Health technology diffusion in developing countries: a case study of CT scanners in Brazil

Background The development of products and services for health care systems is one of the most important phenomena to have occurred in the field of health care over the last 50 years. It generates significant commercial, medical and social results. Although much has been done to understand how health technologies are adopted and regulated in developed countries, little attention has been paid to the situation in low- and middle-income countries (LMICs). Here we examine the institutional environment in which decisions are made regarding the adoption of expensive medical devices into the Brazilian health care system. Methods We used a case study strategy to address our research question. The empirical work relied on in-depth interviews (N = 16) with representatives of a wide range of actors and stakeholders that participate in the process of diffusion of CT (computerized tomography) scanners in Brazil, including manufacturers, health care organizations, medical specialty societies, health insurance companies, regulatory agencies and the Ministry of Health. Results The adoption of CT scanners is not determined by health policy makers or third-party payers of public and private sectors. Instead, decisions are primarily made by administrators of individual hospitals and clinics, strongly influenced by both physicians and sales representatives of the medical industry who act as change agents. Because this process is not properly regulated by public authorities, health care organizations are free to decide whether, when and how they will adopt a particular technology. Conclusions Our study identifies problems in how health care systems in LMICs adopt new, expensive medical technologies, and suggests that a set of innovative approaches and policy instruments are needed in order to balance the institutional and professional desire to practise a modern and expensive medicine in a context of health inequalities and basic health needs.

GIS applied to geotechnical and environmental risk management in a Brazilian oil pipeline

The paper presents the development of a decision support system for the management of geotechnical and environmental risks in oil pipelines using a geographical information system. The system covers a 48.5 km long section of the So Paulo to Brasilia (OSBRA) oil pipeline, which crosses three municipalities in the northeast region of the So Paulo state (Brazil) and represents an area of 205.8 km(2). The spatial database was created using geo-processing procedures, surface and intrusive investigations and geotechnical reports. The risk assessment was based mainly on qualitative models (relative numeric weights and multicriteria decision analysis) and considered pluvial erosion, slope movements, soil corrosion and third party activities. The maps were produced at a scale of 1:10,000.

Assessing the evolution of sustainability reporting in the mining sector

Since the 1990s several large companies have been publishing nonfinancial performance reports. Focusing initially on the physical environment, these reports evolved to consider social relations, as well as data on the firm`s economic performance. A few mining companies pioneered this trend, and in the last years some of them incorporated the three dimensions of sustainable development, publishing so-called sustainability reports. This article reviews 31 reports published between 2001 and 2006 by four major mining companies. A set of 62 assessment items organized in six categories (namely context and commitment, management, environmental, social and economic performance, and accessibility and assurance) were selected to guide the review. The items were derived from international literature and recommended best practices, including the Global Reporting Initiative G3 framework. A content analysis was performed using the report as a sampling unit, and using phrases, graphics, or tables containing certain information as data collection units. A basic rating scale (0 or 1) was used for noting the presence or absence of information and a final percentage score was obtained for each report. Results show that there is a clear evolution in report`s comprehensiveness and depth. Categories ""accessibility and assurance"" and ""economic performance"" featured the lowest scores and do not present a clear evolution trend in the period, whereas categories ""context and commitment"" and ""social performance"" presented the best results and regular improvement; the category ""environmental performance,"" despite it not reaching the biggest scores, also featured constant evolution. Description of data measurement techniques, besides more comprehensive third-party verification are the items most in need of improvement.

Forest certification in Amazonia: standards matter

Forest Stewardship Council (FSC) certification promises international consumers that `green-label` timber has been logged sustainably. However, recent research indicates that this is not true for ipe (Tabebuia spp.), currently flooding the US residential decking market, much of it logged in Brazil. Uneven or non-application of minimum technical standards for certification could undermine added value and eventually the certification process itself. We examine public summary reports by third-party certifiers describing the evaluation process for certified companies in the Brazilian Amazon to determine the extent to which standards are uniformly applied and the degree to which third-party certifier requirements for compliance are consistent among properties. Current best-practice harvest systems, combined with Brazilian legal norms for harvest levels, guarantee that no certified company or community complies with FSC criteria and indicators specifying species-level management. No guidelines indicate which criteria and indicators must be enforced, or to what degree, for certification to be conferred by third-party assessors; nor do objective guidelines exist for evaluating compliance for criteria and indicators for which adequate scientific information is not yet available to identify acceptable levels. Meanwhile, certified companies are expected to monitor the long-term impacts of logging on biodiversity in addition to conducting best-practice forest management. This burden should reside elsewhere. We recommend a clarification of `sustained timber yield` that reflects current state of knowledge and practice in Amazonia. Quantifiable verifiers for best-practice forest management must be developed and consistently employed. These will need to be flexible to reflect the diversity in forest structure and dynamics that prevails across this vast region. We offer suggestions for how to achieve these goals.

Dentin permeability of the apical third in different groups of teeth

This ex vivo study evaluated dentin permeability of the root canal in the apical third of different human groups of teeth. Eighty teeth were used, 8 from each dental group: maxillary and mandibular central incisors, lateral incisors and canines, maxillary first premolars (buccal and palatal roots), mandibular first premolars, and maxillary and mandibular second premolars, totalizing 88 roots that were distributed in 11 groups. The root canals were instrumented, irrigated with 1% NaOCl and 15% EDTA. Roots were immersed in 10% copper sulfate for 30 min and then in 1% rubeanic acid alcohol solution for the same period; this chemical reaction reveals dentin permeability by the formation of copper rubeanate, which is a dark-colored compound. Semi-serial 100-µm-thick cross-sections were obtained from the apical third of the roots. Five sections of each apical third were washed, dehydrated, cleared and mounted on glass slides for examination under optical microscopy. The percentage of copper ion infiltration and the amount of tubular dentin were quantified by morphometric analysis. The penetration of copper ions in the apical third ranged from 4.60 to 16.66%. The mandibular central and lateral incisors presented the highest dentin permeability (16.66%), while the maxillary canines and mandibular second and first premolars presented the lowest dentin permeability (4.60%, 4.80% and 5.71%, respectively; p<0.001). The other teeth presented intermediate permeability. In conclusion, dye penetration into dentin tubules at the apical region is strongly dependent on the group of teeth evaluated.

Near-infrared third-order nonlinearity of PbO-GeO(2) films containing Cu and Cu(2)O nanoparticles

We report measurements of the nonlinear (NL) refractive index n(2) of lead-germanium films (LGFs) containing Cu and Cu(2)O nanoparticles (NPs). The thermally managed eclipse Z-scan technique with 150 fs pulses from a laser operating at 800 nm was used. The NL refractive index measured, n(2)=6.3x10(-12) cm(2)/W has electronic origin and the NL absorption coefficient alpha(2) is smaller than 660 cm/GW. The figure of merit n(2)/lambda alpha(2) is enhanced by more than two orders of magnitude in comparison with the result for the LGFs without the copper based NPs. (C) 2008 American Institute of Physics.

Polarized Light (lambda 400-2000 nm) on Third-Degree Burns in Diabetic Rats: Immunohistochemical Study

Aim: The aim of this study was to evaluate with light microscopy the healing process of third-degree burns on diabetic rats treated with polarized light (lambda 400-2000 nm, 20 or 40 J/cm(2)/session, 40 mW/cm(2), 2.4 J/cm(2)/min, 5.5-cm beam diameter). Background: Uncontrolled diabetes mellitus causes severe disruption of the body's metabolism, including healing. Polarized light sources have been shown to be effective in improving healing in many situations. Animals and Methods: Diabetes mellitus was induced with streptozotocin (60 mg/kg) in 45 male Wistar albino rats, and a third-degree burn (1.5 by 1.5 cm) was created on the dorsum of each animal under general anesthesia. The animals were randomly distributed into three groups: control, 20 J/cm(2), and 40 J/cm(2). Each group was then divided into three subgroups based on time of death (7, 14, 21 d). Phototherapy (20 or 40 J/cm(2) per session) was carried out immediately after the burning and repeated daily until the day before death. Following animal death, specimens were removed, embedded in paraffin, sectioned, and stained with hematoxylin and eosin (HE) or Sirius Red or immunomarked with CK AE1/AE3 antibody. Qualitative and semiquantitative analyses were performed under light microscopy. The results were statistically analyzed. Results: The animals treated with 20 J/cm(2) showed significant differences with regard to revascularization and re-epithelialization. Although the 40 J/cm(2) group showed stimulation of fibroblastic proliferation as an isolated feature, no other difference from the control was observed. Conclusion: Our results suggest that the use of polarized light at 20 J/cm(2) effectively improves the healing of third-degree burns on diabetic animals at both early and late stages of repair.

Optical third-harmonic spectroscopy of the magnetic semiconductor EuTe

EuTe possesses the centrosymmetric crystal structure m3m of rocksalt type in which the second-harmonic generation is forbidden in electric dipole approximation but the third-harmonic generation (THG) is allowed. We studied the THG spectra of this material and observed several resonances in the vicinity of the band gap at 2.2-2.5 eV and at higher energies up to 4 eV, which are related to four-photon THG processes. The observed resonances are assigned to specific combinations of electronic transitions between the ground 4f(7) state at the top of the valence band and excited 4f(6)5d(1) states of Eu(2+) ions, which form the lowest energy conduction band. Temperature, magnetic field, and rotational anisotropy studies allowed us to distinguish crystallographic and magnetic-field-induced contributions to the THG. A strong modification of THG intensity for the 2.4 eV band and suppression of the THG for the 3.15 eV band was observed in applied magnetic field. Two main features of the THG spectra were assigned to 5d(t(2g)) and 5d(e(g)) subbands at 2.4 eV and 3.15 eV, respectively. A microscopic quantum-mechanical model of the THG response was developed and its conclusions are in qualitative agreement with the experimental results.

Femtosecond third-harmonic generation in a glass ceramic containing sodium niobate nanocrystals

The third-harmonic optical susceptibility, chi((3))(3 omega; omega, omega, omega) of a silicate glass ceramic containing sodium niobate nanocrystals was measured for incident broadband light with central frequency omega corresponding to 1900nm. Absolute values of |chi((3))| and the dispersion of the refractive index from 600 to 1900nm were measured using the spectrally resolved femtosecond Maker fringes technique. The experiments show that |chi((3))| is 1 order of magnitude larger than silica, and it grows by similar to 50% when the volume fraction occupied by the nanocrystals increases up to 40%. (C) 2011 Optical Society of America

Third-order nonlinear spectra and optical limiting of lead oxifluoroborate glasses

We have determined two-photon absorption and nonlinear refraction spectra of the 50BO(1.5) - (50-x)PbF(2) - xPbO glasses (with x = 25, 35, 50 cationic %) at the range of the 470 and 1550 nm. The replacement of fluor atoms by oxygen leads to an increase in the third-order susceptibility, due to the formation of non-bridging oxygens (NBO). The nonlinear index of refraction is one order of magnitude higher than the one for fused silica, and it increases almost twice for the sample with x = 50. This sample has also shown promising features for all-optical switching as well as for optical limiting. (C) 2011 Optical Society of America

The development of social tourism in Brazil

This article reflects on the origins and development of social tourism in Brazil, with particular reference to the socio-economic conditions in the country. It discusses the theoretical conceptualisation of social tourism and its implementations in the non-European context. The case study presented here is based on a secondary bibliographical research of existing definitions and an in-depth analysis of the political conditions that have framed its development. More particularly, this article will discuss public initiatives since the Labour Party gained power in Brazil in 2003. Apart from public sector involvement in social tourism, this article also examines the role of the third sector in provision. The example of Social Service of Commerce will be presented. This article will conclude by evaluating the phenomenon of social tourism in Brazil, highlighting where progress has been made and which are the key challenges that need to be overcome.

Design constraints for third-order PLL nodes in master-slave clock distribution networks

Clock signal distribution in telecommunication commercial systems usually adopts a master-slave architecture, with a precise time basis generator as a master and phase-locked loops (PLLs) as slaves. In the majority of the networks, second-order PLLs are adopted due to their simplicity and stability. Nevertheless, in some applications better transient responses are necessary and, consequently, greater order PLLs need to be used, in spite of the possibility of bifurcations and chaotic attractors. Here a master-slave network with third-order PLLs is analyzed and conditions for the stability of the synchronous state are derived, providing design constraints for the node parameters, in order to guarantee stability and reachability of the synchronous state for the whole network. Numerical simulations are carried out in order to confirm the analytical results. (C) 2009 Elsevier B.V. All rights reserved.

Route to chaos in a third-order phase-locked loop network

Phase-locked loops (PLLs) are widely used in applications related to control systems and telecommunication networks. Here we show that a single-chain master-slave network of third-order PLLs can exhibit stationary, periodic and chaotic behaviors, when the value of a single parameter is varied. Hopf, period-doubling and saddle-saddle bifurcations are found. Chaos appears in dissipative and non-dissipative conditions. Thus, chaotic behaviors with distinct dynamical features can be generated. A way of encoding binary messages using such a chaos-based communication system is suggested. (C) 2009 Elsevier B.V. All rights reserved.

Using bifurcations in the determination of lock-in ranges for third-order phase-locked loops

Transmission and switching in digital telecommunication networks require distribution of precise time signals among the nodes. Commercial systems usually adopt a master-slave (MS) clock distribution strategy building slave nodes with phase-locked loop (PLL) circuits. PLLs are responsible for synchronizing their local oscillations with signals from master nodes, providing reliable clocks in all nodes. The dynamics of a PLL is described by an ordinary nonlinear differential equation, with order one plus the order of its internal linear low-pass filter. Second-order loops are commonly used because their synchronous state is asymptotically stable and the lock-in range and design parameters are expressed by a linear equivalent system [Gardner FM. Phaselock techniques. New York: John Wiley & Sons: 1979]. In spite of being simple and robust, second-order PLLs frequently present double-frequency terms in PD output and it is very difficult to adapt a first-order filter in order to cut off these components [Piqueira JRC, Monteiro LHA. Considering second-harmonic terms in the operation of the phase detector for second order phase-locked loop. IEEE Trans Circuits Syst [2003;50(6):805-9; Piqueira JRC, Monteiro LHA. All-pole phase-locked loops: calculating lock-in range by using Evan`s root-locus. Int J Control 2006;79(7):822-9]. Consequently, higher-order filters are used, resulting in nonlinear loops with order greater than 2. Such systems, due to high order and nonlinear terms, depending on parameters combinations, can present some undesirable behaviors, resulting from bifurcations, as error oscillation and chaos, decreasing synchronization ranges. In this work, we consider a second-order Sallen-Key loop filter [van Valkenburg ME. Analog filter design. New York: Holt, Rinehart & Winston; 1982] implying a third order PLL The resulting lock-in range of the third-order PLL is determined by two bifurcation conditions: a saddle-node and a Hopf. (C) 2008 Elsevier B.V. All rights reserved.

Comparing lock-in ranges and transient responses of second- and third-order phase-locked loops in master-slave clock distribution networks

The distribution of clock signals throughout the nodes of a network is essential for several applications. in control and communication with the phase-locked loop (PLL) being the component for electronic synchronization process. In systems with master-slave (MS) strategies, the PLLs are the slave nodes responsible for providing reliable clocks in all nodes of the network. As PLLs have nonlinear phase detection, double-frequency terms appear and filtering becomes necessary. Imperfections in filtering process cause oscillations around the synchronous state worsening the performance of the clock distribution process. The behavior of one-way master-slave (OWMS) clock distribution networks is studied and performances of first- and second-order filter processes are compared, concerning lock-in ranges and responses to perturbations of the synchronous state. (c) 2007 Elsevier GmbH. All rights reserved.