Para que serve uma enfermaria de clínica médica?: reflexões a partir de um hospital universitário.

Esse trabalho propõe uma reflexão sobre a relação entre a organização da estrutura hospitalar baseada em sua divisão por enfermarias de especialidades e a perpetuação da lógica fragmentadora própria da Biomedicina, racionalidade médica hegemônica ocidental. O campo estudado foi o Hospital Universitário Pedro Ernesto. Através de entrevistas semiestruturadas com médicos clínicos, especialistas e profissionais responsáveis pela regulação de vagas desse hospital é discutida a existência de dois discursos diferentes: o discurso clínico e o discurso especialista. A partir da análise dessas entrevistas, foi apontada e debatida a profunda relação entre esses discursos, a estrutura hospitalar e a assistência médica oferecida aos pacientes. A análise realizada evidencia que embora os dois discursos estejam absolutamente inseridos no paradigma biomédico, a clínica médica se identifica e é identificada como responsável pelo paciente como um todo, enquanto as especialidades são reconhecidas como responsáveis apenas por uma determinada parte. Essa diferença apresentou influência tanto na forma de cuidar do paciente, como na função de cada serviço dentro do hospital. As enfermarias de clínica se caracterizaram por serem setores consensualmente capazes de conduzir satisfatoriamente a maioria dos pacientes.Se por um lado a abrangência da clínica é motivo de orgulho para os clínicos, por outro, a falta de autonomia decorrente dessa característica determina um sentimento de depreciação por parte desses profissionais. Esse trabalho foi realizado sob perspectiva hermenêutica filosófica proposta por Hans-Georg Gadamer e com o auxílio dos conceitos de paradigma proposto por Thomas Kuhn e estilo de pensamento elaborado por Ludwik Fleck.

O processo de contratualização do hospital de Angra dos Reis no contexto do federalismo e das relações intergovernamentais.

Trata-se de estudo descritivo, de abordagem qualitativa, do tipo estudo de caso cujo objetivo é analisar o modelo de contratualização de uma unidade hospitalar pública. No contexto da evolução das relações intergovernamentais da saúde, verificaram-se o grau de correspondência entre as ações e serviços de natureza hospitalar ofertados no município e as necessidades de implementação desses na proposta de planejamento municipal, norteada pelo Plano Municipal de Saúde. Na busca do arcabouço teórico, foram aprofundados temas como: o processo contratual do Sistema Único de Saúde, o modelo de assistência hospitalar no Brasil, as redes de atenção à saúde e os mecanismos de gestão/relações interfederativas. São descritos os cenários municipais e regionais contextualizando a implantação da unidade hospitalar. Realizou-se estudo dos sistemas de informação da gestão pública, como: cadastro nacional de estabelecimentos de saúde/CNES, sistemas de informação hospitalar, sistema de informação morbimortalidade e o Plano de Saúde municipal e estadual. Ao final, apresentam-se os desafios da gestão na implantação do novo modelo de contrato diante da dificuldade de financiamento. Acredita-se que repensar o modelo de contratação dos serviços implica assegurar correspondência entre os serviços de saúde e os resultados da assistência à saúde da população usuária.

Contact and channel modelling using part and function libraries in a function-based design approach

To support the development and analysis of engineering designs at the embodiment stage, designers work iteratively with representations of those designs as they consider the function and form of their constituent parts. Detailed descriptions of "what a machine does" usually include flows of forces and active principles within the technical system, and their localization within parts and across the interfaces between them. This means that a representation should assist a designer in considering form and function at the same time and at different levels of abstraction. This paper describes a design modelling approach that enables designers to break down a system architecture into its subsystems and parts, while assigning functions and flows to parts and the interfaces between them. In turn, this may reveal further requirements to fulfil functions in order to complete the design. The approach is implemented in a software tool which provides a uniform, computable language allowing the user to describe functions and flows as they are iteratively discovered, created and embodied. A database of parts allows the user to search for existing design solutions. The approach is illustrated through an example: modelling the complex mechanisms within a humanoid robot. Copyright © 2010 by ASME.

Designing for resilience: Using a Delphi study to identify resilience issues for hospital designs in a changing climate

Hospitals are facing a triple challenge - meeting mandatory climate change targets and refurbishing aging infrastructure while simultaneously providing quality of care. With the potential of more frequent disruptive weather events, a UK government-funded project was launched in 2009 to investigate practical strategies for the National Health Service to increase its resilience to climate change. This paper presents the process of defining resilience by using the Delphi method and demonstrates its applicability within healthcare design. A Delphi survey is nearing completion which has determined the significant resilience issues and temperature ranges for ideal and critical conditions. Our preliminary findings identified six priorities that lead towards increasing resilience. Using the Delphi method can be a useful tool in clarifying the focus for healthcare design considerations. Copyright © 2002-2012 The Design Society. All rights reserved.

Polymorphic microsatellites in largemouth bronze gudgeon (Coreius guichenoti) developed from repeat-enriched libraries and cross-species amplifications

Largemouth bronze gudgeon (Coreius guichenoti) is a medium-sized fish endemic from the upper Yangtze River of China and its survival is threatened by the construction of the Three Gorges Dam. This study reports 20 new polymorphic microsatellites from a repeat-enriched genomic library with a mean number allele of 5.2, and observed and expected heterozygosities ranging from 0.035 to 1, and from 0.13 to 0.917, respectively. In a cross-species amplification test, nine of the 37 tested loci were found to be also polymorphic in a congeneric species, brass gudgeon (C. heterodon). In addition, other four loci from common carp (Cyprinus carpio) were also polymorphic in C. guichenoti. Out of these 24 polymorphic microsatellites, only three loci significantly deviated from Hardy-Weinberg equilibrium in the sampled population (P < 0.0025), and all pairwise tests for linkage disequilibrium among loci were nonsignificant after applying sequential Bonferroni correction (P > 0.0026). These novel microsatellites provide sufficient levels of polymorphism for studies on population genetics and conservation in C. guichenoti and its related species.

Quantified MS analysis applied to combinatorial heterogeneous catalyst libraries

A high-throughput screening system for secondary catalyst libraries has been developed by incorporation of an 80-pass reactor and a quantified multistream mass spectrometer screening (MSMSS) technique. With a low-melting alloy as the heating medium, a uniform reaction temperature could be obtained in the multistream reactor (maximum temperature differences are less than 1 K at 673 K). Quantification of the results was realized by combination of a gas chromatogram with the MSMSS, which could provide the product selectivities of each catalyst in a heterogeneous catalyst library. Because the catalyst loading of each reaction tube is comparable to that of the conventional microreaction system and because the parallel reactions could be operated under identical conditions (homogeneous temperature, same pressure and WHSV), the reaction results of a promising catalyst selected from the library could be reasonably applied to the further scale-up of the system. The aldol condensation of acetone, with obvious differences in the product distribution over different kind of catalysts, was selected as a model reaction to validate the screening system.

Construction and characterization of two bacterial artificial chromosome libraries of Zhikong scallop, Chlamys farreri Jones et Preston, and identification of BAC clones containing the genes involved in its innate immune system

Large-insert bacterial artificial chromosome (BAC) libraries are necessary for advanced genetics and genomics research. To facilitate gene cloning and characterization, genome analysis, and physical mapping of scallop, two BAC libraries were constructed from nuclear DNA of Zhikong scallop, Chlamys farreri Jones et Preston. The libraries were constructed in the BamHI and MboI sites of the vector pECBAC1, respectively. The BamHI library consists of 73,728 clones, and approximately 99% of the clones contain scallop nuclear DNA inserts with an average size of 110 kb, covering 8.0x haploid genome equivalents. Similarly, the MboI library consists of 7680 clones, with an average insert of 145 kb and no insert-empty clones, thus providing a genome coverage of 1.1x. The combined libraries collectively contain a total of 81,408 BAC clones arrayed in 212 384-well microtiter plates, representing 9.1x haploid genome equivalents and having a probability of greater than 99% of discovering at least one positive clone with a single-copy sequence. High-density clone filters prepared from a subset of the two libraries were screened with nine pairs of Overgos designed from the cDNA or DNA sequences of six genes involved in the innate immune system of mollusks. Positive clones were identified for every gene, with an average of 5.3 BAC clones per gene probe. These results suggest that the two scallop BAC libraries provide useful tools for gene cloning, genome physical mapping, and large-scale sequencing in the species.

Construction of bacterial artificial chromosome libraries for Zhikong Scallop Chlamys farreri

Two Large-insert genomic bacterial artificial chromosome (BAC) libraries of Zhikong scallop Chlamys farreri were constructed to promote our genetic and genomic research. High-quality megabase-sized DNA was isolated from the adductor muscle of the scallop and partially digested by BamH I and Mbo I, respectively. The BamH I library consisted of 53 760 clones while the Mbo I library consisted of 7 680clones. Approximately 96 % of the clones in BamH I library contained nuclear DNA inserts in average size of 100 kb, providing a coverage of 5.3 haploid genome equivalents. Similarly, the Mbo I library with an average insert of 145 kb and no insert-empty clones, thus providing a genome coverage of 1.1 haploid genome equivalents.