Uma contribuição à análise dos fatores de determinantes da remuneração dos serviços médicos de uma operadora de planos de saúde: o caso da Unimed de Londrina

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de ProduçãoDiferentemente das demais empresas mercantis, que buscam no lucro a forma de remunerar o capital investido pelos sócios, as cooperativas médicas têm por objetivo principal viabilizar o exercício da profissão, garantindo justa remuneração aos cooperados. Este tem sido o grande desafio ao longo dos 30 trinta anos de existência da Unimed de Londrina/PR. Assim como o lucro para o investidor é motivo de satisfação, também para o cooperado uma remuneração que atenda suas expectativas proporcionará igual satisfação. Surge então a questão de qual seria a expectativa do cooperado quanto à remuneração, situada no mesmo nível dos serviços prestados a particulares ou em cumprimento total da Lista de Procedimentos da Associação Médica Brasileira de 1996. A Lei 9656/98, através da Agência Nacional de Saúde Suplementar - ANS, organizou e disciplinou o segmento de planos de saúde, proporcionando aos clientes maior segurança e tranqüilidade quando da utilização dos benefícios contratados. A padronização da assistência médica privada exigiu a readequação das empresas do setor. Assim, o trabalho procura desenvolver um modelo de remuneração dos serviços médicos visando assegurar o equilíbrio financeiro da operadora de planos de saúde Unimed de Londrina/Pr, inserida num sistema cooperativo, buscando satisfazer seus cooperados e clientes. Tomando como referência a importância do cooperativismo médico na garantia da qualidade dos serviços prestados, o trabalho pautou-se em uma pesquisa realizada junto a quarenta e nove cooperados líderes de comitês eleitos por cada especialidade, cujas respostas serviram de parâmetros para a elaboração de uma proposta de política de remuneração condizente com os anseios da população-alvo. O modelo proposto privilegia o ato médico puro e estabelece, entre os ajustes, percentuais fixos de deságios aplicados sobre os valores estipulados como custo dos exames na Lista de Procedimentos da Associação Médica Brasileira editada em 1996, proporcionando um divisor claro que permita a valorização do serviço médico profissional em detrimento ao custo do exame realizado com uso de máquina. Acredita-se que o modelo ainda precisa ser aperfeiçoado, porém se propõe a proceder de maneira mais justa a distribuição de recursos, diferenciando o ato médico artesanal daquele pautado na realização de exames com uso de máquinas. Os resultados da proposição do novo modelo de remuneração objetivam o resgate e a valorização da inestimável figura humana do médico na relação com o paciente

As estruturas do crime de lavagem de dinheiro e os aspectos processuais sob uma ótica constitucional

O presente trabalho visa à exposição da temática do Crime de Lavagem de Dinheiro, que também é conhecido como “branqueamento de capitais”, a partir de alguns momentos de seu tipo penal histórico. Pretendeu-se analisar o tipo penal em si, discorrendo sobre sua caracterização e fases, seu posicionamento hierárquico como legislação especial, abordando a problemática de qual seria o bem jurídico tutelado pela lei do tipo penal, demonstrando também as etapas da lavagem de dinheiro, e a ligação intrínseca que o papel da lavagem de dinheiro desempenha nas organizações criminosas atuais. Em face das tremendas inovações dos setores financeiros da sociedade, pretendeu-se a demonstração das competências dos órgãos estatais de combate à lavagem de dinheiro, bem como propôs-se a caracterização de algumas questões processuais penais de alta relevância no tocante ao que a lei, oriunda da política criminal define no procedimento especial a lavagem de dinheiro, aspectos como a inversão do ônus da prova, medidas cautelares, colaboração premiada e sua relação quando confrontados aos direitos constitucionais consagrados de cada indivíduo. Diante deste tratamento especial da lei da lavagem de dinheiro demonstrou-se o impacto que a Lei n. 12.683 de julho de 2012, teve em relação a supressão do rol taxativo de crimes antecedentes, e a posição crítica doutrinária acerca da inserção do dispositivo legislativo

Evolution of the temporal structure of world high competition judo combat (2013 a 2017)

[EN] Judo is a sport that is constantly evolving. Rule modifications and changes in tactical strategies have enhanced scoring opportunities and reduced penalties. This study analyzed the evolution of the temporal structure of combat through an assessment of the total match time (TMT), time engaged in combat (CT), time without (TWOG) and with grip (TWG), pause time (PT), the percentage of combat time in tachi-waza and combat in ne-waza, and the frequency of combat/tactical/technical actions/tasks. Data were descriptively analyzed overtime during the 2013, 2014, 2015, and 2017 World Championships and the 2016 Olympic Games. Data from 3,084 male and female matches across weight and gender categories were collapsed and used to compare the TMT, CT, TWOG, TWG, PT, and frequency of tactical actions over time and by competition phase (i.e., qualifiers, quarterfinals, recaps, semi-finals, bronze and finals). There were several temporal changes that occurred due to the rules modifications. The TMT increased by 3.6% over the sampling period for all competition phases. Regarding the duration of combat activities, relative to TMT: 25% was spent in PT (M PT = 8.9 s); 36% (M TWG = 9.6 s) was spent in TWG; 25% (M = 7.3 s) was spent in TWOG; 15% was spent in ne-waza(M = 7.7 s per action). With the changes of the rules in 2017, there was a Golden Point Score increase of 25% in the total number of combat; in relation to the competition phase, there was a 50% increase in the total number of combat activities. There was also a 15% increase in the number of actions in the competition final phase. There was some variation of the time structure of the combat, namely in the total time of the fighting and Golden Point, as a consequence of the change of the Referee rule changes

Data analytics in the cloud with flexible MapReduced workflows

Data analytic applications are characterized by large data sets that are subject to a series of processing phases. Some of these phases are executed sequentially but others can be executed concurrently or in parallel on clusters, grids or clouds. The MapReduce programming model has been applied to process large data sets in cluster and cloud environments. For developing an application using MapReduce there is a need to install/configure/access specific frameworks such as Apache Hadoop or Elastic MapReduce in Amazon Cloud. It would be desirable to provide more flexibility in adjusting such configurations according to the application characteristics. Furthermore the composition of the multiple phases of a data analytic application requires the specification of all the phases and their orchestration. The original MapReduce model and environment lacks flexible support for such configuration and composition. Recognizing that scientific workflows have been successfully applied to modeling complex applications, this paper describes our experiments on implementing MapReduce as subworkflows in the AWARD framework (Autonomic Workflow Activities Reconfigurable and Dynamic). A text mining data analytic application is modeled as a complex workflow with multiple phases, where individual workflow nodes support MapReduce computations. As in typical MapReduce environments, the end user only needs to define the application algorithms for input data processing and for the map and reduce functions. In the paper we present experimental results when using the AWARD framework to execute MapReduce workflows deployed over multiple Amazon EC2 (Elastic Compute Cloud) instances

Automatic environmental quality assessment for mixed-land zones using lidar and intelligent techniques

Human impact on the natural environment is an evident global fact. Natural, industrial and touristic areas coexist in a more than delicate balance. In Andalusia, in the south of Spain, the Regional Ministry for the Environment is responsible for the control and preservation of natural resources. This task bears a high cost in time and money. Remote sensing and the use of intelligent techniques are excellent tools to reduce such costs. This work explores the joint use of the lidar sensor, which provides a great quantity of information describing three dimensional space, and the application of intelligent techniques for rapid and efficient land use and land cover classification with the objective of differentiating urban land from natural ground close to protected areas of Huelva province. For this, seven types of land use and land cover have been studied for a riparian area next to the mouth of the rivers Tinto and Odiel, extracting 33 distinct features from the lidar point cloud. Subsequently, a supervised learning algorithm is applied to construct a model which, with a resolution of 4 m2, obtained relative precision between 71% and 100%and an average total precision of 85%

Decision Trees on LIDAR to Classify Land Uses and Covers

The area of Huelva, in the South of Spain, is a well-known case of human pressure on the natural environment. In Huelva, National Parks, like Donana, and industrial and tourist zones coexist in difficult balance. The Regional Ministry of Andalusia is commissioned ˜ to assure the preservation of the natural resources in this part of Spain although its cost can be high in time and money. Remote sensing is a very suitable tool to carry out this task and automatic land use and cover detection can be a key factor to reduce costs. In addition, Light Detection and Ranging (LIDAR) has the advantage of being able to create elevation surfaces that are in 3D, while also having information on LIDAR intensity values. Many measures based on its intensity, density and its capacity for describing third dimension have been used previously with other purposes and outstanding results. In this paper, a new approach to identify land cover at high resolution is proposed selecting the most interesting attributes from a set of LIDAR measures. Our approach is based on data mining principles to take advantage on intelligent techniques (attribute selection and C4.5 algorithm decision tree) to classify quickly and efficiently without the need for manipulating multiespectral images. Seven types of land cover have been classified in a very interesting zone at the mouth of the River Tinto and Odiel with results of accuracy between 71% and 100%. An overall accuracy of 85% has been reached for a resolution of 4 m2

Sobre a Romanização do Algarve

info:eu-repo/semantics/publishedVersio

Experimental assessment of the performance and emissions of a spark-ignition engine using waste-derived biofuels as additives

The use of biofuels for spark ignition engines is proposed to diversify fuel sources and reduce fossil fuel consumption, optimize engine performance, and reduce pollutant emissions. Additionally, when these biofuels are produced from low-grade wastes, they constitute valorisation pathways for these otherwise unprofitable wastes. In this study, ethanol and pyrolysis biogasoline made from low-grade wastes were evaluated as additives for commercial gasoline (RON95, RON98) in tests performed in a spark ignition engine. Binary fuel mixtures of ethanol + gasoline or biogasoline + gasoline with biofuel incorporation of 2% (w/w) to 10% (w/w) were evaluated and compared with ternary fuel mixtures of ethanol + biogasoline + gasoline with biofuel incorporation rates from 1% (w/w) to 5% (w/w). The fuel mix performance was assessed by determination of torque and power, fuel consumption and efficiency, and emissions (HC, CO, and NOx). An electronic control unit (ECU) was used to regulate the air–fuel ratio/lambda and the ignition advance for maximum brake torque (MBT), wide-open throttle (WOT)), and two torque loads for different engine speeds representative of typical driving. The additive incorporation up to 10% often improved efficiency and lowered emissions such as CO and HC relative to both straight gasolines, but NOx increased with the addition of a blend.This work was supported by FCT-Fundação para a Ciência e Tecnologia within the R&D Units, MEtRICs Project Scope: UIDP/04077/2020. Joaquim da Costa was supported through a PhD Grant from Fundo de Desenvolvimento Capital Humano of the Government of Timor Leste

Genomic Analysis of Prophages from Klebsiella pneumoniae Clinical Isolates

Klebsiella pneumoniae is an increasing threat to public health and represents one of the most concerning pathogens involved in life-threatening infections. The resistant and virulence determinants are coded by mobile genetic elements which can easily spread between bacteria populations and co-evolve with its genomic host. In this study, we present the full genomic sequences, insertion sites and phylogenetic analysis of 150 prophages found in 40 K. pneumoniae clinical isolates obtained from an outbreak in a Portuguese hospital. All strains harbored at least one prophage and we identified 104 intact prophages (69.3%). The prophage size ranges from 29.7 to 50.6 kbp, coding between 32 and 78 putative genes. The prophage GC content is 51.2%, lower than the average GC content of 57.1% in K. pneumoniae. Complete prophages were classified into three families in the order Caudolovirales: Myoviridae (59.6%), Siphoviridae (38.5%) and Podoviridae (1.9%). In addition, an alignment and phylogenetic analysis revealed nine distinct clusters. Evidence of recombination was detected within the genome of some prophages but, in most cases, proteins involved in viral structure, transcription, replication and regulation (lysogenic/lysis) were maintained. These results support the knowledge that prophages are diverse and widely disseminated in K. pneumoniae genomes, contributing to the evolution of this species and conferring additional phenotypes. Moreover, we identified K. pneumoniae prophages in a set of endolysin genes, which were found to code for proteins with lysozyme activity, cleaving the β-1,4 linkages between N-acetylmuramic acid and N-acetyl-D-glucosamine residues in the peptidoglycan network and thus representing genes with the potential for lysin phage therapy.F.F.V. is funded by Fundação para a Ciência e a Tecnologia (FCT) through an Assistant Researcher grant CEECIND/03023/2017, and a project grant (PTDC/BTM-SAL/28978/2017) that supported this work. The work is partially supported by National funds from FCT, projects UIDB/04138/2020 and UIDP/04138/2020.info:eu-repo/semantics/publishedVersio