Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

Dynamic network data envelopment analysis for university hospitals evaluation

ABSTRACT OBJECTIVE To develop an assessment tool to evaluate the efficiency of federal university general hospitals. METHODS Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013. RESULTS The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research. CONCLUSIONS The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.

Using remote lab networks to provide support to public secondary school education level

The advantages of networking are widely known in many areas (from business to personal ones). One particular area where networks have also proved their benefits is education. Taking the secondary school education level into account, some successful cases can be found in literature. In this paper we describe a particular remote lab network supporting physical experiments accessible to students of institutions geographically separated. The network architecture and application examples of using some of the available remote experiments are illustrated in detail.

The simple economics of risk-sharing agreements between the NHS and the pharmaceutical industry

The Janssen-Cilag proposal for a risk-sharing agreement regarding bortezomib received a welcome signal from NICE. The Office of Fair Trading report included risk-sharing agreements as an available tool for the National Health Service. Nonetheless, recent discussions have somewhat neglected the economic fundamentals underlying risk-sharing agreements. We argue here that risk-sharing agreements, although attractive due to the principle of paying by results, also entail risks. Too many patients may be put under treatment even with a low success probability. Prices are likely to be adjusted upward, in anticipation of future risk-sharing agreements between the pharmaceutical company and the third-party payer. An available instrument is a verification cost per patient treated, which allows obtaining the first-best allocation of patients to the new treatment, under the risk sharing agreement. Overall, the welfare effects of risk-sharing agreements are ambiguous, and care must be taken with their use.

Privatization and government preference in a public Stackelberg leader duopoly

We analyse the relationship between the privatization of a public firm and government preferences for tax revenue in a Stackelberg duopoly with the public firm as the leader. We assume that the government payoff is given by a weighted sum of tax revenue and the sum of consumer and producer surplus. We get that if the government puts a sufficiently larger weight on tax revenue than on the sum of both surpluses, it will not privatize the public firm. In contrast, if the government puts a moderately larger weight on tax revenue than on the sum of both surpluses, it will privatize the public firm.

Environmental taxes in a public Stackelberg leader duopoly

We study whether privatization of a public firm improves (or deteriorates) the environment in a mixed Stackelberg duopoly with the public firm as the leader. We assume that each firm can prevent pollution by undertaking abatement measures. We get that, since in the mixed market the industry output is higher than in the private market, the abatement levels are also higher in the mixed market, and, thus, environmental tax rate in the mixed duopoly is higher than that in the privatized duopoly. Furthermore, the environment is more damaged in the mixed than in the private market. The overall effect on the social welfare is that it will becomes higher in the private than in the mixed market.

The role of implicit contracts: Building public works in the 1840s in Portugal

Business History, Vol 50 No 2, p147-162

Personalized public transportation information

Thesis to obtain the Master of Science Degree in Computer Science and Engineering

Perspectives of the Internal Public in a Cultural Event: the Case of Noc Noc, Guimarães - Portugal

Given the significant impact that cultural events may have in local communities and the inherent organization complexity, it is important to understand their specificities. Most of the times cultural events disregard marketing and often marketing is distant from art. Thus an analysis of an inside perspective might bring significant returns to the organization of such an event. This paper considers the three editions (2011, 2012 and 2013) of a cultural event – Noc Noc – organized by a local association in the city of Guimarães, Portugal. Its format is based in analogous events, as Noc Noc intends to convert everyday spaces (homes, commercial outlets and a number of other buildings) into cultural spaces, processed and transformed by artists, hosts and audiences. By interviewing a sample of people (20) who have hosted this cultural event, sometimes doubling as artists, and by experiencing the three editions of the event, this paper illustrates how the internal public understands this particular cultural event, analyzing specifically their motivations, ways of acting and participating, as well as their relationship with the public, with the organization of the event and with art in general. Results support that artists and hosts motivations must be identified in a timely and appropriate moment, as well as their views of this particular cultural event, in order to keep them participating, since low budget cultural events such as this one may have a key role in small scale cities.

Identificação e representação automática de percursos de autocarros

Trabalho final de Mestrado para obtenção do grau de Mestre em Engenharia de Redes de Comunicação e Multimédia

Innovation assessment of a Portuguese railway branch of a foreign multinational - a case study

Paper developed for the unit “Innovation Economics and Management” of the PhD programme in Technology Assessment at the Universidade Nova de Lisboa in 2009-10 under the supervision of Prof. Maria Luísa Ferreira

Performance assessment in the portuguese public administration

Apresentação realizada na Conferência "Changing Public Sevice in a Changing World" realizada em Budapeste a 24 de Abril de 2009

Training needs assessment in public organizations

Comunicação apresentada na Conferência Anual do IASIA, realizada em Kampala, Uganda, de 14 a 18 de Julho de 2008

Public reform in Portugal

Comunicação apresentada à delegação da Bulgária de visita ao INA, em Oeiras, no dia 2 de Dezembro de 2008.

Welfare regimes, work-life balance public policies and gender equality - parental leaves in Portugal and Sweden

Comunicação apresentada na "European Sociological Association Conference" em Lisboa de 2 a 5 de Setembro de 2009.