certain way and that the most aggressive ageing process was that of UV radiation, and that the hybrid laminated fibers of glass-E/curaua composite was most affected in its mechanical properties

Análise de desempenho de um fogão solar construído a partir de sucatas de antena de tv

Given the growing environmental crisis caused by degradation, mainly due to the use of polluting energy sources, increasing the growing use of renewable energies worldwide, with emphasis on solar energy, an abundant supply and available to everyone, which can be harnessed in several ways: electricity generation; dehydration of food; heating, disinfection and distillation and cooking. The latter has as its primary feature the viability of clean, renewable energy for society, combating ecological damage caused by large-scale use of firewood for cooking foods, use in tropical countries with high solar radiation, and has funding NGOs throughout the world with the goal of achieving low-income population. The proposed project consists of a solar cooker for concentration, working from the reflection of sunlight by a hub that they converge to a focal point at the bottom of the pot, getting lots of heat. The solar cooker under study consists of two elliptical reflecting parabolas made from the recycling of scrap TV antenna, having 0.29 m² of surface area for each antenna, which were covered by multiple mirrors of 2 mm thick and mounted on a metal structure, with correction for the mobility of the apparent movement of the sun. This structure was built with the recycling of scrap metal, possessing a relatively low cost compared with other solar cookers, around US$ 50.00. This cost becomes negligible, since that will involve a great benefit to not have fuel costs for each meal, unlike the use of gas or firewood for cooking food. The tests show that the cooker has reached the maximum temperature of 740 ° C, for boiling water in an average time of 28 minutes, cooking various types of foods such as potatoes, rice and pasta in an average time of 45 minutes and still going as a solar oven, making pizza baking and meat. These cooking times do not differ much from the cooking times on a gas stove, it becomes the solar cooker as a good consumer acceptance, and furthermore not to deliver the same gases that can poison the food as with the wood stove. Proves the viability of using the stove to cook or bake in two daily meals for a family, still presenting a position to improve his performance with the addition of new materials, equipment and techniques

Viabilidade térmica de um forno solar fabricado com sucatas de pneus

The proposed design provides a solar furnace alternative, box-like, low-cost operation to be used in cooking, comprising three scrap tires to make the recycling thereof. The tires were coupled to each other, forming an enclosure, which stood on its bottom covered by a parable multiple mirrors made from a urupema (sieve indigenous) and the inner sides of the oven aluminum sheet painted black, obtained from beer cans, thus being made to obtain the increase in the concentration of solar radiation incident on the inside of the prototype studied. Two tires were attached, leaving an air layer between them, with the function of thermal insulation. The third tire aimed to support the other two and thermally insulate the bottom of the oven. Externally was placed a metal frame with flat mirrors to reflect the incident rays into the oven, having a mobility to correct the apparent motion of the sun. Its primary feature is the viability of clean, renewable energy to society by tackling the ecological damage caused by the large-scale use of wood for cooking food. The tests show that the furnace reached the maximum temperature of 123.8 °C and baking various foods such as pizza, bun, and other lasagne in an average time 50 minutes. Proves the feasibility of using the oven. Presenting still able to improve their performance with the addition of new materials, equipment and techniques

Aperfeiçoamento no projeto de um protótipo de misturador-decantador à inversão de fases visando aplicação na indústria do petróleo

In the oil industry the mixture oil/water occurs in the operations of production, transportation and refining, as well as during the use of its derivatives. The amount of water produced associated with the oil varies and can reach values of 90% in volume in the case of mature phase of the production fields. The present work deals with the development of new design of the Mixer Settler based on Phase Inversion (MDIF) in a laboratory scale. We envisage this application in industrial scale so the phases of project, construction and operation are considered. The modifications most significant, in comparison with the original prototype, include the materials of construction and the substitution of the equipment used in the mixing stage of the process. It was tested the viability of substitution of the original system of mechanical mixing by a static mixer. A statistical treatment by means of an experimental design of composed central type was used in order to evaluate the behavior of the main variables of the separation process as function of the efficiency of separation for the new device. This procedure is useful to delimit an optimal region of operation with the equipment. The variables of process considered on the experimental design were: oil concentration in the feeding water (mg/L); Total volumetric flow rate (L/h); Ratio organic/water on volumetric basis (O/A). The separation efficiency is calculated by comparison of the content of oil and greases in the inlet and outlet of the equipment. For determination of TOG (Total Oil and Grease), the method used was based in the absorption of radiation in the infra-red region. The equipment used for these determinations was InfraCal® TOG/TPH Model HATR-T2 of the Wilks Enterprise, Incorporation. It´s important to stand out that this method of measure has being used by PETROBRAS S.A. Results of global efficiency of separation oil/water varied from 75.3 to 97.7% for contaminated waters containing up to 1664,1 mg/L of oil. By means of tests carried out with a real sample of contaminated water supplied by PETROBRAS we have got an effluent specified in terms of the legal standards required for discharging. Thus, the new design of equipment constitutes a real alternative for the conventional systems of treatment of produced water in the oil industry

Preparation and characterization of PVDF/CaCO3 composites

The contribution of new materials, involving composites and blends, has been reaching the most varied fields of science, as much of the scientific as technological point of view. This is due to the man's needs in applications, especially in medicine areas. Thus, this work shows the preparation and characterization of poly(vinylidene fluoride) (PVDF) and calcium carbonate (CaCO3) Composite films in order to analyse the incorporation of CaCO3 in PVDF for future application in bony restoration and bony filling. The films were prepared by casting method, where the PVDF pellet shape was dissolved in dimethylacetamide (DMA) and in a separate container CaCO3/DMA emulsion was also made. Soon afterwards they were mixed in several proportions 100/00, 95/05, 85/15, 70/30 in weight and left to dry in greenhouse. Homogeneous and flexible films were obtained and structurally characterized by attenuated total reflection infrared spectroscopy (FT-IR/ATR), thermal analyses (DSC, TGA), X-ray diffractometry, optical and scanning electron microscopies. The results showed that the material was a composite with good thermal stability until around 400 degrees C, the crystallinity of PVDF was non-polar alpha-phase and the obtained films were porous, being these filled with CaCO3. (c) 2006 Elsevier B.V. All rights reserved.

Multi-population genetic algorithm to solve the synchronized and integrated two-level lot sizing and scheduling problem

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