<p>This dissertation is a collection of three papers, each one being a chapter. In the first chapter, I examine how career interruptions related to child-raising duties affect married women’s labor market trajectory, lifetime earnings, and Social Security retirement benefits. To address this question, I develop and estimate a dynamic life-cycle model of female labor supply, savings, and Social Security benefit claiming. I explicitly model the Social Security benefits system and the federal and payroll tax structure in the United States. The framework, thus, allows me to unravel the complex interdependencies between women’s participation decisions, accumulated work experience, lifetime earnings, and public pension benefits. I estimate the model using the Method of Simulated Moments and match data for the cohort born in 1943-1954. I use the model to simulate labor supply behavior of married women in a revenue-neutral counterfactual scenario where I introduce Social Security caregiver credit that covers the lost earnings during the first 5 child-rearing years through changes in retirement benefits. I find that the model predicts that introducing the provision of earning credits for child care in the Social Security system would reduce participation of married women during the child-rearing years, but the contributory nature of the caregiver credits creates incentive to work in the post-childrearing period.</p> <p><br></p> <p>In the second chapter, I evaluate the implication of introducing Social Security caregiver credit by examining whether and to what extent implementing this child-related policy to the existing Social Security system would help reduce the motherhood earnings penalty over the life cycle. I utilize the dynamic lifecycle model developed in Chapter 1 and conduct revenue-neutral counterfactual policy experiments by introducing caregiver credits in in various settings. First, I analyze the effect of the policy at different generosity levels; and second, I implement the policy in the presence as well as in the absence of the marriage-based noncontributory Social Security benefits (spousal and survivors benefits). Third, I conduct an alternative counterfactual policy experiment where mothers could drop five additional work years from the average career earnings (or equivalently Social Security benefits) calculation. The model predicts that lifetime pre-tax labor earnings of married women increase significantly under when the caregiver credits are introduced in a setting where spousal and survivors benefits are eliminated, and there is a sizeable reduction in gender gap in average career earnings at the Social Security Early Retirement Age. The alternative policy of computing average career earnings based on a mother's 30 years of earnings has significantly smaller impact on offsetting motherhood earnings penalty through retirement benefits compared to the provision of Social Security caregiver credits.</p> <p><br></p> <p>In the third chapter, I examine the effect of Supplemental Nutrition Assistance Program (SNAP) work requirement reinstatement on food insecurity outcomes of able-bodied adults without dependents (ABAWDs). The policy restricts SNAP benefits of ABAWDs to 3 months in a 36 month period if they are not working or participating in any work program for at least 20 hours a week. In the aftermath of the 2008 recession, the American Recovery and Reinvestment Act of 2009 waived work requirements nationwide, and many states reimplemented the work rule at different times beginning in 2011. I employ a difference-in-differences approach utilizing this cross-state variation in the reimplementation of the policy. Using rich information on food affordability and food intake behavior from the Food Security Supplement of the Current Population Survey (CPS-FSS), I find that promoting work for food assistance improved the overall food security status of ABAWDs by reducing disruptions in food intake, anxiety over food affordability and dependency on emergency food receipt. Subsample analyses indicate that effects are stronger for never married and less educated ABAWDs.</p>

Tillskottsvatten i avloppsledningsnät medför stora kostnader i form av underhåll,ökad mängd kemikalier och energi som även belastar miljön. Syftet med detta examensarbetevar att få ökad förståelse av temperaturförhållanden mellan spillvattenoch mark för att förbättra modelleringen av tillskottsvatten. Hypotesen är att spillvattentemperaturensjunker vid inläckage då temperaturen på tillskottsvattnet ärlägre än spillvattnet. Ett spillvattenrör med en längd på ungefär 2,5 km i Umeåundersöktes med givare jämt fördelade längs sträckan. Metoden innebar att medmätvärden på temperaturerna för spillvattnet, luften i spillvattenröret och i markentillsammans med flödet och nivån på spillvattnet modellera värmeutbytet i COMSOLMultiphysics. Resultatet gav fyra liknande funktioner för både spillvattenregionenoch luftregionen som beskrev värmeutbytet mellan spillvattenröret och marken.Effektutbytena hade en linjär tendens som funktion av temperaturdifferensen mellanspillvatten och mark under mätperioden fram till maj månad men med en högspridning då effektutbytet är även beroende på flödet och inte bara temperaturdifferensen.Majoriteten av effektutbytet var mellan ytan på spillvattenröret ochspillvattnet. I regionen mellan luft och yta på spillvattenröret så var majoriteten aveffektutbytet ifrån strålningsutbytet mellan spillvattnet och ytan. Resultaten gaväven U-värden för regionen mellan spillvattenregionen och luftregionen i rörledningenoch dessa var omkring 4 W/(m2K) respektive 0,8 W/(m2K). Tillskottsvattnetmodellerades utifrån värmeutbytet och det visade på ökade flödesnivåer när det varvåtperioder med en noggrannhet på ± 1 kg/s. / Supplemental water in the sewer network entails large costs in the form of maintenance,increased amounts of chemicals and energy that also have a burden on theenvironment. The purpose of this thesis was to gain an increased understandingof temperature conditions between wastewater and soil to improve the modelingof supplemental water. The hypothesis is that the waste water temperature dropswhen leakage occurs and when the temperature of the additional water is lower thanthe wastewater. A wastewater pipe with a length of approximately 2.5 km in Umeåwas examined with sensors evenly distributed along the path. The method involvedmodeling the heat flow in COMSOL Multiphysics with measured values of thetemperatures for the wastewater, the air in the wastewater pipe and in the groundtogether with the flow and the level of the wastewater. The result gave four similarfunctions for both the wastewater region and the air region that described the heattransfer from the wastewater pipe to the ground. The heating effects had a lineartendency as a function of the temperature difference between wastewater and soilduring the measurement period up to the month of May, but with a high spread asthe heat transfer is also dependent on the flow and not just the temperature difference.The majority of the heat transfer was between the surface of the wastewaterpipe and the wastewater. In the region between the air surface on the wastewaterpipe, the majority was the heat transfer from the radiation between the wastewaterand the surface. The results also gave U-values for the wastewater region and theair region in the pipeline and these were around 4 W/(m2K) and 0.8 W/(m2K),respectively. The supplemental water was modeled on the basis of the heat transferand it showed increased flow levels when it was wet periods with an accuracy of ±1 kg/s.

Many poverty alleviation programs are designed to mitigate the difficulties of families facing poverty; however, most programs address a particular need such as food insecurity or unaffordable housing. Participation in multiple programs could be a more comprehensive strategy for addressing the various demands of poverty and, in turn, improving the developmental outcomes of families. This study explores the effects of receiving the Supplemental Nutrition Assistance Program (SNAP), Earned Income Tax Credit (EITC), and their combined or “packaged” effects on child and maternal outcomes for families experiencing poverty when the child is three years old and then at five years old. It also examines any differential outcomes, associations, and preexisting characteristics for these groups of children and mothers. The present study includes panel data from wave 1 to wave 4 of the Future of Families and Child Wellbeing Study (FFCWS) as the selected sample. The analytic sample is restricted to eligible households and children from the wave 3 and wave 4 assessments for the child and maternal outcomes. This study examines the effects and the associations related to a packaged approach in improving the outcomes of children and families to address the multifaceted complexities of poverty. It also examines maternal characteristics of race and ethnicity, marital status, and employment status to moderate the association between receiving multiple programs and family outcomes. Some statistically significant effects and associations are found between receiving programs and child and maternal outcomes when the child is three or five; however, these results must be interpreted and understood within this study’s limitations. This study expands on current research literature that informs public policy efforts to alleviate the various difficulties encountered by families experiencing poverty.

Trata-se de uma pesquisa qualitativa composta por análise bibliográfica categorial com foco em reforma do Estado e regulação, por um levantamento da estrutura do mercado e das atas de reunião da Câmara de Saúde Suplementar (CSS) e por entrevistas semi-estruturadas com os principais atores desta câmara, buscando entender posicionamentos e principais pontos em debate, construindo um quadro de referência do setor, visando identificar sucessos e lacunas do processo. A pergunta central é até que ponto a regulação, a partir do modelo de agência adotado no Brasil para o setor de saúde suplementar, não estaria atingindo os objetivos propostos quando da sua criação, ou seja, de defender o interesse público na assistência suplementar à saúde. O mercado de saúde suplementar é composto por 36,9 milhões de beneficiários de planos de saúde em 2006 representando 19,6% da população brasileira. Apesar do seu tamanho e da relação público-privada que permitiu seu desenvolvimento ao longo do século passado ocorreu à margem de um regramento oficial até 1998, com a promulgação das Leis 9.656/98 e 9.961/00, esta última criando a ANS, estendendo o processo de reconfiguração do papel do Estado para o setor de saúde. Entre 01/2000 e 12/2006 a ANS realizou 25 consultas públicas (4,2 consultas ao ano em média), destas 11 trataram de temas financeiros; enquanto questões cadastrais, de definição de produtos e de contratualização foram temas de três consultas cada. Neste mesmo período a ANS emitiu 790 normativos, uma média de 113 normativos por ano. A comparação entre consultas públicas e normativos sugere uma pequena participação externa à agência no processo de regulação. Desde sua criação em 1998 até 09/2006 a CSS se reuniu 44 vezes, considerando presença relativa (ponderada pelo número de convocações) as representações mais presentes foram: prestadores de serviço, medicinas de grupo, seguradoras, reguladores (ANS) e consumidores com 100%. No pólo inverso foram identificados: trabalhadores, governo e gestores com menos de 55% de presença relativa, sugerindo o grau de importância que cada grupo de representação confere à CSS, seja como fórum de debate ou espaço para disseminação de suas posições. Nestas reuniões foram pautados 129 temas, com predominância daqueles ligados a característica e estrutura da regulamentação (35% dos temas), apresentações da ANS (13% das pautas) e programas da ANS (9% dos temas). Temas como a avaliação da ANS pelos atores e discussão quanto a lacunas no processo de regulação, embora pareçam cruciais para a adequação do modelo, foram tratados apenas uma vez cada. Adicionalmente, a elaboração por parte dos atores da CSS de documentos para discussão foi tema em apenas duas das 129 pautas. As entrevistas com os atores da CSS revelam que há consenso quanto a Reforma do Estado ser a origem da regulação via agência, porém discute-se sua autonomia, distanciamento do controle social do SUS, falta de integração com políticas do Ministério da Saúde, interfaces entre os sistemas público e privado, renúncia fiscal, subordinação entre SUS e sistema suplementar, efetividade dos contratos préregulação e participação (ou interferência) do Judiciário no processo. A maioria das xv representações discute saúde suplementar desde o inicio dos anos 90, sofrendo o desgaste em função do longo período de participação e dos resultados aquém dos esperados. A composição heterogênea, não paritária e o caráter consultivo da CSS dificulta a construção do entendimento. A baixa participação de governo, trabalhadores e gestores e a discussão prévia entre ANS e MS dos assuntos relevantes corroboram com a avaliação de baixa produtividade dada à CSS. Há consenso pela busca de sustentabilidade do mercado, mas com divergências quanto às alternativas para atingi-la, com posicionamentos antagônicos quanto a incentivos fiscais, ressarcimento ao SUS, volume de lucro aceitável e metodologia de apuração dos reajustes de preços. Os gargalos apontados pelos atores foram sistemas e recursos humanos, falta de integração entre as diretorias da agência e o volume de normativos, que são apontados como fatores de lentidão e incremento de custos no processo regulatório. Ressaltam ainda a necessidade de maior participação da sociedade e transparência. São reconhecidos poucos sucessos (definição de produtos, direitos e cobertura, saneamento do mercado e programas de qualificação e troca de informação) e diversas lacunas (adequação do marco regulatório, integração interna da ANS, incorporação do prestador de serviços no campo regulado e integração com o SUS). Conclui-se que a regulação em saúde suplementar atingiu uma fase em que nenhum ator está satisfeito, mesmo entendendo ser este um processo em construção e dadas as divergências de interesses e limitações do fórum de discussão, a construção de consensos via CSS é complexa podendo não ocorrer. Adicionalmente, os posicionamentos e lacunas da agência no processo não permitem enxergá-la como efetiva defensora do interesse público em saúde suplementar. / This qualitative research is composed by a bibliographical analysis focused on state reform and regulation, the market structure analysis, the Câmara de Saúde Suplementar (CSS) meeting minutes analysis and by semi-structured interviews with CSS actors understanding positioning, discussion points, identifying successes and lacking points of the process. The objectives of this thesis are build a frame of reference for the supplementary health market, through a statistical analysis including analysis of the CSS meeting minutes, of the public consultations and rules issued by ANS; as well as analyzing the impacts of regulation on the several groups of interest represented in the CSS, discussing amplitude and range of regulation and questioning ANS mission achievement, as public interest defender in this market. The Brazilian supplementary health market assists 36.9 million beneficiaries, according to 2006 s data, which represents 19.6% of the population. Despite its size and the public-private relationship which allowed its growth since the beginning of last century, it remained unregulated until 1998. Regulatory activity was undertaken by ANS in 2000, extending State role reconfiguration concept to health field. Between 01/2000 and 12/2006 ANS called 25 public consultations (4.2 per year), from which 11 dealt with financial subjects, while masterfile, product definitions and contractualization were subject of 3 consultations each. During this period ANS issued 790 rules, an average of 113 per year. The comparison between the number of public consultations and of rules issued suggests small external participation. Since its creation in 1998 until 09/2006, CSS held 44 meetings. Considering relative participation, the most present representations were service providers, health maintenance groups, insurers, regulators and consumers with 100% of presence. On the other hand health workers, government and public health managers were present to less than 55% of the meetings, suggesting the relative importance given to CSS by each representation. During these meetings 129 different subjects were discussed. Main topics covered were regulation characteristics and structure (35%), ANS presentations (13%) e ANS programs (9%). Subjects as ANS evaluation and lacking points discussion, despite seeming crucial were dealt only once each. Additionally discussion of documents prepared by CSS actors took place only twice. Interviews seeked for actor s positioning on regulation model, were consensus resides on agency origin from state reform process, but autonomy, distance from SUS social control, lack of integration with Health Ministry policies, public and private systems interfaces, tax relieves, subordination of private system to SUS, effectiveness of preregulation contracts and Justice interference in the process are still points of discussion. The majority of representants have being discussing private health issues since the beginning of the 90s, suffering from the stress of long participation with limited results. The uneven composition and consulting status of the CSS are obstacles towards build understanding. Government s, health workers and public health managers low participation in CSS and pre-meeting discussions of relevant xvii subjects between ANS and MS, induce to a low productivity appraisal of CSS. Pursue sustainability seems to be a consensus, although ways to achieve this are discrepant, varying from definition of new fiscal incentives and reimbursement to SUS policy to definition of admited profit margins. ANS s evaluation by actors indicate botlenecks in IT and human resources, lack of integration within the agency s directorships and the amount of rules issued all of with contribute to increase costs and delay the regulatory process. Transparency and participation on decision processes are also claimed for. Few success examples are identified (product, rights and coverage definition, market clearing and implementation of quality programs) and several lacking points are indicated (adequacy of the regulatory base, internal integration, inclusion of the service providers in the regulated field and integration with SUS). Conclusions indicate that regulation has achieved a stage were none of the actors are satisfied, even recognizing that this is still a process in construction, and given the interest discrepancies between actors and limitations of the discussion arena, build consensus via CSS is complex and may not happen. At the same time, the number of lacking points in the regulation process show the distance for ANS to achieve its mission, and therefore do not allow see ANS as effective public interest defender in this market.

Trata-se de uma pesquisa qualitativa composta por análise bibliográfica categorial com foco em reforma do Estado e regulação, por um levantamento da estrutura do mercado e das atas de reunião da Câmara de Saúde Suplementar (CSS) e por entrevistas semi-estruturadas com os principais atores desta câmara, buscando entender posicionamentos e principais pontos em debate, construindo um quadro de referência do setor, visando identificar sucessos e lacunas do processo. A pergunta central é até que ponto a regulação, a partir do modelo de agência adotado no Brasil para o setor de saúde suplementar, não estaria atingindo os objetivos propostos quando da sua criação, ou seja, de defender o interesse público na assistência suplementar à saúde. O mercado de saúde suplementar é composto por 36,9 milhões de beneficiários de planos de saúde em 2006 representando 19,6% da população brasileira. Apesar do seu tamanho e da relação público-privada que permitiu seu desenvolvimento ao longo do século passado ocorreu à margem de um regramento oficial até 1998, com a promulgação das Leis 9.656/98 e 9.961/00, esta última criando a ANS, estendendo o processo de reconfiguração do papel do Estado para o setor de saúde. Entre 01/2000 e 12/2006 a ANS realizou 25 consultas públicas (4,2 consultas ao ano em média), destas 11 trataram de temas financeiros; enquanto questões cadastrais, de definição de produtos e de contratualização foram temas de três consultas cada. Neste mesmo período a ANS emitiu 790 normativos, uma média de 113 normativos por ano. A comparação entre consultas públicas e normativos sugere uma pequena participação externa à agência no processo de regulação. Desde sua criação em 1998 até 09/2006 a CSS se reuniu 44 vezes, considerando presença relativa (ponderada pelo número de convocações) as representações mais presentes foram: prestadores de serviço, medicinas de grupo, seguradoras, reguladores (ANS) e consumidores com 100%. No pólo inverso foram identificados: trabalhadores, governo e gestores com menos de 55% de presença relativa, sugerindo o grau de importância que cada grupo de representação confere à CSS, seja como fórum de debate ou espaço para disseminação de suas posições. Nestas reuniões foram pautados 129 temas, com predominância daqueles ligados a característica e estrutura da regulamentação (35% dos temas), apresentações da ANS (13% das pautas) e programas da ANS (9% dos temas). Temas como a avaliação da ANS pelos atores e discussão quanto a lacunas no processo de regulação, embora pareçam cruciais para a adequação do modelo, foram tratados apenas uma vez cada. Adicionalmente, a elaboração por parte dos atores da CSS de documentos para discussão foi tema em apenas duas das 129 pautas. As entrevistas com os atores da CSS revelam que há consenso quanto a Reforma do Estado ser a origem da regulação via agência, porém discute-se sua autonomia, distanciamento do controle social do SUS, falta de integração com políticas do Ministério da Saúde, interfaces entre os sistemas público e privado, renúncia fiscal, subordinação entre SUS e sistema suplementar, efetividade dos contratos préregulação e participação (ou interferência) do Judiciário no processo. A maioria das xv representações discute saúde suplementar desde o inicio dos anos 90, sofrendo o desgaste em função do longo período de participação e dos resultados aquém dos esperados. A composição heterogênea, não paritária e o caráter consultivo da CSS dificulta a construção do entendimento. A baixa participação de governo, trabalhadores e gestores e a discussão prévia entre ANS e MS dos assuntos relevantes corroboram com a avaliação de baixa produtividade dada à CSS. Há consenso pela busca de sustentabilidade do mercado, mas com divergências quanto às alternativas para atingi-la, com posicionamentos antagônicos quanto a incentivos fiscais, ressarcimento ao SUS, volume de lucro aceitável e metodologia de apuração dos reajustes de preços. Os gargalos apontados pelos atores foram sistemas e recursos humanos, falta de integração entre as diretorias da agência e o volume de normativos, que são apontados como fatores de lentidão e incremento de custos no processo regulatório. Ressaltam ainda a necessidade de maior participação da sociedade e transparência. São reconhecidos poucos sucessos (definição de produtos, direitos e cobertura, saneamento do mercado e programas de qualificação e troca de informação) e diversas lacunas (adequação do marco regulatório, integração interna da ANS, incorporação do prestador de serviços no campo regulado e integração com o SUS). Conclui-se que a regulação em saúde suplementar atingiu uma fase em que nenhum ator está satisfeito, mesmo entendendo ser este um processo em construção e dadas as divergências de interesses e limitações do fórum de discussão, a construção de consensos via CSS é complexa podendo não ocorrer. Adicionalmente, os posicionamentos e lacunas da agência no processo não permitem enxergá-la como efetiva defensora do interesse público em saúde suplementar. / This qualitative research is composed by a bibliographical analysis focused on state reform and regulation, the market structure analysis, the Câmara de Saúde Suplementar (CSS) meeting minutes analysis and by semi-structured interviews with CSS actors understanding positioning, discussion points, identifying successes and lacking points of the process. The objectives of this thesis are build a frame of reference for the supplementary health market, through a statistical analysis including analysis of the CSS meeting minutes, of the public consultations and rules issued by ANS; as well as analyzing the impacts of regulation on the several groups of interest represented in the CSS, discussing amplitude and range of regulation and questioning ANS mission achievement, as public interest defender in this market. The Brazilian supplementary health market assists 36.9 million beneficiaries, according to 2006 s data, which represents 19.6% of the population. Despite its size and the public-private relationship which allowed its growth since the beginning of last century, it remained unregulated until 1998. Regulatory activity was undertaken by ANS in 2000, extending State role reconfiguration concept to health field. Between 01/2000 and 12/2006 ANS called 25 public consultations (4.2 per year), from which 11 dealt with financial subjects, while masterfile, product definitions and contractualization were subject of 3 consultations each. During this period ANS issued 790 rules, an average of 113 per year. The comparison between the number of public consultations and of rules issued suggests small external participation. Since its creation in 1998 until 09/2006, CSS held 44 meetings. Considering relative participation, the most present representations were service providers, health maintenance groups, insurers, regulators and consumers with 100% of presence. On the other hand health workers, government and public health managers were present to less than 55% of the meetings, suggesting the relative importance given to CSS by each representation. During these meetings 129 different subjects were discussed. Main topics covered were regulation characteristics and structure (35%), ANS presentations (13%) e ANS programs (9%). Subjects as ANS evaluation and lacking points discussion, despite seeming crucial were dealt only once each. Additionally discussion of documents prepared by CSS actors took place only twice. Interviews seeked for actor s positioning on regulation model, were consensus resides on agency origin from state reform process, but autonomy, distance from SUS social control, lack of integration with Health Ministry policies, public and private systems interfaces, tax relieves, subordination of private system to SUS, effectiveness of preregulation contracts and Justice interference in the process are still points of discussion. The majority of representants have being discussing private health issues since the beginning of the 90s, suffering from the stress of long participation with limited results. The uneven composition and consulting status of the CSS are obstacles towards build understanding. Government s, health workers and public health managers low participation in CSS and pre-meeting discussions of relevant xvii subjects between ANS and MS, induce to a low productivity appraisal of CSS. Pursue sustainability seems to be a consensus, although ways to achieve this are discrepant, varying from definition of new fiscal incentives and reimbursement to SUS policy to definition of admited profit margins. ANS s evaluation by actors indicate botlenecks in IT and human resources, lack of integration within the agency s directorships and the amount of rules issued all of with contribute to increase costs and delay the regulatory process. Transparency and participation on decision processes are also claimed for. Few success examples are identified (product, rights and coverage definition, market clearing and implementation of quality programs) and several lacking points are indicated (adequacy of the regulatory base, internal integration, inclusion of the service providers in the regulated field and integration with SUS). Conclusions indicate that regulation has achieved a stage were none of the actors are satisfied, even recognizing that this is still a process in construction, and given the interest discrepancies between actors and limitations of the discussion arena, build consensus via CSS is complex and may not happen. At the same time, the number of lacking points in the regulation process show the distance for ANS to achieve its mission, and therefore do not allow see ANS as effective public interest defender in this market.

Stormwater runoff has negative impacts on water resources, human health and environment. In this research the effectiveness of Rain Water Harvesting (RWH) systems is examined as a stormwater Best Management Practice (BMP). Time-based, evapotranspiration-based, and soil moisture-based irrigation scheduling methods in conjunction with RWH and a control site without RWH were simulated to determine the effect of RWH as a BMP on a single-family residence scale. The effects of each irrigation scheduling method on minimizing water runoff leaving the plots and potable water input for irrigation were compared. The scenario that reflects urban development was simulated and compared to other RWH-irrigation scheduling systems by a control treatment without a RWH component. Four soil types (sand, sandy loam, loamy sand, silty clay) and four cistern sizes (208L, 416L, 624L, 833L) were evaluated in the urban development scenario. To achieve the purpose of this study; a model was developed to simulate daily water balance for the three treatments. Irrigation volumes and water runoff were compared for four soil types and four cistern sizes. Comparisons between total volumes of water runoff were estimated by utilizing different soil types, while comparisons between total potable water used for irrigation were estimated by utilizing different irrigation scheduling methods. This research showed that both Curve Number method and Mass-Balance method resulted in the greatest volumes of water runoff predicted for Silty Clay soil and the least volumes of water runoff predicted for Sand soil. Moreover, increasing cistern sizes resulted in reducing total water runoff and potable water used for irrigation, although not at a statistically significant level. Control treatment that does not utilize a cistern had the greatest volumes of predicted supplemental water among all soil types utilized, while Soil Moisture-based treatment on average had the least volume of predicted supplemental water.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O aumento da participação do setor privado no campo dos serviços de saúde vem ganhado destaque desde a década de 1980. O governo brasileiro, a partir da segunda metade da década de 1990, redesenhou o seu papel ao romper o monopólio estatal e permitir a expansão da atividade privada em diversos campos da economia, passando a ser mediador e regulador. Nesse contexto, a instituição da Agência Nacional de Saúde (ANS), em janeiro de 2000, marcou uma etapa da regulação do setor, que passou por diversas transformações que ocasionaram o aumento dos custos e diminuição do número de Operadoras de Planos de Saúde (OPS) em atividade. A interesse em ações que visam manter a saúde financeira dessas empresas é, portanto, o ponto de partida deste estudo. Trata-se de um estudo de caso que tem por objetivo investigar a influência de fatores organizacionais e ambientais, a partir da visão dos gestores de uma pequena cooperativa de trabalho médico (chamada de OPX), que contribuíram para a construção de desempenho organizacional superior, evidênciado em um estudo anterior. A investigação se faz a partir de quatro categorias analíticas que estão relacionadas ao desempenho organizacional: cultura organizacional, estrutura organizacional, gestão estratégica e ambiente externo. Os dados foram coletados a partir de três fontes de evidências: documentos, observação direta e entrevistas semi-estruturadas com a participação de gestores-chave da organização. Os dados foram analisados a partir do método de análise de conteúdo. Foram identificados elementos que caracterizam a cultura organizacional da cooperativa. Quanto ao tipo de estrutura, trata-se de burocracia profissional especializada. Os processos formais de gestão estratégica não são efetivamente utilizadas, mas as ferramentas operacionais de controle se mostraram rígidas. E a respeito do ambiente externo, mostraramse relevantes a concorrência, a regulação, o judiciário e a economia. Todos eles, em alguma medida, influenciaram o desempenho da organização. Não foi constatada nenhuma outra característica para a definição de nova categoria que pudesse ajudar a responder a pergunta de pesquisa. / The increased participation of the private sector in the field of health services has gained prominence since the 1980s. The Brazilian government, from the second half of the 1990s, has redesigned its role in breaking the state monopoly and allowed the expansion of private activity in various fields of economy, becoming a mediator and regulator. In this context, the establishment of the National Health Agency (ANS), in January 2000, marked a stage of sector regulation, which went through several transformations that led to the increase in costs and decrease in the number of Health Plans Operators (OPS) in activity. The concern with actions aimed at maintaining the financial health of these companies is therefore the starting point of this study. This is a case study that aims to investigate the influence of organizational and environmental factors, from the perspective of the managers of a small cooperative medical work (called OPX), which contributed to the construction of higher organizational performance, shown in a previous study. The investigation is based on four analytical categories that are related to organizational performance: organizational culture, organizational structure, strategic management and external environment. Data were collected from three sources of evidence: documents, direct observation and semi-structured interviews with the participation of key managers of the organization. Data were analyzed using Content Analysis method. Elements that characterize the organizational culture of the cooperative were identified. Regarding the type of structure, it is specialized professional bureaucracy. The formal process of strategic management are not effectively used, but operational control tools proved rigid . And about the external environment were relevant competition, regulation, the judiciary and the economy. All of them, to some extent, influenced the organization's performance. It was not found any other feature for defining new category that could help answer the research question. / Dissertação (Mestrado)

Pour la grande majorité des grands herbivores vivant en régions tempérées, l'hiver est la saison la plus limitante à cause des effets combinés du manque de ressources et de la sévérité des conditions climatiques. Les espèces qui ne développent pas d'adaptations morphologiques ou physiologiques particulières pour faire face à la sévérité de l'hiver doivent mettre en place des mouvements et des tactiques d'utilisation de l'espace appropriés (comme par exemple les migrations). Plus spécifiquement, ces patrons d'utilisation de l'espace peuvent émerger à différentes échelles spatio-temporelles pour permettre aux individus d'accéder aux ressources dont ils ont besoin et d'échapper aux conditions climatiques défavorables. Ainsi, ces patrons d'utilisation de l'espace déterminent le sort des individus et la dynamique des populations. Une compréhension détaillée de la relation entre les facteurs limitants durant l'hiver et la réponse des animaux en termes de mouvements est prépondérante pour préserver et gérer les populations d'ongulés sauvages avec succès, tout spécialement dans le contexte actuel de changements climatiques rapides qui induisent des modifications importantes dans le paysage et la distribution des ressources (par exemple changement de patrons de couverture neigeuse en hiver). La comparaison de tactiques de mouvements sous différents scénarios de conditions environnementales, par exemple au moyen d'analyses à vaste échelle de l'aire de distribution de l'espèce cible, représente une approche pertinente pour mieux comprendre comment les mouvements des animaux répondent aux changements dans le paysage. Le chevreuil (Capreoluscapreolus) est une espèce modèle particulièrement intéressante pour étudier ces questions parce que la distribution de cette espèce couvre la plupart des pays d'Europe, grâce à sa forte plasticité écologique / For the majority of large ungulates living in temperate regions winter is the limiting season, because of the combined effects of lack of resource availability and severity of climatic conditions. Those species that did not develop any particular morphological and physiological adaptation to cope with winter severity may adopt movement and space use tactics instead (like e.g. migration). Specifically, these space use patterns may emerge at different spatiotemporal scales to allow individuals to accede the resources they need and escape unfavourable conditions, thus determining both individual fate and population dynamics. A detailed understanding of the relationship between limiting factors in wintertime, and individual movement response, is remarkable to preserve and manage wildlife successfully, especially in the context of fast-occurring climate change that induces important alterations in landscape and resource distribution (e.g. changes of snow cover patterns). The comparison of movement tactics under different environmental scenarios, e.g. by means of large –scale analysis at the species distribution range, represents a valuable approach to work in that direction and to assess the effects of landscape alteration on individual movement. Roe deer (Capreolus capreolus) is an excellent model species to investigate these issues, because its distribution range covers most of Europe, thanks to its high ecological plasticity. For those populations that live in northern and mountain environments, winter is the limiting season because roe deer lack any morphological and physiological adaptations to cope with winter severity. In spite of the adoption of specific movement tactics such as partial migration from summer to winter ranges, roe deer may still face limiting conditions in some areas of the distribution range exposed to winter severity

Background Oxygen is one of the most commonly used drugs by anesthesiologists. The World Health Organization (WHO) gave recommendations regarding perioperative oxygen administration, but the practice of oxygen use in anesthesia, critical emergency, and intensive care medicine remains unclear. Methods We conducted an online survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC). The questionnaire consisted of 46 queries appraising the perioperative period, emergency medicine and in the intensive care, knowledge about current recommendations by the WHO, oxygen toxicity, and devices for supplemental oxygen therapy. Results Seven hundred ninety-eight ESAIC members (2.1% of all ESAIC members) completed the survey. Most respondents were board-certified and worked in hospitals with > 500 beds. The majority affirmed that they do not use specific protocols for oxygen administration. WHO recommendations are unknown to 42% of respondents, known but not followed by 14%, and known and followed by 24% of them. Respondents prefer inspiratory oxygen fraction (FiO2) ≥80% during induction and emergence from anesthesia, but intraoperatively < 60% for maintenance, and higher FiO2 in patients with diseased than non-diseased lungs. Postoperative oxygen therapy is prescribed more commonly according to peripheral oxygen saturation (SpO2), but shortage of devices still limits monitoring. When monitoring is used, SpO2 ≤ 95% is often targeted. In critical emergency medicine, oxygen is used frequently in patients aged ≥80 years, or presenting with respiratory distress, chronic obstructive pulmonary disease, myocardial infarction, and stroke. In the intensive care unit, oxygen is mostly targeted at 96%, especially in patients with pulmonary diseases. Conclusions The current practice of perioperative oxygen therapy among respondents does not follow WHO recommendations or current evidence, and access to postoperative monitoring devices impairs the individualization of oxygen therapy. Further research and additional teaching about use of oxygen are necessary.

A osteomielite possui elevada prevalência e morbidade. O tratamento depende de apropriada terapia antimicrobiana por tempo prolongado e frequentemente requer cirurgia para remoção de tecidos necróticos. A aderência dos pacientes com osteomielite à prescrição do antibiótico, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. O objetivo deste estudo foi mensurar a aderência à terapia antimicrobiana oral em pacientes adultos com osteomielite; identificar se alguns fatores relacionados na literatura estavam associados com a não aderência; estabelecer o valor preditivo dos fatores associados a não aderência ao tratamento em pacientes com osteomielite. Foi realizado um estudo transversal, fundamentado na avaliação por meio de métodos indiretos da aderência para 83 pacientes. Foram considerados pelo menos 30 dias de uso do antimicrobiano à entrevista e os pacientes foram classificados como aderentes de acordo com o questionário de Morisky, que é constituído por 4 questões com respostas dicotômicas para avaliar a aderência. Os pacientes com < 2 pontos foram considerados de baixa aderência e os que obtiverem > 3 pontos, de alta aderência. O presente estudo identificou uma prevalência de alta aderência de 83,1% (n=63). O ajuste dos modelos de regressão logística múltipla não resultou em variáveis conjuntas influenciando a aderência ao tratamento, porém pacientes do gênero masculino sugeriram apresentar maior frequência de baixa aderência ao tratamento em relação aos pacientes do gênero feminino (p = 0,053). Com relação à idade, a análise dos dados mostrou que os pacientes com idade entre 31 e 59 anos possuíam probabilidade de baixa aderência 68% menor que pacientes com idade entre 18 e 30 anos. A aderência observada foi semelhante à encontrada na literatura. Os fatores sociodemográficos podem interferir na aderência de pacientes em uso de antibióticos orais para tratamento de osteomielite / Osteomyelitis is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on appropriate antimicrobial therapy. Adherence of patients with osteomyelitis to the prescribed treatment, although critical for successful treatment, has been little studied. The aim of the study was: to measure the adherence to oral antimicrobial therapy in adult patients with osteomyelitis; to identify whether some of the factors listed in health literature were associated with non-adherence; to establish the predictive values associated with non-adherence to antimicrobial therapy in patients with osteomyelitis. We conducted a cross-sectional study, based on evaluation through indirect methods of adherence for 83 patients. We included patients receiving at least 30 days of antimicrobial use. Patients were interviewed and classified as adherent according to the Morisky questionnaire, that consists of 4 questions with dichotomous responses to assess adherence. Patients with 3 points, with high adherence. This study identified a prevalence of high adherence of 83.1% (n = 63). The multivariate logistic regression analysis did not result in multiple variables influencing adherence to treatment. Gender was the only variable with an suggested association with low adherence, male gender was more associated with low adherence than female (p = 0,053). Regarding age, data analysis showed that patients aged between 31 and 59 years had low adherence probability 68% lower than patients aged between 18 and 30 years. The high adherence observed in this study was similar than previous reported in the literature. Social and demographic factors may interfere in the adherence with patients using oral antibiotics for the treatment of osteomyelitis