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.

Controle vetorial de velocidade de uma máquina de indução sem mancais trifásica com bobinado dividido utilizando estimação neural de fluxo

This work describes the study and the implementation of the vector speed control for a three-phase Bearingless induction machine with divided winding of 4 poles and 1,1 kW using the neural rotor flux estimation. The vector speed control operates together with the radial positioning controllers and with the winding currents controllers of the stator phases. For the radial positioning, the forces controlled by the internal machine magnetic fields are used. For the radial forces optimization , a special rotor winding with independent circuits which allows a low rotational torque influence was used. The neural flux estimation applied to the vector speed controls has the objective of compensating the parameter dependences of the conventional estimators in relation to the parameter machine s variations due to the temperature increases or due to the rotor magnetic saturation. The implemented control system allows a direct comparison between the respective responses of the speed and radial positioning controllers to the machine oriented by the neural rotor flux estimator in relation to the conventional flux estimator. All the system control is executed by a program developed in the ANSI C language. The DSP resources used by the system are: the Analog/Digital channels converters, the PWM outputs and the parallel and RS-232 serial interfaces, which are responsible, respectively, by the DSP programming and the data capture through the supervisory system

Uso de técnicas de otimização baseadas em derivadas como suporte do planejamento operacional de redes de distribuição de energia elétrica

The usual programs for load flow calculation were in general developped aiming the simulation of electric energy transmission, subtransmission and distribution systems. However, the mathematical methods and algorithms used by the formulations were based, in majority, just on the characteristics of the transmittion systems, which were the main concern focus of engineers and researchers. Though, the physical characteristics of these systems are quite different from the distribution ones. In the transmission systems, the voltage levels are high and the lines are generally very long. These aspects contribute the capacitive and inductive effects that appear in the system to have a considerable influence in the values of the interest quantities, reason why they should be taken into consideration. Still in the transmission systems, the loads have a macro nature, as for example, cities, neiborhoods, or big industries. These loads are, generally, practically balanced, what reduces the necessity of utilization of three-phase methodology for the load flow calculation. Distribution systems, on the other hand, present different characteristics: the voltage levels are small in comparison to the transmission ones. This almost annul the capacitive effects of the lines. The loads are, in this case, transformers, in whose secondaries are connected small consumers, in a sort of times, mono-phase ones, so that the probability of finding an unbalanced circuit is high. This way, the utilization of three-phase methodologies assumes an important dimension. Besides, equipments like voltage regulators, that use simultaneously the concepts of phase and line voltage in their functioning, need a three-phase methodology, in order to allow the simulation of their real behavior. For the exposed reasons, initially was developped, in the scope of this work, a method for three-phase load flow calculation in order to simulate the steady-state behaviour of distribution systems. Aiming to achieve this goal, the Power Summation Algorithm was used, as a base for developing the three phase method. This algorithm was already widely tested and approved by researchers and engineers in the simulation of radial electric energy distribution systems, mainly for single-phase representation. By our formulation, lines are modeled in three-phase circuits, considering the magnetic coupling between the phases; but the earth effect is considered through the Carson reduction. It s important to point out that, in spite of the loads being normally connected to the transformer s secondaries, was considered the hypothesis of existence of star or delta loads connected to the primary circuit. To perform the simulation of voltage regulators, a new model was utilized, allowing the simulation of various types of configurations, according to their real functioning. Finally, was considered the possibility of representation of switches with current measuring in various points of the feeder. The loads are adjusted during the iteractive process, in order to match the current in each switch, converging to the measured value specified by the input data. In a second stage of the work, sensibility parameters were derived taking as base the described load flow, with the objective of suporting further optimization processes. This parameters are found by calculating of the partial derivatives of a variable in respect to another, in general, voltages, losses and reactive powers. After describing the calculation of the sensibility parameters, the Gradient Method was presented, using these parameters to optimize an objective function, that will be defined for each type of study. The first one refers to the reduction of technical losses in a medium voltage feeder, through the installation of capacitor banks; the second one refers to the problem of correction of voltage profile, through the instalation of capacitor banks or voltage regulators. In case of the losses reduction will be considered, as objective function, the sum of the losses in all the parts of the system. To the correction of the voltage profile, the objective function will be the sum of the square voltage deviations in each node, in respect to the rated voltage. In the end of the work, results of application of the described methods in some feeders are presented, aiming to give insight about their performance and acuity

Um algoritmo para estimação de estado em alimentadores de distribuição de energia elétrica com base no método da soma de potências

Most algorithms for state estimation based on the classical model are just adequate for use in transmission networks. Few algorithms were developed specifically for distribution systems, probably because of the little amount of data available in real time. Most overhead feeders possess just current and voltage measurements at the middle voltage bus-bar at the substation. In this way, classical algorithms are of difficult implementation, even considering off-line acquired data as pseudo-measurements. However, the necessity of automating the operation of distribution networks, mainly in regard to the selectivity of protection systems, as well to implement possibilities of load transfer maneuvers, is changing the network planning policy. In this way, some equipments incorporating telemetry and command modules have been installed in order to improve operational features, and so increasing the amount of measurement data available in real-time in the System Operation Center (SOC). This encourages the development of a state estimator model, involving real-time information and pseudo-measurements of loads, that are built from typical power factors and utilization factors (demand factors) of distribution transformers. This work reports about the development of a new state estimation method, specific for radial distribution systems. The main algorithm of the method is based on the power summation load flow. The estimation is carried out piecewise, section by section of the feeder, going from the substation to the terminal nodes. For each section, a measurement model is built, resulting in a nonlinear overdetermined equations set, whose solution is achieved by the Gaussian normal equation. The estimated variables of a section are used as pseudo-measurements for the next section. In general, a measurement set for a generic section consists of pseudo-measurements of power flows and nodal voltages obtained from the previous section or measurements in real-time, if they exist -, besides pseudomeasurements of injected powers for the power summations, whose functions are the load flow equations, assuming that the network can be represented by its single-phase equivalent. The great advantage of the algorithm is its simplicity and low computational effort. Moreover, the algorithm is very efficient, in regard to the accuracy of the estimated values. Besides the power summation state estimator, this work shows how other algorithms could be adapted to provide state estimation of middle voltage substations and networks, namely Schweppes method and an algorithm based on current proportionality, that is usually adopted for network planning tasks. Both estimators were implemented not only as alternatives for the proposed method, but also looking for getting results that give support for its validation. Once in most cases no power measurement is performed at beginning of the feeder and this is required for implementing the power summation estimations method, a new algorithm for estimating the network variables at the middle voltage bus-bar was also developed

Uso de técnicas de otimização baseadas em derivadas como suporte do planejamento operacional de redes de distribuição de energia elétrica

The usual programs for load flow calculation were in general developped aiming the simulation of electric energy transmission, subtransmission and distribution systems. However, the mathematical methods and algorithms used by the formulations were based, in majority, just on the characteristics of the transmittion systems, which were the main concern focus of engineers and researchers. Though, the physical characteristics of these systems are quite different from the distribution ones. In the transmission systems, the voltage levels are high and the lines are generally very long. These aspects contribute the capacitive and inductive effects that appear in the system to have a considerable influence in the values of the interest quantities, reason why they should be taken into consideration. Still in the transmission systems, the loads have a macro nature, as for example, cities, neiborhoods, or big industries. These loads are, generally, practically balanced, what reduces the necessity of utilization of three-phase methodology for the load flow calculation. Distribution systems, on the other hand, present different characteristics: the voltage levels are small in comparison to the transmission ones. This almost annul the capacitive effects of the lines. The loads are, in this case, transformers, in whose secondaries are connected small consumers, in a sort of times, mono-phase ones, so that the probability of finding an unbalanced circuit is high. This way, the utilization of three-phase methodologies assumes an important dimension. Besides, equipments like voltage regulators, that use simultaneously the concepts of phase and line voltage in their functioning, need a three-phase methodology, in order to allow the simulation of their real behavior. For the exposed reasons, initially was developped, in the scope of this work, a method for three-phase load flow calculation in order to simulate the steady-state behaviour of distribution systems. Aiming to achieve this goal, the Power Summation Algorithm was used, as a base for developping the three phase method. This algorithm was already widely tested and approved by researchers and engineers in the simulation of radial electric energy distribution systems, mainly for single-phase representation. By our formulation, lines are modeled in three-phase circuits, considering the magnetic coupling between the phases; but the earth effect is considered through the Carson reduction. Its important to point out that, in spite of the loads being normally connected to the transformers secondaries, was considered the hypothesis of existence of star or delta loads connected to the primary circuit. To perform the simulation of voltage regulators, a new model was utilized, allowing the simulation of various types of configurations, according to their real functioning. Finally, was considered the possibility of representation of switches with current measuring in various points of the feeder. The loads are adjusted during the iteractive process, in order to match the current in each switch, converging to the measured value specified by the input data. In a second stage of the work, sensibility parameters were derived taking as base the described load flow, with the objective of suporting further optimization processes. This parameters are found by calculating of the partial derivatives of a variable in respect to another, in general, voltages, losses and reactive powers. After describing the calculation of the sensibility parameters, the Gradient Method was presented, using these parameters to optimize an objective function, that will be defined for each type of study. The first one refers to the reduction of technical losses in a medium voltage feeder, through the installation of capacitor banks; the second one refers to the problem of correction of voltage profile, through the instalation of capacitor banks or voltage regulators. In case of the losses reduction will be considered, as objective function, the sum of the losses in all the parts of the system. To the correction of the voltage profile, the objective function will be the sum of the square voltage deviations in each node, in respect to the rated voltage. In the end of the work, results of application of the described methods in some feeders are presented, aiming to give insight about their performance and acuity

Motor de indução trifásico sem mancais com bobinado dividido: otimização do sistema de posicionamento radial

This dissertation dea1s with the active magnetic suspension controI system of an induction bearingIess motor configured with split windings. It analyses a dynamic modeI for the radial magnetic forces actuating on the rotor. From that, it proposes a new approach for the composition of the currents imposed to the machine's stator. It shows the tests accomplished with a prototype, proving the usefulness of the new actuating structure for the radial positioning controI. Finnaly, it points out the importance of adapting this structure to well-known rotational controI techniques, continuing this kind of equipment research, which is carried out at Federal University of Rio Grande do Norte since 2000

Avaliação do contato pneu-solo em três modelos de pneus agrícolas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Modelagem de Superfícies Seletivas de Freqüência e Antenas de Microfita utilizando Redes Neurais Artificiais

This work has as main objective the application of Artificial Neural Networks, ANN, in the resolution of problems of RF /microwaves devices, as for example the prediction of the frequency response of some structures in an interest region. Artificial Neural Networks, are presently a alternative to the current methods of analysis of microwaves structures. Therefore they are capable to learn, and the more important to generalize the acquired knowledge, from any type of available data, keeping the precision of the original technique and adding the low computational cost of the neural models. For this reason, artificial neural networks are being increasily used for modeling microwaves devices. Multilayer Perceptron and Radial Base Functions models are used in this work. The advantages/disadvantages of these models and the referring algorithms of training of each one are described. Microwave planar devices, as Frequency Selective Surfaces and microstrip antennas, are in evidence due the increasing necessities of filtering and separation of eletromagnetic waves and the miniaturization of RF devices. Therefore, it is of fundamental importance the study of the structural parameters of these devices in a fast and accurate way. The presented results, show to the capacities of the neural techniques for modeling both Frequency Selective Surfaces and antennas

Murcha por Ceratocystis em eucalipto: avaliação de resistência e análise epidemiológica

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

Endoderme com atividade meristemática em raiz de Canna edulis Kerr-Gawler (Cannaceae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Polimorfismo floral em Valeriana scandens L. (Valerianaceae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo da série iso-eletrônica do átomo de hélio pelo método hiperesférico

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

Estudo manométrico do esôfago distal de gatos anestesiados com tiopental sódico

OBJETIVO: Obter o padrão de normalidade da pressão e comprimento do esfíncter inferior do esôfago (EIE) em gatos anestesiados com tiopental e analisar a viabilidade prática do anestésico para uso neste tipo de investigação sobre atividade motora do esôfago de felinos. MÉTODOS: em 12 gatos anestesiados com tiopental sódico foram realizados estudos manométricos do EIE, com leitura por perfusão em três canais radiais. Foram avaliadas as pressões e comprimentos do EIE. RESULTADOS: Os valores médios da pressão e comprimento do EIE foram 33,52 ± 12,42 mmHg e 1,6 ± 0,4 cm, respectivamente. CONCLUSÃO: Foi possível estabelecer valor de referência para a pressão e comprimento do EIE de felinos, com uma contenção e retorno confortáveis para o animal, utilizando o tiopental sódico como agente anestésico.

Desempenho de um trator em função do tipo de pneu, da lastragem e da velocidade de trabalho

O trabalho comparou o desempenho de um trator agrícola 4x2 TDA de 89 kW (121cv) em função do tipo de pneus (radial, diagonal e de baixa pressão), a condição de lastragem (com e sem água nos pneus) e quatro velocidades [V1 (1,84km h-1), V2 (3,18km h-1, V3 (4,57km h-1), V4 (5,04km h-1)]. O experimento foi realizado na UNESP-Jaboticabal-SP, em condição de preparo do solo com escarificador de sete hastes a 30cm de profundidade. Os pneus foram do tipo R1, com as seguintes características: [radial (dianteiros-14.9 R 26; traseiros-620/75 R 30) diagonal (dianteiros-14.9-26, traseiros-23.1-30) e BPAF (dianteiros-500/60-26.5; traseiros-700/55-34)]. O delineamento experimental foi blocos casualizados, em esquema fatorial 3x2x4, com 24 tratamentos e três repetições. Os resultados evidenciaram vantagens para o trator equipado com pneus radiais.

Morfologia comparativa e distribuição batimétrica de duas espécies de Ophiuroidea, na região costeira de Ubatuba

Durante o período de outubro de 1985 a julho de 1987, foram coletados 722 ofíuróides pertencentes às espécies Ophioderma januarii e Ophioplocus januarii, na costa do Estado de São Paulo. Realizou-se medidas do diâmetro do disco dos exemplares e estas variaram entre 10,5 e 21,5 mm para Ophioderma januarii e entre 2,6 e 21,5 mm, para Ophioplocus januarii. Foram efetuadas observações das características morfológicas externas dos indivíduos e posteriormente, organizadas séries de crescimento, com o intuito de evidenciar possíveis alterações. Verificou-se para Ophioderma januarii, variações na forma dos escudos, no número de papilas orais e de espinhos braquiais, na coloração da superfície dorsal do disco e das placas braquiais dorsais e para Ophioplocus januarii variações nas escamas primárias, na série de escamas maiores da região interradial dorsal do disco, no número de escamas entre a centro-dorsal e a margem do disco, na forma dos escudos radiais e orais, no número de papilas orais, na coloração da superfície dorsal do disco e das placas braquiais dorsais. O resultado das análises de parâmetros ambientais dos locais de coleta, mostrou que as duas espécies ocorreram em áreas com condições ambientais distintas. Ophioderma januarii foi amostrada na região costeira até 36 m de profundidade e Ophioplocus januarii entre 30 e 100 m.