Habitação social em centros urbanos consolidados: análise dialógica desde o percurso do projeto ao uso social: São Paulo (Brasil) e Roma (Itália)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Electroconvulsive Therapy in Brazil After the "Psychiatric Reform" A Public Health Problem-Example From a University Service

Objectives: The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of Sao Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Methods: Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. Results: During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from Sao Paulo city, 50 (15.2%) from Sao Paulo's metropolitan area, 39 (11.8%) from Sao Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. Conclusions: There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.

Spatio-temporal patterns of tuberculosis incidence in Ribeirao Preto, State of Sao Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

Introduction: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirao Preto, State of Sao Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. Methods: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. Results: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirao Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. Conclusions: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

The implementation of the Medical Regulation Office and Mobile Emergency Attendance System and its impact on the gravity profile of non-traumatic afflictions treated in a University Hospital: a research study

Abstract Background The public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity. The knowledge of this phenomenon induced Ribeirão Preto to implement the Medical Regulation Office and the Mobile Emergency Attendance System. The objective of this study was to analyze the impact of these services on the gravity profile of non-traumatic afflictions in a University Hospital. Methods The study conducted a retrospective analysis of the medical records of 906 patients older than 13 years of age who entered the Emergency Care Unit of the Hospital of the University of São Paulo School of Medicine at Ribeirão Preto. All presented acute non-traumatic afflictions and were admitted to the Internal Medicine, Surgery or Neurology Departments during two study periods: May 1996 (prior to) and May 2001 (after the implementation of the Medical Regulation Office and Mobile Emergency Attendance System). Demographics and mortality risk levels calculated by Acute Physiology and Chronic Health Evaluation II (APACHE II) were determined. Results From 1996 to 2001, the mean age increased from 49 ± 0.9 to 52 ± 0.9 (P = 0.021), as did the percentage of co-morbidities, from 66.6 to 77.0 (P = 0.0001), the number of in-hospital complications from 260 to 284 (P = 0.0001), the mean calculated APACHE II mortality risk increased from 12.0 ± 0.5 to 14.8 ± 0.6 (P = 0.0008) and mortality rate from 6.1 to 12.2 (P = 0.002). The differences were more significant for patients admitted to the Internal Medicine Department. Conclusion The implementation of the Medical Regulation and Mobile Emergency Attendance System contributed to directing patients with higher gravity scores to the Emergency Care Unit, demonstrating the potential of these services for hierarchical structuring of pre-hospital networks and referrals.

Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

INTRODUCTION: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirão Preto, State of São Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. METHODS: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. RESULTS: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirão Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. CONCLUSIONS: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Natural blood feeding and temperature shift modulate the global transcriptional profile of Rickettsia rickettsii infecting its tick vector

Rickettsia rickettsii is an obligate intracellular tick-borne bacterium that causes Rocky Mountain Spotted Fever (RMSF), the most lethal spotted fever rickettsiosis. When an infected starving tick begins blood feeding from a vertebrate host, R. rickettsii is exposed to a temperature elevation and to components in the blood meal. These two environmental stimuli have been previously associated with the reactivation of rickettsial virulence in ticks, but the factors responsible for this phenotype conversion have not been completely elucidated. Using customized oligonucleotide microarrays and high-throughput microfluidic qRT-PCR, we analyzed the effects of a 10 degrees C temperature elevation and of a blood meal on the transcriptional profile of R. rickettsii infecting the tick Amblyomma aureolatum. This is the first study of the transcriptome of a bacterium in the genus Rickettsia infecting a natural tick vector. Although both stimuli significantly increased bacterial load, blood feeding had a greater effect, modulating five-fold more genes than the temperature upshift. Certain components of the Type IV Secretion System (T4SS) were up-regulated by blood feeding. This suggests that this important bacterial transport system may be utilized to secrete effectors during the tick vector's blood meal. Blood feeding also up-regulated the expression of antioxidant enzymes, which might correspond to an attempt by R. rickettsii to protect itself against the deleterious effects of free radicals produced by fed ticks. The modulated genes identified in this study, including those encoding hypothetical proteins, require further functional analysis and may have potential as future targets for vaccine development.

A parallel future for Ocean research?

[EN] Today, science is difficult to pursue because funding is so tenuous. In such a financial climate, researchers need to consider parallel alternatives to ensure that scientific research can continue. Based on this thinking, we created BIOCEANSolutions, a company born of a research group. A great variety of environmental regulations and standards have emerged over recent years with the purpose of protecting natural ecosystems. These have enabled us to link our research to the market of environmental management. Marine activities can alter environmental conditions, resulting in changes in physiological states, species diversity, abundance, and biomass in the local biological communities. In this way, we can apply our knowledge, to plankton ecophysiology and biochemical oceanography. We measure enzyme activities as bio-indicators of energy metabolism and other physiological rates and biologic-oceanographic processes in marine organisms. This information provides insight into the health of marine communities, the stress levels of individual organisms, and potential anomalies that may be affecting them. In the process of verifying standards and complying with regulations, we can apply our analytic capability and knowledge. The main analyses that we offer are: (1) the activity of the electron transport system (ETS) or potential respiration (Φ), (2) the physiological measurement of respiration (oxygen consumption), (3) the activity of Isocitrate dehydrogenase (IDH), (4) the respiratory CO2 production, and (5) the activity of Glutamate dehydrogenase (GDH) and (6) the physiological measurement of ammonium excretion. In addition, our experience in a productive research group allows us to pursue and develop technical-experimental activities such as marine and freshwater aquaculture, oceanographic field sampling, as well as providing guidance, counseling, and academic services. In summary, this new company will permit us to create a symbiosis between public and private sectors that serve clients and will allow us to grow and expand as a research team.

Respiratory electron transport activity in plankton: determinants and detection

[ES]La presente tesis, se centra en el estudio del Sistema de Transporte de Electrones (ETS) en organismos del plancton marino, los factores que lo influencian la interpretación de estas mediciones y su detección mediante espectrofotometría y espectrofluorometría, en muestras oceánicas naturales y en cultivos de organismos marinos. Se pudo establecer, la biomasa, la respiración (R) y la respiración potencial (ɸ), en tres transectos en los océanos Índico y Atlántico Norte Sur. A su vez, se determino el estado fisiológico, en tres tamaños del zooplancton, midiendo la relación R/ɸ. Se exploró los efectos de la inanición sobre la R y la variación con respecto a la ɸ en el zooplancton

Rekonstitution des Fumaratsensors DcuS in Liposomen und Transport von Fumarat und Succinat in Escherichia coli

Das Zweikomponentenregulationssystem DcuSR kontrolliert die Expression der wichtigsten fumaratinduzierten Gene in Escherichia coli. Die Gene dcuB und dctA, die fürDicarboxylatcarrier kodieren, sowie das Fumaratreduktase-Operon (frd), sind Zielgene für DcuSR. DcuS ist eine membranständige Sensorkinase mit einer großen periplasmatischen Domäne. NMR-spektroskopische Untersuchungen dieser Domäne zeigen Alpha-Helices und Beta-Faltblätter. Für die Fumaratbindung wichtige Aminosäuren wurden durch Mutagenese identifiziert. Gereinigtes DcuS wurde in Liposomen rekonstituiert. In Anwesenheit von ATP wird DcuS autophosphoryliert. Der Phosphatrest kann dann auf DcuR übertragen werden und beweist somit die Aktivität dieses in vitro Testsystems.Der Transport von C4-Dicarboxylaten erfolgt unter anaeroben Bedingungen durch die sekundären Carrier DcuA, DcuB und DcuC. Es konnte ein weiteres Protein (DcuD) identifiziert werden, das hohe Sequenzähnlichkeit zu DcuC aufweist. Eine dcuD-Mutante zeigte keinen Phänotyp und überproduziertes DcuD konnte den Ausfall der anderen Dcu-Carrier nicht kompensieren. DcuD ist damit ein kryptisches Mitglied der Dcu-Carrierfamilie. Unter aeroben Bedingungen katalysiert DctA den Transport von C4-Dicarboxylaten. Dennoch können dctA-Mutanten noch mit Succinat wachsen. Die Diffusionsrate von Succinat durch Membranen wurde bestimmt. Sie ist um Größenordnungen niedriger als der Transport in der Mutante. Bei dem DctA unabhängigen Transportsystem handelt es sich um einen H+/Succinat2-Symporter, der bei saurem pH aktiv ist und viele Eigenschaften eines Monocarboxylatcarriers aufweist.

La razionalizzazione del trasporto merci su strada

Il presente lavoro, senza alcuna pretesa di esaustività, ha inteso ricostruire il quadro normativo relativo alla disciplina dell’autotrasporto merci su strada. In primis, ci si è soffermata sugli aspetti generali del settore, approfondendo, in seguito, la normativa europea e nazionale. Tale excursus, ha permesso di riscontrare i molteplici interventi legislativi susseguitisi in ambito di regolamentazione dell’autotrasporto merci su strada, evidenziando i passaggi più significativi in tema di riordino della disciplina. Si è pertanto proceduto all’analisi del primo importante intervento legislativo del settore, intercorso ad opera della Legge n. 298/1974, disciplinante gli aspetti di natura pubblicistica del settore. Tale provvedimento, ha un apposito Albo Nazionale per gli autotrasportatori di merci per conto terzi, identificando i requisiti necessari per l’accesso al mercato e l’esercizio della professione di autotrasportatore di cose in conto terzi. Importati novità vengono introdotte con il D.lgs. 286/2005, provvedimento che ha portato al raggiungimento del processo di liberalizzazione del mercato. Successivamente si è proceduto a riscontrare l’intensa produzione normativa, posta a regolamentazione del settore, che nella ricerca di un equilibrio tra esigenze di mercato e corretto esercizio dell’attività di autotrasporto, si propone di addivenire al raggiungimento degli obiettivi comunitari di armonizzazione della disciplina e qualificazione del settore dell’autotrasporto. Significativi, in tal senso, i recenti interventi di riforma posti in essere con il “Pacchetto comunitario del 21 ottobre 2009” ( Regolamento (CE) 1071/2009 e Regolamento (CE) 1072/2009. Da ultimo, al fine di verificare le eventuali debolezze del sistema normativo vigente, in relazione al raggiungimento degli obiettivi comunitari suesposti, si è ritenuto di indirizzare la ricerca verso un’attenta valutazione dell’efficienza dei modelli di trasporto merci su strada, verificandone l’impatto in termini di maggior incidenza sui costi esterni derivanti dal trasporto. A tal proposito, particolare attenzione è stata rivolta anche alla disciplina del trasporto in conto proprio.

Operational research applied to regional healthcare system

In this thesis we focus on optimization and simulation techniques applied to solve strategic, tactical and operational problems rising in the healthcare sector. At first we present three applications to Emilia-Romagna Public Health System (SSR) developed in collaboration with Agenzia Sanitaria e Sociale dell'Emilia-Romagna (ASSR), a regional center for innovation and improvement in health. Agenzia launched a strategic campaign aimed at introducing Operations Research techniques as decision making tools to support technological and organizational innovations. The three applications focus on forecast and fund allocation of medical specialty positions, breast screening program extension and operating theater planning. The case studies exploit the potential of combinatorial optimization, discrete event simulation and system dynamics techniques to solve resource constrained problem arising within Emilia-Romagna territory. We then present an application in collaboration with Dipartimento di Epidemiologia del Lazio that focuses on population demand of service allocation to regional emergency departments. Finally, a simulation-optimization approach, developed in collaboration with INESC TECH center of Porto, to evaluate matching policies for the kidney exchange problem is discussed.

Lysosomaler Transport kationischer Aminosäuren durch Mitglieder der SLC7-Familie

Lysosomaler Transport kationischer Aminosäuren (KAS) stellt einen Rettungsweg in der Cystinose-Therapie dar. Ein solches Transportsystem wurde in humanen Hautfibroblasten beschrieben und mit System c benannt. Des Weiteren stellt lysosomales Arginin eine Substratquelle für die endotheliale NO-Synthase (eNOS) dar. Das von der eNOS gebildete NO ist ein wichtiges vasoprotektiv wirkendes Signalmolekül. Ziel war es daher, herauszufinden, ob Mitglieder der SLC7-Unterfamilie hCAT möglicherweise System c repräsentieren.rnIn dieser Arbeit konnte ich die lysosomale Lokalisation verschiedener endogener, sowie als EGFP-Fusionsproteine überexprimierter CAT-Isoformen nachweisen. Mittels Fluoreszenz-mikroskopie wurde festgestellt, dass die in U373MG-Zellen überexprimierten Fusionsproteine hCAT-1.EGFP sowie SLC7A14.EGFP mit dem lysosomalen Fluoreszenz-Farbstoff LysoTracker co-lokalisieren. Eine Lokalisation in Mitochondrien oder dem endoplasmatischem Retikulum konnte mit entsprechenden Fluoreszenz-Farbstoffen ausgeschlossen werden. Zusätzlich reicherten sich die überexprimierten Proteine hCAT-1.EGFP, hCAT-2B.EGFP und SLC7A14.EGFP in der lysosomalen Fraktion C aus U373MG-Zellen zusammen mit den lysosomalen Markern LAMP-1 und Cathepsin D an. Gleiches galt für den endogenen hCAT-1 in der lysosomalen Fraktion C aus EA.hy926- und U373MG-Zellen sowie für den SLC7A14 in den humanen Hautfibroblasten FCys5. Mit dem im Rahmen dieser Arbeit generierte Antikörper gegen natives SLC7A14 konnte erstmals die endogene Expression und Lokalisation von SLC7A14 in verschiedenen Zelltypen analysiert werden.rnObwohl eine Herunterregulation des hCAT-1 in EA.hy926-Endothelzellen nicht zu einer Reduktion der Versorgung der eNOS mit lysosomalem Arginin führte, ist eine Funktion von hCAT-1 im Lysosom wahrscheinlich. Sowohl die [3H]Arginin- als auch die [3H]Lysin-Aufnahme der Fraktion C aus U373MG-hCAT-1.EGFP war signifikant höher als in die Fraktion C aus EGFP-Kontrollzellen. Dies konnte ebenfalls für den hCAT-2B.EGFP gezeigt werden. Zusätzlich zeigten lysosomale Proben aus U373MG-hCAT-2B.EGFP-Zellen in der SSM-basierten Elektrophysiologie eine elektrogene Transportaktivität für Arginin. Das Protein SLC7A14.EGFP zeigte in keiner der beiden durchgeführten Transportstudien eine Aktivität. Dies war unerwartet, da die aus der Diplomarbeit stammende und im Rahmen dieser Dissertation erweiterte Charakterisierung der hCAT-2/A14_BK-Chimäre, die die „funktionelle Domäne“ des SLC7A14 im Rückgrat des hCAT-2 trug, zuvor den Verdacht erhärtet hatte, dass SLC7A14 ein lysosomal lokalisierter Transporter für KAS sein könnte. Diese Studien zeigten allerding erstmals, dass die „funktionelle Domäne“ der hCATs die pH-Abhängigkeit vermittelt und eine Rolle in der Substraterkennung spielt.rnZukünftig soll weiter versucht werden auch endogen eine Transportaktivität der hCATs für KAS im Lysosom nachzuweisen und das Substrat für das intrazellulär lokalisierte Waisen-Protein SLC7A14 zu finden. Eine mögliche Rolle könnte SLC7A14 als Transporter für Neurotransmitter spielen, da eine sehr prominente Expression im ZNS festgestellt wurde.rn

Classification algorithms for Intelligent Transport Systems

Intelligent Transport Systems (ITS) consists in the application of ICT to transport to offer new and improved services to the mobility of people and freights. While using ITS, travellers produce large quantities of data that can be collected and analysed to study their behaviour and to provide information to decision makers and planners. The thesis proposes innovative deployments of classification algorithms for Intelligent Transport System with the aim to support the decisions on traffic rerouting, bus transport demand and behaviour of two wheelers vehicles. The first part of this work provides an overview and a classification of a selection of clustering algorithms that can be implemented for the analysis of ITS data. The first contribution of this thesis is an innovative use of the agglomerative hierarchical clustering algorithm to classify similar travels in terms of their origin and destination, together with the proposal for a methodology to analyse drivers’ route choice behaviour using GPS coordinates and optimal alternatives. The clusters of repetitive travels made by a sample of drivers are then analysed to compare observed route choices to the modelled alternatives. The results of the analysis show that drivers select routes that are more reliable but that are more expensive in terms of travel time. Successively, different types of users of a service that provides information on the real time arrivals of bus at stop are classified using Support Vector Machines. The results shows that the results of the classification of different types of bus transport users can be used to update or complement the census on bus transport flows. Finally, the problem of the classification of accidents made by two wheelers vehicles is presented together with possible future application of clustering methodologies aimed at identifying and classifying the different types of accidents.

INTERNAL AUDIT AND GROWTH OF PUBLIC INSTITUTIONS

The ONATRACOM was established by the law number 08/2007 of 03/02/2007 determining the responsibilities, organization and functioning of Rwanda Public Transport Authority with function of promoting public transportation between Rwanda and other countries; participating in the implementation of the public transportation policy of Ministry in charge of transportation; perform any other activity that is directly or indirectly related to its objectives; and establish relations and collaborate with other regional and international agencies with similar attributions. In the recent days many public institutions have been listed by general auditor for being mismanaged and are on the course of deficit. This study aimed at examining internal audit growth of public institutions, case study of ONATRACOM – Rwanda. This research was conducted as a case study using ONATRACOM in NYARUGENGE District. The study was built at four specific objectives which are to determine if internal audit lead to the business growth of ONATRACOM, to find out if achieving internal audit increases the net profit and sales of ONATRACOM, to explore if there is internal sources of funds for pursuing growth opportunities in ONATRACOM, to assess whether ONATRACOM is able to obtain external sources of funds for pursuing growth opportunities as a result of internal audit impact or not. The findings were got from 27 respondents as the sample from the total target population of 96. Questionnaire was used as the technique to obtain primary data, while secondary data were obtained through examining the existing literature about the study. Chapter four presents the finding in form of descriptive statistical tables starting with the profile of the respondent and findings in line with the research objectives, It was found out that ONATRACOM was failure in its services because it was not achieve its targeted objectives and in this company, the internal audit was not effective in order to make performance of that company.

Explosionsfeste Transportbehälter – mehr Sicherheit für das Transportwesen

Weltweit ist eine Zunahme terroristischer Aktivitäten zu verzeichnen, sodass allgemein damit gerechnet werden muss, dass auch das zivile Verkehrs- und Transportwesen ein bevorzugtes Ziel terroristischer Anschläge darstellt. Mehrfach wurden schon Sprengkörper in Transportmittel des öffentlichen und zivilen Personen- aber auch Güterverkehrs eingeschleust, um die Bevölkerung durch materielle Zerstörung und massive Personenschäden einzuschüchtern und zu beängstigen. Daher ist eine Anpassung der sich derzeit im Einsatz befindlichen Transportbehälter an die geänderten Rahmenbedingungen unerlässlich, um auch den Schutz vor Sprengkörpern, die gemeinsam mit dem Handgepäck in Luft-, Land- und Wasserfahrzeuge eingeschleust werden, zu gewährleisten.