Existe trade-off entre eficiência e qualidade nas organizações hospitalares?

A mudança do perfil demográfico e epidemiológico das populações, com progressivo envelhecimento populacional e aumento de portadores de doenças crônicas não transmissíveis, somado a necessidade da ampliação da oferta de serviços de saúde e crescentes custos em saúde, impõe enormes desafios aos sistemas e serviços de saúde. A eficiência organizacional dos serviços de saúde tem papel importante tanto na racionalização dos custos quanto na melhoria da qualidade e segurança assistencial. Tendo papel central nos sistemas de saúde como centros difusores de conhecimento, capacitação profissional, incorporação de tecnologias, prestação de serviços de maior complexidade aos pacientes e, consequentemente, elevados custos destes serviços, aos hospitais é fundamental a busca por essa eficiência. Este estudo buscou analisar se existe trade-off entre eficiência e qualidade em organizações hospitalares e identificar quais determinantes poderiam estar associados com maiores ou menores escores de eficiência. Utilizou-se dois modelos de análise de envelopamento de dados (data envelopment analysis, DEA), sem e com variáveis de qualidade, com retornos variáveis de escala e orientados para resultado. Foram estudados 47 hospitais gerais públicos do estado de São Paulo. No modelo sem variáveis de qualidade 14 deles foram considerados eficientes, enquanto que 33 no modelo com estas variáveis. O coeficiente de correlação de Spearman entre os dois modelos foi de 0,470 (correlação moderada). Não há evidências de que haja trade-off entre eficiência e qualidade nestas organizações hospitalares. Hospitais eficientes no modelo sem variáveis de qualidade, também o foram com variáveis de qualidade, assim como houve hospitais ineficientes no modelo sem variáveis de qualidade que foram eficientes com estas variáveis. Não foram encontradas associações estatisticamente significantes (p<0,05) entre eficiência e as características dos hospitais estudados, como acreditação, modelos de gestão, porte hospitalar e atividades de ensino, apesar de alguns achados de maior ou menor escore de eficiência para alguns determinantes. Desta maneira, concluiu-se que a utilização de variáveis de qualidade é um fator fundamental na determinação da eficiência de organizações de saúde, e não podem estar dissociadas. Gestões eficientes também estão relacionadas à obtenção de melhores resultados assistenciais sem a necessidade que se tenha de optar em alcançar melhores resultados econômico-financeiros ou melhores resultados assistenciais.

Headspace solid-phase microextraction combined with mass spectrometry as a powerful analytical tool for profiling the terpenoid metabolomic pattern of hop-essential oil derived from Saaz variety

Hop(HumuluslupulusL.,Cannabaceaefamily)isprizedforitsessentialoilcontents,usedin beer production and, more recently, in biological and pharmacological applications. In this work,a methodinvolvingheadspace solid-phase microextractionand gas chromatography– mass spectrometry was developed and optimized to establish the terpenoid (monoterpenes and sesquiterpenes) metabolomic pattern of hop-essential oil derived from Saaz variety as a mean to explore this matrix as a powerful biological source for newer, more selective, biodegradable and naturally produced antimicrobial and antioxidant compounds. Different parameters affecting terpenoid metabolites extraction by headspace solid-phase microextraction were considered and optimized: type of fiber coatings, extraction temperature, extraction time, ionic strength, and sample agitation. In the optimized method, analytes were extracted for 30 min at 40 C in the sample headspace with a 50/30 m divinylbenzene/carboxen/polydimethylsiloxane coating fiber. The methodology allowed the identification of a total of 27 terpenoid metabolites, representing 92.5% of the total Saaz hop-essential oil volatile terpenoid composition. The headspace composition was dominated by monoterpenes (56.1%, 13 compounds), sesquiterpenes (34.9%, 10), oxygenated monoterpenes (1.41%, 3), and hemiterpenes (0.04%, 1) some of which can probably contribute to the hop of Saaz variety aroma. Mass spectrometry analysis revealed that the main metabolites are the monoterpene -myrcene (53.0±1.1% of the total volatile fraction), and the cyclic sesquiterpenes, -humulene (16.6 ± 0.8%), and -caryophyllene (14.7 ± 0.4%), which together represent about 80% of the total volatile fraction from the hop-essential oil. Thesefindingssuggestthatthismatrixcanbeexploredasapowerfulbiosourceofterpenoid metabolites.

Fatores críticos de sucesso das empresas familiares: uma abordagem competitiva

The present objective study to inside identify the critical factors of success of the local family companies of a competitive boarding. For in such a way the same it understands the culture and the management of the family companies of success, identifies the essential areas of performance, it establishes the restrictive factors of the success, and analyzes the level of influence of the critical factors of success in the competitiveness of this type of company. In function of the subject little to be explored, and of this study to provide a general vision concerning the factors that take the family companies to get success, this research is explorer. On the other hand, for describing characteristic of the familiar companies in prominence in the local scene and for being worried about the practical performance, the same one also is descriptive. The sample in turn is the not-probabilist one of the intentional type, for accessibility. For operacionalization of the collection of data, the direct contact was used, being the composed instrument of research for variable as management, culture, critical factors of success and competitiveness. The study it evidences that in regards to the management and the culture of the family companies of success, some variable are turned aside from the standard of the conventional family companies cited by literature. Of general form in the familiar companies of success it has a bigger level of professionalization of the management. As for the value given to the knowledge, the study sample that the conventional family companies give little importance to it, in contrast of the family companies in prominence, who value of significant form the search for the knowledge. He is demonstrated despite the family companies of success, even so total are not professionalized, possess a bigger level of professionalization of the management, ratifying of certain forms the reason for which the majority develops the Strategical Planning formal periodically. In short, the results point 17 critical factors of success with respect to the family companies, in special factors as the product quality and services, and the use of the technology

Estudo do genoma do vírus causador da mionecrose infecciosa em camarões e desenvolvimento de métodos para detecção de diferentes variantes

Shrimp farming is one of the activities that contribute most to the growth of global aquaculture. However, this business has undergone significant economic losses due to the onset of viral diseases such as Infectious Myonecrosis (IMN). The IMN is already widespread throughout Northeastern Brazil and affects other countries such as Indonesia, Thailand and China. The main symptom of disease is myonecrosis, which consists of necrosis of striated muscles of the abdomen and cephalothorax of shrimp. The IMN is caused by infectious myonecrosis virus (IMNV), a non-enveloped virus which has protrusions along its capsid. The viral genome consists of a single molecule of double-stranded RNA and has two Open Reading Frames (ORFs). The ORF1 encodes the major capsid protein (MCP) and a potential RNA binding protein (RBP). ORF2 encodes a probable RNA-dependent RNA polymerase (RdRp) and classifies IMNV in Totiviridae family. Thus, the objective of this research was study the IMNV complete genome and encoded proteins in order to develop a system differentiate virus isolates based on polymorphisms presence. The phylogenetic relationship among some totivirus was investigated and showed a new group to IMNV within Totiviridae family. Two new genomes were sequenced, analyzed and compared to two other genomes already deposited in GenBank. The new genomes were more similar to each other than those already described. Conserved and variable regions of the genome were identified through similarity graphs and alignments using the four IMNV sequences. This analyze allowed mapping of polymorphic sites and revealed that the most variable region of the genome is in the first half of ORF1, which coincides with the regions that possibly encode the viral protrusion, while the most stable regions of the genome were found in conserved domains of proteins that interact with RNA. Moreover, secondary structures were predicted for all proteins using various softwares and protein structural models were calculated using threading and ab initio modeling approaches. From these analyses was possible to observe that the IMNV proteins have motifs and shapes similar to proteins of other totiviruses and new possible protein functions have been proposed. The genome and proteins study was essential for development of a PCR-based detection system able to discriminate the four IMNV isolates based on the presence of polymorphic sites

Peat humic substances enriched with nutrients for agricultural applications: Competition between nutrients and non-essential metals present in tropical soils

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos de peixes zooplanctívoros e onívoros sobre a resposta de comunidades planctônicas à fertilização por nutrientes

The food chain theory predict that presence of omnivory prevent the trophic cascade and could be a strong stabilizing factor over resource and consumer community dynamics, and that the nutrient enrichment destabilize populations dynamics. Most of the freshwater tropical reservoirs are eutrophic, and strategies that seek improve the water quality through the control of phytoplankton biomass and nutrient input, become essential for the improvement and preservation of water quality. The aim of this study was test the zooplanktivory (when larvae) and omnivory (when young and adult) effects of Nile Tilapia over the structure and dynamics of plankton communities, in addition or absence of nutrients enrichment. For this, one field experiment was performed with a factorial design 2x3 resulting in six treatments: control, without fish and nutrient (C); with omnivorous fish (O); with zooplanktivorous fish (Z); without fish and with enrichment of nutrients (NP); with omnivorous fish and nutrients (ONP); and, with zooplanktivorous fish and nutrients (ZNP). The two planktivory types reduced the zooplankton biomass and increased the phytoplankton biomass, but the omnivory of filter-feeding fish attenuated the trophic cascade magnitude. The fertilization by nutrients increases the nutrient concentrations in water and the phytoplankton biomass, but the effect on zooplankton is dependent of the trophic structure. In a general way, the effects of the fish and nutrient addition were addictive, but significant interactions among those factors were observed in the answer of some zooplankton groups. The effects of omnivorous fish over the temporal variability of phytoplankton and zooplankton biomass were very variable, the increase or reduce in variability of the plankton depending of the level of nutrients and of the analyzed variable. With base in this study, we conclude that the planktivory type exercised by the fish and the concentrations of nutrients in the water affects the force of pelagic trophic cascades and probably the success of biomanipulation programs for the handling of water quality in lakes and tropical reservoirs

Kinetics of chronic inflammation in Nile tilapia fed n-3 and n-6 essential fatty acids

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

Distinctively variable sequence-based nuclear DNA markers for multilocus phylogeography of the soybean- and rice-infecting fungal pathogen Rhizoctonia solani AG-1 IA

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

Molecular Identification and Characterization of Ileal and Cecal Fungus Communities in Broilers Given Probiotics, Specific Essential Oil Blends, and Under Mixed Eimeria Infection

Broiler digestive tract fungal communities have gained far less scrutiny than that given corresponding bacterial communities. Attention given poultry-associated fungi have focused primarily on feed-associated toxin-producers, yeast, and yeast products. The current project focused on the use of pyrosequencing and denaturing gradient gel electrophoresis (DGGE) to identify and monitor broiler digestive fungal communities. Eight different treatments were included. Four controls were an Uninfected-Unmedicated Control, an Unmedicated-Infected Control, the antibiotic bacitracin methylene disalicylate plus the ionophore monensin as Positive Control, and the ionophore monensin alone as a Negative Control. Four treatments were two probiotics (BC-30 and Calsporin) and two specific essential oil blends (Crina Poultry Plus and Crina Poultry AF). All chickens except the Unmedicated-Uninfected Control were given, at 15 days of age, a standard oral Eimeria inoculum of sporulated oocysts. Ileal and cecal digesta were collected at pre-Eimeria infection at 14 days of age and at 7 days post-Eimeria infection at 22 days of age. Extracted cecal DNA was analyzed by pyrosequencing to examine the impact of diet supplements and Eimeria infection on individual constituents in the fungal community, while DGGE was used to compare more qualitative changes in ileal and cecal communities. Pyrosequencing identified three phyla, seven classes, eight orders, 13 families, 17 genera, and 23 fungal species. Ileal and cecal DGGE patterns showed fungal communities were clustered mainly into pre- and post-infection patterns. Post-infection Unmedicated-Uninfected patterns were clustered with pre-infection groups demonstrating a strong effect of Eimeria infection on digestive fungal populations. These combined techniques offered added versatility towards unraveling the effects of enteropathogen infection and performance enhancing feed additives on broiler digestive microflora.

Towards new botanical pesticides: the toxic effect of Eremanthus goyazensis (Asteraceae) leaves essential oil against Brevipalpus phoenicis (Acari: Tenuipalpidae)

This work reports the chemical characterization of Eremanthusgoyzensis essential oil and its toxic effect over Brevipalpus phoenicis. The essential oil displayed a major composition of sesquiterpenes (61.87%) including trans-caryophillene (26.81%) and germacrene-D (13.31%). The fumigation test indicated a promising bioactivity over adult B. phoenicis individuals at 24 h (2.03 µL/L of air) and 48 h (1.08 µL/L of air) of exposition. A brief discussion of essential oils composition and their singular role on the toxic effect over B. phoenicis is provided here. Our results may contribute to a new and profitable use of a species of Brazilian flora on agribusiness.

Composition and acaricidal activity of the essential oil of Lychnophora ericoides Mart. to Tetranychus urticae Koch (Acari: Tetranychidae).

The essential oil of the leaves and branches obtained by hydrodistillation of Lychnophora ericoides, collected in the Reserve of Furnas - MG, Brazil, was analyzed by CG/EM (Shimadzu QP2010). The major parts of the volatile components identified in the essential oil of leaves were monoterpenes (44.02%) and the sesquiterpene [alpha]-bisabolol (2.05%). The major acaricidal activity of the essential oil from L. ericoides was observed at 48 (14.55 [mu]L/L of air) and 72 h (8.01 [mu]L/L of air) of exposition. The oviposition of T. urticae oviposition was influenced by the essential oil, but the eclosion of eggs was not affected.

Development of mint (Mentha piperita L.) grown on biosolids: evaluation of productivity and essential oil content

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Controle feedback de nível baseado em sensor de imagem aplicado ao equipamento misturador-decantador à inversão de fases (MDIF®)

The treatment of wastewaters contaminated with oil is of great practical interest and it is fundamental in environmental issues. A relevant process, which has been studied on continuous treatment of contaminated water with oil, is the equipment denominated MDIF® (a mixer-settler based on phase inversion). An important variable during the operation of MDIF® is the water-solvent interface level in the separation section. The control of this level is essential both to avoid the dragging of the solvent during the water removal and improve the extraction efficiency of the oil by the solvent. The measurement of oil-water interface level (in line) is still a hard task. There are few sensors able to measure oil-water interface level in a reliable way. In the case of lab scale systems, there are no interface sensors with compatible dimensions. The objective of this work was to implement a level control system to the organic solvent/water interface level on the equipment MDIF®. The detection of the interface level is based on the acquisition and treatment of images obtained dynamically through a standard camera (webcam). The control strategy was developed to operate in feedback mode, where the level measure obtained by image detection is compared to the desired level and an action is taken on a control valve according to an implemented PID law. A control and data acquisition program was developed in Fortran to accomplish the following tasks: image acquisition; water-solvent interface identification; to perform decisions and send control signals; and to record data in files. Some experimental runs in open-loop were carried out using the MDIF® and random pulse disturbances were applied on the input variable (water outlet flow). The responses of interface level permitted the process identification by transfer models. From these models, the parameters for a PID controller were tuned by direct synthesis and tests in closed-loop were performed. Preliminary results for the feedback loop demonstrated that the sensor and the control strategy developed in this work were suitable for the control of organic solvent-water interface level

Evidence of ecotypic differentiation between populations of the tree species Parapiptadenia rigida due to flooding

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)