O papel da análise custo-efetividade no processo decisório em saúde: o caso do sub-programa de controle da hanseníase

A introdução da Análise Custo-Efetividade na área da Saúde decorre desta preocupação de aperfeiçoamento dos métodos gerenciais em geral, e de escolha de alternativas de ação que levem ao melhor resultado em relação ao custo. Derivada das técnicas econômicas de análise de investimentos em uso no setor empresarial, a ACE pode ser de grande utilidade na montagem de programas e planos de saúde, na escolha entre diversos programas alternativos, e na sua avaliação. Consiste basicamente em confrontar os custos (esperados ou realizados a) de um programa, com seus resultados ou impactos (esperados ou realizados). A aplicação da Análise Custo-Efetividade é ainda recente, e restringe-se aos Estados Unidos e a alguns países europeus. No Brasil, embora comece a ser divulgada, ainda não foi utilizada em programas reais. Seus princípios e sua metodologia são relativamente simples, mas sua utilização em casos concretos esbarra em algumas dificuldades. Assim, a aplicação da análise a um dos programas desenvolvidos na Secretaria da Saúde poderá, além de divulgar a ACE na instituição, estabelecer claramente seu potencial e suas limitações no contexto da saúde pública brasileira. Um dos programas mais problemáticos da Secretaria é o Sub-programa de Controle da Hanseníase. Em vigência há vários anos, seus resultados estão aquém do esperado, em que pesem as características de uma doença endêmica e complexa e as falhas do próprio sub-programa. O interesse em se avaliar um programa cujos resultados são reconhecidamente insatisfatórios, e nosso conhecimento e experiência pessoal na área da hanseníase, justificam a escolha deste Sub-programa para a aplicação da Análise Custo-Efetividade.

Classificação dos custos agroindustriais

A ferramenta de custos se mostra relevante do ponto de vista gerencial, auxiliando no controle de gastos e na tomada de decisões nas empresas. Para melhor entender este conceito, o material apresenta a taxonomia dos sistemas de custos, além de suas classificações quanto à natureza, à identificação com o produto e à variação quantitativa. Como o estoque representa grande parte dos custos de produção, são apresentadas três formas contábeis para avaliação dos mesmos: PEPS (primeiro a entrar, primeiro a sair), UEPS (último a entrar, primeiro a sair) e Custo Médio.

Controle aplicado a poços com método de elevação e bombeio centrífugo submerso

The Electrical Submersible Pumping is an artificial lift method for oil wells employed in onshore and offshore areas. The economic revenue of the petroleum production in a well depends on the oil flow and the availability of lifting equipment. The fewer the failures, the lower the revenue shortfall and costs to repair it. The frequency with which failures occur depends on the operating conditions to which the pumps are submitted. In high-productivity offshore wells monitoring is done by operators with engineering support 24h/day, which is not economically viable for the land areas. In this context, the automation of onshore wells has clear economic advantages. This work proposes a system capable of automatically control the operation of electrical submersible pumps, installed in oil wells, by an adjustment at the electric motor rotation based on signals provided by sensors installed on the surface and subsurface, keeping the pump operating within the recommended range, closest to the well s potential. Techniques are developed to estimate unmeasured variables, enabling the automation of wells that do not have all the required sensors. The automatic adjustment, according to an algorithm that runs on a programmable logic controller maintains the flow and submergence within acceptable parameters avoiding undesirable operating conditions, as the gas interference and high engine temperature, without need to resort to stopping the engine, which would reduce the its useful life. The control strategy described, based on modeling of physical phenomena and operational experience reported in literature, is materialized in terms of a fuzzy controller based on rules, and all generated information can be accompanied by a supervisory system

Perfis do controle jurisdicional de políticas publicas: parâmetros objetivos e tutela coletiva

This paper focuses on a study of public policy jurisdictional control as some effectiveness mechanism for cultural, economical, and social fundamental rights. It investigates the juridical profile of public policies based on premises of the current (Neo)Constitutional State model and the assertion of an essentially constitutionalist Law paradigm from its genesis to its most peculiar elements, and through tormenting issues, such as: its position between Law and Politics, the difference with reflective subjective rights, and the problem of high financial costs. Once its object is identified, it moves forward into the theme itself, which is that of jurisdictional control, investigating its legitimacy based on paradigmatic judicial precedents and the facing of themes such as: current role of the Judicial Power, the splitting of state functions, administrative discretion, financial affordability, illegal omissions, and budget control. Finally, it examines, as its study central object, objective parameters for definition control, execution, and transparency of public policies, as well as identifying the most appropriate collective jurisdictional tutoring to its purposes together with some of its law process means. Therefrom, it shows new perspectives for the recent study on jurisdictional control of public policies, building foundations for the fundamental rights effectiveness

Compatibilidade entre acaricidas e fertilizantes foliares em função de diferentes águas no controle do ácaro da leprose dos citros Brevipalpus phoenicis

A adição de fertilizantes foliares à calda acaricida é frequentemente empregada na citricultura com o intuito de reduzir os custos das aplicações. Todavia, as implicações desta prática, na maioria dos casos, são desconhecidas. O objetivo do trabalho foi avaliar o efeito de caldas acaricidas em mistura com fertilizantes foliares e preparadas com diferentes águas no controle do ácaro B. phoenicis. Foram realizados dois experimentos em laboratório, nos anos de 2009 e 2010, utilizando-se de frutos de laranja para conter ácaros Brevipalpus phoenicis. Um dos experimentos constou de três bioensaios, nos quais se procurou verificar o efeito das misturas entre fertilizantes foliares e os acaricidas cyhexatin, propargite e acrinatrhrin sobre B. phoenicis. No outro experimento, além de verificar o efeito das misturas de fertilizantes com os acaricidas propargite e acrinatrhrin, buscou-se também avaliar o efeito de águas coletadas em diferentes fontes utilizadas no preparo das caldas sobre B. phoenicis. Os resultados evidenciaram que a aplicação dos fertilizantes foliares cloreto de zinco, cloreto de manganês, ureia e a mistura de fosfito de potássio + ureia + cloreto de zinco não afetaram a ação dos acaricidas cyhexatin, propargite e acrinathrin sobre o controle de B. phoenicis. As misturas dos cloretos de zinco e de manganês com o sulfato de magnésio e a adição de fosfito de potássio diminuíram a eficiência dos acaricidas propargite e acrinathrin, não devendo, a princípio, ser adicionadas numa mesma aplicação. Águas provenientes dos municípios paulistas de Itápolis, Pirangi e Pirassununga interferiram na ação dos acaricidas propargite e acrinathin sobre B. phoenicis, sendo que a água coletada em Itápolis apresentou resultados superiores em termos de eficiência. Verificaram-se alterações dos valores de pH e da condutividade elétrica após a adição de alguns dos fertilizantes à calda acaricida.

Controle Adaptativo Robusto para Filtros Ativos de Potência Paralelo

Conventional control strategies used in shunt active power filters (SAPF) employs real-time instantaneous harmonic detection schemes which is usually implements with digital filters. This increase the number of current sensors on the filter structure which results in high costs. Furthermore, these detection schemes introduce time delays which can deteriorate the harmonic compensation performance. Differently from the conventional control schemes, this paper proposes a non-standard control strategy which indirectly regulates the phase currents of the power mains. The reference currents of system are generated by the dc-link voltage controller and is based on the active power balance of SAPF system. The reference currents are aligned to the phase angle of the power mains voltage vector which is obtained by using a dq phase locked loop (PLL) system. The current control strategy is implemented by an adaptive pole placement control strategy integrated to a variable structure control scheme (VS-APPC). In the VS-APPC, the internal model principle (IMP) of reference currents is used for achieving the zero steady state tracking error of the power system currents. This forces the phase current of the system mains to be sinusoidal with low harmonics content. Moreover, the current controllers are implemented on the stationary reference frame to avoid transformations to the mains voltage vector reference coordinates. This proposed current control strategy enhance the performance of SAPF with fast transient response and robustness to parametric uncertainties. Experimental results are showing for determining the effectiveness of SAPF proposed control system

Estratégia de controle robusto para filtro ativo paralelo sem detecção de harmônicos de correntes

Conventional control strategies used in shunt active power filters (SAPF) employs real-time instantaneous harmonic detection schemes which is usually implements with digital filters. This increase the number of current sensors on the filter structure which results in high costs. Furthermore, these detection schemes introduce time delays which can deteriorate the harmonic compensation performance. Differently from the conventional control schemes, this paper proposes a non-standard control strategy which indirectly regulates the phase currents of the power mains. The reference currents of system are generated by the dc-link voltage controller and is based on the active power balance of SAPF system. The reference currents are aligned to the phase angle of the power mains voltage vector which is obtained by using a dq phase locked loop (PLL) system. The current control strategy is implemented by an adaptive pole placement control strategy integrated to a variable structure control scheme (VS¡APPC). In the VS¡APPC, the internal model principle (IMP) of reference currents is used for achieving the zero steady state tracking error of the power system currents. This forces the phase current of the system mains to be sinusoidal with low harmonics content. Moreover, the current controllers are implemented on the stationary reference frame to avoid transformations to the mains voltage vector reference coordinates. This proposed current control strategy enhance the performance of SAPF with fast transient response and robustness to parametric uncertainties. Experimental results are showing for determining the effectiveness of SAPF proposed control system

Modelagem e controle adaptativo de uma planta didática de nível com instrumentação industrial

The control, automation and optimization areas help to improve the processes used by industry. They contribute to a fast production line, improving the products quality and reducing the manufacturing costs. Didatic plants are good tools for research in these areas, providing a direct contact with some industrial equipaments. Given these capabilities, the main goal of this work is to model and control a didactic plant, which is a level and flow process control system with an industrial instrumentation. With a model it is possible to build a simulator for the plant that allows studies about its behaviour, without any of the real processes operational costs, like experiments with controllers. They can be tested several times before its application in a real process. Among the several types of controllers, it was used adaptive controllers, mainly the Direct Self-Tuning Regulators (DSTR) with Integral Action and the Gain Scheduling (GS). The DSTR was based on Pole-Placement design and use the Recursive Least Square to calculate the controller parameters. The characteristics of an adaptive system was very worth to guarantee a good performance when the controller was applied to the plant

Controle vetorial para velocidade de um motor de indução trifásico utilizando estimador filtro de Kalman

This paper describes the study, computer simulation and feasibility of implementation of vector control speed of an induction motor using for this purpose the Extended Kalman Filter as an estimator of rotor flux. The motivation for such work is the use of a control system that requires no sensors on the machine shaft, thus providing a considerable cost reduction of drives and their maintenance, increased reliability, robustness and noise immunity as compared to control systems with conventional sensors

Controle por modos deslizantes com compensação difusa aplicado a sistemas com descontinuidade

The development of non-linear controllers gained space in the theoretical ambit and of practical applications on the moment that the arising of digital computers enabled the implementation of these methodologies. In comparison with the linear controllers more utilized, the non -linear controllers present the advantage of not requiring the linearity of the system to determine the parameters of control, which permits a more efficient control especially when the system presents a high level of non-linearity. Another additional advantage is the reduction of costs, since to obtain the efficient control through linear controllers it is necessary the utilization of sensors and more refined actuators than when it is utilized a non-linear controller. Among the non-linear theories of control, the method of control by gliding ways is detached for being a method that presents more robustness, before uncertainties. It is already confirmed that the adoption of compensation on the region of residual error permits to improve better the performance of these controllers. So, in this work it is described the development of a non-linear controller that looks for an association of strategy of control by gliding ways, with the fuzzy compensation technique. Through the implementation of some strategies of fuzzy compensation, it was searched the one which provided the biggest efficiency before a system with high level of nonlinearities and uncertainties. The electrohydraulic actuator was utilized as an example of research, and the results appoint to two configurations of compensation that permit a bigger reduction of the residual error

Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Tratamento de toletes de cana-de-açúcar para o controle da podridão-abacaxi em pulverização conjugada ao plantio mecanizado

No plantio mecanizado da cana-de-açúcar, há dificuldades em se proteger a cultura contra pragas e doenças do solo, requerendo uma tecnologia de aplicação de produtos fitossanitários que respeite o ambiente e os custos de produção. O objetivo deste trabalho foi avaliar um sistema de pulverização para controle de doenças e pragas do solo, conjugado ao equipamento de plantio mecanizado de toletes de cana-de-açúcar, tomando como alvo-indicador a podridão-abacaxi. Delineou-se o experimento em blocos ao acaso, em área de plantio comercial da variedade SP-891115. A pulverização deu-se na região da calha do equipamento de plantio, por onde os toletes deslizam até o solo. Avaliaram-se o número de perfilhos brotados e a produção da cultura. Os resultados foram comparados pelo número e percentagem de perfilhos e pelo acréscimo na produção em relação à testemunha não-tratada. Com base nos resultados observados, concluiu-se que o sistema de pulverização de produtos fitossanitários conjugado ao plantio mecanizado proporcionou a recuperação da produtividade na cultura da cana-de-açúcar de até 15%, na maior dose utilizada para o controle da podridão-abacaxi, demonstrando ser promissor para o tratamento de toletes e visando à proteção contra doenças e pragas de solo.

Comparação de propostas para alocação dos custos de perdas na transmissão

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

Estudo comparativo dos métodos Nodal e Zbus para alocação de custos pelo uso do sistema de transmissão

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