O desenho de uma organização: o Instituto Nacional de Previdencia Social INPS

O tema Central deste trabalho é o desenho organizacional expressão originaria da inglesa organization design, significando o complexo processo de estruturação de organizações que envolve mais elementos do que aqueles normalmente apresentados num organograma.

Saúde da Família: características do financiamento para municípios selecionados no Paraná

Este estudo teve por objetivo analisar as características do financiamento da atenção básica e do Programa de Saúde da Família (PSF), na 10 RS do Estado do Paraná, e sua relação como indutor do modelo assistencial à saúde. Identifica o comportamento das receitas para o PSF na 10 RS do Paraná, o comportamento das despesas com atenção básica em relação à despesa total com saúde da regional e o papel dos incentivos financeiros do PSF como indutores de manutenção e expansão do PSF na assistência à saúde dos municípios selecionados. O financiamento estável e suficiente é imprescindível para que o acesso às ações e serviços de saúde a todos os cidadãos brasileiros possa efetivamente acontecer. A implementação do SUS traz consigo um desafio na mudança do modelo assistencial: de um acesso restrito aos beneficiários do INPS ao acesso universal, o SUS garante a saúde como um direito de todos e dever do Estado, mediante políticas públicas que são os pilares básicos da transição de um modelo curativo para um modelo preventivo com ações pautadas na integralidade. Os desafios na mudança do modelo assistencial estão intimamente ligados aos desafios pelo financiamento. O embate constante por financiamento e as tentativas de vinculação de receita para garantir a suficiência e estabilidade de recursos para o SUS constituem imperativos para que o sistema possa dar conta de atender a todos os cidadãos. A 10 Regional de Saúde do Estado do Paraná, sediada na cidade de Cascavel, possui 25 municípios e apenas um não tem implantada a Estratégia Saúde da Família. Para a análise das características do financiamento da atenção básica e do PSF para o caso analisado, foram utilizados dados provenientes de sistemas de informação oficiais de caráter público, sendo eles: Sistema de Informação sobre Orçamentos Públicos em Saúde (SIOPS), Cadastro Nacional dos Estabelecimentos de Saúde (CNES), Departamento Nacional de Atenção Básica (DAB) e Fundo Nacional de Saúde (FNS). A partir da análise dos dados, foi possível identificar o papel indutor dos recursos do PAB variável ao PSF nos municípios, pois a maioria possui menos de 20 mil habitantes e sua organização dos serviços no nível municipal tem a atenção básica como único nível de assistência. As transferências intergovernamentais, entre elas os incentivos financeiros, têm alto peso no total de recursos dos municípios, mas a capacidade de gestão e a possibilidade de implantação das equipes com atuação nos moldes que se propõem a adotar a ESF precisam ser repensadas e discutidas no nível municipal, para que a implantação da estratégia não seja apenas a maneira através da qual os municípios buscam recursos. Desta forma, o Governo Federal continua sendo o agente definidor da política de saúde no território nacional. Num país onde os municípios são caracterizados por enorme heterogeneidade de tamanho e renda, os repasses federais cumprem e deverão continuar cumprindo papel fundamental no gasto do PSF, o que se confirma nos municípios analisados.

Ice-binding proteins adsorb to their ligand via anchored clathrate waters

The main success of my thesis has been to establish the mechanism by which antifreeze proteins (AFPs) bind irreversibly to ice crystals, and hence prevent their growth. AFPs organize ice-like water on their ice-binding site, which then merges and freezes with the quasi-liquid layer of ice. This was revealed from studying the exceptionally large (ca. 1.5-MDa) Ca 2+-dependent AFP from the Antarctic bacterium Marinomonas primoryensis (MpAFP). The 34-kDa antifreeze- active region of MpAFP was predicted to fold as a novel Ca 2+-binding β-helix. Site-directed mutagenesis confirmed the model and demonstrated that its ice-binding site (IBS) consisted of solvent-exposed Thr and Asx parallel arrays on the Ca 2+-binding turns. The X-ray crystal structure of the antifreeze region was solved to a resolution of 1.7 Å. Two of the four molecules within the unit cell of the crystal had portions of their IBSs freely exposed to solvent. Identical clathrate-like cages of water molecules were present on each IBS. These waters were organized by the hydrophobic effect and anchored to the protein via hydrogen bonds. They matched the spacing of water molecules in an ice lattice, demonstrating that anchored clathrate waters bind AFPs to ice. This mechanism was extended to other AFPs including the globular type III AFP from fishes. Site-directed mutagenesis and a modified ice-etching technique demonstrated this protein uses a compound ice-binding site, comprised of two flat and relatively hydrophobic surfaces, to bind at least two planes of ice. Reinvestigation of several crystal structures of type III AFP identified anchored clathrate waters on the solvent-exposed portion of its compound IBS that matched the spacing of waters on the primary prism plane of ice. Ice nucleation proteins (INPs), which can raise the temperature at which ice forms in solution to just slightly below 0oC, have the opposite effect to AFPs. A novel dimeric β-helical model was proposed for the INP produced by the bacterium Pseudomonas borealis. Molecular dynamics simulations showed that INPs are also capable of ordering water molecules into an ice- like lattice. However, their multimerization brings together sufficient ordered waters to form an ice nucleus and initiate freezing.

Exploring several nonconventional interactions of ice-binding proteins

Traditionally, ice-binding proteins (IBPs), also known as antifreeze proteins (AFPs), have been defined by two universal activities: ice recrystallization inhibition and thermal hysteresis. However, there remains the possibility IBPs have other complementary functions given the diversity found within this protein group. This thesis explores some of these in both natural and applied settings, in the hopes of furthering our understanding of this remarkable group of proteins. Plant IBPs could function as part of a defensive strategy against ice nucleators produced by certain pathogens. To assess this hypothesis, recombinant IBPs from perennial ryegrass and purple false brome were combined with the ice nucleation protein (INP) from the plant pathogen, Pseudomonas syringae. Strikingly, the plant proteins depressed the freezing point of the bacterial INP, while a fish AFP could not, nor did the INPs have any effect on IBP activity. Thus, the interaction between these two different proteins suggests a role in plant defensive strategies against pathogenic bacteria as another IBP function. In addition, the potential use of hyperactive insect IBPs in organ preservation was investigated. Current kidney preservation techniques involve storing the organ at 4 °C for a maximum of 24 h prior to transplantation. Extending this “safe” time would have profound effects on renal transplants, however, ischemic injury is prevalent when storage periods are prolonged. Experiments described here allowed subzero preservation for 72 h with the addition of a beetle IBP to CryoStasis® solution. Kidneys stored using the traditional technique for 24 h and the method developed here for 72 h showed similar levels of biomarker enzymes, underscoring the potential utility of insect IBPs for future transplant purposes. Finally, IBP function in the freeze-tolerant gall fly, Eurosta solidaginis, was examined. Larvae representing the mid-autumn stage displayed ice-binding activity, suggesting an IBP is being expressed, possibly as a protective measure against freezing damage when fall temperatures can unpredictably drop. IBP activity was also observed in the larvae’s host plant, Solidago spp. Mass spectrometry analysis of ice-affinity purified plant extracts provided three candidate pathogenesis-related proteins that could be responsible for the detected activity, further demonstrating additional functions of IBPs.

Exploring several nonconventional interactions of ice-binding proteins

Traditionally, ice-binding proteins (IBPs), also known as antifreeze proteins (AFPs), have been defined by two universal activities: ice recrystallization inhibition and thermal hysteresis. However, there remains the possibility IBPs have other complementary functions given the diversity found within this protein group. This thesis explores some of these in both natural and applied settings, in the hopes of furthering our understanding of this remarkable group of proteins. Plant IBPs could function as part of a defensive strategy against ice nucleators produced by certain pathogens. To assess this hypothesis, recombinant IBPs from perennial ryegrass and purple false brome were combined with the ice nucleation protein (INP) from the plant pathogen, Pseudomonas syringae. Strikingly, the plant proteins depressed the freezing point of the bacterial INP, while a fish AFP could not, nor did the INPs have any effect on IBP activity. Thus, the interaction between these two different proteins suggests a role in plant defensive strategies against pathogenic bacteria as another IBP function. In addition, the potential use of hyperactive insect IBPs in organ preservation was investigated. Current kidney preservation techniques involve storing the organ at 4 °C for a maximum of 24 h prior to transplantation. Extending this “safe” time would have profound effects on renal transplants, however, ischemic injury is prevalent when storage periods are prolonged. Experiments described here allowed subzero preservation for 72 h with the addition of a beetle IBP to CryoStasis® solution. Kidneys stored using the traditional technique for 24 h and the method developed here for 72 h showed similar levels of biomarker enzymes, underscoring the potential utility of insect IBPs for future transplant purposes. Finally, IBP function in the freeze-tolerant gall fly, Eurosta solidaginis, was examined. Larvae representing the mid-autumn stage displayed ice-binding activity, suggesting an IBP is being expressed, possibly as a protective measure against freezing damage when fall temperatures can unpredictably drop. IBP activity was also observed in the larvae’s host plant, Solidago spp. Mass spectrometry analysis of ice-affinity purified plant extracts provided three candidate pathogenesis-related proteins that could be responsible for the detected activity, further demonstrating additional functions of IBPs.

Qualidade do Atendimento na Administração Pública em Cabo Verde, o Caso do Instituto Nacional de Previdência Social na ilha de São Vicente

O trabalho apresenta o tema “ Qualidade do Atendimento Publico, tendo como ponto de partida a qualidade do serviço prestado no Instituto Nacional de Previdência Social, ilha de São Vicente. Tem como objetivo principal dar resposta à questão de partida que é, simultaneamente, o tema a desenvolver e o título do mesmo, ou seja avaliar o grau de satisfação dos utentes em relação a qualidade do atendimento prestado pelo Instituto Nacional de Previdência Social (INPS) em São Vicente, com a finalidade de conhecer melhor a qualidade do serviço prestado por essa Instituição Pública e contribuir com informações que possam ser efetivamente úteis e capazes de desencadear ações de melhoria ao nível do atendimento publico na referida instituição. Face à responsabilidade assumida, tentou-se proceder a investigação e análise dos aspetos considerados mais relevantes, de forma a encontrar soluções para a melhoraria da qualidade no atendimento aos utentes do INPS na ilha de São Vicente. Para o efeito, a metodologia do estudo foi orientada pela pesquisa bibliográfica e exploratória centrada nas contribuições teóricas de vários autores, a respeito da qualidade de atendimento nas organizações e os fatores que o influencia, em livros, artigos publicados e sites da internet. Recorreu-se ao Modelo SERVQUAL para a avaliação da perceção e expetativa dos utentes do INPS sobre a qualidade de serviço prestado.