Abstract
Hospital Information System is the most fragile component of the health care system in the countries in development process. The modernization of the health care system does not integrate a rigid reflection on the installation of these tools into hospitals, which remain foreign with the strategies of these countries. The main objective of this research is to present a systematic review on the relationship between process approach and continuous improvement with the development and continuity of hospital information systems. Hospital Information System and its sustainability are key factors for the functioning of services in Hospital Institutions which requires principles respect of quality management as the process approach among others. The main question to be treated in this paper is " Which reasons have been given for the views that the process approach is or isn't helping to have and give a Hospital Information System in continuous development?", in order to contribute to the systematization of knowledge in this area, the main objective of this research is to present a systematic review on the relationship between process approach and continuous improvement with the development and continuity of hospital information systems. The systematic review methodology was the PRISMA Statement (R), the search granted to find 7735 based on defined key-words, and after a preliminary examination, according to the exclusion conditions and the eligibility criteria 20 papers were considered relevant to a more detailed study. After an analysis of all relevant documents we have tried to reveal the important gap, which we will try to explore more in future investigations.

Abstract
This study aims to evaluate the economic efficiency of Nursing Homes owned by 96 Santas Casas da Misericordia (SCM) and the determinants that influenced their efficiency in 2012 and 2013. The SCM are the oldest non-profit entities, which belong to Third Sector in Portugal, provide this social response and receive significant financial contributions annually from the state. The study is developed in two stages. In the first stage, the efficiency scores were calculated through the non-parametric DEA technique. In the second stage, Tobit regression is used to verify the effect of certain organizational variables on efficiency, namely the number of users and existence of Nursing Home chains. The results of the DEA model show that the efficiency average is 81.9%, and only 10 out of 96 Nursing Homes are efficient. Tobit regression shows that the number of users has a positive effect on the efficiency of Nursing Homes, whereas the existence of Nursing Home chains affects their efficiency negatively.

Abstract
This paper aims to analyse the bi-directional relationship between technical efficiency, as a measure of companies' performance, and capital structure, under the agency cost theory as well as the pecking order and trade-off theory, to explain the capital structure decisions. The technical efficiency was estimated by the DEA method and corrected by using a suitable bootstrap to obtain statistical inferences. To test the agency cost hypothesis, asymmetric information hypothesis, risk-efficiency hypothesis and franchise value hypothesis (under pecking order and trade off theories framework), two models were applied using some determinants of capital structure such as size, profitability, tangibility, liquidity as control and explanatory variables through a truncated regression with bootstrapping. From an initial sample of 1024 small and medium sized companies from the interior of Portugal, for the period 2006-2009, a subsample of 210 SMEs from secondary and tertiary sectors was selected. The results suggest that medium sized companies have higher average bias-corrected efficiency than small companies; that short-term leverage is positively related to efficiency and that the companies in the sample follow pecking order theory.

Abstract

Abstract
Aim: We investigated the demographic, anthropometric, clinical, biochemical and behavioural factors associated with children and adolescents who missed breakfast. Methods: This 2012 cross-sectional study was carried out in the city of Juiz de Fora, Brazil, with a sample of 684 students: 191 children aged 7-9 and 493 adolescents aged 10-14. Data on demographic, physical activity and breakfast consumption were based on a 24-hour recall record and a three-day dietary record. Weight, height, body fat, waist circumference and blood pressure were also measured. Finally, samples were collected for analysis of blood total cholesterol, low-density and high-density lipoproteins, triglycerides and glucose. The statistics are presented as prevalence ratios (PR) with 95% confidence (95% CI) intervals. Results: Missing breakfast was more common among adolescents than children (30% versus 22%) and among girls of all ages than among boys (33% versus 22%). It was also associated with children, but not adolescents, with increased levels of diastolic blood pressure (PR 5.6, 95% CI 1.8-17.4), total cholesterol (PR 1.5, 95% CI 1.2-1.9) and low-density lipoprotein (PR 2.1, 95% CI 1.5-2.9). Conclusion: Missing breakfast was more common among adolescents and females and associated with increased levels of diastolic blood pressure, total cholesterol and low-density lipoprotein in children.

Abstract
The irregular strip packing problem consists of cutting a set of convex and non-convex two-dimensional polygonal pieces from a board with a fixed height and infinite length. Owing to the importance of this problem, a large number of mathematical models and solution methods have been proposed. However, only few papers consider that the pieces can be rotated at any angle in order to reduce the board length used. Furthermore, the solution methods proposed in the literature are mostly heuristic. This paper proposes a novel mixed integer quadratically-constrained programming model for the irregular strip packing problem considering continuous rotations for the pieces. In the model, the pieces are allocated on the board using a reference point and its allocation is given by the translation and rotation of the pieces. To reduce the number of symmetric solutions for the model, sets of symmetry-breaking constraints are proposed. Computational experiments were performed on the model with and without symmetry-breaking constraints, showing that symmetry elimination improves the quality of solutions found by the solution methods. Tests were performed with instances from the literature. For two instances, it was possible to compare the solutions with a previous model from the literature and show that the proposed model is able to obtain numerically accurate solutions in competitive computational times.