Abstract: Optimal power flows are used in electrical systems to optimize the distribution of electrical energy. In general terms, the aim is to minimize the costs associated with the generation and distribution of electrical energy while meeting the system's operational and safety constraints. To achieve this, mathematical algorithms are used to solve the problem of finding the optimal power flow, resulting in the flows in each transmission line of the system. These algorithms take into account various input factors, such as energy demand, the generation capacity of power plants, operational constraints of transmission lines, and the costs associated with energy generation and distribution. They aim to maximize the efficiency of the electrical system by minimizing costs while meeting operational and safety constraints. In this research, a custom tool is developed using MATLAB programming to determine the optimal power flow of an EPS and, additionally, to consider system constraints. The IEEE 14-bus EPS is used as a reference for analysis, where its optimal power flow is obtained, and both emissions and fuel cost constraints are analyzed, thus encompassing power optimization while considering environmental issues.

Resumen: Los flujos óptimos de potencia se emplean en sistemas eléctricos para optimizar la distribución de energía eléctrica. En términos generales, se busca minimizar los costos asociados a la generación y distribución de energía eléctrica, mientras se cumplen con las restricciones operativas y de seguridad del sistema. Para lograr esto, se utilizan algoritmos matemáticos que permiten resolver el problema de encontrar el flujo de potencia óptimo, obteniéndose como resultado los flujos en cada línea de transmisión del sistema. Estos algoritmos tienen en cuenta diversos datos de entrada factores, como la demanda de energía, la capacidad de generación de las centrales eléctricas, las restricciones operativas de las líneas de transmisión y los costos asociados a la generación y distribución de energía eléctrica, y tienen como objetivo además buscan maximizar la eficiencia del sistema eléctrico, a través de la minimización de los costos y cumpliendo con las restricciones operativas y de seguridad del sistema. De esta manera en el presente trabajo de investigación se realiza una herramienta propia con programación en MATLAB que determina el flujo óptimo de potencia de un SEP y además considerando las restricciones del sistema, se ha tomado como referencia para el análisis el SEP de 14 barras de la IEEE en donde se obtiene su flujo óptimo de potencia y se analizan las restricciones tanto de emisiones como de costos de los combustibles abarcando de esta manera la optimización de potencia y considerando el tema ambiental.

Abstract:Technical specifications (TS) comprise all the items of a construction project. Each TS must have seven primary sections providing adequate and accurate information for the project's execution. However, construction delays and over costs have been reported as being generated by deficiencies in TS definition during the planning phase of the construction projects. Despite the project's effects, the quality of TS has been scarcely studied to establish its main failures. This research aimed to evaluate the quality of the TS in civil works based on the expectation-reality relationship. For this purpose, an on-site evaluation was carried out during working days in a total of 176 items being executed or recently executed in 30 projects located in Zone 3 of Ecuador. SPSS software was used to process and interpret data. The results show a 39.81% quality of the TS for the analyzed sample, which could cause the increase in cost and term that has been evidenced in many public construction contracts.

Resumen:Las especificaciones técnicas (ET) se componen de todos los elementos de un proyecto de construcción. Cada una de las ET debe contar con 7 apartados básicos que proporcionen información adecuada y precisa para la correcta ejecución del proyecto. Sin embargo, se han reportado retrasos en la construcción y sobrecostos generados por deficiencias en la definición de ET durante la fase de planificación de los proyectos de construcción. A pesar de las afectaciones del proyecto, la calidad de las ET ha sido escasamente estudiada para establecer sus principales fallas. El objetivo de esta investigación fue evaluar la calidad de ET en obras civiles a partir de la relación expectativa-realidad. Para ello se realizó una evaluación in situ durante días hábiles en un total de 176 partidas que se encontraban ejecutando o que han sido ejecutadas recientemente en 30 proyectos ubicados en la Zona 3 del Ecuador. Para el procesamiento e interpretación de los datos se utilizó el software SPSS. Los resultados muestran un 39,81% de calidad en las ET para la muestra analizada lo que podría ser la causa del aumento en costo y plazo que se ha evidenciado en muchos contratos públicos de construcción.

Abstract The COVID-19 pandemic has had a profound effect on food security worldwide. Colombian farmers were adversely affected by prolonged periods of lockdown, disruptions in the agricultural supply chain, increased poverty levels, and heightened socioeconomic uncertainty. The objective of this study is to evaluate the perceptions of pea producers with regard to the impact of the COVID-19 pandemic. To this end, and ex-ante (2019) and ex-post (2020-2022) diagnostic analysis was conducted in the south of Nariño. We carried out semi-structured interviews with 35 farmers, four key informants, and three focus groups. A sentiment analysis (text mining) was conducted to process sensitive information on environmental, economic, and intrinsic aspects of the productive system. The results revealed that participants maintained constant levels of happiness and confidence across the two-time periods. However, in the period subsequent to the pandemic, higher levels of anger and sadness were reported, attributed to effects of the pandemic itself and the inherent challenges associated with pea cultivation. The implementation of confinement measures resulted in an increase in feelings of uncertainty and sadness, in addition too the emergence of challenges in fieldwork context. Moreover, the increased production costs were attributed to the greater demand for agricultural inputs and labour in 2020. However, in 2022, the increased the price paid per kilogram of pea grains helped mitigate the adverse impact of the pandemic. The study concludes that the econ economic uncertainty introduced by the COVID-19 pandemic affected crop profitability. Nevertheless, small-scale farmers exhibited remarkable resilience and adaptability, allowing them to persist in growing and selling their pea harvest.

Resumen La pandemia de COVID-19 ha tenido un impacto significativo en la seguridad alimentaria en todo el mundo. El agricultor colombiano se vio afectado por bloqueos prolongados, interrupciones en la cadena de suministro agrícola, mayores niveles de pobreza y una mayor incertidumbre socioeconómica. Este estudio tiene como objetivo evaluar la percepción de los productores de arveja sobre el COVID-19, realiza un diagnóstico ex ante (2019) y ex post (2020-2022) en el sur de Nariño. Se realizaron entrevistas semiestructuradas a 35 agricultores, 4 informantes clave y 3 grupos focales. A través de un análisis de sentimiento (Text Mining) se procesó información sensible sobre aspectos ambientales, económicos e intrínsecos del sistema productivo. Los resultados revelaron que los participantes mantuvieron niveles constantes de felicidad y confianza durante dos períodos de tiempo. Sin embargo, en el período posterior a la COVID-19, se informaron niveles más altos de ira y tristeza, atribuidos a los efectos de la pandemia y los desafíos inherentes asociados con el cultivo de arvejas o guisantes. Las medidas de confinamiento intensificaron los sentimientos de incertidumbre y tristeza, además de desafíos en el trabajo de campo. Asimismo, atribuyeron el aumento de los costos de producción a la mayor demanda de insumos agrícolas y mano de obra en 2020. Sin embargo, en 2022, el aumento del precio pagado por kilogramo de granos de arvejas ayudó a mitigar el impacto adverso de la pandemia. El estudio concluye que la COVID-19 introdujo incertidumbre económica en la región y, en consecuencia, afectó la rentabilidad de los cultivos. Sin embargo, los pequeños agricultores mostraron una notable resiliencia y adaptabilidad, lo que les permitió persistir en el cultivo y venta de su cosecha de guisantes.

Resumo Introdução: O início da terapia renal substitutiva (TRS) de modo não planejado em portadores de doença renal crônica (DRC) é situação frequente mundialmente. Nesse cenário, a diálise peritoneal (DP) tem se evidenciado como opção terapêutica em comparação à hemodiálise (HD). Na TRS planejada, os custos da DP são inferiores aos da HD, porém a literatura carece dessas análises quando o início é urgente. Objetivo: Avaliar clínica e economicamente, na perspectiva do Sistema Único de Saúde (SUS), a estratégia de iniciar TRS não planejada por HD e DP em pacientes durante seu primeiro ano de terapia. Metodologia: Estudo quase experimental com análise de custo-efetividade a partir de dados primários de pacientes incidentes em TRS, em horizonte temporal de doze meses, por intenção de tratamento. A coleta de dados ocorreu de maneira prospectiva, diretamente dos prontuários médicos, computando dados de utilização de terapia dialítica, medicações de alto custo, procedimentos em acessos dialíticos e eventos ocorridos, com estimativa de custos pelos valores repassados pelo SUS. Na análise econômica, foi proposta a aplicação de método de bootstrapping e construção de gráficos. Resultados: No fim de um ano, não houve diferenças entre custos e efetividade ao iniciar a TRS de maneira não planejada por DP e HD. Conclusão: Iniciar TRS por DP é opção semelhante a iniciar por HD em pacientes com necessidade de métodos não planejados. A mínima necessidade de investimento inicial para criação de vagas de DP é fator que a fortalece como política de saúde pública para expansão da TRS em países em desenvolvimento.

Abstract Introduction: Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent. Objective: To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy. Methodology: Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed. Results: At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD. Conclusion: Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries.

The shipping industry is shifting towards efficient and environmentally friendly propulsion systems to reduce costs and ecological impact. Traditional diesel engines, predominant in maritime operations, face challenges of high operating costs and environmental pollution, prompting the exploration of alternatives. Electric propulsion emerges as a promising solution, offering cost reduction and environmental preservation through reduced noise, This paper reviews electric ship propulsion systems and compares various marine propulsion systems, including in-hull, azimuth, and POD propulsion, with an emphasis on the latest POD systems. Specifically, it analyzes AZIPOD (ABB) and Mermaid (Rolls-Royce) propulsion systems in terms of motor type, cooling system, and power range. Additionally, the paper provides insights into the electrical components of POD propulsion, and the latest technology in ship propulsion, such as transformers, frequency converters, and propulsion motors, and explores redundancy in ship propulsion systems. It offers a detailed comparison of different electric motors, including DC motors, induction motors, superconducting motors, synchronous motors, and permanent magnet motors, discussing the advantages and disadvantages of each. This comprehensive review under-scores the potential of electric propulsion systems to transform the maritime industry toward sustainability and efficiency.

Internationally, universities face the consequences of the disruption caused by the Fourth Industrial Revolution, accelerated by COVID-19. Traditional universities have lost their competitive advantage due to rapidly changing skills needed and online learning gaining momentum. Historically, universities benefitted from higher levels of enrolments, also increasing their tuition fees above inflation with researchers indicating their concern, but failing to address the reason(s) for this increase. To assess the extent to which universities are geared to face the disruption of potentially declining enrolments with limited opportunity to increase tuition fees in the future (relevance of skills, more competition, students having more choices), it is imperative to assess why tuition fees increased above inflation in the past. The focus of this quantitative research study is to establish the level of efficiency of managing Expenses amongst a sample of sixteen publicly funded South African universities from 2010 to 2019. The data was secondary data in the public domain. Serious levels of financial distress caused by declining enrolments have already been reported in many universities in the United Kingdom (UK), Europe, the United States of America (USA) and Australia. The research question addressed in this article is to assess what the reasons are for the abnormal increases in tuition fees in the past with the intent to assist universities in the Although this study focused only on South African universities, the unique contribution of this research is the methodology applied using Management and Cost accounting to assess the efficient management of expenses at South African universities from 2010 to 2019.

Abstract This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors “Diabetes mellitus,” “Diabetes Melito,” “Diabetes,” “Diabetes Melito,” “Model ECHO,” “Project ECHO,” and “Extension for Community Healthcare Outcomes.” Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals’ knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

Resumo A presente revisão teve como objetivo identificar o impacto do modelo ECHO® no acompanhamento de pessoas com diagnóstico de diabetes mellitus. O trabalho foi desenvolvido de acordo com as recomendações do Joanna Briggs Institute e do Checklist PRISMA-ScR, cujas buscas foram realizadas nas bases de dados Cochrane Library, Embase, Biblioteca Virtual em Saúde, PubMed/MEDLINE, Scopus e Web of Science, por meio de estratégias compostas pelos descritores “Diabetes mellitus”, “Diabete Melito”, “Diabetes”, “Diabetes Melito”, “model ECHO”, “Project ECHO” e “Extension for Community Healthcare Outcomes”. A seleção dos estudos contou com dois revisores trabalhando de forma independente através do software de gestão Rayyan-Intelligent Systematic Review. Dos 151 trabalhos identificados, nove foram selecionados. Um estudo foi identificado na literatura cinzenta. Os dez estudos incluídos foram publicados em inglês, entre os anos de 2012 a 2022. Observou-se melhorias no conhecimento e na autoconfiança dos profissionais, além de diminuição da hemoglobina glicada, redução de hospitalizações e de gastos com internações das pessoas com diabetes. Conclui-se que este trabalho expõe um impacto positivo do Modelo ECHO® no acompanhamento de pessoas com diabetes mellitus, principalmente em comunidades de maior vulnerabilidade.

Resumen La presente revisión tuvo como objetivo identificar el impacto del modelo ECHO® en el seguimiento de personas diagnosticadas con diabetes mellitus. El trabajo se desarrolló de acuerdo con las recomendaciones del Instituto Joanna Briggs y el PRISMA-ScR Checklist, cuyas búsquedas se realizaron en las bases de datos Cochrane Library, Embase, Biblioteca Virtual de Salud (BVS), PubMed/MEDLINE, Scopus y Web of Science, mediante estrategias compuestas por los descriptores “Diabetes mellitus”, “Diabete Melito”, “Diabetes”, “Diabetes Melito”, “model ECHO”, “Project ECHO” y “Extension for Community Healthcare Outcomes”. La selección de estudios incluyó a dos revisores que trabajaron de forma independiente utilizando el software de gestión Rayyan-Intelligent Systematic Review. Se seleccionaron nueve de las 151 obras identificadas y se identificó un estudio por medio de la literatura gris. Los diez estudios incluidos fueron publicados en inglés entre 2012 y 2022. Se observaron mejoras en el conocimiento y la confianza en sí mismos de los profesionales, además de una reducción de la hemoglobina glucosilada, de las hospitalizaciones y de los costos de hospitalización de las personas con diabetes. Se concluye que este trabajo expuso un impacto positivo del Modelo ECHO® en el seguimiento de personas con diabetes mellitus, especialmente en comunidades más vulnerables.

Abstract This research aimed to estimate the direct costs and analyze the epidemiological aspects of ambulatory care-sensitive conditions (ACSC) in children under one year of age, São Paulo municipality, 2011-2022. Total and average costs were calculated according to ACSC diagnosis groups by components (early neonatal, late neonatal, and post-neonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. 98,679 hospitalizations were identified. There was an annual increase of 10.2% in the ACSC rate of early neonates and in the other components the trend was stationary. The cost for the period was estimated at R$ 130.5 million in <1 year, a reduction of 8.6%. The highest absolute values were related to the most frequent causes, such as lung diseases with 43.7% of the cost in <1 year, 52.5% in late neonates, and 48.8% in post-neonates. In early neonates, 83.5% of the cost was attributed to prenatal-related diseases, especially congenital syphilis. It is concluded that it was possible to identify the costs and characteristics of hospitalizations, showing an increase in ACSC rates and the conditions that require greater attention from primary health care services to reduce hospitalizations and hospital costs in the public sector.

Resumo O objetivo desta pesquisa foi estimar os custos diretos e analisar os aspectos epidemiológicos das Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, município de São Paulo, 2011-2022. Os custos total e médio foram calculados segundo grupos de diagnóstico de ICSAP por componentes (neonatal precoce, tardio e pós-neonatal). Analisou-se a tendência das taxas de ICSAP por meio da regressão linear generalizada de Prais-Winsten. Foram identificadas 98.679 internações. Houve aumento anual de 10,2% na taxa de ICSAP dos neonatos precoces e nos demais componentes a tendência foi estacionária. O custo do período foi estimado em R$ 130,5 milhões em <1 ano, com redução de 8,6%. Os maiores valores absolutos estiveram relacionados às causas mais frequentes, como às Doenças pulmonares com 43,7% do custo em <1 ano, 52,5% nos neonatos tardios e 48,8% nos pós-neonatos. Nos neonatos precoces, 83,5% do custo foi atribuído às Doenças relacionadas ao pré-natal, especialmente à sífilis congênita. Conclui-se que foi possível identificar os custos e características das internações, evidenciando aumento das taxas de ICSAP e as condições que requerem maior atenção dos serviços de saúde primária para reduzir internações e gastos hospitalares no setor público.

Resumen Este artículo tuvo como objetivo estimar los costos directos y analizar los aspectos epidemiológicos de las Hospitalizaciones por Condiciones Sensibles a la Atención Primaria (HCSAP) en niños menores de un año, en São Paulo, Brasil, de 2011 a 2022. Se calcularon los costos totales y promedios según grupos de diagnóstico de HCSAP por componentes (neonatal temprano, tardío y posneonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. Se identificaron 98.679 hospitalizaciones. Hubo un aumento anual del 10,2% en la tasa de HCSAP de recién nacidos tempranos y en los demás componentes la tendencia fue estacionaria. El costo del período se estimó en R$ 130,5 millones en <1 año, una reducción del 8,6%. Los valores absolutos más altos estuvieron relacionados con las causas más frecuentes, como las enfermedades pulmonares con el 43,7% del coste en <1 año, el 52,5% en neonatos tardíos y el 48,8% en posneonatos. El 83,5% del costo se atribuyó a enfermedades relacionadas con la atención prenatal, especialmente la sífilis congénita en los recién nacidos prematuros. Se concluye que fue posible identificar los costos y características de las hospitalizaciones, mostrando un aumento en las tasas de HCSAP y las condiciones que requieren mayor atención por parte de los servicios primarios de salud para reducir las hospitalizaciones y los gastos hospitalarios en el sector público.

Resumo Este artigo discute o desenvolvimento, ao longo do século 19, da tecnologia de produção em massa nos Estados Unidos. Assim como o computador e aviação espacial, essa tecnologia surgiu de um esforço liderado pelo estado para promover o progresso técnico na produção de armas e defesa, dando origem ao que era conhecido no século 19 como o “Sistema Americano de Manufaturas”. Embora as raízes desse sistema na política militar-industrial estejam bem estabelecidas, economistas continuam a sugerir que o progresso técnico na América neste período foi impulsionado por forças de mercado, liderado por empreendedores interessados em obter patentes e reduzir custos de produção. Oferecemos uma perspectiva diferente, com base em extensa pesquisa histórica já existente sobre este tópico. Discutimos as origens da tecnologia de peças intercambiáveis na Europa, seu desenvolvimento inicial nos Estados Unidos e sua difusão para a fabricação de bens de consumo após 1850. Também refletimos sobre as razões do interesse do Departamento de Guerra dos Estados Unidos nessa tecnologia após 1800.

Abstract This article discusses the development of mass production technology in the United States. Like spaceflight and the computer, this technology grew out of a state-led effort to promote technical progress in weapons and defense production, giving rise to what was known in the 19th century as the “American System of manufactures”. Though the roots of this system in military-industrial policy are well-established, economists continue to suggest that technical progress in 19th-century America was a market-driven affair, led by entrepreneurs eager to reduce production costs and obtain patents. We offer a different perspective, based on extensive historical research on this topic. We discuss the origins of interchangeable parts technology in Europe, its early development in the United States, and its diffusion to consumer goods manufacturing after 1850. We also reflect on the reasons for the United States War Department’s interest in this technology after 1800.

RESUMO As vilas urbanas são um tipo de área urbana em declínio na China, marcada por aluguéis de baixo custo e por sua localização favorável a uma população flutuante. No entanto, essas vilas apresentam condições de habitação inferiores, externalidades negativas substanciais e um elevado potencial que motiva os governos a desenvolverem ações de requalificação urbana. Este estudo explora o modelo de governança cooperativa entre a requalificação de “vilas urbanas” e a habitação da população flutuante, centrando-se no bem-estar de tais populações por meio de um estudo de caso utilizando dados de entrevistas e análise de cenários. Os resultados observados no estudo de caso mostram que um modo de requalificação adequada tem o potencial de reduzir as dificuldades habitacionais das populações flutuantes, tais como poupar até 154 minutos de tempo de deslocamento por dia de trabalho e 150 dólares em custos mensais de habitação para cada migrante. Finalmente, sugere-se que o modo de requalificação inclusivo seja adotado para todas as futuras intervenções nas vilas urbanas. Considerando as diferentes características dessas vilas e os desejos dos proprietários, o governo pode seguir o modo de requalificação que envolve “requalificação abrangente + locação unificada + gestão de propriedade” ou “aluguel governamental + sistema de previdência social + locação de habitação pública para arrendamento”.

ABSTRACT Urban villages are declining areas in China that attract floating populations due to low rent and favorable locations. These villages have poor housing conditions and substantial negative externalities, yet they also possess a potential that motivates governments to redevelop them. This research explores a cooperative governance model for urban village redevelopment and floating population housing through a case study focusing on the welfare of these populations. Using data from interviews and scenario analysis, the case study reveals that a proper redevelopment mode could alleviate the floating population’s housing difficulties, such as saving up to 154 minutes of commuting time per workday and reducing monthly housing costs by 150 dollars for each migrant. Finally, the research suggests that an inclusive redevelopment mode should be adopted for all future projects in urban villages. Considering the different characteristics of urban villages and the owner’s wishes, the government could pursue redevelopment based on “comprehensive redevelopment + unitizing leasing + property management” or “government rent + social security system + public rental housing leasing.”

RESUMEN Un tipo de área urbana en declive en China es la aldea urbana, en la que los bajos alquileres y la ubicación ventajosa atraen a la población flotante. Sin embargo, las aldeas urbanas tienen condiciones de vivienda inferiores, externalidades negativas sustanciales y un alto potencial que motiva a los gobiernos a reconstruirlas. Este estudio explora el modelo de gobernanza cooperativa entre la renovación de “aldeas urbanas” y la vivienda para poblaciones flotantes, centrándose en el bienestar de las poblaciones flotantes a través de un estudio de caso que utiliza datos de entrevistas y análisis de escenarios. Descubrimos que un modo de reurbanización adecuado podría aliviar las dificultades de vivienda de la población flotante, como ahorrar hasta 154 minutos de tiempo de viaje por día laboral y 150 dólares en costos mensuales de vivienda para cada migrante. Finalmente, sugerimos que se adopte el modo de reurbanización inclusiva para todas las futuras renovaciones de aldeas urbanas. Y teniendo en cuenta las diferentes características de las aldeas urbanas y los deseos de los propietarios, el gobierno puede seguir el modo de reurbanización de “reurbanización integral + arrendamiento unitario + administración de la propiedad” o “alquiler gubernamental + sistema de seguridad social + arrendamiento de viviendas públicas de alquiler”.

RESUMO O objetivo deste estudo foi analisar o desempenho produtivo e reprodutivo de cordeiras submetidas a diferentes formas de suplementação alimentar na fase de crescimento e na estação de monta. Foram utilizadas 28 cordeiras Texel, com idades entre três e 12 meses. As cordeiras foram distribuídas em dois tratamentos, com suplementação proteico-energética em níveis de 1,6 e 2,4% do peso corporal (PC) e mantidas em pastos de Brachiaria brizantha cv. Marandu. O desempenho foi avaliado no início do período experimental e a cada 28 dias até o final da estação de monta, observando-se os seguintes dados: peso corporal final, ganho médio diário (GMD) e ganho de peso total (GPT). No período de crescimento, as cordeiras suplementadas com 2,4% do PC apresentaram maior GMD, o que resultou em maior GPT e peso final. Assim, as cordeiras suplementadas com 2,4% do PC apresentaram maior espessura de gordura subcutânea na fase de crescimento. No entanto, durante o crescimento, as cordeiras suplementadas com 1,6% do PC apresentaram melhor escore de condição corporal do que aquelas suplementadas com 2,4% do PC. Não houve efeito da suplementação no tamanho dos órgãos reprodutivos das cordeiras no final da fase de crescimento e no início da estação reprodutiva. Os níveis de suplementação utilizados afetaram a taxa de gestação das cordeiras. O grupo que recebeu 1,6% do PC teve uma taxa de gestação mais alta do que o grupo tratado com 2,4% do PC. Assim, conclui-se que a suplementação com 1,6% do PC foi economicamente viável para promover ganho de peso, escore de condição corporal e estimular a taxa de fertilidade para cordeiras primíparas em uma estação reprodutiva de 45 dias.

ABSTRACT The aim of this study was to analyze the productive and reproductive performance of lambs submitted to different forms of feed supplementation in the growth phase and breeding season. Twenty-eight Texel sheep aged between three and 12 months were used. The lambs were distributed in two treatments with protein-energy supplementation at levels 1.6 and 2.4% of body weight and reared on Brachiaria brizantha cv. Marandu. The performance was evaluated at the beginning of the experimental period and every 28 days until the end of the breeding season, the following data were observed: final body weight, average daily gain (ADG) and total weight gain (TWG). In the growth period, the lambs supplemented with 2.4% BW presented higher average daily gain, which resulted in higher total weight gain and final weight. Thus, the ewe lambs supplemented with 2.4% BW showed greater subcutaneous fat thickness in the growth phase. However, during growth the lambs supplemented with 1.6% of BW showed better body condition score than those supplemented with 2.4% BW. There was no effect of supplementation on the size of the reproductive organs of the lambs at the end of the growth phase and at the beginning of the reproductive season. The supplementation levels used affected the pregnancy rate of the lambs. The group that received 1.6% BW had a higher pregnancy rate than the group treated with 2.4% BW. Thus, it is concluded that supplementation with 1.6% BW was economically viable to promote weight gain, body condition score, and stimulate fertility rate for primiparous lambs in a 45-day reproductive season.

ABSTRACT The article examines the impact of Ordinance GM/MS No. 1,262, published in September 2023, which links financial incentives to measurable outcomes in liver transplant programs in Brazil. The initiative, which considers the number of transplants performed and 30-day and 1-year survival rates, is viewed as progress toward greater accountability and improved patient care. However, the author highlights significant flaws in the current classification system that may undermine the principles of equity, universality, and decentralization of the Unified Health System [Sistema Único de Saúde (SUS)]. The payment model in use is outdated, does not cover the actual costs of transplants, and ends up using financial incentives to fill budgetary gaps rather than reward excellence in outcomes. Furthermore, the emphasis on the absolute volume of transplants disadvantages centers in smaller and less populated regions, making it harder for them to compete with large centers in more populous states. This exacerbates regional inequalities and encourages the centralization of transplant operations, contravening the SUS’s principle of decentralization. The author proposes adjustments to the system, such as updating the base payment to reflect actual costs, enabling all centers to operate with financial stability. It is also suggested that financial incentives reward excellence in outcomes and that the scoring system assigns greater weight to one-year survival rates, creating a fairer and results-oriented model. Proportional measures based on population size and redistributive funding for lower-ranked centers are recommended to promote equity and stability in transplant access. Ordinance GM/MS No. 1,262 is recognized as an initial milestone, but adjustments are needed to align quality and efficiency with the fundamental principles of the SUS, ensuring that all patients receive high-quality care, regardless of where they are treated.

RESUMO O artigo analisa a influência da Portaria GM/MS Nº 1.262, publicada em setembro de 2023, que vincula incentivos financeiros a resultados mensuráveis nos programas de transplante de fígado no Brasil. Considerando as taxas de sobrevida de 30 dias e 1 ano, bem como o número de transplantes realizados, essa iniciativa representa um progresso em direção a maior responsabilidade e melhor tratamento aos pacientes. No entanto, o autor chama atenção para falhas importantes no sistema atual de classificação que podem comprometer os valores de justiça, universalidade e descentralização do Sistema Único de Saúde (SUS). O modelo de pagamento atual é antiquado, não cobre os custos reais dos transplantes e acaba utilizando os incentivos financeiros para suprir déficits orçamentários, em vez de recompensar a excelência nos resultados. Além disso, o foco no número absoluto de transplantes prejudica os centros em áreas menores e menos habitadas, tornando mais difícil a competição com grandes centros em estados mais populosos. Isso agrava as desigualdades regionais e incentiva a centralização das operações de transplante, contrariando o princípio descentralizador do SUS. O autor sugere mudanças no sistema, como a atualização do pagamento base para refletir os custos reais, permitindo que todos os centros operem com estabilidade financeira. Também são recomendados incentivos financeiros que recompensem a excelência nos resultados e um modelo mais justo e orientado por resultados, com o sistema de pontuação atribuindo maior peso às taxas de sobrevida de 1 ano. Para promover equidade e consistência no acesso ao transplante, são aconselhadas medidas proporcionais ao tamanho da população e financiamento redistributivo para hospitais com menor classificação. Embora a Portaria GM/MS Nº 1.262 seja reconhecida como um marco inicial, mudanças são necessárias para alinhar eficiência e qualidade com os valores fundamentais do SUS, garantindo que todos os pacientes recebam um tratamento de excelência, independentemente de onde sejam atendidos.

Resumo A volatilidade do preço do leite está entre os diversos tipos de risco aos quais as propriedades leiteiras estão expostas, pois se destaca pelo impacto significativo no desempenho econômico desses negócios. Objetivou-se investigar como as variações do preço do leite influenciam o desempenho econômico, bem como sugerir dois indicadores para análises dos riscos em propriedades leiteiras. Utilizou-se a Simulação de Monte Carlo para realizar 10.000 simulações de preços possíveis do leite em 485 propriedades leiteiras localizadas no estado de Minas Gerais. As propriedades com os menores custos de produção foram as que apresentaram as maiores tolerâncias às variações do preço do leite. Aquelas que apresentaram maior eficiência econômica e sofreram os menores riscos decorrentes da variação do preço do leite. Os indicadores aqui sugeridos, denominados Preço de Equilíbrio e Índice de Tolerância do Preço Leite (ITPL), permitiram medir a capacidade dessas propriedades em suportar a redução do preço do leite.

Abstract Milk price volatility is among the several risk types livestock farms are exposed to, since it stands out for its significant impact on these businesses’ economic performance. The aims of the present research are to investigate how product price (milk) variations influence economic performance, as well as suggest an indicator to analyze risks posed to livestock farms in Minas Gerais State, Brazil. The Monte Carlo Simulation was applied to carry out 10.000 simulations of possible milk prices in 485 livestock farms in Minas Gerais State, based on variations observed in this state, from 2015 to 2021. Farms accounting for the lowest production costs were the ones presenting the highest tolerance to milk price variations. Thus, farms showing the best efficiency and profitability suffered with the lowest risks posed by milk price variation. The herein suggest indicators, known as Price Balance and Milk Price Tolerance, allowed measuring these farms’ capacity to support milk price reductions.

Abstract Introduction Community-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. Methods Retrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. Results A total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. Conclusions Our findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

ABSTRACT Objective This study aimed to explore the association between high outliers and intensive care unit admissions and to identify the factors contributing to high intensive care unit costs. Methods This retrospective cohort study used data from 17 Belgian hospitals from 2018 and 2019. The study focused on the 10 most frequently admitted diagnosis-related groups in the intensive care unit. The dataset included medical discharge summaries and cost per stay from the hospital perspective. Results A total of 39,279 hospital stays were analyzed, 11,124 of which were intensive care unit admissions; additionally, 2,500 of these stays were high outliers. The proportion of high outliers was significantly greater in the intensive care unit group, and admission to the intensive care unit was significantly associated with high outliers in the multivariate analyses. Factors associated with high intensive care unit outliers included the medical diagnosis-related group category, patients from nursing homes, intensive care unit stay duration exceeding 4 days, and specific technical procedures (measurement of intracranial pressure, continuous hemofiltration, and mechanical ventilation). Conclusion Admission to the intensive care unit increases the likelihood of being classified as an outlier, thus significantly impacting hospital costs. This study identified factors that can be used to predict intensive care unit outliers, which can enable adjustments to diagnosis-related group-based funding for intensive care units.