Hospitals consume most of the health systems' financial resources. In Portugal, for instance, public hospitals represent more than half of the National Health Service debt and are decisive in their financial insufficiency. Although profit is not the primary goal of hospitals, it is essential to guarantee their financial sustainability to ensure users' health care and the necessary resources. An analysis of the existing literature shows that researches focus mainly on the hospital's technical efficiency. The literature has paid little or even no attention to the use of composite indicators in hospital benchmarking studies. This study uses the Benefit of Doubt methodology alongside recent data about Portuguese public hospitals (2013–2017) to understand the factors that contribute to low performance and high indebtedness levels. Our results suggest that hospitals perform better in terms of access (average score: 0.982). The group of criteria with the lowest performance was efficiency and productivity (average score: 0.919), suggesting resources waste. Financial performance is, in general, higher than quality, raising social concerns about the way that public hospitals have been managed. Findings bring relevant implications. For example, the way hospitals are currently financed should consider efficiency, productivity, quality, and access. Regulators should ensure that minimum performance levels are fulfilled, applying preventive and corrective measures to avoid future low-performance levels. We suggest that hospital managers introduce satisfaction inquiries to improve quality. These improvements can attract more patients in the medium- or long-term; thus, our results are useful to citizens to make a better choice.

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For engineering purposes it is especially useful to be able to predict and control sewer corrosion rates and odor impacts as well as to design effective measures aiming to reduce effects related to hydrogen sulfide formation and release. Doing so, it is important to use modeling tools that are capable of assessing variations of dissolved oxygen, dissolved sulfide and hydrogen sulfide gas concentrations for a wide range of environmental scenarios. Two such models were assessed: AEROSEPT, an empirical formulation, and WATS, a conceptual and more complex approach. The models were applied to evaluate the effects of transitions between pressure mains and gravity sewers in the air-liquid mass transfer of hydrogen sulfide at the Ericeira sewer system in Portugal. This network is known to have odor and corrosion problems, especially during summer. Despite the unavoidable uncertainties due to the unsteady flow rate and the quantification of air velocity and turbulence, the simulation results obtained with both models have been shown to adequately predict the overall behavior of the system.

The work presented herein was carried out to assess the effect of intermittent pumping events in sewer headspace pressure differentials, as well as their relationship with hydrogen sulfide gas concentration. A full scale gravity sewer in Portugal, located downstream of several pumping stations, was used as the guiding case study. Under normal system operation, pressure difference between the outside atmosphere and the sewer headspace seemed to influence the in and out-gassing of gas pollutants emitted through the venting stack. Wastewater pumping cycles generated maximum pressure differentials of roughly 100 Pa, which in turn originated maximum air velocities of 1.76 m s−1 exiting the venting stack. Each pumping event was followed by a pressure drop of about 50 Pa, quickly attaining null concentrations of H2S at the venting stack. A statistically significant relationship between pressure differentials and air exit velocity was observed, which allowed obtaining an empirical equation for expedite prediction of airflows emitted to the outside atmosphere (R2 = 0.77). Conversely, the same effect was not observed along the length of the sewer pipe, unlike the findings of other studies. The effect of a full flowing pipe at the downstream end of the gravity trunk sewer was also noticeable in downstream sewer pressurization and gas build-up. It was concluded that the magnitude of the gas pollutant emissions may heavily depend on the impacts of hydraulic flows and pumping characteristics in headspace pressure differences, denoting the need for better approaches when designing and installing venting stacks.