A qualidade nos serviços de saúde tem sido objeto de estudo entre diversos pesquisadores. As dificuldades econômicas e a exigência dos usuários pelos seus direitos em obter qualidade nos serviços prestados, torna relevante esse estudo. O enfermeiro é o profissional que deve estimular e conduzir a equipe para elaboração e implementação de novas abordagens e ferramentas gerenciais que levem a melhorias na assistência Uma das ferramentas gerenciais que o enfermeiro pode lançar mão é a padronização das intervenções de enfermagem. Devido à necessidade de melhoria da qualidade da assistência prestada, os Procedimentos Operacionais Padrão de enfermagem foram implantados na Secretaria Municipal de Saúde de Ribeirão Preto entre os anos de 2011 e 2012. O estudo objetiva descrever o modelo de implantação dos Procedimentos Operacionais Padrão (POP) da equipe de enfermagem e identificar as fragilidades e potencialidades na utilização desses POP da equipe de enfermagem. Trata-se de pesquisa do tipo avaliativa, com abordagem quantitativa realizada com profissionais de enfermagem que atuam nas Unidades de Saúde da Secretaria Municipal de Saúde de Ribeirão Preto. A coleta de dados foi realizada em duas fases. Na primeira, ocorreu a análise documental que foi realizada no mês de outubro de 2014. Já a segunda fase compreendeu a aplicação de um questionário aos enfermeiros, técnicos e auxiliares de enfermagem. Participaram do estudo 247 profissionais de enfermagem, sendo 64 enfermeiros, 31 técnicos de enfermagem e 152 auxiliares de enfermagem. Destes, 87,4% eram do sexo feminino. A faixa etária que predominou foi a de 51 a 60 anos, com 34%, seguidos de 30,8% na faixa etária de 41 a 50 anos. Em relação ao tempo de formação 38,5% possuíam de 2 a 8 anos de formados, 24,3% possuía de 16 a 22 anos e 19,4% possuíam 23 a 29 anos de tempo de formação. Dos participantes do estudo, 77,7 % atuavam em Unidades de Saúde da Família. Participaram da capacitação dos POP 222 (89,9%) profissionais de enfermagem. Dentre os participantes da pesquisa, 225 (91,1%) afirmaram que consultam os POP no local de trabalho, porém, apenas 142 (57,5%) os consultaram nos últimos doze meses, sendo a maioria enfermeiros (92,2%). A intervenção mais citada que passou a ser executada após a capacitação dos POP foi o cateterismo por cistostomia (17,8%), apesar de ainda haver um percentual de 39,3% que não a executam. Houve mudança na forma de execução e aprofundamento do conhecimento em todas as intervenções trabalhadas. A implantação dos POP foi desenvolvida de forma pontual, necessitando ser avaliado e repensado nos moldes de um processo educativo contínuo. As fragilidades identificadas foram o número reduzido de profissionais, inadequação da estrutura física, ausência de materiais, entre outros. As potencialidades foram relacionadas à padronização dos materiais, material da instituição para consulta disponível na unidade, valorização profissional, preocupação do gestor em relação à segurança do paciente e do profissional. Ressalta-se a capacitação dos POP como relevante para a contribuição da melhoria da qualidade da assistência prestada pela enfermagem, porém, deve ser pautada em processos educativos permanentes / The quality of health services has been the object of study among many researchers. The economic difficulties and demands from users for their rights to obtain quality in the services rendered make this study relevant. Nurses are the professionals who must encourage and lead the team to create and implement new managerial tools and approaches to improve care. One of the managerial tools that nurses can use is the standardization of nursing interventions. Given the need to improve the quality of the care delivered, standard operational procedures(SOP) in nursing were implemented in the Municipal Health Secretariat of RibeirãoPretobetween 2011 and 2012. The aim of this study was to describe the implementation model of the standard operational proceduresof the nursing team and to identify the weak and strong points in the use of these SOP by the nursing team. This was an evaluative study, with a quantitative approach, conducted with nursing professionals who work in health units of the Municipal Health Secretariat of RibeirãoPreto.Data were collected in two phases. The first phase consisted of a documentary analysis performed in October 2014, whereas the second phase comprised the application of a questionnaire to nurses and nursing technicians and aides. The study participants were 247 nursing professionals, namely 64 nurses, 31 nursing technicians and 152 nursing aides. Of these, 87.4% were women. The age range that prevailed was between 51 and 60 years, with 34%, followed by the age range between 41 and 50 years, with 30.8%. Regarding the time since graduation, 38.5% had graduated from 2 to 8 years ago, 24.3% had graduated between 16 and 22 years agoand 19.4% had from 23 to 29 years since graduation. Among the study participants, 77.7% worked in family health units. A total of 222 (89.9%) nursing professionals participated in the training for SOP. Of all study participants, 225 (91.1%) stated refer to SOP at their work place, however, only 142 (57.5%) referred to them over the last 12 months, with most of them being nurses (92.2%). The most commonly cited intervention that started being executed after the SOP training was cystostomy (17.8%), although there is still a percentage of 39.3% professionals who do not perform it. There was a change in the form of execution and broadening of knowledge in all interventions used. The implementation of the SOP was developedfor a specific scenario, so it should be evaluated and replanned in the scope of a continuous educational process. The weak points identified were the reduced number of professionals, inadequate physical structure, lack of materials, among others. The strengths were related to the standardization of materials, institution materials for reference available in the unit, professional appreciation, andconcern on the part of administrators toward the safety of patients and professionals. It is noteworthy that the training for SOP is relevant as it contributes to improve the quality of the nursing care provided, however, it should be guided by permanent educational processes

Ho Kin-Pui. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 92-95). / Abstracts in English and Chinese. / Abstract --- p.2 / 摘要 --- p.4 / Acknowledgements --- p.5 / Table of Contents --- p.6 / List of Figures --- p.10 / List of Tables --- p.14 / Chapter Chapter 1 --- Introduction --- p.15 / Overview --- p.15 / Objective --- p.17 / Thesis Organization --- p.17 / Chapter Chapter 2 --- Fundamentals of Operational Amplifier --- p.19 / Chapter 2.1 --- Definitions of Commonly Used Figures --- p.19 / Chapter 2.1.1 --- Input Differential Voltage Range --- p.19 / Chapter 2.1.2 --- Maximum Output Voltage Swing --- p.20 / Chapter 2.1.3 --- Input Common Mode Voltage Range --- p.20 / Chapter 2.1.4 --- Input Offset Voltage --- p.20 / Chapter 2.1.5 --- Gain Bandwidth Product --- p.21 / Chapter 2.1.6 --- Phase Margin --- p.22 / Chapter 2.1.7 --- Slew Rate --- p.22 / Chapter 2.1.8 --- Settling Time --- p.23 / Chapter 2.1.9 --- Common Mode Rejection Ratio --- p.23 / Chapter 2.2 --- Frequency Compensation of Operational Amplifier --- p.24 / Chapter 2.2.1 --- Overview --- p.24 / Chapter 2.2.2 --- Miller Compensation --- p.25 / Chapter Chapter 3 --- CMOS Current Feedback Operational Amplifier --- p.27 / Chapter 3.1 --- Introduction --- p.27 / Chapter 3.2 --- Current Feedback Operational Amplifier with Active Current Mode Compensation --- p.28 / Chapter 3.2.1 --- Circuit Description --- p.29 / Chapter 3.2.2 --- Small Signal analysis --- p.32 / Chapter 3.2.3 --- Simulation Results --- p.34 / Chapter Chapter 4 --- Reversed Nested Miller Compensation --- p.38 / Chapter 4.1 --- Introduction --- p.38 / Chapter 4.2 --- Frequency Response --- p.39 / Chapter 4.2.1 --- Gain-bandwidth product --- p.40 / Chapter 4.2.2 --- Right half complex plane zero --- p.40 / Chapter 4.2.3 --- The Pair of Complex Conjugate Poles --- p.42 / Chapter 4.3 --- Components Sizing --- p.47 / Chapter 4.4 --- Circuit Simulation --- p.48 / Chapter Chapter 5 --- Enhancement Technique for Reversed Nested Miller Compensation --- p.54 / Chapter 5.1 --- Introduction --- p.54 / Chapter 5.2 --- Working principle of the proposed circuit --- p.54 / Chapter 5.2.1 --- The introduction of nulling resistor --- p.55 / Chapter 5.2.2 --- The introduction of a voltage buffer --- p.55 / Chapter 5.2.3 --- Small Signal Analysis --- p.57 / Chapter 5.2.4 --- Sign Inversion of the RHP Zero with Nulling Resistor --- p.59 / Chapter 5.2.5 --- Frequency Multiplication of the Complex Conjugate Poles --- p.60 / Chapter 5.2.6 --- Stability Conditions --- p.63 / Chapter 5.3 --- Performance Comparison --- p.67 / Chapter 5.4 --- Conclusion: --- p.70 / Chapter 5.4.1 --- Circuit Modifications: --- p.70 / Chapter 5.4.2 --- Advantages: --- p.71 / Chapter Chapter 6 --- Physical Design of Operational Amplifier --- p.72 / Chapter 6.1 --- Introduction --- p.72 / Chapter 6.2 --- Transistor Layout Techniques --- p.72 / Chapter 6.2.1 --- Multi-finger Layout Technique --- p.72 / Chapter 6.2.2 --- Common-Centroid Structure --- p.73 / Chapter 6.3 --- Layout Techniques of Passive Components --- p.74 / Chapter 6.3.1 --- Capacitor Layout --- p.74 / Chapter 6.3.2 --- Resistor Layout --- p.75 / Chapter Chapter 7 --- Measurement Results --- p.77 / Chapter 7.1 --- Overview --- p.77 / Chapter 7.2 --- Measurement Results for the Current Feedback Operational Amplifier --- p.77 / Chapter 7.2.1 --- Frequency Response of the inverting amplifier --- p.77 / Chapter 7.3 --- Measurement Results for the Three-Stage Operational Amplifier --- p.80 / Chapter 7.3.1 --- Input Offset Voltage Measurement --- p.80 / Chapter 7.3.2 --- Input Common Mode Range Measurement --- p.80 / Chapter 7.3.3 --- Gain Band width Measurement --- p.81 / Chapter 7.3.4 --- DC Gain measurement --- p.85 / Chapter 7.3.5 --- Slew Rate Measurement --- p.87 / Chapter 7.3.6 --- Phase Margin --- p.88 / Chapter 7.3.7 --- Performance Summary --- p.89 / Chapter Chapter 8 --- Conclusions --- p.90 / Chapter Chapter 9 --- Appendix --- p.96

by Chung-Yuk Or. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 95-[98]). / Abstract also in Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Fully Differential CMOS Operational Amplifier Design --- p.4 / Chapter 2.1 --- Wide-Swing Current Mirror --- p.5 / Chapter 2.2 --- Wide-Swing Biasing Network --- p.8 / Chapter 2.3 --- Fully differential folded-cascode operational amplifier --- p.13 / Chapter 2.3.1 --- Small-Signal Analysis --- p.16 / Chapter 2.4 --- Gain-boost technique --- p.18 / Chapter 2.4.1 --- Frequency Response --- p.24 / Chapter 2.5 --- Common-Mode Feedback Network --- p.26 / Chapter 2.5.1 --- Continuous-Time CMFB Circuit --- p.27 / Chapter 2.5.2 --- Discrete-Time CMFB circuit --- p.33 / Chapter 2.6 --- Design Flow of the Operational Amplifier --- p.35 / Chapter 3 --- Physical Design of the Operational Amplifier --- p.39 / Chapter 3.1 --- Layout Level Design --- p.40 / Chapter 3.2 --- Layout Techniques --- p.42 / Chapter 3.3 --- Input Protection Circuitry --- p.47 / Chapter 4 --- Simulation Results --- p.49 / Chapter 4.1 --- Simulation of the Operational Amplifier --- p.49 / Chapter 4.2 --- Simulation of Auxiliary Amplifiers --- p.57 / Chapter 4.3 --- Simulation of the Common-Mode Feedback Circuit --- p.62 / Chapter 5 --- Measurement Results --- p.70 / Chapter 5.1 --- Transient Response Measurement --- p.70 / Chapter 5.2 --- Frequency Response Measurement --- p.74 / Chapter 5.3 --- Power Consumption Measurement --- p.78 / Chapter 5.4 --- Performance Evaluation --- p.81 / Chapter 6 --- Layout Driven Operational Amplifiers Macromodelling --- p.82 / Chapter 6.1 --- Motivations --- p.83 / Chapter 6.2 --- Methodology --- p.84 / Chapter 6.3 --- Macromodelling the operational amplifier --- p.85 / Chapter 6.4 --- Simulation Results --- p.88 / Chapter 6.5 --- Conclusions --- p.92 / Chapter 7 --- Conclusions --- p.93 / Bibliography --- p.95 / A Layout Diagrams and Chip Micrograph --- p.99

Essa tese tem como objetivo desenvolver um modelo matemático de programação mista para auxiliar na indicação das regiões ótimas para acréscimo da oferta de cana-de-açúcar no Brasil. Fazendo uso do ferramental desenvolvido almeja-se avaliar o comportamento espacial da produção de cana, dos fluxos de abastecimento e do consumo de açúcar e etanol mediante projeções futuras da demanda, e também mediante a incorporação dos novos projetos ferroviários, hidroviários e dutoviários na malha intermodal de transportes. Considerando as projeções do consumo doméstico e das exportações sucroalcooleiras para 2020/2021, o modelo matemático sugeriu as regiões ideais para aumentar a oferta de cana-de-açúcar, dentre as áreas com aptidão edafoclimática para o cultivo da cultura, visando a maximização da receita das indústrias do setor. As recomendações do modelo indicam acréscimo de 220 milhões de toneladas na produção dos canaviais do estado de São Paulo, 79 milhões em Mato Grosso do Sul, 70 milhões no Paraná, 65 milhões em Minas Gerais, 60 milhões na Bahia, 42 milhões em Goiás, 24 milhões no Tocantins, 15 milhões no Maranhão, 8 milhões no Mato Grosso e 7 milhões no estado do Piauí, nas condições do cenário com projeções de crescimento pessimista. Além disso, a alocação ótima dos fluxos de transporte de açúcar sugere uma participação de 45% do modal ferroviário, 52% do modal rodoviário e 3% de alternativas hidro-ferroviárias na produção total de serviços de transporte (TKU), considerando a demanda 2020/2021. No caso do etanol as proporções recomendadas indicam 61% para a modalidade rodoviária, 27% para a alternativa ferroviária e 12% para a combinação intermodal hidro-dutoviária. Os benefícios econômicos diretos proporcionados pela expansão da malha intermodal de transporte podem gerar economias com fretes próximas a R$ 444 milhões por safra, no escoamento da produção sucroalcooleira, baixando o frete unitário médio do setor de R$ 59,12 por tonelada para 54,12 por tonelada transportada. O método revelou-se uma ferramenta importante na análise da distribuição espacial da oferta de cana-de-açúcar, e os resultados geraram informações importantes para condução de políticas públicas e para organização do setor sucroenergético. / This thesis aims to construct a mathematical model of mix and integer programming for supporting the decisions about the best regions to increase the supply of sugar cane in Brazil. In addition is intended to use the model to provide inputs for analyzing the spatial sugar cane production and ethanol and sugar transport flows considering future supply and demand assumptions and different multimodal transportation network configuration. Supposing sugar and ethanol demand and exports projections to crop 2020/2021 the mathematical model recommended the optimum agricultural areas to increase the production of sugar cane in other to maximize the sector revenue. The model outputs recommended an increase of 220 million tons in sugarcane production at São Paulo state, 79 millions at Mato Grosso do Sul, 70 million at Paraná, 65 million at Minas Gerais, 60 millions at Bahia, 42 million at Goiás, 24 million at Tocantins, 15 million at Maranhão, 8 millions at Mato Grosso and 7 millions tons at Piauí. Regarding the sugar transportation flows the results proposed a share of 45% for rail mode, 52% for road and 3% for barge-rail alternatives in the total freight (Ton-Kilometer). In the case of ethanol the results indicated a share of 61% for road, 27% for rail, and 12% for barge-pipelines alternatives. The direct economic benefits provided by the expansion of multimodal transportation network implicates savings on freight near to R$ 444 million per crop, that involves a decrease from R$ 59.12 per ton to R$ 54,12 per ton in the unit freight cost. The mathematical model revealed be an important tool for spatial analysis of sugar cane supply in Brazil and the results provided important inputs for Federal Government policies and for planning the sugar and ethanol sector.

Thesis. 1977. Ph.D.--Massachusetts Institute of Technology. Dept. of Mechanical Engineering. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Vita. / Bibliography: p. 293-295. / Ph.D.

Esta tese estuda a implementação de heurísticas e da metaheurística scatter search (SS) em um problema de roteirização de veículos com frota heterogênea, janelas de tempo e entregas fracionadas (Heterogeneous Fleet Vehicle Routing Problem with Time Windows and Split Deliveries – HFVRPTWSD). O HFVRPTWSD é uma combinação do problema de roteirização com frota heterogênea (HFVRP), problema de roteirização de veículos com janelas de tempo (VRPTW) e problema de roteirização com entregas fracionadas (VRPSD). O problema é baseado em um único depósito, a demanda dos clientes pode ser maior que a capacidade dos veículos e, além das restrições de janelas de tempo, há também restrições de capacidade dos veículos e restrições quanto ao tipo de veículo. O VRPSD foi introduzido na literatura por Dror e Trudeau em 1989. No problema de roteirização de veículos com entregas fracionadas, cada cliente pode ser abastecido por mais de um veículo, enquanto no problema clássico de roteirização de veículos (VRP), cada cliente é atendido por um único veículo. Desta forma, para o VRPSD, além dos roteiros de entrega, deve-se determinar a quantidade entregue a cada cliente em cada veículo. Todos os problemas de roteirização com entregas fracionadas encontrados na literatura (VRPSD e suas extensões) têm como característica frota homogênea. O problema estudado neste trabalho difere, portanto, de todos os problemas de roteirização com entregas fracionadas da literatura, pois tem, como característica, frota heterogênea. O mesmo raciocínio vale para problemas de roteirização de veículos com frota heterogênea. Os modelos são aplicados em uma rede de varejo no Brasil que é abastecida a partir de um centro de distribuição. A rede compõe um total de 519 lojas distribuídas em 12 estados do país. As heurísticas e a metaheurística scatter search também são aplicadas em três conjuntos de problemas encontrados na literatura (SOLOMON, 1987; HO E HAUGLAND, 2004; LIU E SHEN, 1999), com o objetivo de avaliar o desempenho dos algoritmos para cada problema. O problema consiste em determinar, a cada dia, como alocar os caminhões às lojas, a quantidade de carga em cada caminhão a ser entregue em cada uma das lojas, qual o melhor roteiro e o tempo de início de atendimento do primeiro cliente da rota, de forma a minimizar o custo total de distribuição, garantindo que a demanda das lojas seja atendida e as demais restrições do problema sejam respeitadas. Para a resolução do VRPSD e suas extensões, a única metaheurística encontrada na literatura foi busca tabu. Para o problema de roteirização com frota heterogênea e suas extensões, foram implementadas apenas as metaheurísticas busca tabu e BATA (Back-Tracking Adaptative Threshold Accepting). As estratégias de solução propostas no presente trabalho consistem na implementação de heurísticas construtivas e da metaheurística scatter search. As soluções iniciais de SS são obtidas através da implementação de quatro heurísticas construtivas: heurística de economias, heurística de inserção seqüencial baseada nas idéias de Solomon (1987), heurística de inserção seqüencial baseada nas idéias de Ho e Haugland (2004) e adaptação da heurística de inserção seqüencial de Dullaert et al. (2002). Para o caso real, foi possível uma redução no custo total da frota comparado com a solução atual da empresa. Para algumas instâncias dos três conjuntos de problemas da literatura, os algoritmos apresentaram resultados similares ou superiores às melhores soluções encontradas. / This thesis studies the implementation of heuristics and scatter search (SS) metaheuristic in a Heterogeneous Fleet Vehicle Routing Problem with Time Windows and Split Deliveries (HFVRPTWSD). The HFVRPTWSD is a combination of Heterogeneous Fleet Vehicle Routing Problem (HFVRP), Vehicle Routing Problem with Time Windows (VRPTW) and Vehicle Routing Problem with Split Deliveries (VRPSD). The problem is based in a single depot, the demand of each client can be greater than the vehicle’s capacity and beyond the time windows constraints, and there are also constraints on the vehicle capacity and vehicles type. The VRPSD was introduced in the literature by Dror e Trudeau in 1989. In the split deliveries vehicle routing problem, each client can be supplied by more than one vehicle; while in a classic vehicle routing problem (VRP) each client is supplied by only one vehicle. Thus, for the VRPSD, besides the delivery routes, the amount to be delivered to each client in each vehicle must also be determined. All the split delivery vehicle routing problems researched in the literature (VRPSD and its extensions) have as a characteristic the homogeneous fleet. Therefore, the problem studied differs from the split deliveries vehicle routing problems of the literature because it has a heterogeneous fleet. The same reasoning can be applied in heterogeneous fleet vehicle routing problem. The models will be applied in a retail market in Brazil that is supplied by a distribution center. The market has 519 stores distributed in 12 Brazilian states. The heuristics and the scatter search metaheuristic will also be applied in three benchmark problems (SOLOMON, 1987; HO AND HAUGLAND, 2004; LIU AND SHEN, 1999), aiming to evaluate the design of the algorithms for each problem. The problem consists in determining, each day, how to allocate the trucks to the stores, the amount to be delivered in each truck to each client, which one is the best route and the initial time for attending the first client, with the aim of minimizing the total distribution cost, attending the clients’ demand and respecting all the problem’s constraints. For the VRPSD and its extensions, the only metaheuristic implemented in the literature was tabu search. For the heterogeneous fleet vehicle routing problem and its extensions, only the tabu search and BATA (Back-Tracking Adaptative Threshold Accepting) metaheuristics have been implemented. The strategies proposed here consist in the implementation of constructive heuristics and the scatter search metaheuristic. The initial solutions of SS are obtained with the implementation of four constructive heuristics: saving heuristics, sequential insertion heuristic based on the ideas of Solomon (1987), sequential insertion heuristic based on the ideas of Ho e Haugland (2004) and adaptation of the sequential insertion heuristic of Dullaert et al. (2002). For the real case, it was possible to reduce the total fleet cost, when comparing to the actual solution. At some instances of the three benchmark problems, the algorithms presented similar or better results when compared to the best solutions in the literature.

Over the last decade considerable interest has been generated into the use of analytical methods in organisations. Along with this, many have reported a significant gap between organisational demand for analytical-trained staff, and the number of potential recruits qualified for such roles. This interest is of high relevance to the operational research discipline, both in terms of raising the profile of the field, as well as in the teaching and training of graduates to fill these roles. However, what is less clear, is the extent to which operational research teaching in universities, or indeed teaching on the various courses labelled as analytics , are offering a curriculum that can prepare graduates for these roles. It is within this space that this research is positioned, specifically seeking to analyse the suitability of current provisions, limited to master s education in UK universities, and to make recommendations on how curricula may be developed. To do so, a mixed methods research design, in the pragmatic tradition, is presented. This includes a variety of research instruments. Firstly, a computational literature review is presented on analytics, assessing (amongst other things) the amount of research into analytics from a range of disciplines. Secondly, a historical analysis is performed of the literature regarding elements that can be seen as the pre-cursor of analytics, such as management information systems, decision support systems and business intelligence. Thirdly, an analysis of job adverts is included, utilising an online topic model and correlations analyses. Fourthly, online materials from UK universities concerning relevant degrees are analysed using a bagged support vector classifier and a bespoke module analysis algorithm. Finally, interviews with both potential employers of graduates, and also academics involved in analytics courses, are presented. The results of these separate analyses are synthesised and contrasted. The outcome of this is an assessment of the current state of the market, some reflections on the role operational research make have, and a framework for the development of analytics curricula. The principal contribution of this work is practical; providing tangible recommendations on curricula design and development, as well as to the operational research community in general in respect to how it may react to the growth of analytics. Additional contributions are made in respect to methodology, with a novel, mixed-method approach employed, and to theory, with insights as to the nature of how trends develop in both the jobs market and in academia. It is hoped that the insights here, may be of value to course designers seeking to react to similar trends in a wide range of disciplines and fields.

A cultura da cana-de-açúcar no Brasil teve na safra 2007/2008 um aumento de 7,4% na área de plantio, sendo o estado e São Paulo responsável por 67% deste aumento. Estabelecer estas expansões ou reformas de canaviais com qualidade se torna imprescindível, pois a cana é uma gramínea perene com ciclo de quatro a cinco anos. Uma das alternativas para melhorar esta qualidade é a utilização de ferramentas como o controle estatístico do processo (CEP) que vem apresentando bons resultados nesta busca. Devido a importância da cultura da cana-de-açúcar, o aumento considerável no plantio da cultura e a exigência pela qualidade no setor, o objetivo deste trabalho foi identificar os fatores críticos e analisar o processo de melhoria continua no plantio da cana-de-açúcar. O trabalho foi desenvolvido na usina Pioneiros Bioenergia S.A e contou com o apoio da equipe técnica da usina. Na primeira etapa selecionaram-se as principais falhas do plantio, que posteriormente foram classificadas de acordo com a severidade, facilidade de ocorrência e de detecção. Em seguida definiram-se seus respectivos indicadores críticos, sendo eles o paralelismo, a profundidade de sulco, número de gemas viáveis por metro e altura de cobrição. Na segunda etapa se utilizaram histogramas, gráficos de controle e Pareto para avaliar a qualidade operacional no plantio, que se mostrou com grande instabilidade e variabilidade. Elaborou-se então, um conjunto de ações para diminuir esta instabilidade, denominado de plano de melhorias. Com a implantação deste plano deu-se inicio a etapa três, onde se avaliou novamente os indicadores considerados insatisfatórios. O paralelismo e a profundidade de sulco apresentaram um aumento dos dados dentro das especificações técnicas, porém, a altura de cobrição sofreu influência da época seca desfavorável para esta operação, proporcionando um aumento da terra na cobrição das mudas. Elaborou-se novamente, um segundo plano de melhorias e para isso utilizaram-se as informações dos gráficos de Pareto. Concluiu-se que a etapa dois apresentou-se com grande instabilidade e fora dos padrões estabelecidos. Com a implantação do plano de melhorias, etapa três, estes se mostraram com melhor estabilidade e com mais dados dentro das especificações. A utilização das ferramentas do CEP e do gráfico de Pareto se mostrou de grande valor na diminuição da instabilidade e melhoria dos processos, bem como na elaboração de um segundo plano de melhorias. / The sugar cane cultivation in Brazil, during the 2007/2008 period, showed a planting area increase of 7.4%. Sao Paulo state was responsible for 67% of this increase. It is vital to conduct those sugar cane plantation expansions and renovations with high quality, because sugar cane is a perennial grass, with a cycle of four to five years. A good alternative to improve plantation expansion and renovation process is the use of Statistical Process Control (SPC). The application of this tool has showed good results. Taking into consideration the great importance of sugar cane cultivation, the increase of sugar cane cultivation area and demand for higher quality, the purpose of this project is to identify critical factors and study the continuous improvement of sugar cane planting process. This project was developed in Pioneiros Bioenergia S.A. sugar mill and had the support of plant technical staff. In the first phase, the main planting failures were selected and classified by severity, occurrence probability and detection easiness. The critical parameters of the selected failures were also defined: furrow parallelism, furrow depth, number of good gemmas per meter and soil covering height. In the second phase histograms, control graphs and Paretto charts were used to evaluate planting operational quality, which showed high instability and variability. An action plan was then developed to reduce that instability, named Improvement Plan. The third phase started with improvement plan implementation, including reevaluation of critical parameters. There was an improvement of furrow parallelism and an increase of furrow depth values in accordance with specifications, but soil covering height was negatively influenced by dry season, which makes covering soil excess more likely to occur. A second Improvement Plan was developed, using Paretto chart information. It was concluded that the instability and values outside the established pattern observed in phase two were reduced by the implementation of the improvement plans carried out during phase three, which has shown better stability and more values in accordance with specifications. The application of SPC tools and Paretto charts was very useful in the process of obtaining planting process stability improvement, including the development of a second Improvement Plan.

A qualidade nos serviços de saúde tem sido objeto de estudo entre diversos pesquisadores. As dificuldades econômicas e a exigência dos usuários pelos seus direitos em obter qualidade nos serviços prestados, torna relevante esse estudo. O enfermeiro é o profissional que deve estimular e conduzir a equipe para elaboração e implementação de novas abordagens e ferramentas gerenciais que levem a melhorias na assistência Uma das ferramentas gerenciais que o enfermeiro pode lançar mão é a padronização das intervenções de enfermagem. Devido à necessidade de melhoria da qualidade da assistência prestada, os Procedimentos Operacionais Padrão de enfermagem foram implantados na Secretaria Municipal de Saúde de Ribeirão Preto entre os anos de 2011 e 2012. O estudo objetiva descrever o modelo de implantação dos Procedimentos Operacionais Padrão (POP) da equipe de enfermagem e identificar as fragilidades e potencialidades na utilização desses POP da equipe de enfermagem. Trata-se de pesquisa do tipo avaliativa, com abordagem quantitativa realizada com profissionais de enfermagem que atuam nas Unidades de Saúde da Secretaria Municipal de Saúde de Ribeirão Preto. A coleta de dados foi realizada em duas fases. Na primeira, ocorreu a análise documental que foi realizada no mês de outubro de 2014. Já a segunda fase compreendeu a aplicação de um questionário aos enfermeiros, técnicos e auxiliares de enfermagem. Participaram do estudo 247 profissionais de enfermagem, sendo 64 enfermeiros, 31 técnicos de enfermagem e 152 auxiliares de enfermagem. Destes, 87,4% eram do sexo feminino. A faixa etária que predominou foi a de 51 a 60 anos, com 34%, seguidos de 30,8% na faixa etária de 41 a 50 anos. Em relação ao tempo de formação 38,5% possuíam de 2 a 8 anos de formados, 24,3% possuía de 16 a 22 anos e 19,4% possuíam 23 a 29 anos de tempo de formação. Dos participantes do estudo, 77,7 % atuavam em Unidades de Saúde da Família. Participaram da capacitação dos POP 222 (89,9%) profissionais de enfermagem. Dentre os participantes da pesquisa, 225 (91,1%) afirmaram que consultam os POP no local de trabalho, porém, apenas 142 (57,5%) os consultaram nos últimos doze meses, sendo a maioria enfermeiros (92,2%). A intervenção mais citada que passou a ser executada após a capacitação dos POP foi o cateterismo por cistostomia (17,8%), apesar de ainda haver um percentual de 39,3% que não a executam. Houve mudança na forma de execução e aprofundamento do conhecimento em todas as intervenções trabalhadas. A implantação dos POP foi desenvolvida de forma pontual, necessitando ser avaliado e repensado nos moldes de um processo educativo contínuo. As fragilidades identificadas foram o número reduzido de profissionais, inadequação da estrutura física, ausência de materiais, entre outros. As potencialidades foram relacionadas à padronização dos materiais, material da instituição para consulta disponível na unidade, valorização profissional, preocupação do gestor em relação à segurança do paciente e do profissional. Ressalta-se a capacitação dos POP como relevante para a contribuição da melhoria da qualidade da assistência prestada pela enfermagem, porém, deve ser pautada em processos educativos permanentes / The quality of health services has been the object of study among many researchers. The economic difficulties and demands from users for their rights to obtain quality in the services rendered make this study relevant. Nurses are the professionals who must encourage and lead the team to create and implement new managerial tools and approaches to improve care. One of the managerial tools that nurses can use is the standardization of nursing interventions. Given the need to improve the quality of the care delivered, standard operational procedures(SOP) in nursing were implemented in the Municipal Health Secretariat of RibeirãoPretobetween 2011 and 2012. The aim of this study was to describe the implementation model of the standard operational proceduresof the nursing team and to identify the weak and strong points in the use of these SOP by the nursing team. This was an evaluative study, with a quantitative approach, conducted with nursing professionals who work in health units of the Municipal Health Secretariat of RibeirãoPreto.Data were collected in two phases. The first phase consisted of a documentary analysis performed in October 2014, whereas the second phase comprised the application of a questionnaire to nurses and nursing technicians and aides. The study participants were 247 nursing professionals, namely 64 nurses, 31 nursing technicians and 152 nursing aides. Of these, 87.4% were women. The age range that prevailed was between 51 and 60 years, with 34%, followed by the age range between 41 and 50 years, with 30.8%. Regarding the time since graduation, 38.5% had graduated from 2 to 8 years ago, 24.3% had graduated between 16 and 22 years agoand 19.4% had from 23 to 29 years since graduation. Among the study participants, 77.7% worked in family health units. A total of 222 (89.9%) nursing professionals participated in the training for SOP. Of all study participants, 225 (91.1%) stated refer to SOP at their work place, however, only 142 (57.5%) referred to them over the last 12 months, with most of them being nurses (92.2%). The most commonly cited intervention that started being executed after the SOP training was cystostomy (17.8%), although there is still a percentage of 39.3% professionals who do not perform it. There was a change in the form of execution and broadening of knowledge in all interventions used. The implementation of the SOP was developedfor a specific scenario, so it should be evaluated and replanned in the scope of a continuous educational process. The weak points identified were the reduced number of professionals, inadequate physical structure, lack of materials, among others. The strengths were related to the standardization of materials, institution materials for reference available in the unit, professional appreciation, andconcern on the part of administrators toward the safety of patients and professionals. It is noteworthy that the training for SOP is relevant as it contributes to improve the quality of the nursing care provided, however, it should be guided by permanent educational processes

The implementation of the mandatory alternative payment model (APM) guarantees savings for Medicare regardless of participant hospitals ability for reducing spending that shifts the cost minimization burden from insurers onto the hospital administrators. Surgical interventions account for more than 30% and 40% of hospitals total cost and total revenue, respectively, with a cost structure consisting of nearly 56% direct cost, thus, large cost reduction is possible through efficient operation management. However, optimizing operating rooms (ORs) schedules is extraordinarily challenging due to the complexities involved in the process. We present new algorithms and managerial guidelines to address the problem of OR planning and scheduling with disturbances in demand and case times, and inconsistencies among the performance measures. We also present an extension of these algorithms that addresses production scheduling for sustainability. We demonstrate the effectiveness and efficiency of these algorithms via simulation and statistical analyses.