Nos locais onde a implantação do SUS avançou para a formação de redes de atenção, os hospitais foram impulsionados à plena integração às redes municipais, o que impôs modificações conceituais e operacionais nos modelos de gerenciamento. O hospital do estudo, adotou, recentemente, um modelo gerencial baseado em “linhas de cuidado”, cujo objetivo geral é a descentralização da gestão, através da construção de Unidades Funcionais (UF). A proposta de descentralização e a adoção de uma lógica de organização do trabalho, mais por “equipe” do que por “profissão”, ancoram esse novo modelo, cuja operacionalização local provocou o desmantelamento do Serviço e a desarticulação/desmobilização dos trabalhadores de enfermagem. O presente estudo teve, como objetivo geral: construir as mudanças que deveriam ser implementadas na organização do trabalho em Enfermagem, tendo em vista o novo modelo de gestão adotado pelo hospital. Os objetivos específicos foram: Reconstruir os determinantes históricos implicados na instituição do modelo gerencial de enfermagem; identificar o contexto atual deste modelo, o seu significado e as possibilidades futuras; articular as estratégias de enfrentamento dessa problemática, no que se refere aos saberes e poderes e elaborar proposta e estratégias para a sua reconstrução. Esta pesquisa é do tipo estudo de caso e de abordagem qualitativa, fundamentada no referencial histórico e social. Teve como cenário, o HC/UFPR e a população foram os trabalhadores de enfermagem, que somam, aproximadamente, 1200 funcionários. Para a coleta de dados, utilizou-se a técnica de grupo focal. O grupo foi composto por 12 sujeitos, sendo 8 enfermeiras, 2 técnicas e 2 auxiliares de Enfermagem, que aceitaram voluntariamente participar da pesquisa. As falas foram transcritas e categorizadas, usando-se a técnica de análise de conteúdo, na modalidade da análise temática. Como resultado, foi possível apreender 3 categorias empíricas: os determinantes históricos implicados na instituição do modelo gerencial de enfermagem; o contexto atual deste modelo, o seu significado e as possibilidades futuras e as estratégias de enfrentamento, no que se refere aos saberes e poderes. No que concerne aos determinantes históricos, ressalta-se: o estranhamento das enfermeiras com o cenário externo e interno, o “desmanche intencional” da Enfermagem no hospital; a constituição histórica do trabalho da Enfermagem e sua posição dentro da organização, e a percepção de que as enfermeiras que assumiram cargos de confiança no novo modelo se comportam mais como gerentes do que como enfermeiras-gerentes. Na categoria que identifica a situação atual, seu significado e as possibilidades futuras, foi possível extrair a crise de identidade causada pela perda da Direção de Enfermagem, e os dois aspectos que se perceberam mais afetados: o cuidado e o poder. Na categoria estratégias de enfrentamento, foi possível apreender que as opções estratégicas para fazer o enfrentamento incluem: agregar forças, encontrar uma liderança, legitimá-la e construir um projeto próprio. Em síntese, o estudo mostra um ambiente em processo de mutação, os fatos que justificam a mudança e as contradições entre os pressupostos teóricos do modelo e sua operacionalização. Na perspectiva do gerenciamento que institui o novo, foram feitas propostas para o desenvolvimento da Enfermagem do HC/UFPR, considerando os conhecimentos e as estratégias necessárias à conquista de competências que poderão impactar em resultados nas dimensões técnica, política, comunicativa e de desenvolvimento da cidadania. Neste sentido , os maiores desafios para a Enfermagem serão: construir uma nova identidade, realizar o trabalho em equipe mantendo a unidade e a identidade profissional, adquirir visibilidade na instituição, mudar o cuidado e ampliar a gerência. Para tanto, as enfermeiras precisam superar a formação tradicional e investir na formação inovadora. A seu favor, contam com a experiência e o conhecimento adquiridos ao longo de muitos anos, que as qualificam a fazer, se assim o desejarem, uma mudança bem sucedida / Wherever the National Health System was implemented as a caring network hospitals were pushed towards a full integration into municipal health networks, something which demanded conceptual and operational changes in managerial models. The hospital in the study has recently adopted a managerial model which follow “caring guidelines ” whose general goal is management decentralization by building Functional Units (FU). The proposed decentralization process and the adoption of its new logic in work organization is centered on the “team” rather than on the “occupation”. However, its local implementation has caused service failure and motivated breakdown and takeover by nursing professionals. The present study aimed at finding out what changes should be implemented in the professional nursing organization according to the current managerial model adopted by the hospital. Specific goals were as follows: to rebuild the historical background underlying the implementation of the managerial nursing model; to identify the current context of such a model, its meaning as well as future outlook; to think up strategies to cope with this problem concerning knowledge and competency and to work out a new proposal and strategies to rebuild this system. This research is a case study. Our qualitative analysis takes into account historical and social backgrounds. The setting was Hospital das Clinicas at the Federal University of the state of Paraná, Brazil. Our participants were chosen from the nursing staff of the hospital, which totals 1200 nursing professionals. We used a Focus Group technique to collect data. The group was comprised of 12 subjects: 2 nurses, 2 nursing technicians and 2 nursing assistants who had volunteered for the research. The accounts were transcribed and classified according to a content analysis within a theme analysis approach. Three (3) empirical categories were created: the historical background underlying the implementation of the managerial nursing model; the current context of such a model, its meaning and future outlook as well as the coping strategies concerning knowledge and competency. Concerning the historical background, we can highlight the following elements: the nursing professionals’ uneasiness towards the inner and outer scenarios, the intentional breakdown of nursing services at the hospital; the historical organization of nursing and its position in the institution; and the impression that nurses holding trustworthy positions in the new managerial model acted more like managers rather than nursing managers. In our analysis of the present situation, its meaning and future outlook, it was possible to discern the identity crisis brought about by the elimination of the Nursing Director position, and two aspects of the service which were most affected: care and power. In our analysis of the coping strategies, it was possible to identify the following strategic coping options used by the nursing staff: the joining of forces, the identification and legitimation of leadership, and the building of a project of their own. In short, the study discloses a changing environment and the facts supporting its change as well as the contradictions between the theoretical assumptions of the new model and its operationalization. As for the new managerial perspective, proposals were elaborated aiming at improving nursing service at Hospital das Clinicas at the Federal University of the state of Paraná, Brazil, keeping in mind the knowledge and the related strategies to reach the competency that may bring about positive results to technical, political, and communicative development in the exercise of citizenship. Thus, the hardest challenges for nursing will be: building up a new identity, carrying out team work - while keeping professional unit and identity- improving their visibility in the institution, changing care and extending management. Therefore, nurses need to do away with the traditional model and invest in an innovative model. Long-term gathered experience and knowledge favor them in order to foster, if they wish, a successful change

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

Os Laboratórios de Investigação Médica (LIM) do HCFMUSP foram criados com a publicação do Decreto n. 9.720, de 20 de abril de 1977, que oficializou o Regulamento do Hospital das Clínicas da FMUSP (HCFMUSP). Por esse instrumento, os LIM se apresentam como uma das unidades do HCFMUSP, ao qual se vinculam administrativamente. Pelo mesmo instrumento, vinculam-se academicamente à Faculdade de Medicina da USP (FMUSP). Esse conjunto de laboratórios desenvolve pesquisa básica e aplicada nos diversos campos das ciências da saúde, além de métodos diagnósticos. Até a implantação da Reforma Universitária, em 1968, as atividades de pesquisa básica transcorriam nos departamentos básicos da FMUSP, articuladas com os departamentos aplicados, que se estabeleceram no HCFMUSP desde sua criação, em 1943, resultando no avanço da assistência médica prestada aos pacientes. Os departamentos básicos, com seus laboratórios e salas de aula, ocupavam quase todo o edifício sede. Com a aplicação das medidas da Reforma Universitária e presentes no Estatuto da USP, esses departamentos foram transferidos para o campus da Cidade Universitária, onde nuclearam, sobretudo, o Instituto de Ciências Biomédicas (ICB). Decorreu da Reforma importante ruptura na produção de conhecimentos na FMUSP, além do arriscado esvaziamento do prédio. O objetivo desta dissertação é reconstituir, pela perspectiva histórica, a trajetória institucional percorrida para sanar as perdas sofridas pela FMUSP e pelo HC e que culminaram com a criação dos LIM no período compreendido entre a implantação da Reforma Universitária até sua efetiva incorporação à estrutura do HCFMUSP, em 1977. O percurso da criação dos LIM foi reconstituído pelo diálogo entre os vestígios encontrados na documentação institucional e as memórias de atores institucionais que viveram esse período, apoiado pela historiografia acerca do ensino e das práticas médicas da FMUSP e do HCFMUSP / The Medical Investigation Laboratories (LIMs) of the University of São Paulo Medical School Clinics Hospital (HCFMUSP) were created with the passing of decree n. 9.720 of April 20, 1977, which formalized the latter\'s by-laws. As set by the decree, the LIMs are one of the units of HCFMUSP, to which they are administratively connected. The same instrument also establishes an academic link between the labs and the Medical School of the University (FMUSP). This set of labs conducts basic and applied research in the most diverse fields of health sciences, and develops diagnostic methods. Up until the 1968 University Reform in Brazil, basic research activity was conducted by the basic departments in conjunction with the applied departments of the Medical School - which existed at HCFMUSP since its foundation in 1943. This arrangement resulted in improvements in the medical care provided to patients. The basic departments, along with their labs and classrooms, occupied almost the entire headquarters building. With the enforcement of the measures defined by the University Reform - also present in the by-laws of the University of São Paulo - these departments were transferred to the main campus (Cidade Universitária) and mostly placed under the umbrella of the Institute of Biomedical Sciences (ICB). As a consequence of the Reform, there was a risky emptying of FMUSP\'s building, and a disruption in its knowledge production. The objective of the present dissertation is to reconstruct, from a historical perspective, the institutional path taken with the aim of overcoming the losses faced by the medical school and its hospital, which culminated in the creation of the LIMs in the period between the implementation of the University Reform and the laboratories\' actual incorporation into HCFMUSP\'s structure in 1977. The LIMs\' creation process was reconstructed based on a dialogue between the traces found in the institution\'s documents and the recollections of players who witnessed the process, with the support of historiography on FMUSP and HCFMUSP\'s medical and teaching practices

To determine how leading companies in North America, Europe, and Asia develop and sustain strong talent pipelines, this research investigates talent management processes and practices in a sample of 37 multinational corporations, selected on the basis of their international scope, reputation, and long-term performance. In-depth case studies and a Web-based survey of human resources professionals identify various effective practices that can help companies attract, select, develop, and retain talent. However, the results suggest that competitive advantage comes not primarily from designing and implementing best practices but rather from the proper internal alignment of various elements of a company's talent management system, as well as their embeddedness in the value system of the firm, their links to business strategy, and their global coordination.

This Master’s thesis is about personal management in a Small Company. First part of the thesis describes common requirements of personal management. Then it is followed by analysis of the present state of the company. Last part contains suggestions to develop personal management in the company, which should help to increase its effectiveness.

Although the topic is trending globally, clear steps forward for female leadership are yet to be made. This is impacted even more by the fact that little empirical research has been conducted to examine the attitudes towards females in managerial positions from different countries' point of view. Therefore, the aim of this research is to get an understanding of the current state of affairs of female leadership in a more global context, with input from both developed and developing countries. Specifically, it explores the similarities and differences of female leadership challenges in Afghanistan and The Netherlands. To explore challenges experienced by, as well as strategies of, Afghan and Dutch female leaders, a qualitative study was conducted. Ten semi-structured interviews were done in-person and through video calls, consisting of 5 interviews for each country. Ten participants, meeting the criteria of holding a leadership/management position, were chosen through convenience sampling. The results showed significant similarities and differences in female leadership challenges, as well as strategies.  The unfortunate entanglement of culture in Afghanistan, under Taliban rule, has resulted in the oppression of female leaders. In the Netherlands, female leadership progress appears idealized. Nevertheless, female leaders in both countries share similar strength and strategies to cope with challenges themselves because society seemingly fails to bring change. As the results also show leadership skills specific to female leaders, societies and organizations worldwide should spread awareness and take action in gender equality, unlocking the full potential of female leadership.

本研究旨在探討國民小學的公共關係、組織創新經營與學校效能之關係，以瞭解目前國內國民小學推動公共關係的情形，以及確認組織創新經營與學校效能之高低情形，以作為國民小學行政實務運作的參考，以達成學校校務革新與發展的目的。 本研究採用調查研究法，並根據研究目的，研究問題及文獻探討結果，編製「國民小學公共關係、創新經營與學校效能現況調查問卷」進行預試，並依據因素分析結果編製正式問卷進行調查研究。本研究以台灣地區公立國民小學的教師為母群體，依北、中、南、東四區以分層隨機抽樣方法進行抽取樣本，總計抽取1375 位國小教師，回收有效樣本1023人。問卷調查結果採用描述性統計、Pearson積差相關、t 檢定、單因子變異數、多元迴歸分析、結構方程模式等統計方法進行分析。 本研究之主要發現如下： 一、國民小學公共關係實際情況良好，並以「成果回饋」為最佳。 二、國民小學創新經營表現良好，並以「行政運作創新」為最佳。 三、國民小學學校效能實際情況良好，並以「溝通協調」最佳。 四、國民小學公共關係、創新經營與學校效能三者間具有正向的關聯。 五、國民小學公共關係及創新經營的分層面對學校效能有正向預測作用。 六、國民小學公共關係可透過組織創新經營，增強對學校效能的正向影響力。 依據以上之研究發現，本研究對教育行政機關、學校與未來研究分別提出以下建議： 一、對教育行政機關之建議： （一）應給予教職員工更多進修機會，鼓勵終身學習。 （二）提供具體策略，有效降低小型與大型學校辦學壓力。 （三）將公共關係與創新經營之課程納入培育課程中。 （四）訂定獎勵辦法推動學校行銷與創新。 二、對學校之建議： （一）加強教師參與，使所有成員共同參與校務推動。 （二）尊重資深教師之經驗及意見，善用人力資源。 （三）積極鼓勵教職員工進修以落實終身學習理念。 （四）提供與建置相關資源，鼓勵教師發揮創造力。 （五）都會區大型學校，應強化溝通機制，追求團隊合作。 三、對未來研究之建議： （一）研究對象方面，建議擴大研究群體。 （二）研究方法方面，建議兼採質性研究。 （三）研究變項方面，建議納入其他變項進行分析。 / The main purposes of this study are: (1) to understand the present condition of public relations, organization innovative management, and school effectiveness in the elementary schools; (2) to analyze the diversity of different background variables in public relations, organization innovative management, and school effectiveness in the elementary schools; (3) to discuss the relationships among the public relations, organization innovative management, and school effectiveness in the elementary schools; (4) to investigate the preditive analysis of public relations, organization innovative management, and school effectiveness in the elementary schools; (5) to conclude the path relationships among public relations, organization innovative management, and school effectiveness in the elementary schools. The present study applied literature analysis and questionnaire survey method. According to related literature, the theoretical foundation was constructed and “Elementary School Public Relations, Organization Innovative Management, and School Effectiveness Survey Questionnaire” was organized. 117 elementary schools were chosen randomly from north, central, south, and east regions in Taiwan. Totally there were 1023 elementary school teachers. Subjects’ viewpoints about elementary school public relations, organization innovative management, and school effectiveness were collected. The data were analyzed by descriptive statistics, one-way ANOVA, Pearson product-moment correlation, stepwise regression, and structural equation modeling. The findings of this research were as follows: 1. The perceptions from the elementary school teachers about public relations are positive. And “outcome feedback” is the highest. 2. The perceptions from the elementary school teachers about organization innovative management are positive. And “administration operation” is the highest. 3. The perceptions from the elementary school teachers about school effectiveness are positive. And “communication and coordination” is the highest. 4. There are significant relationships between school effectiveness and public relations as well as between school effectiveness and organization innovative management. 5. Public relations and organization innovative management can effectively predict school effectiveness. 6. The results from the structural equation model indicated that there is a positive indirect effect between public relations and school effectiveness when organization innovative management served as a mediator variable. Based upon the findings, some suggestions are addressed for educational administrators, elementary schools, and future researchers. 1. For educational administrators (1)Provide more opportunities of further education and encourage lifelong learning. (2)Administer effective and concrete strategies about lower stress in large and small school management. (3)Include public relations and innovative management among the curriculum of administrator preparation. (4)Prompt school marketing and innovation by reward. 2. For elementary schools (1)Amplify the scope of teacher participation in school management. (2)Respect senior teachers’ experiences and opinions by human resource management. (3)Encourage school members to participate in further education and achieve the vision of lifelong learning. (4)Provide correlative resources and encourage teachers to amplify creativity. (5)Reinforce communicative mechanism and pursuit team cooperation in large and urban schools. 3. For future researchers (1)The samples should be expanded. (2)Qualitative studies should be adopted to make more in-depth data. (3)More demographic variables and environmental variables should be added.

The content of this thesis is an analysis of crisis preparedness organizations in the field of education. It consists of a theoretical - methodological part and a practical part. The theoretical part discusses the specifics and peculiarities of crisis management, and analyzes the objectives and nature of crisis preparedness organizations of this type. The practical part presents the current research shows the strengths and weaknesses, as well as the threats and opportunities, which significantly limits the status and level of crisis preparedness of schools surveyed. The penultimate section focuses on the design methodology to ensure crisis preparedness in schools. Conclusion then summarizes and evaluates the investigation. For the sake of better illustration is the work of the Annex attached to the issue more closely.

A prática da reutilização de produtos médico-hospitalares de uso único vem sendo aplicada desde meados da década de setenta. A principal razão que tem contribuído para disseminação desta conduta pelas instituições hospitalares radicadas tanto nos países em desenvolvimento como naqueles considerados ricos, tem sido a aparente economia de custos. Apesar dos riscos relacionados com a prática da reutilização, como reações pirogênicas, danos ocasionados por bactérias consideradas patogênicas em pacientes imunologicamente comprometidos, danos na integridade fisica dos produtos, assim como aumento do período de permanência dos pacientes no hospital, têm despertado o interesse em avaliar aspectos fisicos e biológicos dos produtos médico-hospitalares reutilizados. Baseando-se nestas considerações foram aplicados desafios com esporos de Bacillus Subtilis varo niger ATCC 9372 e endotoxina bacteriana E. coli 055:B5. Os produtos desafiados foram cateteres intravenosos, torneira três vias e tubos de traqueostomia. A possível presença microbiana foi investigada após contaminação intencional dos esporos de B. Subtillis (107 ufc/unid.) com submissão das unidades contaminadas à limpeza e posterior esterilização, utilizando óxido de etileno/CFC na proporção 12:88. Os ciclos de reprocessamentos simulados de produtos médico-hospitalares consistiram de contaminação de cada unidade teste com carga microbiana, lavagem com detergente enzimático, secagem e esterilização. Ao término de cada ciclo de reprocessamento foram separadas unidades representativas para avaliação por contagem microbiana (pour plate), testes de esterilidade por inoculação direta e indireta, citotoxidade por cultura de células e microscopia eletrônica de varredura. A eficiência da esterilidade foi avaliada tanto por contagem microbiana como pelos testes de esterilidade, que resultaram em níveis microbianos de 103 ufc/unid. e detecção de contaminação até o 6° ciclo de reprocessamento nos cateteres intravenosos, tubos de traqueostomia e torneiras três vias. A segurança dos reprocessamentos dos produtos médico-hospitalares foi avaliada pela cultura de células de fibroblastos de camundongo (NCTC clone 929), as quais não apresentaram toxicidade. Entretanto, os resultados obtidos durante microscopia eletrônica de varredura comprovaram presença de carga microbiana após 10° ciclo de reprocessamento, assim como danos na superficie polimérica. Durante desafio com endotoxina bacteriana, que consistiu em contaminar as unidades com 200 UE, secagem e exposição ao ciclo de esterilização com óxido de etileno/CFC (12:88), verificou-se que após ciclos de reprocessamentos simulados, totalizando dez ciclos, foi possível detectar valores de recuperação de endotoxina em torno de 100%. Os cateteres-guia que foram adquiridos em instituição hospitalar após quatro reutilizações, apresentaram níveis de contaminação de 105 ufc/unid., assim como presença de bactérias consideradas patogênicas em pacientes comprometidos imunologicamente, já a detecção de endotoxina bacteriana nestes cateteres não foi considerada significativa. Logo, as avaliações aplicadas nas unidades submetidas aos ciclos de reprocessamentos simulados, assim como nos cateteres-guia reprocessados e reutilizados quatro vezes, refletiram a realidade de algumas instituições no âmbito nacional e internacional que praticam a reutilização de produtos médico-hospitalares de uso-único. Os resultados obtidos vêm enfatizar objeções quanto à prática da reutilização, considerando que a ausência de segurança pode ocasionar em danos ao paciente. / The practices of reutilization of single use hospital medical devices came into practice since mid seventies. The main reason that has contributed for dissemination of this practice by institutional hospitals in underdeveloped as well as those considered as rich countries has been the appellant economy of costs. Despite well known risks related with the practice of reutilization, such as pyrogenic reactions, damages caused by bacteria\'s considered pathogenic in patients immunologically compromised, damages to the physical integrity of the materials, as well as prolonged permanence of the patient in the hospital, has raised interests in the evaluation of physical and biological aspects of the reused medical device. Based on these considerations, challenges had been applied with spores of Bacillus Subtilis varo niger 9372 ATCC and bacterial endotoxin E. coli 055:B5. The selected materials includes, intravenous catheters, three-way stopcocks and traqueostomy tubes. The possible presence of bacteria was investigated after intentional contamination with spores of B. Subtillis (107 cfu/unit) followed by submission of the inoculated units to the cleaning process and posterior sterilization using ethylene oxide at 12:88. The simulated reprocessing cycles of the medical device had consisted of contamination of each test unit with predetermined microbial load, washing with enzymatic detergent, drying and sterilization. At the end of each reprocessing cycle, representative sarnples had been segregated to evaluate microbial count (pour plate), terility test through direct and indirect inoculation, cytotoxicity test through cell culture and scanning electron microscopy. The efficiency of the sterility was evaluated through microbial count, as for the sterility tests, that had resulted in microbial count of 103 cfu/unit and detection of contamination until the 6th cycle of reprocessing in the intravenous catheters, three-way stopcocks and traqueostomy tubes. The safety of these reprocessed medical devices was evaluated by mouse fibroblasts cell culture (NCTC clone 929), which didn\'t presented significant toxicity. However, the results obtained by scanning electron microscopy proved the presence of microbial load after 10th reprocessing cycle, as well as damages to the polymeric surface. During challenge with bacterial endotoxin, that consisted of contaminating the units with 200 EU, drying and submission to sterilization cycles with ethylene oxide/cfe (12:88), it was verified that after ten simulated reprocessing cycles, it was possible to recover around 100% of endotoxin. The catheter guide that were acquired from institutional hospital after four times reuse, had presented levels of contamination of 105 cfu/unit, as well as presenee of bacteria considered pathogenic in patients immunologically compromised, on the other hand the detention of bacterial endotoxin in these catheters was not considered significant. The evaluations studies condueted with the units submitted to the simulated reprocessing cycles, as well as the catheter guide reprocessed and reused four times, had reflected the reality of some national and foreign hospitais which reutilize single use medical device. The results obtained lead us to raise objections to the reusing practice, considering the absence of adequate patients safety.

The aim of the thesis Collaboration of Stakeholders in a Tourism Destination is to evaluate the level and intensity of cooperation in tourism in the South Bohemian Region from the perspective of key stakeholders in the destination, including the management and development relationship of tourism in the destination. In the first part of the research, the information concerning the destination management and marketing, the stakeholders and their cooperation was obtained with the help of secondary data. For the collection of secondary data, printed literature and websites were mainly used in connection with the selected tourism destination - the South Bohemian Region. Based on the findings from the literature and other secondary sources, the collection of primary data was planned in the form of a questionnaire survey. It has become clear that the destination marketing organizations, which best meet the attributes of power, legitimacy and urgency, are the key stakeholder. According to the research, it was found out that the cooperation between the public and private sectors is significantly inadequate. There are several major obstacles that prevent effective cooperation among the particular stakeholders. To improve the cooperation, it is necessary to streamline the communication between the organizations and other stakeholders and to plan a project within the tourism industry, which will help with the cooperation among as many stakeholders as possible.