Política de saúde e gestão no processo de (re)construção do SUS em município de grande porte: um estudo de caso de São Paulo, Brasil

O processo de (re)construção do SUS no Município de São Paulo, Brasil, foi analisado, no período de 2001- 2008, por meio de estudo de caso, utilizando-se distintas fontes: documentos; entrevistas com informantes-chave e observação participante. Os conceitos de política de saúde e de gestão em saúde foram utilizados na qualidade de categorias analíticas. Foram selecionadas e analisadas apenas políticas priorizadas pela gestão iniciada em 2001 e que tiveram sustentação até 2008. Discutem-se desafios para a (re)construção do SUS no município relacionados com o contexto político-institucional e com mudanças de estrutura implementadas. As reorganizações da Secretaria Municipal de Saúde de São Paulo propiciaram a constituição e manutenção de dois subsistemas municipais, um hospitalar e outro ambulatorial. Negociações entre os governos municipal, estadual e federal não avançaram para que o município assumisse a gestão de fato de todo sistema de saúde, constatando-se a coexistência de três subsistemas públicos de saúde paralelos: dois municipais e um estadual. A sustentação política do Programa Saúde da Família foi associada ao fato de que esse programa não se constituiu como marca da primeira gestão municipal e, ainda, de ser política prioritária e estimulada pelo governo federal.

A influência da AIDS no processo de desenvolvimento organizacional das organizações não-governamentais: um estudo de caso sobre a Casa de Assistência Filadélfia

A AIDS foi um evento marcante tanto por sua capacidade devastadora como pela forma como estimulou a solidariedade e a mobilização da sociedade na defesa dos direitos de pessoas vivendo e convivendo com HIV/AIDS. De iniciativas para dar dignidade na morte, as ONG/AIDS passaram por mudanças estruturais para responder às demandas da epidemia. Este estudo descreve a trajetória da ONG/AIDS Casa de Assistência Filadélfia com relação à evolução da epidemia de AIDS ressaltando o desenvolvimento organizacional. Utilizou-se uma metodologia qualitativa com estudo de caso, sendo os dados colhidos por meio de análise documental e entrevistas semi-estruturadas com informantes-chave referidos pela organização. A análise dos dados baseou-se nas proposições teóricas de desenvolvimento organizacional e mostra como a organização saiu da fase pioneira marcada pela improvisação, se expandiu, indo para uma fase de regulamentação até chegar à fase de flexibilização e inovação com a diversificação dos projetos. O estudo aponta para a importância do desenvolvimento organizacional como elemento essencial na formação de organizações saudáveis e ágeis na resposta às suas demandas.

Nonlinear refraction and absorption through phase transition in a Nd:SBN laser crystal

Time-resolved Z-scan measurements were performed in a Nd(3+)-doped Sr(0.61)Ba(0.39)Nb(2)O(6) laser crystal through ferroelectric phase transition. Both the differences in electronic polarizability (Delta alpha(p)) and cross section (Delta sigma) of the neodymium ions have been found to be strongly modified in the surroundings of the transition temperature. This observed unusual behavior is concluded to be caused by the remarkable influence that the structural changes associated to the ferro-to-paraelectric phase transition has on the 4f -> 5d transition probabilities. The maximum polarizability change value Delta alpha(p)=1.2x10(-25) cm(3) obtained at room temperature is the largest ever measured for a Nd(3+)-doped transparent material.

Magnetostriction of polycrystalline Fe-Ge alloys

The longitudinal and transverse magnetostriction and microstructure of polycrystalline Fe(100-x)Ge(x) (x= 8, 12, 15, 20) alloys were investigated in order to correlate the magnetostriction with microstructure. In order to obtain different microstructures in the Fe(100-x)Ge(x) alloys, the samples were annealed at 600 degrees C during 2 h and at 1150 degrees C for half hour and then quenched in cold water. For Ge concentrations lower than 14 at.%, the longitudinal magnetostriction is positive and increases positively up to 22 ppm at 12 at.% Ge then decreases and vanishes at about 14 at.% Ge. For further Ge concentration increase the longitudinal magnetostriction is negative and reaches -30 ppm for Fe(80)Ge(20). This behavior, that is very similar to that reported for Fe-Si alloys, is explained by the structural changes caused by different thermal histories of the alloys. (C) 2008 Published by Elsevier B. V.

Technological advances and mechanistic basis for fungal biopulping

Biopulping fundamentals, technology and mechanisms are reviewed in this article. Mill evaluation of Eucalyptus grandis wood chips biotreated by Ceriporiopsis subvermispora on a 50-tonne pilot-plant demonstrated that equivalent energy savings can be obtained in lab- and mill-scale biopulping. Some drawbacks concerning limited improvements in pulp strength and contamination of the chip pile with opportunist fungi have been observed. The use of pre-cultured wood chips as inoculum seed for the biotreatment process minimized contamination problems related to the use of blended mycelium and corn-steep liquor in the inoculation step. Alkaline wash restored part of the brightness in biopulps and marketable brightness values were obtained by one-stage bleaching with 5% H2O2 when bio-TMP pulps were under evaluation. Considering the current scenario, the understanding of biopulping mechanisms has gained renewed attention because more resistant and competitive fungal species could be selected with basis on a function-directed screening project. A series of studies aimed to elucidate structural changes in lignin during wood biodegradation by C. subvermispora had indicated that lignin depolymerization occurs during initial stages of wood biotreatment. Aromatic hydroxyls did not increase with the split of aryl-ether linkages, suggesting that the ether-cleavage-products remain as quitione-type structures. On the other hand, cellulose is more resistant to the attack by C subvermispora. MnP-initiated lipid peroxidation reactions have been proposed to explain degradation of non-phenolic lignin substructures by C subvermispora, while the lack of cellobiohydrolases and the occurrence of systems able to suppress Fenton`s reaction in the cultures have explained non-efficient cellulose degradation by this biopulping fungus. (C) 2007 Elsevier Inc. All rights reserved.

Relevance of extractives and wood transformation products on the biodegradation of Pinus taeda by Ceriporiopsis subvermispora

Ceriporiopsis subvermispora is a promising white-rot fungus for biopulping. However, the underlying biochemistry involved in lignin removal and insignificant cellulose degradation by this species is not completely understood. This paper addresses this topic focusing on the involvement of ethanol-soluble extractives and wood transformation products in the biodegradation process. Cultures containing ethanol-extracted or in natura wood chips presented similar levels of extracellular enzymes and degradation of wood components. Fe3+-reducing compounds present in undecayed Pinus taeda were rapidly diminished by fungal degradation. Lignin-degradation products released during biodegradation restored part of the Fe3+-reducing activity. However, Fe3+ reduction was ineffective in presence of 0.5 mM oxalate at pH 4.5. Fungal consumption of Fe3+-reducing compounds and secretion of oxalic acid minimized the significance of Fenton`s reaction in the initial stages of wood biotreatment. This would explain limited polysaccharide degradation by the fungus that also lacks a complete set of hydrolytic enzymes. Scientific relevance of the paper: Ceriporiopsis subvermispora is a white-rot fungus suitable for biopulping processes because it degrades lignin selectively and causes significant structural changes on the wood components during the earlier decay stages. However, the intricate mechanism to explain lignin transformation and insignificant cellulose degradation by this species remains poorly understood. Some recent evidences pointed out for lipid peroxidation reactions as all initiating process explaining lignin degradation. On the other hand, alkylitaconic acids produced by the fungus via transformations of fatty acids occurring in wood showed to prevent polysaccharide degradation in Fenton reactions. In this context, one may conclude that the involvement of native wood substances or their transformation products in the overall wood biodegradation process induced by C subvermispora is still a matter of discussion. While free and esterified fatty acids present in wood extractives may be involved in the biosynthesis of alkylitaconic acids and in lipid peroxidation reactions, some extractives and lignin degradation products can reduce Fe3+, providing Fe2+ species needed to form OH radical via Fenton`s reaction. The present study focuses on this topic by evaluating the relevance of ethanol-soluble extractives and wood transformation products on the biodegradation of P. taeda by C subvermispora. For this, solid-state cultures containing ethanol-extracted and in natura wood chips were evaluated in details for up to 4 weeks. (C) 2007 Elsevier Ltd. All rights reserved.

Influence of Water Content, Time, and Temperature on the Rheological Behavior of Polyethylene Terephtalate

In this work, the main factors affecting the rheological behavior of polyethylene terephtalate (PET) in the linear viscoelastic regime (water content, time delay before test, duration of experiment, and temperature) were accessed. Small amplitude oscillatory shear tests were performed after different time delays ranging from 300 to 5000 s for samples with water contents ranging from 0.02 to 0.45 wt %. Time sweep tests were carried out for different durations to explain the changes undergone by PET before and during small amplitude oscillatory shear measurements. Immediately after the time sweep tests, the PET samples were removed from the rheometer, analyzed by differential scanning calorimetry and their molar mass was obtained by viscometry analysis. It was shown that for all the samples, the delay before test and residence time within the rheometer (i.e. duration of experiment) result in structural changes of the PET samples, such as increase or decrease of molar mass, broadening of molar mass distribution, and branching phenomena. (C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 116: 3525-3533, 2010

Heat-moisture treatment and enzymatic digestibility of Peruvian carrot, sweet potato and ginger starches

The aim of this work was to study the effects of heat-moisture treatment (27% moisture, 100 degrees C, 16 h) and of enzymatic digestion (alpha-amylase and glucoamylase) on the properties of sweet potato (SP), Peruvian carrot (PC) and ginger (G) starches. The structural modification with heat-moisture treatment (HMT) affected crystallinity, enzyme susceptibility and viscosity profile. The changes in PC starch were the most pronounced, with a strong decrease of relative crystallinity (from 0.31 to 0.21) and a shift of X-ray pattern from B- to A-type. HMTof SP and G starch did not change the Xray pattern (A-type). The relative crystallinity of these starches changed only slightly, from 0.32 to 0.29 (SP) and from 0.33 to 0.32 (G). The extent of these structural changes (PC > SP > G) altered the susceptibility of the starches to enzymatic attack, but not in same order (PC > G > SP). HMT increased the starches digestion, probably due to rearrangement of disrupted crystallites, increasing accessible areas to attack of enzymes. The viscosity profiles and values changed significantly with HMT, resulting in higher pasting temperatures, decrease of viscosity values and no breakdown, i.e., stability at high temperatures and shear rates. Changes in pasting properties appeared to be more significant for PC and SP starch, whereas the changes for G starch were small. Setback was minimized following HMT in SP and G starches.

Sustainability certification of bioethanol: how is it perceived by Brazilian stakeholders?

This paper investigates whether initiatives for sustainability certification of Brazilian ethanol can be expected to stimulate a change among producers toward more sustainable production - and, if so, what those changes would likely be. Connected to this, several questions are raised including whether producers might prefer to target other markets with less stringent demands, and if certification might lead to structural changes in the sector because producers who lack the capacity to meet the new requirements cannot remain competitive. The analysis of interviews with a diverse group of stakeholders under the guidance of the Technological Innovation Systems framework allowed us identify different actions taken by the Brazilian sugarcane ethanol sector in response to requirements of sustainability. The interviewees agreed that sustainability certification is an important element for the expansion of biofuel production in Brazil. Brazilian stakeholders have created a platform for more competitive sustainable production and have initiated relevant processes in response to the development connected to sustainability certification. Yet, the certification activities have had a limited impact in terms of the number of involved stakeholders. But interview responses indicate that the sector may adapt to new certification requirements rather than leave markets where such requirements become established. Structural changes can be expected if certification requirements as they exist in many initiatives are introduced in unflexible ways. The social importance of the ethanol industry is large in Brazil and some adjustments for certification may be required. The paper concludes by suggesting some actions for the industry. (C) 2010 Society of Chemical Industry and John Wiley & Sons, Ltd

Lercanidipine reduces matrix metalloproteinase-2 activity and reverses vascular dysfunction in renovascular hypertensive rats

Increased expression/activity of matrix metalloproteinases (MMPs), especially MMP-2, plays a role in the vascular alterations induced by hypertension, and increased oxidative stress is a major factor activating MMPs. Here, we hypothesized that lercanidipine, a calcium channel blocker, could attenuate the increases in oxidative stress and MMP-2 expression/activity in the two-kidney, one-clip (2K-1C) hypertensive rats. Sham-operated or 2K-1C hypertension rats were treated with lercanidipine 2.5 mg/kg/day (or vehicle) starting three weeks after hypertension was induced. Systolic blood pressure was monitored weekly. After five weeks of treatment, aortic rings were isolated to assess endothelium-dependent and independent relaxations. Quantitative morphometry of structural changes in the aortic wall were studied in hematoxylin/eosin sections. Aortic MMP-2 levels were determined by gelatin zymography. Aortic MMP-2/tissue inhibitor of metalloproteinases (TIMP)-2 mRNA levels were determined by quantitative real-time RT-PCR. Plasma thiobarbituric acid reactive substances concentrations were determined using a fluorometric method. Lercanidipine attenuated 2K-1C hypertension (224 12 versus 183 11 mm Hg in 2K-1C rats and 2K-1C + Lercandipine rats, respectively; P < 0.01) and prevented the reduction in endothelium-dependent vasorelaxation found in 2K-1C rats. Increased MMP-2 and Pro-MMP-2 levels were found in the aortas of 2K-1C rats (all P < 0.05). Lercandipine attenuated 2K-1C-induced increases in MMP-2 by more than 60% and blunted 2K-1C-induced increases in oxidative stress (both P < 0.001). While hypertension-induced significant aortic wall hypertrophy and approximately 9-fold increases in the ratio of MMP-2MMP-2 mRNA expression (both P < 0.05), lercandipine did not affect these changes. These results suggest that lercanidipine produces antihypertensive effects and reverses the endothelial dysfunction associated with 2K-1C hypertension, probably through mechanisms involving antioxidant effects leading to lower MMP-2 activation. (C) 2008 Elsevier B.V. All rights reserved.

The effect of methanol on the stability of Pt/C and Pt-RuO(x)/C catalysts

The behavior of Pt/C and Pt-RuO(x)/C electrodes subjected to a larger number of potential scans and constant potential for prolonged time periods was investigated in the absence and presence of methanol. The structural changes were analyzed on the basis of the modifications observed in the X-ray diffraction pattern of the catalysts. Carbon monoxide stripping experiments were performed before and after the potential scans, thus enabling analysis of the behavior of the electrochemically active surface area. The resulting solutions were examined by inductively coupled plasma mass spectrometry (ICP-MS). There was reduction in the electrochemically active surface area, as well as increase in crystallite size and dissolution of catalyst components after the potential scan tests. Catalyst degradation was more pronounced in the presence of methanol, and cyclic potential conditions accelerate the degradation mechanisms. (C) 2010 Professor T. Nejat Veziroglu. Published by Elsevier Ltd. All rights reserved.

Use of AST platelet ratio index (APRI Score) as an alternative to liver biopsy for treatment indication in chronic hepatitis C

Chronic hepatitis C (CHC) is one of the most important causes of chronic liver disease in the world, potentially resulting in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Liver biopsy is currently performed before therapy indication. Although, it is the golden standard there are many reasons to avoid or delay the procedure. APRI Score is an easy, low cost and practice alternative method which was described as an alternative for assessing structural changes in chronic hepatitis C (CHC). The rationale of this study was to observe the accuracy of APRI Score in comparison to liver biopsy in 400 patients divided into two groups of 200 carriers (Validation and Experimental groups respectively) selected at random or according to liver fibrosis staging (METAVIR). The ROC curves showed a concordance among these two methods of 92% and 88.5% when 1.05 was the cut off (F3 and F4), and 87% and 83%, on 0.75 cut offs (F2-F4). The discordance in advanced fibrosis staging (F3 and F4) was only 16 (8%) and 22 (11%) out of 200 patients in the experimental and validation groups, respectively. In 26 (13%) out of 200 patients in the experimental group and 34 (17%) out of 200 patients in the validation group, there was discordance between APRI Score and liver biopsy in moderate and advanced fibrosis (F2-F4). In conclusion APRI is a serological marker that has satisfactory sensitivity and specificity together with a high predictive value and it can be useful either in the absence of a biopsy or to reduce the frequency with which biopsies need to be carried out to monitor the evolution of chronic hepatitis C and the right moment for treatment indication.

AT(1) blockade during lactation as a model of chronic nephropathy: mechanisms of renal injury

Suppression of the renin-angiotensin system during lactation causes irreversible renal structural changes. In this study we investigated 1) the time course and the mechanisms underlying the chronic kidney disease caused by administration of the AT(1) receptor blocker losartan during lactation, and 2) whether this untoward effect can be used to engender a new model of chronic kidney disease. Male Munich-Wistar pups were divided into two groups: C, whose mothers were untreated, and L(Lact), whose mothers received oral losartan (250 mg.kg(-1).day(-1)) during the first 20 days after delivery. At 3 mo of life, both nephron number and the glomerular filtration rate were reduced in L(Lact) rats, whereas glomerular pressure was elevated. Unselective proteinuria and decreased expression of the zonula occludens-1 protein were also observed, along with modest glomerulosclerosis, significant interstitial expansion and inflammation, and wide glomerular volume variation, with a stable subpopulation of exceedingly small glomeruli. In addition, the urine osmolality was persistently lower in L(Lact) rats. At 10 mo of age, L(Lact) rats exhibited systemic hypertension, heavy albuminuria, substantial glomerulosclerosis, severe renal interstitial expansion and inflammation, and creatinine retention. Conclusions are that 1) oral losartan during lactation can be used as a simple and easily reproducible model of chronic kidney disease in adult life, associated with low mortality and no arterial hypertension until advanced stages; and 2) the mechanisms involved in the progression of renal injury in this model include glomerular hypertension, glomerular hypertrophy, podocyte injury, and interstitial inflammation.

Small airway remodeling in acute respiratory distress syndrome: a study in autopsy lung tissue

Introduction: Airway dysfunction in patients with the Acute Respiratory Distress Syndrome (ARDS) is evidenced by expiratory flow limitation and dynamic hyperinflation. These functional alterations have been attributed to closure/obstruction of small airways. Airway morphological changes have been reported in experimental models of acute lung injury, characterized by epithelial necrosis and denudation in distal airways. To date, however, no study has focused on the morphological airway changes in lungs from human subjects with ARDS. The aim of this study is to evaluate structural and inflammatory changes in distal airways in ARDS patients. Methods: We retrospectively studied autopsy lung tissue from subjects who died with ARDS and from control subjects who died of non pulmonary causes. Using image analysis, we quantified the extension of epithelial changes (normal, abnormal and denudated epithelium expressed as percentages of the total epithelium length), bronchiolar inflammation, airway wall thickness, and extracellular matrix (ECM) protein content in distal airways. The Student`s t test or the Mann-Whitney test was used to compare data between the ARDS and control groups. Bonferroni adjustments were used for multiple tests. The association between morphological and clinical data was analyzed by Pearson rank test. Results: Thirty-one ARDS patients (A: PaO(2)/FiO(2) <= 200, 45 +/- 14 years, 16 males) and 11 controls (C:52 +/- 16 years, 7 males) were included in the study. ARDS airways showed a shorter extension of normal epithelium (A:32.9 +/- 27.2%, C:76.7 +/- 32.7%, P < 0.001), a larger extension of epithelium denudation (A:52.6 +/- 35.2%, C:21.8 +/- 32.1%, P < 0.01), increased airway inflammation (A:1(3), C:0(1), P = 0.03), higher airway wall thickness (A:138.7 +/- 54.3 mu m, C:86.4 +/- 33.3 mu m, P < 0.01), and higher airway content of collagen I, fibronectin, versican and matrix metalloproteinase-9 (MMP-9) compared to controls (P = 0.03). The extension of normal epithelium showed a positive correlation with PaO(2)/FiO(2) (r(2) = 0.34; P = 0.02) and a negative correlation with plateau pressure (r(2) = 0.27; P = 0.04). The extension of denuded epithelium showed a negative correlation with PaO(2)/FiO(2) (r(2) = 0.27; P = 0.04). Conclusions: Structural changes in small airways of patients with ARDS were characterized by epithelial denudation, inflammation and airway wall thickening with ECM remodeling. These changes are likely to contribute to functional airway changes in patients with ARDS.

Metallic Voice: Physiological and Acoustic Features

The metallic voice is usually confused with ring or nasality by singers and nontrained listeners. who are not used to perceptual vocal analysis. They believe a metallic voice results from a rise in fundamental frequency. A diagnostic error in this aspect may lead to lowering pitch, an incorrect procedure that Could Cause vocal overload and fatigue. The purpose of this article is to Study the quality of metallic voice considering the correlation between information of the physiological and acoustic plans, based on a perceptive consensual assumption. Fiberscopic video pharyngolaryngoscopy was performed on 21 professional singers while speaking vowel [e]-in normal and metallic modes to observe muscular movements and structural changes of the velopharynx, pharynx, and larynx. Vocal samples captured simultaneously to the fiberscopic examination were acoustically analyzed. Frequency and amplitude of the first four formants (F(1), F(2), F(3), and F(4)) were extracted by means of linear predictor coefficients (LPC) Spectrum and were statistically analyzed. Vocal tract adjustments such as velar lowering, pharyngeal wall narrowing, laryngeal rise, aryepiglottic, and lateral laryngeal constrictions were frequently found: there were no significant changes in frequency and amplitude of F(1) in the metallic voiced there were significant increases in amplitudes of F(2), F(3), and F(4) and in frequency for F, metallic Voice perceived as louder was correlated to an increase ill amplitude of F(3) and F(4). Physiological adjustments of velopharynx, pharynx, and larynx are combined in characterizing the metallic voice and can be acoustically related to changes in formant pattern.