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The implementation of health technology assessment (HTA) in emerging countries depends on the characteristics of the health care system and the needs of public health care. The objective of this survey was to investigate experts' expectations for the development of HTA in Brazil and to derive measures to strengthen the impact of HTA in Brazil on health care decisions. Based on a scoping literature review, a questionnaire was developed proposing eight theses for seven domains of HTA: (i) capacity building, (ii) public involvement, (iii) role of cost-effectiveness analysis (CEA), (iv) institutional framework, (v) scope of HTA studies, (vi) methodology of HTA, and (vii) HTA as the basis for jurisdiction. Thirty experts responded in full to the survey and agreed to five of the eight theses proposed. Experts suggested several measures to promote HTA within the scope of each domain, thus addressing capacity building related to HTA, availability, and reliability of population data, and legal endowment of the HTA system. Finally, HTA processes in Brazil should also address public health issues (e.g., appraisal of interventions directed at chronic diseases).

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Introduction: Governmental hospitals have so far managed in different ways to increase the efficiency of hospitals, each of which has its disadvantages and advantages. This study aimed to determine the factors affecting the independence of hospital management in Iran University of Medical Science. Material and Methods: This descriptive-survey study was conducted pragmatically at hospitals of Iran University of Medical Sciences to identify obstacles and provide the necessary infrastructure by conducting study and follow-up. The sample was 94 people including university dean, deputies and chief executives of hospitals, educational and research deputies, therapists and professionals. Questionnaire was used as data collection tools and field data collection method. Results: The mean age of participants was 47.24 ± 5.41 years. Cronbach's alpha of 41 questions was assessed to test the reliability of the questionnaire. The total alpha coefficient was 0.843. The results showed that the mean score of all domains based on experience time was not significantly different (p> 0.05). The mean score of all domains in the first and third items based on education was statistically significant (p <0.05). In other items, there was no significant difference based on education level (p> 0.05). Conclusion: In general, according to the results and extracted five items, the independence of hospital management can improve the efficacy of services and satisfy the patients and staff.

Introducción: Los hospitales gubernamentales hasta ahora se han manejado de diferentes maneras para aumentar la eficiencia de los hospitales, cada uno de los cuales tiene sus desventajas y ventajas. Objetivo: determinar los factores que afectan la independencia de la gestión del hospital en la Universidad de Ciencias Médicas de Irán. Material y métodos: este estudio de encuesta descriptiva se realizó pragmáticamente en los hospitales de la Universidad de Ciencias Médicas de Irán para identificar obstáculos y proporcionarla infraestructura necesaria mediante la realización de estudios y seguimiento. La muestra fue de 94 personas, incluidos decanos universitarios, diputados y directores ejecutivos de hospitales, diputados de educación e investigación, terapeutas y profesionales. El cuestionario utilizó como herramientas de recolección de datos y método de recolección de datos de campo. Resultados: La edad media de los participantes fue de 47,24 ± 5,41 años. Se evaluó el alfa de Cronbach de 41 preguntas para evaluar la fiabilidad del cuestionario. El coeficiente alfa total fue de 0,843. Resultado: Los resultados mostraron que la puntuación media de todos los dominios basada en el tiempo de experiencia no fue significativamente diferente (p> 0,05). La puntuación media de todos los dominios en el primer y tercer ítems basados en educación fue estadísticamente significativa(p<0,05). En otros ítems, no hubo diferencias significativas en función del nivel educativo (p> 0,05). Conclusión: En general, de acuerdo con los resultados y extraídos cinco ítems, la independencia de la gestión hospitalaria puede mejorar la eficacia de los servicios y satisfacer a los pacientes y al personal.

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Rational design is an important tool for sculpting functional and stability properties of proteins and its potential can be much magnified when combined with in vitro and natural evolutionary diversity. Herein, we report the structure-guided design of a xylose-releasing exo-ß-1,4-xylanase from an inactive member of glycoside hydrolase family 43 (GH43). Structural analysis revealed a nonconserved substitution (Lys247 ) that results in the disruption of the hydrogen bond network that supports catalysis. The mutation of this residue to a conserved serine restored the catalytic activity and crystal structure elucidation of the mutant confirmed the recovery of the proper orientation of the catalytically relevant histidine. Interestingly, the tailored enzyme can cleave both xylooligosaccharides and xylan, releasing xylose as the main product, being the first xylose-releasing exo-ß-1,4-xylanase reported in the GH43 family. This enzyme presents a unique active-site topology when compared with closely related ß-xylosidases, which is the absence of a hydrophobic barrier at the positive-subsite region, allowing the accommodation of long substrates. Therefore, the combination of rational design for catalytic activation along with naturally occurring differences in the substrate binding interface led to the discovery of a novel activity within the GH43 family. In addition, these results demonstrate the importance of solvation of the ß-propeller hollow for GH43 catalytic function and expand our mechanistic understanding about the diverse modes of action of GH43 members, a key and polyspecific carbohydrate-active enzyme family abundant in most plant cell-wall-degrading microorganisms.

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Contexto: El presente trabajo describe el proceso de rediseño curricular de la Carrera de Medicina de la Universidad Central del Ecuador. Discusión: se desarrolló conforme a las disposiciones y lineamientos del Reglamento de Régimen Académico (RRA), con base al análisis de mallas curriculares de Medicina a nivel regional y mundial; sumado a estudios de documentos de pertinencia, prospectiva, empleo; y talleres de consenso y mesas de discusión en la que intervinieron: docentes, estudiantes y otros actores involucrados con la formación médica. Se reformuló el objeto de estudio de la Medicina y sus núcleos problémicos; se adaptó el perfil de egreso de la carrera, lo que propició la inclusión de nuevas asignaturas y la reforma de las existentes, mejorando la interrelación e integración mesocurricular. Resultados: el producto obtenido es una malla curricular con 72 asignaturas que se cursan en 12 semestres. Este proceso fue una oportunidad para innovar y debatir la matriz curricular de la carrera. Conclusión: el rediseño curricular aprobado, con un adecuado ajuste microcurricular horizontal y vertical, lo eleva a categoría cinco en la escala de Harden, es decir, es un diseño curricular de enseñanza integrada que favorece la coordinación metodológica de las asignaturas, visionando en el mediano plazo a lograr un programa de aproximación transdisciplinar o nivel once de Harden, donde se reemplazan las asignaturas por constructos de ideas que llegan a ser parte de la experiencia real y globalizada del estudiante, a través de tareas concretas y tangibles que las aplica en el mundo real y capaz de resolver problemas del entorno. (AU)

Context: The present work is a description of the curricular redesign process that the Medicine Career of the UCE. Discussion: it was developed according to the dispositions and guidelines of the Regulation of Academic Regime (RRA), based on the analysis of curricular meshes of Medicine worldwide; studies of relevance, prospective, employment documents; and consensus workshops of discussion groups in which they took part: teachers, students and other actors involved with medical training. the object of study of Medicine and its problem nuclei was reformulated; the graduate profile of the career was adapted, which led to the inclusion of new subjects and the reform of existing ones, improving the interrelation and meso-curricular integration. Results: the obtained product is a curricular mesh with 72 subjects that are studied in 6 years. This process was an opportunity to innovate and debate the curricular matrix of the career.Conclusion: : the curricular redesign transforms the old curriculum into a Transdisciplinary Approach Program, or level eleven of Harden, where the subjects are replaced by constructs of ideas that become part of the student's real and globalized experience, through specific tasks and tangible that applies them in the real world and capable of solving environmental problems. (AU)

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Resumen: resolver el alto tiempo de espera de las consultas de especialidad en un Hospital público, desde el momento de solicitud de interconsulta, hasta la resolución de ésta tienen directa relación con la satisfacción de los usuarios. Se rediseñaron los procesos administrativos en el departamento de gestión del usuario para reducir el tiempo de permanencia de los usuarios en la lista de espera de especialidad traumatológica no garantizada. Para ello se identificaron los nudos críticos del proceso administrativo y mediante metodología de rediseño de procesos se logró una propuesta que implicó la definición de diagramas de flujo para reducir el tiempo de espera entre las distintas etapas del proceso, lo que fue coherente con los objetivos sanitarios 2011-2020 y los compromisos de gestión definidos para la disminución de tiempos de espera para consultas de especialidad e intervenciones quirúrgicas.

Abstract: resolving the high waiting time of the specialist consultations in a public hospital, from the time an application for consultation is entered until the resolution of this one is in direct relation with the user dissatisfaction. This reality was faced by redesigning the administrative processes in the user management department to reduce the time of permanence of the users in the waiting list of non-guaranteed traumatological specialty. To this end, the critical nodes of the administrative process were identified to achieve a redesign proposal, through a process redesign methodology. This involved the design of flow diagrams that allowed the waiting time to be reduced between the different stages of the process was consistent with the health objectives 2011-2020 and the management commitments defined for the reduction of waiting times for specialist consultations and surgical interventions.

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O job crafting é um processo de ações proativas individuais para redesenhar o trabalho, visando adequá-lo aos valores, competências e motivações individuais, ou para otimizar recursos e demandas com necessidades e recursos pessoais. Verificou-se as qualidades científicas das medidas do construto em quatro bases de dados no período entre 2001 a agosto de 2017. Identificou-se duas formas diferentes de conceitualizar o construto, quatro instrumentos diferentes para sua avaliação e sete trabalhos de adaptação e validação para outros contextos. Analisou-se os 11 instrumentos selecionados em termos de fontes de evidência de validade e precisão. As formas mais utilizadas foram as evidências de validade baseadas na estrutura interna e na relação com variáveis externas e a precisão por meio do alfa de Cronbach. Duas medidas foram validadas para o Brasil, possibilitando a pesquisa sobre as ações de redesenho do trabalho. Conclui-se que o job crafting é mensurável de forma válida e precisa. (AU)

Job crafting is a process of proactive individual actions to redesign work to match individual values, competencies and motivations, or to optimize resources and demands with personal needs and resources. We verified the scientific qualities of the construct measures in four databases between 2001 and August 2017. We identified two different ways of conceptualizing the construct, four different instruments for its evaluation, and seven works to adapt and validate for other contexts. We analyzed 11 selected instruments in terms of validity evidence and accuracy. The most used forms were those with validity evidence based on the internal structure, and those that related external variables and accuracy through Cronbach's alpha. Two measures were validated for Brazil, enabling research on work redesign actions, and we concluded that job crafting is measurable in validity and accuracy. (AU)

El Job crafting es un proceso de acciones proactivas individuales para rediseñar el trabajo con el fin de adecuarlo a los valores, competencias y motivaciones individuales, o para optimizar recursos y demandas con necesidades y recursos personales. Verificamos las cualidades científicas de las medidas del constructo en cuatro bases de datos en el período de 2001 a agosto de 2017. Identificamos dos formas diferentes de conceptualizar el constructo, cuatro instrumentos diferentes para su evaluación y siete trabajos de adaptación y validación para otros contextos. Analizamos los 11 instrumentos seleccionados en términos de fuentes de evidencia de validez y precisión. Las formas más utilizadas fueron las evidencias de validez basadas en la estructura interna y en la relación con variables externas y la precisión por medio del alpha de Cronbach. Dos medidas fueron validadas para Brasil posibilitando la investigación sobre las acciones de rediseño del trabajo. Se concluye que el job crafting es mensurable de forma válida y precisa. (AU)

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Design and redesign of water quality monitoring networks were evaluated for two similarly sized watersheds in the tropical Andes via optimization techniques using geographic information system technology (GIS) and a matter-element analysis of 5-day biological oxygen demand (BOD5) and total suspended solids (TSS). This resulted in a flexible, objectively based design for a 1128-km2 watershed without prior water quality data (La Miel River), and a network redesign of a 1052-km2 watershed with historical water quality monitoring (Chinchiná River). Monitoring design for the undocumented basin incorporated mathematical expressions for physical, anthropological, and historical factors-and was based on clear objectives for diagnosis and intervention of water pollution. Network redesign identified network redundancy, which resulted in a 64% reduction in the number of water quality monitoring stations along the channel, and a 78% reduction of stations throughout the basin. Most tropical drainage basins throughout the world have little to no prior water quality data. But even in well-studied drainage basins like the Chinchiná River, which is among the most thoroughly studied basins in Colombia, redesign of historical and existing monitoring networks will become a standard tool to advance the restoration of polluted surface waters, not only in Colombia, but also throughout the world.

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Health care systems have utilized various process redesign methodologies to improve care delivery. This article describes the creation of a novel process improvement methodology, Rapid Process Optimization (RPO). This system was used to redesign emergency care delivery within a large academic health care system, which resulted in a decrease: (1) door-to-physician time (Department A: 54 minutes pre vs 12 minutes 1 year post; Department B: 20 minutes pre vs 8 minutes 3 months post), (2) overall length of stay (Department A: 228 vs 184; Department B: 202 vs 192), (3) discharge length of stay (Department A: 216 vs 140; Department B: 179 vs 169), and (4) left without being seen rates (Department A: 5.5% vs 0.0%; Department B: 4.1% vs 0.5%) despite a 47% increased census at Department A (34 391 vs 50 691) and a 4% increase at Department B (8404 vs 8753). The novel RPO process improvement methodology can inform and guide successful care redesign.

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Neste artigo relata-se a avaliação da acessibilidade e usabilidade de quatro sites disponibilizados na Web com informações e serviços para o usuário idoso. A partir dos resultados encontrados, o site que obteve a menor avaliação foi selecionado e passou por um processo de Redesign com o intuito de melhorar sua acessibilidade. Nesta pesquisa a metodologia adotada aplicou a abordagem ergonômica e a utilização do Design em fases. Para isso, adotou-se a pesquisa-ação, que se destaca pela sua característica de conhecer e atuar, para depois estudar os resultados. Participaram nessa pesquisa 21 usuários idosos, voluntariamente, que avaliaram os quatro sites selecionados, ajudaram em algumas etapas do desenvolvimento do protótipo e da sua avaliação sobre acessibilidade. Entre os resultados encontrados, após o processo de Redesign do protótipo e avaliação, evidenciou-se que houve um ganho na acessibilidade e usabilidade em relação à versão original do site. Fato constatado, por meio da aplicação de dois Checklists, específicos para avaliação de sites e pela avaliação sobre acessibilidade e usabilidade realizada com os idosos participantes do estudo.

This paper presents the evaluation of the accessibility and usability of four sites with information and services for the elderly user. With the results, the site with the lowest score was selected and underwent a process of Redesign in order to improve their accessibility. In this study the methodology used the ergonomic approach and the use of Design in phases. For this, adopted action research, which stands out for its characteristic of knowing and acting, and then study the results. Participated in this study 21 elderly users voluntarily reviewed the four selected sites, helped in some stages of prototype development and its assessment of accessibility. Among the results, after the Redesign process of prototype and evaluation, it became clear that there was a gain in accessibility and usability over the original version of the site. Fact verified through the application of two Checklists, specific to review sites and for its assessment of accessibility and usability held with the participants of the study elderly.

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Neste artigo relata-se a avaliação da acessibilidade e usabilidade de quatro sites disponibilizados na Web com informações e serviços para o usuário idoso. A partir dos resultados encontrados, o site que obteve a menor avaliação foi selecionado e passou por um processo de Redesign com o intuito de melhorar sua acessibilidade. Nesta pesquisa a metodologia adotada aplicou a abordagem ergonômica e a utilização do Design em fases. Para isso, adotou-se a pesquisa-ação, que se destaca pela sua característica de conhecer e atuar, para depois estudar os resultados. Participaram nessa pesquisa 21 usuários idosos, voluntariamente, que avaliaram os quatro sites selecionados, ajudaram em algumas etapas do desenvolvimento do protótipo e da sua avaliação sobre acessibilidade. Entre os resultados encontrados, após o processo de Redesign do protótipo e avaliação, evidenciou-se que houve um ganho na acessibilidade e usabilidade em relação à versão original do site. Fato constatado, por meio da aplicação de dois Checklists, específicos para avaliação de sites e pela avaliação sobre acessibilidade e usabilidade realizada com os idosos participantes do estudo.(AU)

This paper presents the evaluation of the accessibility and usability of four sites with information and services for the elderly user. With the results, the site with the lowest score was selected and underwent a process of Redesign in order to improve their accessibility. In this study the methodology used the ergonomic approach and the use of Design in phases. For this, adopted action research, which stands out for its characteristic of knowing and acting, and then study the results. Participated in this study 21 elderly users voluntarily reviewed the four selected sites, helped in some stages of prototype development and its assessment of accessibility. Among the results, after the Redesign process of prototype and evaluation, it became clear that there was a gain in accessibility and usability over the original version of the site. Fact verified through the application of two Checklists, specific to review sites and for its assessment of accessibility and usability held with the participants of the study elderly.(AU)

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INTRODUÇÃO: Para competir no mercado atual de medicina laboratorial, há a necessidade de processos com elevado nível de agregação de valor aos clientes e alta flexibilidade para atender às modificações constantes nos requisitos de clientes e legais, bem como capacidade de se adaptar às modificações no ambiente competitivo. Esses desafios exigem uma adaptação global do laboratório para uma visão baseada em processos. OBJETIVO: Avaliar criticamente uma iniciativa de mapeamento e redesenho de processos desenvolvida em um laboratório clínico de grande porte. Nessa análise crítica, serão apresentados e avaliados os resultados de um projeto de redesenho realizado na área técnica da empresa, incluindo processos técnicos e de apoio. MATERIAIS E MÉTODOS: Foram mapeados 37 processos técnicos, utilizando metodologia adaptada e identificando as principais desconexões e oportunidades de melhoria. Cada processo foi sequencialmente analisado e redesenhado e um plano de ação foi gerado para a implementação de cada novo processo. Resultados: Após a implementação dos novos processos redesenhados, a produtividade de pessoal técnico aumentou em mais de 30 por cento. Outro resultado importante foi obtido em termos de flexibilidade dos processos, principalmente em razão da nova estrutura de subáreas na área técnica. DISCUSSÃO: Os principais pontos críticos do projeto estiveram relacionados com a disponibilidade de recursos de tecnologia da informação (TI) e a não priorização de medições nos processos no momento inicial do projeto. CONCLUSÃO: A iniciativa de redesenho de processos, se implementada com um roteiro planejado, orientada a resultados e alinhada à estratégia da organização, pode proporcionar resultados significativos para os laboratórios clínicos.

INTRODUCTION: In order to ensure market competitiveness in laboratory medicine, there is a current demand for processes with high customer added value, high flexibility to attend fluctuating customer and legal requirements, as well as ability to adapt to changes. These challenges require global adaptation to a processbased view. OBJECTIVE: To evaluate critically an initiative of process mapping and redesigning developed in a major clinical laboratory. In this analysis, the results of the redesign project developed in the technical area are presented and evaluated, including technical and support processes METHODS: Thirty-seven technical processes were mapped by use of customized methodology, and key disconnections and improvement opportunities were identified. Each process was sequentially reviewed and redesigned. Furthermore, an action plan was outlined for the implementation of each new process. Results: After implementing new redesigned processes, staff productivity rose by over 30 percent. Another important result was obtained in terms of process flexibility, mainly due to the new subarea structure in the technical area. DISCUSSION: The main crucial points of the project were related to information technology (IT) resource availability and no prioritization of process assessment at the beginning of the project. CONCLUSION: Clinical laboratories may attain significant results with process redesign initiatives as long as these are result-oriented, aligned with the organization strategies and implemented with a planned approach.

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