Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Aplicação da metodologia de “lean management” no processo de desenvolvimento de produto

O presente trabalho de dissertação teve como objetivo a implementação de metodologias de Lean Management e avaliação do seu impacto no processo de Desenvolvimento de Produto. A abordagem utilizada consistiu em efetuar uma revisão da literatura e levantamento do Estado da Arte para obter a fundamentação teórica necessária à implementação de metodologias Lean. Prosseguiu com o levantamento da situação inicial da organização em estudo ao nível das atividades de desenvolvimento de produto, práticas de gestão documental e operacional e ainda de atividades de suporte através da realização de inquéritos e medições experimentais. Este conhecimento permitiu criar um modelo de referência para a implementação de Lean Management nesta área específica do desenvolvimento de produto. Após implementado, este modelo foi validado pela sua experimentação prática e recolha de indicadores. A implementação deste modelo de referência permitiu introduzir na Unidade de Desenvolvimento de Produto e Sistemas (DPS) da organização INEGI, as bases do pensamento Lean, contribuindo para a criação de um ambiente de Respeito pela Humanidade e de Melhoria Contínua. Neste ambiente foi possível obter ganhos qualitativos e quantitativos nas várias áreas em estudo, contribuindo de forma global para um aumento da eficiência e eficácia da DPS. Prevê-se que este aumento de eficiência represente um aumento da capacidade instalada na Organização, pela redução anual de 2290 horas de desperdício (6.5% da capacidade total da unidade) e pela redução significativa em custos operacionais. Algumas das implementações de melhoria propostas no decorrer deste trabalho, após verificado o seu sucesso, extravasaram a unidade em estudo e foram aplicadas transversalmente à da organização. Foram também obtidos ganhos qualitativos, tais como a normalização de práticas de gestão documental e a centralização e agilização de fluxos de informação. Isso permitiu um aumento de qualidade dos serviços prestados pela redução de correções e retrabalho. Adicionalmente, com o desenvolvimento de uma nova ferramenta que permite a monitorização do estado atual dos projetos a nível da sua percentagem de execução (cumprimento de objetivos), prazos e custos, bem como a estimação das datas de conclusão dos projetos possibilitando o replaneamento do projeto bem como a detecção atempada de desvios. A ferramenta permite também a criação de um histórico que identifica o esforço horário associado à realização das atividades/tarefas das várias áreas de Desenvolvimento de Produto e desta forma pode ser usada como suporte à orçamentação futura de atividades similares. No decorrer do projeto, foram também criados os mecanismos que permitem o cálculo de indicadores das competências técnicas e motivações intrínsecas individuais da equipa DPS. Estes indicadores podem ser usados na definição por parte dos gestores dos projetos da composição das equipas de trabalho, dos executantes de tarefas individuais do projeto e dos destinatários de ações de formação. Com esta informação é expectável que se consiga um maior aproveitamento do potencial humano e como consequência um aumento do desempenho e da satisfação pessoal dos recursos humanos da organização. Este caso de estudo veio demonstrar que o potencial de melhoria dos processos associados ao desenvolvimento de produto através de metodologias de Lean Management é muito significativo, e que estes resultam em ganhos visíveis para a organização bem como para os seus elementos individualmente.

Työterveyshuolto ikääntyvän työntekijän työkyvyn tukijana

Tutkimuksen tarkoituksena oli kuvata, miten työterveyshuolto tukee nykyisellä toiminnallaan ikääntyvien (45–54-vuotiaat) työntekijöiden työkykyä ja mitä työkyvyn tukemiseen liittyviä odotuksia ikääntyvillä työntekijöillä on työterveyshuollolle. Tutkimuskysymykset olivat ”Miten ikääntyvän työntekijän mielestä työterveyshuolto tukee ikääntyvän työntekijän työkykyä?” ja ”Millaista tukea työkyvyn ylläpitämiseksi ikääntyvät työntekijät odottavat työterveyshuollolta?”. Tutkimuksen kohderyhmänä olivat pääkaupunkiseudulla toimivan yksityisen lääkäriasemaketjun yli 10 hengen asiakasyritysten ikääntyvät työntekijät, jotka tekevät toimistotyöhön rinnastettavaa työtä. Tutkimusaineisto kerättiin sähköisellä kyselyllä kesäkuussa 2011. Tutkimukseen osallistui 21 yritystä, joissa oli ikääntyviä työntekijöitä yhteensä 422. Kyselyyn vastasi 93 työntekijää. Vastausprosentti oli 22. Aineisto analysoitiin tilastollisilla menetelmillä ja avoimien vastausten tuottama aineisto induktiivisella sisällön analyysillä. Työntekijöistä kaksi kolmasosaa oli samaa mieltä siitä, että työterveyshuollon palvelut yleisesti ottaen tukevat ikääntyvän työntekijän työkykyä. Kuitenkin työntekijöistä vain hieman yli yksi viidesosaa oli samaa mieltä siitä, että työterveyshuollon toimintatavat ikääntyvän työntekijän työkyvyn tukemiseksi ovat riittävät. Syitä sille, miksi työterveyshuollon toimintaa ei pidetty työkykyä tukevana, olivat riittämätön aktiivisuus ja seuranta, asiakasorganisaation tuntemuksen puute ja näkemys siitä, että työterveyshuollon vaikutusmahdollisuudet yrityksen sisäisissä asioissa ovat riittämättömät. Työterveyshuollon arvioitiin tukevan enemmän fyysistä kuin psyykkistä työkykyä. Työterveyshuollon eri toimintojen osa-alueista ikääntyvät työntekijät arvioivat työterveyshuollon ohjaus- ja neuvontatoiminnan ja sairaanhoidon tukevan eniten työkykyään. Työterveyshuollon yleisen toiminnan arvioitiin tukevan työkykyä toiseksi eniten. Jaksamisessa ja muutoksissa tukeminen ja kuntoutustoiminta arvioitiin työkykyä vähiten tukevaksi toiminnaksi. Työntekijät odottivat työterveyshuollon toiminnalta aktiivisuutta, toiminnan ja seurannan säännöllisyyttä ja yksilöllisyyden huomioimista. Keskeisinä osaalueina, joihin työterveyshuollon tulisi panostaa, pidettiin psyykkisen jaksamisen, terveellisten elämäntapojen ja fyysisen jaksamisen tukemista sekä terveystarkastuksia ja ryhmätoimintaa. Tutkimuksen tuloksia voidaan hyödyntää suunniteltaessa ja toteutettaessa työterveyshuollon ennaltaehkäisevää ikääntyville suunnattua pysyvän työkyvyn tukemiseen tähtäävää toimintaa. Tulokset auttavat suuntaamaan työterveyshuollon resurssit ja voimavarat oikeisiin kohteisiin.

Terceirização de serviços públicos e reforma gerencial: o caso Secretaria da Fazenda de Pernambuco

A terceirização de serviços é considerada uma ferramenta de gestão em tempos atuais. Essa modalidade de contratação de serviços se expande em qualquer das esferas pública ou privada. Nesta última, a globalização da economia e a competição desenfreada pelo mundo impulsionam a produtividade e a otimização das etapas da produção substituindo custo fixo por variável. Na esfera pública, a partir da década de 1970, a crise fiscal prevaleceu na maioria das discussões, sugerindo a idéia neoliberal de limitar a intervenção do Estado na economia para conter o déficit público. Emerge a solução reformista de isolar num pequeno núcleo as atividades principais, que são exclusivas do Estado e intransferíveis a terceiros. Por meio da desestatização, um dos eixos da reforma, os serviços sociais são publicizáveis e a produção de bens e de serviços públicos entregues ao mercado. O foco deste trabalho se concentra na apuração do resultado que subsidie estrategicamente a Secretaria da Fazenda do Estado de Pernambuco, em termos financeiros e de eficiência administrativa, a escolher a opção mais vantajosa para a Administração entre contratar servidores efetivos via concurso público para realizar as atividades acessórias de apoio ou terceirizar os serviços.

Análise estatística de parâmetros elétricos em usinas sucroalcoleiras do centro-oeste paulista

The industry of sugar cane has become an important contributor to the generation of electricity in Brazil. Currently there are 434 sugar and ethanol plants operating in the country, 23% of the total export electricity to the National Integrated System (SIN), the state of São Paulo has 182 plants and 30% of them export energy to the SIN. The objective of this study is to compare parameters of electrical efficiency in the sugar and alcohol industry. For the study, three plants localized in the midwest region of Sao Paulo state with great potential for production and exporting bioenergy were chosen. Five energy analyzers LANDYS + GYR SAGA were used for measure the electrical parameters. The variables studied were energy consumption (C) and power factor (PF). For the statistical analysis it was adopteda randomized block design in a factorial 3 5composed of three companies and five sectors of energy consumption,in which: reception(1), milling (2), boiler (3), supporting activities / juice treatment (4), and distillation (5), totaling 15 treatments. Each group comprised 192 repetitions (48 hours 4 measurements per hour). It was concluded that there is no interest for the plans to fix the FP and reach a value 0.92, which is considered the ideal power factor.This,because the plants generate their own energy and are not penalized. Regarding the energy consumed, all sectors had significant differences. When comparingsector to sector, the plant called USB showed no significant differences in sectors 1 and 3, and the plant USC, in sectors 1 and 4. Considering the production units of this sector and selling power this type of evaluation is essential to perform this analysis, since the analyzed sectors are most important in the production of sugar and ethanol, and analyze and monitor these parameters, use and consumption energy can provide a greater supply of energy to be commercialized.

Modulation of human CYP19A1 activity by mutant NADPH P450 oxidoreductase

Mutations in NADPH P450 oxidoreductase (POR) cause a broad spectrum of human disease with abnormalities in steroidogenesis. We have studied the impact of P450 reductase mutations on the activity of CYP19A1. POR supported CYP19A1 activity with a calculated Km of 126 nm for androstenedione and a Vmax of 1.7 pmol/min. Mutations R457H and V492E located in the FAD domain of POR that disrupt electron transfer caused a complete loss of CYP19A1 activity. The A287P mutation of POR decreased the activities of CYP17A1 by 60-80% but had normal CYP19A1 activity. Molecular modeling and protein docking studies suggested that A287P is involved in the interaction of POR:CYP17A1 but not in the POR:CYP19A1 interaction. Mutations C569Y and V608F in the NADPH binding domain of POR had 49 and 28% of activity of CYP19A1 compared with normal reductase and were more sensitive to the amount of NADPH available for supporting CYP19A1 activity. Substitution of NADH for NADPH had a higher impact on C569Y and V608F mutants of POR. Similar effects were obtained at low/high (5.5/8.5) pH, but using octanol to limit the flux of electrons from POR to CYP19A1 inhibited activity supported by all variants. High molar ratios of KCl also reduced the CYP19A1 supporting activities of C569Y and V608F mutants of POR to a greater extent compared to normal POR and A287P mutant. Because POR supports many P450s involved in steroidogenesis, bone formation, and drug metabolism, variations in the effects of POR mutations on specific enzyme activities may explain the broad clinical spectrum of POR deficiency.

Towards developing a customer relationship management (CRM) strategy for supporting pre-implementation activities in business

Effectively preparing and planning for Customer Relationship Management (CRM) strategy is critical to CRM implementation success. A lack of a common and systematic way to implement CRM means that focus must be placed on the pre-implementation stage to ensure chance of success. Although existing CRM implementation approaches evidence the need to concentrate mostly on the pre-implementation stage, they fail to address some key issues, which raises the need for a generic framework that address CRM strategy analysis. This paper proposes a framework to support effective CRM pre-implementation strategy development.

Federal programs supporting multicounty substate regional activities : an overview /

Cover title.

Future contributions of crop modelling - from heuristics and supporting decision making to understanding genetic regulation and aiding crop improvement

Crop modelling has evolved over the last 30 or so years in concert with advances in crop physiology, crop ecology and computing technology. Having reached a respectable degree of acceptance, it is appropriate to review briefly the course of developments in crop modelling and to project what might be major contributions of crop modelling in the future. Two major opportunities are envisioned for increased modelling activity in the future. One opportunity is in a continuing central, heuristic role to support scientific investigation, to facilitate decision making by crop managers, and to aid in education. Heuristic activities will also extend to the broader system-level issues of environmental and ecological aspects of crop production. The second opportunity is projected as a prime contributor in understanding and advancing the genetic regulation of plant performance and plant improvement. Physiological dissection and modelling of traits provides an avenue by which crop modelling could contribute to enhancing integration of molecular genetic technologies in crop improvement. Crown Copyright (C) 2002 Published by Elsevier Science B.V. All rights reserved.

Supporting leadership development by exposure to role models: two case studies

The idiomatic expression “In Rome be a Roman” can be applied to leadership training and development as well. Leaders who can act as role models inspire other future leaders in their behaviour, attitudes and ways of thinking. Based on two examples of current leaders in the fields of Politics and Public Administration, I support the idea that exposure to role models during their training was decisive for their career paths and current activities as prominent characters in their profession. Issues such as how students should be prepared for community or national leadership as well as cross-cultural engagement are raised here. The hypothesis of transculturalism and cross-cultural commitment as a factor of leadership is presented. Based on current literature on Leadership as well as the presented case studies, I expect to raise a debate focusing on strategies for improving leaders’ training in their cross-cultural awareness.

Supporting learning through tagging systems

With the advent of Web 2.0, new kinds of tools became available, which are not seen as novel anymore but are widely used. For instance, according to Eurostat data, in 2010 32% of individuals aged 16 to 74 used the Internet to post messages to social media sites or instant messaging tools, ranging from 17% in Romania to 46% in Sweden (Eurostat, 2012). Web 2.0 applications have been used in technology-enhanced learning environments. Learning 2.0 is a concept that has been used to describe the use of social media for learning. Many Learning 2.0 initiatives have been launched by educational and training institutions in Europe. Web 2.0 applications have also been used for informal learning. Web 2.0 tools can be used in classrooms, virtual or not, not only to engage students but also to support collaborative activities. Many of these tools allow users to use tags to organize resources and facilitate their retrieval at a later date or time. The aim of this chapter is to describe how tagging has been used in systems that support formal or informal learning and to summarize the functionalities that are common to these systems. In addition, common and unusual tagging applications that have been used in some Learning Objects Repositories are analysed.

Autonomic workflow activities: the award framework

Workflows have been successfully applied to express the decomposition of complex scientific applications. This has motivated many initiatives that have been developing scientific workflow tools. However the existing tools still lack adequate support to important aspects namely, decoupling the enactment engine from workflow tasks specification, decentralizing the control of workflow activities, and allowing their tasks to run autonomous in distributed infrastructures, for instance on Clouds. Furthermore many workflow tools only support the execution of Direct Acyclic Graphs (DAG) without the concept of iterations, where activities are executed millions of iterations during long periods of time and supporting dynamic workflow reconfigurations after certain iteration. We present the AWARD (Autonomic Workflow Activities Reconfigurable and Dynamic) model of computation, based on the Process Networks model, where the workflow activities (AWA) are autonomic processes with independent control that can run in parallel on distributed infrastructures, e. g. on Clouds. Each AWA executes a Task developed as a Java class that implements a generic interface allowing end-users to code their applications without concerns for low-level details. The data-driven coordination of AWA interactions is based on a shared tuple space that also enables support to dynamic workflow reconfiguration and monitoring of the execution of workflows. We describe how AWARD supports dynamic reconfiguration and discuss typical workflow reconfiguration scenarios. For evaluation we describe experimental results of AWARD workflow executions in several application scenarios, mapped to a small dedicated cluster and the Amazon (Elastic Computing EC2) Cloud.

Autonomic Activities in the Execution of Scientific Workflows: Evaluation of the AWARD Framework

Workflows have been successfully applied to express the decomposition of complex scientific applications. However the existing tools still lack adequate support to important aspects namely, decoupling the enactment engine from tasks specification, decentralizing the control of workflow activities allowing their tasks to run in distributed infrastructures, and supporting dynamic workflow reconfigurations. We present the AWARD (Autonomic Workflow Activities Reconfigurable and Dynamic) model of computation, based on Process Networks, where the workflow activities (AWA) are autonomic processes with independent control that can run in parallel on distributed infrastructures. Each AWA executes a task developed as a Java class with a generic interface allowing end-users to code their applications without low-level details. The data-driven coordination of AWA interactions is based on a shared tuple space that also enables dynamic workflow reconfiguration. For evaluation we describe experimental results of AWARD workflow executions in several application scenarios, mapped to the Amazon (Elastic Computing EC2) Cloud.

Epidemiological pattern of leprosy in an endemic area of North-East Brazil, 1996-2005: the supporting role of a Nongovernmental Organization

In an endemic area of North-East Brazil (the town of Picos, State of Piauí), a nongovernmental organization (NGO) supported the activity against leprosy in connection with governmental health organizations and local agents. The indicators of leprosy elimination were compared over time (within Picos) and across space (Picos versus Piauí). The case detection rate, above 8 per 10,000 people in the last two years of observation, increased over time in Picos (p=0.010). This finding could be due to active detection activities rather than expanding endemicity, as suggested by the reduction in leprosy in children (p=0.053) and the decrease in the proportion of new cases with grade 2 disability (p<0.001). These indicators showed a more favorable time trend in the city than in the State, suggesting that NGO activity was supportive in the battle towards leprosy control.