Federalismo e gestão metropolitana: subsídios para o planejamento territorial dos serviços de saúde.

Esta tese analisou o planejamento, a gestão e a configuração do sistema de saúde na região metropolitana do estado do Rio de Janeiro. Tem com base o referencial teórico do federalismo e apoiou-se em pesquisa qualitativa de caráter descritivo. A pesquisa versou sobre aspectos político-institucionais; normativos, organizacionais; práticos e estruturais da rede de serviços de saúde na região. A análise empreendida aponta as características do modelo tridimensional do federalismo brasileiro a Constituição Federal de 1988 transfere o poder de instituir regiões metropolitanas aos estados, mas na prática, anula a capacidade de intervenção nos municípios e reduz o papel político e administrativo dos estados. Entre os desafios apontados pela tese estão: o comportamento autárquico dos municípios; a disparidade existente entre eles; o enfraquecimento do papel de coordenação do governo estadual; a descontinuidade e pouca integração entre políticas públicas para as regiões metropolitanas; a falta de experiência em planejamento regional e intersetorial; a necessidade de institucionalizar um órgão metropolitano que, entre outras funções, estabeleça fundos financeiros, com definição de fontes de receitas e critérios de alocação de recursos regionais. Quanto à política de regionalização da saúde análise da capacidade instalada dos municípios na integração de serviços de saúde regionais , a tese destaca as fragilidades e desigualdades na distribuição da oferta de serviços; a relação concorrencial entre os municípios para incorporar maior força produtiva qualificada, a oferta de serviços especializados, o adensamento e a concentração de serviços e profissionais de saúde no núcleo metropolitano (a cidade do Rio de Janeiro). O trabalho destaca o potencial de atuação do novo pacto de gestão, representado pelo Contrato Organizativo de Ação Pública em Saúde (COAP) e dos Mapas de Saúde como instrumentos político-institucionais na regulação regional e metropolitana da saúde. Apesar disso, sinaliza que avanços na governança regional serão possíveis com a institucionalização de um órgão que tenha autonomia para tomada de decisões regionais. O estudo reforça a importância da revalorização da gestão das regiões metropolitanas e o potencial de conectividade entre as políticas públicas urbanas através da organização de redes de serviços públicos na agenda política em detrimento das práticas municipalistas.

Elementos finitos em fluidos dominados pelo fenômeno de advecção: um método semi-Lagrangeano.

Os escoamentos altamente convectivos representam um desafio na simulação pelo método de elementos finitos. Com a solução de elementos finitos de Galerkin para escoamentos incompressíveis, a matriz associada ao termo convectivo é não simétrica, e portanto, a propiedade de aproximação ótima é perdida. Na prática as soluções apresentam oscilações espúrias. Muitos métodos foram desenvolvidos com o fim de resolver esse problema. Neste trabalho apresentamos um método semi- Lagrangeano, o qual é implicitamente um método do tipo upwind, que portanto resolve o problema anterior, e comparamos o desempenho do método na solução das equações de convecção-difusão e Navier-Stokes incompressível com o Streamline Upwind Petrov Galerkin (SUPG), um método estabilizador de reconhecido desempenho. No SUPG, as funções de forma e de teste são tomadas em espaços diferentes, criando um efeito tal que as oscilações espúrias são drasticamente atenuadas. O método semi-Lagrangeano é um método de fator de integração, no qual o fator é um operador de convecção que se desloca para um sistema de coordenadas móveis no fluido, mas restabelece o sistema de coordenadas Lagrangeanas depois de cada passo de tempo. Isto prevê estabilidade e a possibilidade de utilizar passos de tempo maiores.Existem muitos trabalhos na literatura analisando métodos estabilizadores, mas não assim com o método semi-Lagrangeano, o que representa a contribuição principal deste trabalho: reconhecer as virtudes e as fraquezas do método semi-Lagrangeano em escoamentos dominados pelo fenômeno de convecção.

As construções simbólicas dos profissionais da saúde sobre humanização: um estudo no campo das representações sociais

Diante dos avanços que hoje se vive na sociedade tecnológica, globalizada, informatizada e marcada por avanços científicos parece ser uma verdadeira anomalia tratar do tema humanização na saúde. Entretanto, a questão toma assento nas diversas discussões que envolvem a problemática da saúde e, sobretudo, das diretrizes governamentais que a envolvem, enquanto aposta ético-política de Estado. Esta investigação teve como objetivo analisar o processo de humanização no campo da saúde a partir das construções simbólicas produzidas e das experiências vivenciadas por profissionais de saúde. O estudo teve como campo um hospital universitário federal, com a Política Nacional de Humanização implantada e, como sujeitos, profissionais de saúde que desenvolviam suas atividades laborais nesse mesmo campo. O desenho da pesquisa foi qualitativo, do tipo exploratório-descritivo, assumindo como referencial teórico a Teoria das Representações Sociais e também se amparando numa perspectiva filosófica. A coleta dos dados foi realizada utilizando as técnicas de questionário para caracterização dos sujeitos (n=24); e entrevista em profundidade (n=24). Os dados foram submetidos às análises de conteúdo e hermenêutica. Nos resultados destacam-se quatro eixos temáticos: atributos teóricos do conceito de humanização; atributos práticos do conceito de humanização; atributos práticos reais e ideais do processo de humanização e; fatores determinantes do processo de humanização. As representações sociais sobre a humanização no campo da saúde apreendidas neste trabalho encontram-se definidas a partir de dois conceitos: a humanização como a assistência voltada para o ser humano de forma integral/singular e; a tríade processo de humanização-estratégias para a humanização-facilidades versus dificuldades para a humanização. Destaca-se no significado da humanização a perspectiva humanista e naturalista e os fatores sociopolíticos, humanos e relacionados à gestão, como dimensões que interferem na promoção da humanização da assistência. Conclui-se que o grupo de trabalhadores da saúde estudado concebe a humanização de forma transcendente, a despeito dos próprios limites, possibilidades, fragilidades, desigualdades, mas que, ainda assim, preserva a capacidade de idealizar e, quiçá, sonhar

Three-dimensional ultrasound imaging.

This review is about the development of three-dimensional (3D) ultrasonic medical imaging, how it works, and where its future lies. It assumes knowledge of two-dimensional (2D) ultrasound, which is covered elsewhere in this issue. The three main ways in which 3D ultrasound may be acquired are described: the mechanically swept 3D probe, the 2D transducer array that can acquire intrinsically 3D data, and the freehand 3D ultrasound. This provides an appreciation of the constraints implicit in each of these approaches together with their strengths and weaknesses. Then some of the techniques that are used for processing the 3D data and the way this can lead to information of clinical value are discussed. A table is provided to show the range of clinical applications reported in the literature. Finally, the discussion relating to the technology and its clinical applications to explain why 3D ultrasound has been relatively slow to be adopted in routine clinics is drawn together and the issues that will govern its development in the future explored.

Poverty in the fisheries, inductors, causes and intervention

The study is prompted by the poverty that persisted among the fishing communities of lake victoria at time of considerable cash inflow into the fisheries development of fish processing industry. There has been need for understanding of the poverty and what strategies would be most appreciate for it's reduction.This study has attempted to respond to the needby identifying the nature and distribution of the poverty within the fisheries lake victoria,Uganda, the factor responsible for itand the options for poverty reduction intervention. The study examined the global and regional perspectives of poverty and wealth distribution, noting that wide disparities existed between the developed and the developing world and also between the developing countries themselves. A historical review of development policies and strategies revealed that while successive strategies were able to contribute to growth, their achievement towards poverty alleviation were less than satisfactory, hence the need for continually developing new strategies. A background to Uganda’s society and economy is provided, examining the demographic, political, environmental and economic conditions of the country. Uganda’s development strategies are reviewed, highlighting the role of the Poverty Eradication Action Plan, Uganda’s main strategy for implementing the policy of poverty reduction and wealth distribution. At the agricultural sector level, the Plan for the Modernisation of Agriculture has been formulated, followed by the National Fisheries Policy, aimed at providing a policy framework for the management and development of the fisheries. An appropriate definition of poverty was formulated, considered relevant to the situation of Lake Victoria. The dimensions of poverty included inadequate basic necessities, low education and health achievements, a sense of insecurity and exposure to risk. The research methodology was enhanced by the examination of the Lélé Model of the Poverty–Environmental Degradation problem, the World Bank Model of Poverty Causation and the subsequent Lake Victoria Model developed in this study. It has provided a plan for the research, the consideration of criteria and a data collection plan. The data collection instruments included secondary data search, key informant interviews and a sample survey based on a structured questionnaire. The study identified all the four dimensions of poverty in the fisheries, provided poverty profiles with respect to the different activities, groups of people and regions in the fisheries, based on consumption poverty. Among the people identified to be in poverty were the fishing labourers, fishers of Oreochromis niloticus and those operating with non-powered boats. In the post-harvest fisheries, large proportions of processors involved in salting and sun-drying, market stall and bicycle traders were in the poverty category. The ethnic groups most affected included the Samia, Basoga and Bakenye while the Districts of Jinja, Bugiri and Busia had the highest proportions of fishers in the poverty category. With respect to the other dimensions of poverty, the study showed that educational achievement was low within the fishing communities. The health status was poor, due mainly to the prevalence of malaria, diarrhoea, bilharzia and HIV/AIDS. There was a sense of insecurity within certain sections of the fishing community, due to leadership weaknesses within the local as well as the Government institutions. Some community members operated in a state of risk because they were vulnerable to episodes of income, health and education. The causes of poverty in fisheries included weaknesses within the institutional and social environment, limitations in the technology available to the poor, resource degradation and unfavourable economic factors. The recommendations of the study for poverty reduction included strengthening of policies, developing links, improving capacities and increasing resources, to be applied at the levels of Central Government, Local Government and of the community. In view of the achievements of the methodology used on this study, involving reference to the models, it is recommended that future research should build upon this model approach, as it will continue to produce results, especially when attempting to forecast changes relating to interventions.

Molecular phylogenetics and the origins of placental mammals

The precise hierarchy of ancient divergence events that led to the present assemblage of modern placental mammals has been an area of controversy among morphologists, palaeontologists and molecular evolutionists. Here we address the potential weaknesses o

Assessments of the Indian Mackerel (Rastrelliger kanagurta) and the Hilsa shad (Tenualosa ilisha) fisheries in the BOBLME countries

Assessment of the Indian Mackerel (Rastrelliger kanagurta) and the Hilsa shad (Tenualosa ilisha) fisheries in BOBLME countries.Each country was benchmarked against three principles; status of stocks, impact of fisheries on the environment and management frameworks in place. A wide range of indicators was used with a simple color-coded scoring system allowing easy identification of both strengths and weaknesses in those three areas. Individual country assessments are also included.

Trust-Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety. © 2013 Society for Risk Analysis.

The meta-converse bound is tight

We show that the meta-converse bound derived by Polyanskiy et al. provides the exact error probability for a fixed joint source-channel code and an appropriate choice of the bound parameters. While the expression is not computable in general, it identifies the weaknesses of known converse bounds to the minimum achievable error probability. © 2013 IEEE.

Oxide electronics for imaging and displays

Despite material weaknesses, considerable progress has been made in designing large area systems such as displays and imaging arrays. This talk will address the various large area technologies, and in particular, review amorphous oxide semiconductors and associated design approaches, along with driving schemes for displays, imaging and other applications. © 2013 IEEE.

Comparisons of operating envelopes for contaminated soil stabilised/solidified with different cementitious binders

This work initiated the development of operating envelopes for stabilised/solidified contaminated soils. The operating envelopes define the range of operating variables for acceptable performance of the treated soils. The study employed a soil spiked with 3,000 mg/kg each of Cd, Cu, Pb, Ni and Zn, and 10,000 mg/kg of diesel. The binders used for treatment involved Portland cement (CEMI), pulverised fuel ash (PFA), ground granulated blast furnace slag (GGBS) and hydrated lime (hlime). The specific binder formulations were CEMI, CEMI/PFA = 1:4, CEMI/GGBS = 1:9 and hlime/GGBS = 1:4. The water contents employed ranged from 13 % to 21 % (dry weight), while binder dosages ranged from 5 % to 20 % (w/w). We monitored the stabilised/solidified soils for up to 84 days using different performance tests. The tests include unconfined compressive strength (UCS), hydraulic conductivity, acid neutralisation capacity (ANC) and pH-dependent leachability of contaminants. The water content range resulted in adequate workability of the mixes but had no significant effect on leachability of contaminants. We produced design charts, representing operating envelopes, from the results generated. The charts establish relationships between water content, binder dosage and UCS; and binder dosage, leachant pH and leachability of contaminants. The work also highlights the strengths and weaknesses of the different binder formulations. © 2013 Springer-Verlag Berlin Heidelberg.

Biopotentials of marine sponges from China oceans: past and future

An extensive literature survey of over 17 Journals was carried out on Chinese sponges and their natural products in the period from 1980 to 2001. This review is thus intended to provide the first thorough overview of research on marine sponges from China Ocean territories. Information is provided about the rather-limited taxonomic study of Chinese marine sponges, with an analysis on their distribution and diversity. Research findings on the natural products and their bioactivity screening from Chinese sponges are summarized. The weaknesses, gaps and problems in the past R&D program of Chinese sponges are identified, which point to the future opportunities in exploiting these huge untapped sponge resources. The report is expected to serve as an entry point for understanding Chinese sponges and for furthering R&D on their bioactive compounds for new drug development. (C) 2003 Elsevier Science B.V. All rights reserved.

Stable Isotope Probing:Linking Functional Activity to Specific Members of Microbial Communities

Linking organisms or groups of organisms to specific functions within natural environments is a fundamental challenge in microbial ecology. Advances in technology for manipulating and analyzing nucleic acids have made it possible to characterize the members of microbial communities without the intervention of laboratory culturing. Results from such studies have shown that the vast majority of soil organisms have never been cultured, highlighting the risks of culture-based approaches in community analysis. The development of culture-independent techniques for following the flow of substrates through microbial communities therefore represents an important advance. These techniques, collectively known as stable isotope probing (SIP), involve introducing a stable isotope-labeled substrate into a microbial community and following the fate of the substrate by extracting diagnostic molecular species such as fatty acids and nucleic acids from the community and determining which specific molecules have incorporated the isotope. The molecules in which the isotope label appears provide identifying information about the organism that incorporated the substrate. Stable isotope probing allows direct observations of substrate assimilation in minimally disturbed communities, and thus represents an exciting new tool for linking microbial identity and function. The use of lipids or nucleic acids as the diagnostic molecule brings different strengths and weaknesses to the experimental approach, and necessitates the use of significantly different instrumentation and analytical techniques. This short review provides an overview of the lipid and nucleic acid approaches, discusses their strengths and weaknesses, gives examples of applications in various settings, and looks at prospects for the future of SIP technology.

Biopotentials of marine sponges from China oceans: past and future

An extensive literature survey of over 17 Journals was carried out on Chinese sponges and their natural products in the period from 1980 to 2001. This review is thus intended to provide the first thorough overview of research on marine sponges from China Ocean territories. Information is provided about the rather-limited taxonomic study of Chinese marine sponges, with an analysis on their distribution and diversity. Research findings on the natural products and their bioactivity screening from Chinese sponges are summarized. The weaknesses, gaps and problems in the past R&D program of Chinese sponges are identified, which point to the future opportunities in exploiting these huge untapped sponge resources. The report is expected to serve as an entry point for understanding Chinese sponges and for furthering R&D on their bioactive compounds for new drug development. (C) 2003 Elsevier Science B.V. All rights reserved.

基于UKF滤波的自主移动机器人锂电池SOC估计

准确估计剩余电量(state of charge,SOC)关系到自主移动机器人(AMR)的生存与安全,是AMR研究中所面临的主要挑战之一。针对广义卡尔曼滤波估计SOC的不足,本文给出基于无色卡尔曼滤波(UKF)估计AMR锂电池SOC的新方法。通过试验对UKF和EKF进行了比较。试验验证了同样条件下,UKF比EKF具有更好的滤波估计精度。