Obama's law : analysis of a breakthrough law on healthcare access and lessons for the Portuguese health system management

ABSTRACT - The Patient Protection and Affordable Care Act shook the foundations of the US health system, offering all Americans access to health care by changing the way the health insurance industry works. As President Obama signed the Act on 23 March 2010, he said that it stood for “the core principle that everybody should have some basic security when it comes to their health care”. Unlike the U.S., the Article 64 of the Portuguese Constitution provides, since 1976, the right to universal access to health care. However, facing a severe economic crisis, Portugal has, under the supervision of the Troika, a tight schedule to implement measures to improve the efficiency of the National Health Service. Both countries are therefore despite their different situation, in a conjuncture of reform and the use of new health management measures. The present work, using a qualitative research methodology examines the Affordable Care Act in order to describe its principles and enforcement mechanisms. In order to describe the reality in Portugal, the Portuguese health system and the measures imposed by Troika are also analyzed. The intention of this entire analysis is not only to disclose the innovative U.S. law, but to find some innovative measures that could serve health management in Portugal. Essentially we identified the Exchanges and Wellness Programs, described throughout this work, leaving also the idea of the possibility of using them in the Portuguese national health system.

Plant density in production of mini lettuce cultivars in organic system management

Production of mini vegetables in organic system is a good alternative to improve profit, but there are no researches about the optimum plant density for these cultivars in Brazilian conditions. Two experiments were conducted to evaluate the production of mini lettuce cultivars in different plant densities. Experiment 1 was conducted from January 1th (sowing) to February 10th (harvesting), 2012. The experimental design was completely randomized blocks, with six treatments in factorial scheme, 3 mini lettuce cultivars (Tudela, Renoir and Sartre) x 2 spacing between plants (16 and 20 cm), with eight replications and plots (2.04 m(2)) with six rows, spaced 15 cm. Experiment 2 was conducted from June 6th (sowing) to July 18th (harvesting), 2012. The cultivars Sartre and Renoir were evaluated under four plant densities (444,444; 333,333; 266,667 and 200,000 plants ha(-1), corresponding to spacing of 15x15, 15x20, 25x15 and 25x20 cm, respectively). Eight treatments were defined by a factorial scheme 2 (cultivars) x 4 (plant densities) and arranged in a completely randomized block design, with nine replications and plots with 2.04 m2. The evaluated characteristics in both experiments were total and marketable fresh weight per plant, plant dry weight, plant diameter and height, marketable yield and discard percentage. In first experiment, during the summer, cultivar Sartre showed the highest marketable fresh weight (72 g plant(-1)). Heaviest plants (91.6 g plant(-1)) were obtained with the higher plant spacing, but the highest yield (2.51 kg m(-2)) was obtained with the smaller spacing. In winter, plants with higher total (190 g plant(-1)) and marketable (146 g planta(-1)) fresh weight were obtained with cultivar Sartre, and the same was observed in low plant density. However, the higher plant density, the higher the yield.

NURSES AND THE ASSESSMENT IN HEALTH SYSTEM MANAGEMENT

The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.

Decarbonization of toll plazas: impact assessment of toll collection system management

Transport climate change impacts have become a worldwide concern. The use of Intelligent Transport Systems (ITS) could contribute to a more effective use of resources in toll road networks. Management of toll plazas is central to the reduction of greenhouse gas (GHG) emissions, as it is there that bottlenecks and congestion occur. This study focuses on management strategies aimed at reducing climate change impacts of toll plazas by managing toll collection systems. These strategies are based on the use of different collection system technologies – Electronic Toll Collection (ETC) and Open Road Tolling (ORT) – and on queue management. The carbon footprint of various toll plazas is determined by a proposed integrated methodology which estimates the carbon dioxide (CO2) emissions of the different operational stages at toll plazas (deceleration, service time, acceleration, and queuing) for the different toll collection systems. To validate the methodology, two main-line toll plazas of a Spanish toll highway were evaluated. The findings reveal that the application of new technologies to toll collection systems is an effective management strategy from an environmental point of view. The case studies revealed that ORT systems lead to savings of up to 70% of CO2 emissions at toll plazas, while ETC systems save 20% comparing to the manual ones. Furthermore, queue management can offer a 16% emissions savings when queue time is reduced by 116 seconds. The integrated methodology provides an efficient environmental management tool for toll plazas. The use of new technologies is the future of the decarbonization of toll plazas.

Manual for police traffic services personnel performance evaluation system. Management and implementation. Volume I.

Mode of access: Internet.

Transportation system management: promise, performance and prognosis. Summary final report.

Transportation Department, Research and Special Programs Administration, Washington, D.C.

Transportation system management element of the Rhode Island ground transportation plan /

Vol. 2 has title: Appendix 1, Profiles of routes, Rhode Island Public Transit Authority.

Transportation system management, air quality, and energy conservation /

Mode of access: Internet.

The Approach to Development the Human Resources Intellectual Management System. Management Procedures

The Article suggests an approach to designing the Human Resources Intellectual Management System in order to increase Human Resources reliability, using the management methods known from the Theory of Management.. The Article examines the realization of the Subsystem of implementing management methods by the number of management procedures, executing the corresponding management method.

Review of virtual power plant applications for the power system management and V2G market development

Utilization of renewable energy sources and energy storage systems is increasing with fostering new policies on energy industries. However, the increase of distributed generation hinders the reliability of power systems. In order to stabilize them, a virtual power plant emerges as a novel power grid management system. The VPP has a role to make a participation of different distributed energy resources and energy storage systems. This paper defines core technology of the VPP which are demand response and ancillary service concerning about Korea, America and Europe cases. It also suggests application solutions of the VPP to V2G market for restructuring national power industries in Korea.

Dynamics and diversity of Escherichia coli in animals and system management of the manure on a commercial farrow-to-finish pig farm

The objective of this study was to determine the dynamics and diversity of Escherichia coli populations in animal and environmental lines of a commercial farrow-to-finish pig farm in Spain along a full production cycle (July 2008 to July 2009), with special attention to antimicrobial resistance and the presence of integrons. In the animal line, a total of 256 isolates were collected from pregnant sows (10 samples and 20 isolates), 1-week-old piglets (20 samples and 40 isolates), unweaned piglets (20 samples and 38 isolates), growers (20 samples and 40 isolates), and the finishers' floor pen (6 samples and 118 isolates); from the underfloor pits and farm slurry tank environmental lines, 100 and 119 isolates, respectively, were collected. Our results showed that E. coli populations in the pig fecal microbiota and in the farm environment are highly dynamic and show high levels of diversity. These issues have been proven through DNA-based typing data (repetitive extragenic palindromic PCR [REP-PCR]) and phenotypic typing data (antimicrobial resistance profile comprising 19 antimicrobials). Clustering of the sampling groups based on their REP-PCR typing results showed that the spatial features (the line) had a stronger weight than the temporal features (sampling week) for the clustering of E. coli populations; this weight was less significant when clustering was performed based on resistotypes. Among animals, finishers harbored an E. coli population different from those of the remaining animal populations studied, considering REP-PCR fingerprints and resistotypes. This population, the most important from a public health perspective, demonstrated the lowest levels of antimicrobial resistance and integron presence.

Modeling the vulnerability of an urban groundwater system due to the combined impacts of climate change and management scenarios

Climate change impact on a groundwater-dependent small urban town has been investigated in the semiarid hard rock aquifer in southern India. A distributed groundwater model was used to simulate the groundwater levels in the study region for the projected future rainfall (2012-32) obtained from a general circulation model (GCM) to estimate the impacts of climate change and management practices on groundwater system. Management practices were based on the human-induced changes on the urban infrastructure such as reduced recharge from the lakes, reduced recharge from water and wastewater utility due to an operational and functioning underground drainage system, and additional water extracted by the water utility for domestic purposes. An assessment of impacts on the groundwater levels was carried out by calibrating a groundwater model using comprehensive data gathered during the period 2008-11 and then simulating the future groundwater level changes using rainfall from six GCMs Institute of Numerical Mathematics Coupled Model, version 3.0 (INM-CM. 3.0); L'Institut Pierre-Simon Laplace Coupled Model, version 4 (IPSL-CM4); Model for Interdisciplinary Research on Climate, version 3.2 (MIROC3.2); ECHAM and the global Hamburg Ocean Primitive Equation (ECHO-G); Hadley Centre Coupled Model, version 3 (HadCM3); and Hadley Centre Global Environment Model, version 1 (HadGEM1)] that were found to show good correlation to the historical rainfall in the study area. The model results for the present condition indicate that the annual average discharge (sum of pumping and natural groundwater outflow) was marginally or moderately higher at various locations than the recharge and further the recharge is aided from the recharge from the lakes. Model simulations showed that groundwater levels were vulnerable to the GCM rainfall and a scenario of moderate reduction in recharge from lakes. Hence, it is important to sustain the induced recharge from lakes by ensuring that sufficient runoff water flows to these lakes.

Implementing an Integrated Management System (IMS) at an Aerospace Manufacturing Facility

This project analyzes the challenges, issues, benefits, and lessons learned that several companies experienced while implementing integrated management systems. Based on previous experiences, this paper defines several strategies that an organization should use to increase the probability of implementing an integrated management system (IMS) successfully. Strategies include completing a feasibility analysis, creating a policy, allocating resources, developing objectives, modifying documentation, and creating a continuous monitoring process. Moreover, an organization can reduce potential obstacles by promoting a culture that encourages management commitment and employee participation. Results indicate the implementation of an IMS provides the framework to manage environmental, health, and safety programs effectively. By implementing an IMS, an organization can save time and money, as well as proactively control risk.