A regulação assistencial e a produção do cuidado: um arranjo potente para qualificar a atenção

A produção do cuidado integral e a eqüidade são desafios na gestão do SUS. Analisou-se um arranjo da gestão municipal para a produção do cuidado implantado por meio da regulação assistencial com o objetivo de enriquecer as reflexões sobre o tema. Foi realizado estudo de caso em que os dados foram obtidos mediante observação, entrevistas, narrativas escritas e análise documental. Os sujeitos da pesquisa foram gestores e trabalhadores da Secretaria de Saúde. Como resultado destaca-se um conceito de rede viva, produzida ativamente pela construção de relações entre os trabalhadores dos diferentes serviços. Destacam-se as ações de apoio ao cuidado produzido pelas equipes, com base na regulação assistencial e na gestão dos processos de trabalho. Os resultados foram expressivos na qualificação do cuidado, na redução das filas às especialidades e na satisfação dos profissionais. Como marca do processo, evidencia-se a necessidade de enriquecer, em ato, os saberes técnicos com as tecnologias leves e os saberes produzidos em movimentos ativos da gestão para a produção do cuidado.

Contaminated sites and brownfield management State of art in Brazil and in Germany

Purpose - The aim of this paper is to briefly present aspects of public brownfield management policies from Brazilian and German points of view. Design methodology approach - The data collection method combined literature and documental research. The bibliography included Brazilian and German literature about brownfield management. The documental research includes Brazilian and German legislation and official documents published by CETESB, the Environmental Company of the State of São Paulo, Brazil. Furthermore, publications of German governmental research institutions have been integrated in the paper. Findings - In Brazil, despite the lack of a federal public policy, the State of São Paulo has approved specific rules to deal with contaminated sites. Topics that could be targets of scientific studies have been identified. Experiences in Germany show that it is essential to have political will and cooperation between the different political levels and technical disciplines. Partnerships between German and Brazilian universities would be welcome as there is a wide range of opportunities for academic post-graduation studies and research focusing on human resources capacitation in environmental management. Originality value - The paper makes an original contribution of exploring an area (brownfield management) that is at the forefront of discussion in academe and industry

Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48months. Two hundred and eighteen patients (88.5 per cent ) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5 per cent ) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3 per cent , a second reconstructive technique was indicated and in 2.2 per cent a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management

Mobility and social network effects on extremist opinions

Understanding the emergence of extreme opinions and in what kind of environment they might become less extreme is a central theme in our modern globalized society. A model combining continuous opinions and observed discrete actions (CODA) capable of addressing the important issue of measuring how extreme opinions might be has been recently proposed. In this paper I show extreme opinions to arise in a ubiquitous manner in the CODA model for a multitude of social network structures. Depending on network details reducing extremism seems to be possible. However, a large number of agents with extreme opinions is always observed. A significant decrease in the number of extremists can be observed by allowing agents to change their positions in the network.

Anticipation of pain enhances the nociceptive transmission and functional connectivity within pain network in rats

Background: Expectation is a very potent pain modulator in both humans and animals. There is evidence that pain transmission neurons are modulated by expectation preceding painful stimuli. Nonetheless, few studies have examined the influence of pain expectation on the pain-related neuronal activity and the functional connectivity within the central nociceptive network. Results: This study used a tone-laser conditioning paradigm to establish the pain expectation in rats, and simultaneously recorded the anterior cingulate cortex (ACC), the medial dorsal thalamus (MD), and the primary somatosensory cortex (SI) to investigate the effect of pain expectation on laser-induced neuronal responses. Cross-correlation and partial directed coherence analysis were used to determine the functional interactions within and between the recorded areas during nociceptive transmission. The results showed that under anticipation condition, the neuronal activity to the auditory cue was significantly increased in the ACC area, whereas those to actual noxious stimuli were enhanced in all the recorded areas. Furthermore, neuronal correlations within and between these areas were significantly increased under conditions of expectation compared to those under non-expectation conditions, indicating an enhanced synchronization of neural activity within the pain network. In addition, information flow from the medial (ACC and MD) to the lateral (SI cortex) pain pathway increased, suggesting that the emotion-related neural circuits may modulate the neuronal activity in the somatosensory pathway during nociceptive transmission. Conclusion: These results demonstrate that the nociceptive processing in both medial and lateral pain systems is modulated by the expectation of pain.

Border figure detection using a phase oscillator network with dynamical coupling

Oscillator networks have been developed in order to perform specific tasks related to image processing. Here we analytically investigate the existence of synchronism in a pair of phase oscillators that are short-range dynamically coupled. Then, we use these analytical results to design a network able of detecting border of black-and-white figures. Each unit composing this network is a pair of such phase oscillators and is assigned to a pixel in the image. The couplings among the units forming the network are also dynamical. Border detection emerges from the network activity.

AtPIN: Arabidopsis thaliana Protein Interaction Network

Background: Protein-protein interactions (PPIs) constitute one of the most crucial conditions to sustain life in living organisms. To study PPI in Arabidopsis thaliana we have developed AtPIN, a database and web interface for searching and building interaction networks based on publicly available protein-protein interaction datasets. Description: All interactions were divided into experimentally demonstrated or predicted. The PPIs in the AtPIN database present a cellular compartment classification (C(3)) which divides the PPI into 4 classes according to its interaction evidence and subcellular localization. It has been shown in the literature that a pair of genuine interacting proteins are generally expected to have a common cellular role and proteins that have common interaction partners have a high chance of sharing a common function. In AtPIN, due to its integrative profile, the reliability index for a reported PPI can be postulated in terms of the proportion of interaction partners that two proteins have in common. For this, we implement the Functional Similarity Weight (FSW) calculation for all first level interactions present in AtPIN database. In order to identify target proteins of cytosolic glutamyl-tRNA synthetase (Cyt-gluRS) (AT5G26710) we combined two approaches, AtPIN search and yeast two-hybrid screening. Interestingly, the proteins glutamine synthetase (AT5G35630), a disease resistance protein (AT3G50950) and a zinc finger protein (AT5G24930), which has been predicted as target proteins for Cyt-gluRS by AtPIN, were also detected in the experimental screening. Conclusions: AtPIN is a friendly and easy-to-use tool that aggregates information on Arabidopsis thaliana PPIs, ontology, and sub-cellular localization, and might be a useful and reliable strategy to map protein-protein interactions in Arabidopsis. AtPIN can be accessed at http://bioinfo.esalq.usp.br/atpin.

ELECTRONIC GOVERNMENT POLICIES IN BRAZIL: CONTEXT, ICT MANAGEMENT AND OUTCOMES

The State Reform processes combined with the emergence and use of Information and Communication Technology (ICT) originated electronic government policies and initiatives in Brazil. This paper dwells on Brazilian e-government by investigating the institutional design it assumed in the state's public sphere, and how it contributed to outcomes related to e-gov possibilities. The analyses were carried out under an interpretativist perspective by making use of Institutional Theory. From the analyses of interviews with relevant actors in the public sphere, such as state secretaries and presidents of public ICT companies, conclusions point towards low institutionalization of e-gov policies. The institutional design of Brazilian e-gov limits the use of ICT to provide integrated public services, to amplify participation and transparency, and to improve public policies management.

THE RELEVANCE OF SUBSIDIARY INITIATIVES FOR BRAZILIAN MULTINATIONALS

The put-pose of this paper is to analyze relationship patterns between headquarters and subsidiaries of Brazilian Multinationals Enterprises (BrMNEs). The key construct for that investigation is Subsidiary Initiative, which comprises Subsidiary Entrepreneurial Orientation, Autonomy, Integration, Local Competitive Context and Business Network. A survey was carried out in a sample of 65 subsidiaries of 29 BrMNEs. The main outcome is that subsidiaries are highly integrated and receive Entrepreneurial Orientation from Headquarters (HQs), but Initiative is limited. Actually, the main determinants of subsidiary's initiatives are Local Context and Business Networking in the host country. This apparent paradox may be explained by what we call 'rebellious subsidiaries', which take initiatives based on their business environment and connections, regardless of their HQs' directions or delegation of autonomy.

State-of-the-Art and Future Directions for Green Human Resource Management: Introduction to the Special Issue

The topic of environmental sustainability is generating increased concern among business executives, governments, consumers, and management scholars. As these stakeholders struggle with the challenges and opportunities presented by an array of environmental issues, HRM scholars and practitioners alike have been relatively slow to engage in the ongoing discussions and debates. Through this special issue on Green FIRM, we seek to stimulate the field of HRM to expand its role in the pursuit of environmentally sustainable business. In this introduction to the special issue, we first provide an overview of the articles that appear in the special issue. Next we present a detailed discussion of research questions that arise from a consideration of several functional HRM practices, including performance management; training, development, and learning; compensation and rewards; and organizational culture. We conclude by describing opportunities for research at the intersection of strategic HRM and environmental management. If pursued with vigor, research addressing this extensive agenda could begin to establish a healthy field of Green FIRM scholarship.

Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney

Background and Purpose: A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a ""simple"" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. Patients and Methods: From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney ( 43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. Results: Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. Conclusion: Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.

Management of Chronic Unilateral Hematuria by Ureterorenoscopy

Background and Purpose: Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. In the past, it was managed with partial or total nephrectomy. In the age of minimally invasive procedures, however, endoscopy has enabled more accurate diagnosis and management. We analyzed our experience with transurethral ureterorenoscopy using a flexible ureteroscope to determine the feasibility and success of endoscopic management of renal hematuria. Patients and Methods: We reviewed the records of 13 patients who presented with chronic unilateral hematuria, in whom radiologic and laboratory tests failed to reveal the source of bleeding. In the cases in which the lesion was identified, after complete inspection of the collecting systems, the bleeding site was treated ureteroscopically with a holmium: yttrium-aluminum-garnet ( YAG) laser. Results: Follow-up ranged from 4 to 60 months ( mean 26 mos). During the follow-up of the 13 patients, 11 remained symptom-free, with only one session of flexible ureterorenoscopy necessary. Relapse occurred in two patients after 4 months and 6 months, respectively; during a second session of flexible ureteroscopy, the bleeding site was successfully identified and cauterized with a holmium: YAG laser. No surgical complications occurred. Conclusions: Conservative treatment of patients with chronic unilateral hematuria should always be considered. Laser ureteroscopic treatment is an excellent method and should be considered as the first option for the management of chronic unilateral hematuria.

Management of Bell's Palsy: A Report of 2 Cases

Bell's palsy is a neuropathy of the peripheral seventh cranial nerve, resulting from traumatic, compressive, infective, inflammatory or metabolic abnormalities or it can be idiopathic. HIV, Epstein-Barr virus and hepatitis B virus have been suspected as initiating organisms, but herpes simplex virus is the most frequently implicated. This report describes 2 cases of Bell's palsy in children that were managed with antiviral agents. Both patients experienced complete recovery within 28 days; after 1 year follow-up, no recurrence was observed and both patients have normal facial movement. Differential diagnosis is essential to guide the treatment plan in Bell's palsy. Special attention should be given to children with respect to prescription of medications that can cause important side effects.

POPREP: a generic report for population management

Genetic variation provides a basis upon which populations can be genetically improved. Management of animal genetic resources in order to minimize loss of genetic diversity both within and across breeds has recently received attention at different levels, e. g., breed, national and international levels. A major need for sustainable improvement and conservation programs is accurate estimates of population parameters, such as rate of inbreeding and effective population size. A software system (POPREP) is presented that automatically generates a typeset report. Key parameters for population management, such as age structure, generation interval, variance in family size, rate of inbreeding, and effective population size form the core part of this report. The report includes a default text that describes definition, computation and meaning of the various parameters. The report is summarized in two pdf files, named Population Structure and Pedigree Analysis Reports. In addition, results (e. g., individual inbreeding coefficients, rate of inbreeding and effective population size) are stored in comma-separate-values files that are available for further processing. Pedigree data from eight livestock breeds from different species and countries were used to describe the potential of POPREP and to highlight areas for further research.

The BRAzilian Seismographic Integrated Systems (BRASIS): infrastructure and data management

In geophysics and seismology, raw data need to be processed to generate useful information that can be turned into knowledge by researchers. The number of sensors that are acquiring raw data is increasing rapidly. Without good data management systems, more time can be spent in querying and preparing datasets for analyses than in acquiring raw data. Also, a lot of good quality data acquired at great effort can be lost forever if they are not correctly stored. Local and international cooperation will probably be reduced, and a lot of data will never become scientific knowledge. For this reason, the Seismological Laboratory of the Institute of Astronomy, Geophysics and Atmospheric Sciences at the University of Sao Paulo (IAG-USP) has concentrated fully on its data management system. This report describes the efforts of the IAG-USP to set up a seismology data management system to facilitate local and international cooperation.