Health financing changes in the context of health care decentralization: the case of three Latin American countries

OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing.

The role of discriminant analysis in the refinement of customer satisfaction assessment

OBJECTIVE: To test discriminant analysis as a method of turning the information of a routine customer satisfaction survey (CSS) into a more accurate decision-making tool. METHODS: A 7-question, 10-multiple choice, self-applied questionnaire was used to study a sample of patients seen in two outpatient care units in Valparaíso, Chile, one of primary care (n=100) and the other of secondary care (n=249). Two cutting points were considered in the dependent variable (final satisfaction score): satisfied versus unsatisfied, and very satisfied versus all others. Results were compared with empirical measures (proportion of satisfied individuals, proportion of unsatisfied individuals and size of the median). RESULTS: The response rate was very high, over 97.0% in both units. A new variable, medical attention, was revealed, as explaining satisfaction at the primary care unit. The proportion of the total variability explained by the model was very high (over 99.4%) in both units, when comparing satisfied with unsatisfied customers. In the analysis of very satisfied versus all other customers, significant relationship was identified only in the case of the primary care unit, which explained a small proportion of the variability (41.9%). CONCLUSIONS: Discriminant analysis identified relationships not revealed by the previous analysis. It provided information about the proportion of the variability explained by the model. It identified non-significant relationships suggested by empirical analysis (e.g. the case of the relation very satisfied versus others in the secondary care unit). It measured the contribution of each independent variable to the explanation of the variation of the dependent one.

Virtual communities of practice: investigating motivations and constraints in the processes of knowledge creation and transfer

With accelerated market volatility, faster response times and increased globalization, business environments are going through a major transformation and firms have intensified their search for strategies which can give them competitive advantage. This requires that companies continuously innovate, to think of new ideas that can be transformed or implemented as products, processes or services, generating value for the firm. Innovative solutions and processes are usually developed by a group of people, working together. A grouping of people that share and create new knowledge can be considered as a Community of Practice (CoP). CoP’s are places which provide a sound basis for organizational learning and encourage knowledge creation and acquisition. Virtual Communities of Practice (VCoP's) can perform a central role in promoting communication and collaboration between members who are dispersed in both time and space. Nevertheless, it is known that not all CoP's and VCoP's share the same levels of performance or produce the same results. This means that there are factors that enable or constrain the process of knowledge creation. With this in mind, we developed a case study in order to identify both the motivations and the constraints that members of an organization experience when taking part in the knowledge creating processes of VCoP's. Results show that organizational culture and professional and personal development play an important role in these processes. No interviewee referred to direct financial rewards as a motivation factor for participation in VCoPs. Most identified the difficulty in aligning objectives established by the management with justification for the time spent in the VCoP. The interviewees also said that technology is not a constraint.

The role of Lifelong Learning in the creation of a knowledge-based society for Europe: european policies

Link do editor: http://www.igi-global.com/chapter/role-lifelong-learning-creation-european/13314

Some translation difficulties in the use of false friends in english

This paper will focus on some aspects of translation based on blending distinct linguistic domains such as English Language and Portuguese in using false friends in the English class in tertiary level students, reflecting namely on: 1. the choice of a word suitable to the context in L2 ; 2. the difficulties encountered by choice of that word that could be misleading, by relying in a false L1 reality that is going to adulterate reality in the L2 domain; 3. the difficulty in making such type of distinctions due to the lack of linguistic and lexical knowledge. 4. the need to study the cause of these difficulties by working, not only with their peers, but also with their language teacher to develop strategies to diminish and if possible to eradicate this type of linguistic and, above all, translation problem by making an inventory of those types of mistakes. In relation to the first point it is necessary to know that translation tasks involve much more than literal concepts ( Ladmiral, 1975) : furthermore it is necessary and suitable to realise that lexicon relies in significant contexts (Coseriu 1966), which connects both domains, that, at first sight do not seem to be compatible. In other words, although students have the impression they dominate lexicon due to the fact that they possess at least seven years of foreign language exposure that doesn’t mean they master the particularities engaged in such a delicate task as translation is concerned. There are some chromaticisms in the words (false friends), that need to be researched and analysed later on by both students and language teachers. The reason for such state of affairs lies in their academic formation, of a mainly general stream, which has enabled them only for knowledge of the foreign language, but not for the translation as a tool as it is required only when they reach the tertiary level. Besides, for their translations they rely, most of the times, on glossaries, whose dominant language is portuguese of Brazil, which is, obviously, much different from the portuguese mother tongue reality and even more of English. So it seems necessary to use with caution the working tools (glossaries) that work as surpluses, but could bring translation problems as we will see.

Intra-population plasticity of Anopheles darlingi's (Diptera, Culicidae) biting activity patterns in the state of Amapá, Brazil

OBJECTIVE: To assess the variation in Anopheles darlingi's biting activity compared to An. marajoara in the same locality and to biting activity data from other regions. METHODS: Using human bait, eight observations of the biting activity of An. darlingi and An. marajoara were carried out during 1999 and 2000 in the municipality of São Raimundo do Pirativa, state of Amapá, Brazil. Each observation consisted of three consecutive 13-hour collections, close to full moon. There were shifts of collectors in the observation points and nocturnal periods. RESULTS: An. darlingi revealed considerable plasticity of biting activity in contrast to An. marajoara, which showed well-defined crepuscular biting peaks. No significant correlation between density and biting activity was found, but a significant correlation existed between time and proportional crepuscular activity, indicating underlying ecological processes not yet understood. Two of the four available data sets having multiple observations at one locality showed considerable plasticity of this species' biting patterns as well. CONCLUSION: Intra-population variation of biting activity can be as significant as inter-population variation. Some implications in malaria vector control and specific studies are also discussed.

Performance of microstrip antennas in the presence of EBG in an indoor localization system

Indoor localization systems in nowadays is a huge area of interest not only at academic but also at industry and commercial level. The correct location in these systems is strongly influenced by antennas performance which can provide several gains, bandwidths, polarizations and radiation patterns, due to large variety of antennas types and formats. This paper presents the design, manufacture and measurement of a compact microstrip antenna, for a 2.4 GHZ frequency band, enhanced with the use of Electromagnetic Band-Gap (EBG) structures, which improve the electromagnetic behavior of the conventional antennas. The microstrip antenna with an EBG structure integrated allows an improvement of the location system performance in about 25% to 30% relatively to a conventional microstrip antenna.

Remuneration and tariffs in the context of virtual power players

Power systems have been through deep changes in recent years, namely with the operation of competitive electricity markets in the scope and the increasingly intensive use of renewable energy sources and distributed generation. This requires new business models able to cope with the new opportunities that have emerged. Virtual Power Players (VPPs) are a new player type which allows aggregating a diversity of players (Distributed Generation (DG), Storage Agents (SA), Electrical Vehicles, (V2G) and consumers), to facilitate their participation in the electricity markets and to provide a set of new services promoting generation and consumption efficiency, while improving players` benefits. A major task of VPPs is the remuneration of generation and services (maintenance, market operation costs and energy reserves), as well as charging energy consumption. This paper proposes a model to implement fair and strategic remuneration and tariff methodologies, able to allow efficient VPP operation and VPP goals accomplishment in the scope of electricity markets.

Using demand response to deal with unexpected low wind power generation in the context of smart grid

Demand response is assumed an essential resource to fully achieve the smart grids operating benefits, namely in the context of competitive markets. Some advantages of Demand Response (DR) programs and of smart grids can only be achieved through the implementation of Real Time Pricing (RTP). The integration of the expected increasing amounts of distributed energy resources, as well as new players, requires new approaches for the changing operation of power systems. The methodology proposed aims the minimization of the operation costs in a smart grid operated by a virtual power player. It is especially useful when actual and day ahead wind forecast differ significantly. When facing lower wind power generation than expected, RTP is used in order to minimize the impacts of such wind availability change. The proposed model application is here illustrated using the scenario of a special wind availability reduction day in the Portuguese power system (8th February 2012).

Study of Pt/MCM-22 based catalysts in the transformation of n-hexane: effect of rare earth elements and mode of platinum introduction

The bifunctional transformation of n-hexane was carried out over Pt/MCM-22 based catalysts. MCM-22 was synthesized and submitted to ion exchange with rare earth nitrate solutions of La, Nd and Yb, followed by Pt introduction. Three different methods were used to introduce about 1 wt% of Pt in the zeolite: ion exchange, incipient wetness impregnation and mechanical mixture with Pt/Al(2)O(3). The bifunctional catalysts were characterized by transmission electron microscopy and by the model reaction of toluene hydrogenation. These experiments showed that, in the ion exchanged sample, Pt is located both within the inner micropores and on the outer surface, whereas in the impregnated one, the metal is essentially located on the outer surface under the form of large particles. The presence of RE elements increases the hydrogenating activity of Pt/MCM-22 since the location of these species at the vicinity of metal particles causes modification on its electronic properties. Whatever the mode of Pt introduction, a fast initial decrease in conversion is observed for n-hexane transformation, followed by a plateau related to the occurrence of the catalytic transformations at the hemicages located at the outer surface of the crystals. The effect of rare earth elements on the hydrogenating function leads to a lower selectivity in dibranched isomers and increased amounts of light products.

Undulation Instabilities in the Meniscus of Smectic Membranes

Using optical microscopy, phase shifting interferometry, and atomic force microscopy, we characterize the undulated structures which appear in the meniscus of freestanding ferroelectric smectic-C* films. We demonstrate that these periodic structures correspond to undulations of the smectic-air interface. The resulting striped pattern disappears in the untilted smectic-A phase. The modulation amplitude and wavelength of the instability both depend on meniscus thickness. We study the temperature evolution and propose a model that qualitatively accounts for the observations.

Hybrid fuzzy Monte Carlo and logic programming model for distribution network reconfiguration in the presence of outages

This paper presents a methodology for distribution networks reconfiguration in outage presence in order to choose the reconfiguration that presents the lower power losses. The methodology is based on statistical failure and repair data of the distribution power system components and uses fuzzy-probabilistic modelling for system component outage parameters. Fuzzy membership functions of system component outage parameters are obtained by statistical records. A hybrid method of fuzzy set and Monte Carlo simulation based on the fuzzy-probabilistic models allows catching both randomness and fuzziness of component outage parameters. Once obtained the system states by Monte Carlo simulation, a logical programming algorithm is applied to get all possible reconfigurations for every system state. In order to evaluate the line flows and bus voltages and to identify if there is any overloading, and/or voltage violation a distribution power flow has been applied to select the feasible reconfiguration with lower power losses. To illustrate the application of the proposed methodology to a practical case, the paper includes a case study that considers a real distribution network.

Trends in the modes of delivery and their impact on perinatal mortality rates

OBJECTIVE: To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS: A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS: Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0‰), early neonatal mortality (from 30.6 to 9.0‰), and perinatal mortality (from 56.4 to 19.3‰). CONCLUSIONS: The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.

Intelligent energy resources management in the context of smart grids

Smart grids are envisaged as infrastructures able to accommodate all centralized and distributed energy resources (DER), including intensive use of renewable and distributed generation (DG), storage, demand response (DR), and also electric vehicles (EV), from which plug-in vehicles, i.e. gridable vehicles, are especially relevant. Moreover, smart grids must accommodate a large number of diverse types or players in the context of a competitive business environment. Smart grids should also provide the required means to efficiently manage all these resources what is especially important in order to make the better possible use of renewable based power generation, namely to minimize wind curtailment. An integrated approach, considering all the available energy resources, including demand response and storage, is crucial to attain these goals. This paper proposes a methodology for energy resource management that considers several Virtual Power Players (VPPs) managing a network with high penetration of distributed generation, demand response, storage units and network reconfiguration. The resources are controlled through a flexible SCADA (Supervisory Control And Data Acquisition) system that can be accessed by the evolved entities (VPPs) under contracted use conditions. A case study evidences the advantages of the proposed methodology to support a Virtual Power Player (VPP) managing the energy resources that it can access in an incident situation.

A new approach for multi-agent coalition formation and management in the scope of electricity markets

This paper presents a new methodology for the creation and management of coalitions in Electricity Markets. This approach is tested using the multi-agent market simulator MASCEM, taking advantage of its ability to provide the means to model and simulate VPP (Virtual Power Producers). VPPs are represented as coalitions of agents, with the capability of negotiating both in the market, and internally, with their members, in order to combine and manage their individual specific characteristics and goals, with the strategy and objectives of the VPP itself. The new features include the development of particular individual facilitators to manage the communications amongst the members of each coalition independently from the rest of the simulation, and also the mechanisms for the classification of the agents that are candidates to join the coalition. In addition, a global study on the results of the Iberian Electricity Market is performed, to compare and analyze different approaches for defining consistent and adequate strategies to integrate into the agents of MASCEM. This, combined with the application of learning and prediction techniques provide the agents with the ability to learn and adapt themselves, by adjusting their actions to the continued evolving states of the world they are playing in.