The impact of late diagnosis on the survival of patients following their first AIDS-related hospitalization in Belo Horizonte, Brazil

The purpose of this study is to estimate the survival probability of patients following their first admission for the treatment of AIDS to an infectious disease reference hospital in Belo Horizonte, Brazil, during 2005. Study subjects were monitored during a 12-month period to identify factors associated with survival probability. Late diagnosis was recorded among many of the 250 study subjects: almost half (44.8%) were diagnosed less than 30 days prior to or during their hospitalization. A high mortality rate was also detected: 39.6% of the subjects died during the 12 months of monitoring. The cumulative survival probability of the cohort group was estimated at 68.0% after 3 months and at 61.2% after 12 months. However, certain patient subgroups analyzed had even lower cumulative survival probabilities after 12 months of monitoring: if diagnosed during hospitalization, it was estimated at only 48.0% and those with no record of antiretroviral treatment had a 48.5% cumulative survival probability. Patients with severe anemia had the lowest survival probability, similar among the two lymphocyte count groups (<1000 mm(3) and >= 1000 mm(3)), the former with a 45.5% survival probability and the latter with a 46.7% one. The proportional death risk was 2.5-fold higher for men residing in other area than the capital city of the State of Minas Gerais and greater metropolitan region when compared with women residing there. The findings of this study highlight the importance of early diagnosis for predicting patient survival and reinforce the necessity off acilitating HIV diagnosis.

Indices representing landscape as a support for pedological survey in GIS environment

Mapping of soil has been highlighted in the scientific community, because as alertness about the environment increases, it is necessary to understand more and more about the distribution of the soil in the landscape, as well as its potential and its limitations for the use. In that way the main aim of this study was to apply indices representing landscape with the use of geoprocessing to give support in the delimitation of different compartments of landscape. Primary indices used were altitude above channel network (AACN) and secondary channel network base level (CNBL), multiresolution index of valley bottom flatness (MRVBF) and Wetness index (ITW), having as object of study the Canguiri Experimental Farm, located in Pinhais, Curitiba's Metropolitan region. To correlate the chemical attributes and granulometric ones in sampling groups, totalizing 17 points (Sugamosto, 2002), a matrix of a simple linear correlation (Pearson) with the indices of the landscape were generated in the Software Statistica. The conclusion is that the indices representing the landscape used in the analysis of groupings were efficient as support to map soil at the level of suborder of Brazilian Soil Classification System.

UNESCO Biosphere Reserves in an Urbanized World

Bosch Foundation, Germany

Paleolimnologically inferred eutrophication of a shallow, tropical, urban reservoir in southeast Brazil

We studied the eutrophication history of a tropical shallow reservoir in the So Paulo metropolitan region, southeast Brazil. We analyzed grain size, geochemistry, diatom assemblages, and land-use records in a sediment core from the reservoir to infer its trophic state history during the last similar to 110 years (1894-2005). Eighty diatom species were observed in the core and shifts in the relative abundances of planktonic and benthic taxa indicate major limnological changes associated with complex interactions between hydrologic factors and eutrophication. Discostella stelligera was associated with deforestation and water physical changes whereas Aulacoseira granulata, a species abundant throughout the core, was mostly associated with high flux conditions and erosion events, regardless of trophic state. Eutrophication was triggered by construction of the city zoo (1958) and installation of the So Paulo State Department of Agriculture (1975) within the Gar double dagger as watershed, and increasing loads of untreated sewage from these institutions. The data suggest that deterioration in water quality began after similar to 1975 and markedly accelerated after similar to 1990. The reservoir has been hypereutrophic since 1999. Steady increases in geochemical proxies for trophic state, along with a decrease in C/N ratios, indicated higher nutrient concentrations and the prevalence of autochthonous production towards the core top. Appearance of Achnanthidium catenatum similar to 1993 highlighted the onset of a marked eutrophication phase. The subsequent dominance of Planothidium rostratum and Cyclotella meneghiniana suggested a sharp shift to a hypereutrophic state since 1999. Land-use history proved valuable for validating the chronology and interpreting anthropogenic impacts. Multi-proxy analysis of the sediment record provided an effective tool for tracking ecological shifts in the reservoir ecosystem. This study provides the first reconstruction of lake eutrophication history in Brazil and highlights the importance of hydrological/physical changes as drivers of diatom assemblage shifts in reservoirs, which may confound trophic state inferences based on shifts in the planktonic/benthic diatom ratio.

Urban air pollution: a representative survey of PM2.5 mass concentrations in six Brazilian cities

In urban areas of Brazil, vehicle emissions are the principal source of fine particulate matter (PM2.5). The World Health Organization air quality guidelines state that the annual mean concentration of PM2.5 should be below 10 mu g m(-3). In a collaboration of Brazilian institutions, coordinated by the University of Sao Paulo School of Medicine and conducted from June 2007 to August 2008, PM2.5 mass was monitored at sites with high traffic volumes in six Brazilian state capitals. We employed gravimetry to determine PM2.5 mass concentrations, reflectance to quantify black carbon concentrations, X-ray fluorescence to characterize elemental composition, and ion chromatography to determine the composition and concentrations of anions and cations. Mean PM2.5 concentrations and proportions of black carbon (BC) in the cities of Sao Paulo, Rio de Janeiro, Belo Horizonte, Curitiba, Recife, and Porto Alegre were 28.1 +/- 13.6 mu g m(-3) (38% BC), 17.2 +/- 11.2 mu g m(-3) (20% BC), 14.7 +/- 7.7 mu g m(-3) (31% BC), 14.4 +/- 9.5 mu g m(-3) (30% BC), 7.3 +/- 3.1 mu g m(-3) (26% BC), and 13.4 +/- 9.9 mu g m(-3) (26% BC), respectively. Sulfur and minerals (Al, Si, Ca, and Fe), derived from fuel combustion and soil resuspension, respectively, were the principal elements of the PM2.5 mass. We discuss the long-term health effects for each metropolitan region in terms of excess mortality risk, which translates to greater health care expenditures. This information could prove useful to decision makers at local environmental agencies.

Organização dos serviços de saúde e a gestão do cuidado à tuberculose

Este estudo teve como objetivo analisar a discursividade de gestores sobre a relação entre a organização dos serviços de saúde e a gestão do cuidado à tuberculose (TB) em um município da região metropolitana de João Pessoa/PB. Conduzido pela pesquisa qualitativa no campo analítico da Análise de Discurso de linha francesa, participaram 16 trabalhadores de saúde que atuavam como integrantes de equipes gestoras. Os depoimentos transcritos foram organizados com uso do software Atlas.ti versão 6.0. Após leitura minuciosa do material empírico procurou-se observar nos discursos os processos parafrásicos, polissêmicos e metafóricos, os quais possibilitaram a identificação da seguinte formação discursiva: organização dos serviços de saúde e a relação com a gestão do cuidado à TB; o plano e a prática. Nos discursos dos gestores evidencia-se a fragmentação das ações de controle da tuberculose, a falta de articulação entre os serviços e os setores, o cumprimento de atividades específicas à TB, bem como a falta de planejamento estratégico para gestão do cuidado da doença. Nesse sentido, para que a organização dos serviços de saúde seja efetiva, se faz necessário que a tuberculose seja prioridade na agenda da gestão e reconhecida como um problema social.

Characteristics of WWTP sludge after drying in greenhouse for agricultural purposes

The sludge generated by sewage treatment which meets regulatory standards can be used in agriculture. With this understanding, the focus of this study is the evaluation of the agricultural characteristics and inorganic substances in excess activated sludge, which was subjected to drying in a greenhouse. The variables (factor) evaluated during the drying process were: type of sludge (digested or not digested), addition of lime to the sludge, and the physical layout and rotation of sludge in the greenhouse. The parameters monitored for this assessment were moisture, volatile solids and pH. The greenhouse cover and sides were made of translucent plastic to allow the penetration of solar radiation and prevent water from entering. A impermeable floor was used. The sludge was generated in sewage treatment plants located in the metropolitan region of Grande Vitoria, Espirito Santo, Brazil. The solar drying of wastewater sludge in a greenhouse presented satisfactory results.

Modeling the formation and aging of secondary organic aerosols during CalNex 2010

Four different literature parameterizations for the formation and evolution of urban secondary organic aerosol (SOA) frequently used in 3-D models are evaluated using a 0-D box model representing the Los Angeles metropolitan region during the California Research at the Nexus of Air Quality and Climate Change (CalNex) 2010 campaign. We constrain the model predictions with measurements from several platforms and compare predictions with particle- and gas-phase observations from the CalNex Pasadena ground site. That site provides a unique opportunity to study aerosol formation close to anthropogenic emission sources with limited recirculation. The model SOA that formed only from the oxidation of VOCs (V-SOA) is insufficient to explain the observed SOA concentrations, even when using SOA parameterizations with multi-generation oxidation that produce much higher yields than have been observed in chamber experiments, or when increasing yields to their upper limit estimates accounting for recently reported losses of vapors to chamber walls. The Community Multiscale Air Quality (WRF-CMAQ) model (version 5.0.1) provides excellent predictions of secondary inorganic particle species but underestimates the observed SOA mass by a factor of 25 when an older VOC-only parameterization is used, which is consistent with many previous model–measurement comparisons for pre-2007 anthropogenic SOA modules in urban areas. Including SOA from primary semi-volatile and intermediate-volatility organic compounds (P-S/IVOCs) following the parameterizations of Robinson et al. (2007), Grieshop et al. (2009), or Pye and Seinfeld (2010) improves model–measurement agreement for mass concentration. The results from the three parameterizations show large differences (e.g., a factor of 3 in SOA mass) and are not well constrained, underscoring the current uncertainties in this area. Our results strongly suggest that other precursors besides VOCs, such as P-S/IVOCs, are needed to explain the observed SOA concentrations in Pasadena. All the recent parameterizations overpredict urban SOA formation at long photochemical ages (3 days) compared to observations from multiple sites, which can lead to problems in regional and especially global modeling. However, reducing IVOC emissions by one-half in the model to better match recent IVOC measurements improves SOA predictions at these long photochemical ages. Among the explicitly modeled VOCs, the precursor compounds that contribute the greatest SOA mass are methylbenzenes. Measured polycyclic aromatic hydrocarbons (naphthalenes) contribute 0.7% of the modeled SOA mass. The amounts of SOA mass from diesel vehicles, gasoline vehicles, and cooking emissions are estimated to be 16–27, 35–61, and 19–35 %, respectively, depending on the parameterization used, which is consistent with the observed fossil fraction of urban SOA, 71(+-3) %. The relative contribution of each source is uncertain by almost a factor of 2 depending on the parameterization used. In-basin biogenic VOCs are predicted to contribute only a few percent to SOA. A regional SOA background of approximately 2.1 μgm-3 is also present due to the long-distance transport of highly aged OA, likely with a substantial contribution from regional biogenic SOA. The percentage of SOA from diesel vehicle emissions is the same, within the estimated uncertainty, as reported in previous work that analyzed the weekly cycles in OA concentrations (Bahreini et al., 2012; Hayes et al., 2013). However, the modeling work presented here suggests a strong anthropogenic source of modern carbon in SOA, due to cooking emissions, which was not accounted for in those previous studies and which is higher on weekends. Lastly, this work adapts a simple two-parameter model to predict SOA concentration and O/C from urban emissions. This model successfully predicts SOA concentration, and the optimal parameter combination is very similar to that found for Mexico City. This approach provides a computationally inexpensive method for predicting urban SOA in global and climate models. We estimate pollution SOA to account for 26 Tg yr-1 of SOA globally, or 17% of global SOA, one third of which is likely to be non-fossil.

Using small area estimation and geographic information systems technology to target health services for the uninsured

The three articles that comprise this dissertation describe how small area estimation and geographic information systems (GIS) technologies can be integrated to provide useful information about the number of uninsured and where they are located. Comprehensive data about the numbers and characteristics of the uninsured are typically only available from surveys. Utilization and administrative data are poor proxies from which to develop this information. Those who cannot access services are unlikely to be fully captured, either by health care provider utilization data or by state and local administrative data. In the absence of direct measures, a well-developed estimation of the local uninsured count or rate can prove valuable when assessing the unmet health service needs of this population. However, the fact that these are “estimates” increases the chances that results will be rejected or, at best, treated with suspicion. The visual impact and spatial analysis capabilities afforded by geographic information systems (GIS) technology can strengthen the likelihood of acceptance of area estimates by those most likely to benefit from the information, including health planners and policy makers. ^ The first article describes how uninsured estimates are currently being performed in the Houston metropolitan region. It details the synthetic model used to calculate numbers and percentages of uninsured, and how the resulting estimates are integrated into a GIS. The second article compares the estimation method of the first article with one currently used by the Texas State Data Center to estimate numbers of uninsured for all Texas counties. Estimates are developed for census tracts in Harris County, using both models with the same data sets. The results are statistically compared. The third article describes a new, revised synthetic method that is being tested to provide uninsured estimates at sub-county levels for eight counties in the Houston metropolitan area. It is being designed to replicate the same categorical results provided by a current U.S. Census Bureau estimation method. The estimates calculated by this revised model are compared to the most recent U.S. Census Bureau estimates, using the same areas and population categories. ^

Environmental policy and knowledge. Copying with complexity through inclusive management

Scholars agree that governance of the public environment entails cooperation between science, policy and society. This requires the active role of public managers as catalysts of knowledge co-production, addressing participatory arenas in relation to knowledge integration and social learning. This paper deals with the question of whether public managers acknowledge and take on this task. A survey accessing Directors of Environmental Offices (EOs) of 64 municipalities was carried out in parallel for two regions - Tuscany (Italy) and Porto Alegre Metropolitan Region (Brazil). The survey data were analysed using the multiple correspondence method. Results showed that, regarding policy practices, EOs do not play the role of knowledge co-production catalysts, since when making environmental decisions they only use technical knowledge. We conclude that there is a gap between theory and practice, and identify some factors that may hinder local environmental managers in acting as catalyst of knowledge co-production, raising a further question for future research.

Los asentamientos populares en la Región Metropolitana de Buenos Aires : Emergencia y reproducción del territorio en los procesos neoliberales de construcción de ciudad (1980-2010)

El presente artículo tiene como objetivo presentar algunas líneas argumentativas sobre la territorialidad asumida por los asentamientos populares en la Región Metropolitana de Buenos Aires (RMBA) como forma distintiva de urbanización informal a lo largo de su historia (1980- 2010). Se presenta, en primer lugar, una problematización del concepto de territorio, rescatándolo como elemento explicativo de la realidad social urbana. En segundo lugar, nos preguntarnos por qué surgen los asentamientos populares en la RMBA, y argumentamos la necesidad de considerar las transformaciones de la cuestión social en la Argentina y de las formas de presencia estatal distintivas de la periferia urbana como elementos centrales para comprender la emergencia de lo que llamamos una territorialidad neoliberal excluyente. Por último, indagamos sobre la dinámica interna de reproducción de los asentamientos: las transformaciones históricas en los actores y la disputa por las relaciones sociales que los definen.

Dinámicas territoriales en el frente portuario de la microregión de Zárate y Campana en las últimas dos décadas

Este trabajo es parte de un Proyecto de Incentivos de mayor envergadura. En esta oportunidad, se presenta el análisis realizado sobre las dinámicas del sector industrial y los espacios portuarios de la microregión de Zárate y Campana haciendo énfasis en las tensiones territoriales resultantes durante la etapa neoliberal y neodesarrollista iniciada en el año 2002. La elección de estas ciudades se debió a que han mostrado en los últimos años un dinamismo superior a la media de la región y conforman un importante polo industrial y portuario. En los períodos analizados se pudo observar que recibieron grandes inversiones en industria, servicios e infraestructuras de parte de firmas trasnacionales y del Estado, en sus diversos niveles jurisdiccionales, que ayudaron a consolidar su liderazgo en la Región Metropolitana de Buenos Aires y redefinir su posición a diferentes escalas. Pasaron así a integrar un nuevo espacio geoeconómico, por su inserción en cadenas productivas globales en el contexto del Mercosur

La 'nueva ruralidad' en Cañuelas : Entre la agroecología y las nuevas urbanizaciones

Las transformaciones de la Región Metropolitana de Buenos Aires han impactado en territorios rurales. Es el caso de Cañuelas, donde "proyectos de desarrollo urbano" han avanzado, con lo cual desplazaron actividades agrícolas. No obstante, algunos de ellos intentan ser parte de la "nueva ruralidad" que se busca para el partido. Esta investigación exploratoria busca contribuir al estado del arte sobre "nueva ruralidad". Específicamente, indagamos sobre transformaciones territoriales y modelos de desarrollo que se disputan hegemonía en el territorio. Se utiliza un enfoque que conjuga estudios urbanos y rurales, una metodología cualitativa y basada en fuentes secundarias. Los resultados plantean una difícil convivencia entre usos del suelo.

La 'nueva ruralidad' en Cañuelas : Entre la agroecología y las nuevas urbanizaciones

Las transformaciones de la Región Metropolitana de Buenos Aires han impactado en territorios rurales. Es el caso de Cañuelas, donde "proyectos de desarrollo urbano" han avanzado, con lo cual desplazaron actividades agrícolas. No obstante, algunos de ellos intentan ser parte de la "nueva ruralidad" que se busca para el partido. Esta investigación exploratoria busca contribuir al estado del arte sobre "nueva ruralidad". Específicamente, indagamos sobre transformaciones territoriales y modelos de desarrollo que se disputan hegemonía en el territorio. Se utiliza un enfoque que conjuga estudios urbanos y rurales, una metodología cualitativa y basada en fuentes secundarias. Los resultados plantean una difícil convivencia entre usos del suelo.

Los asentamientos populares en la Región Metropolitana de Buenos Aires : Emergencia y reproducción del territorio en los procesos neoliberales de construcción de ciudad (1980-2010)

El presente artículo tiene como objetivo presentar algunas líneas argumentativas sobre la territorialidad asumida por los asentamientos populares en la Región Metropolitana de Buenos Aires (RMBA) como forma distintiva de urbanización informal a lo largo de su historia (1980- 2010). Se presenta, en primer lugar, una problematización del concepto de territorio, rescatándolo como elemento explicativo de la realidad social urbana. En segundo lugar, nos preguntarnos por qué surgen los asentamientos populares en la RMBA, y argumentamos la necesidad de considerar las transformaciones de la cuestión social en la Argentina y de las formas de presencia estatal distintivas de la periferia urbana como elementos centrales para comprender la emergencia de lo que llamamos una territorialidad neoliberal excluyente. Por último, indagamos sobre la dinámica interna de reproducción de los asentamientos: las transformaciones históricas en los actores y la disputa por las relaciones sociales que los definen.