HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.

Enterprises' internationalisation strategy: skills in exportation and customs law

Economical development has always been connected to the commercial exchanges between people, due to the necessity to suppress their needs. With the increasing growth of international business and more competitive and demanding markets, exportation has become an important first step to internationalisation. Unlike what happened in the past, companies must be aware that the enrolment in the current global market is risky and requires elaborated technical procedures. Internationalisation should not be treated as an isolated event of business management. The first part of this paper aims to understand the export process and fit it in the current stage of international trade, keeping in mind the framework of export under the customs law. Then, we tried to understand how Portuguese companies should face this process in their internationalisation strategy, and what skills organisations must acquire to be able to export competitively in the current scenario of globalisation. The investigation was based on interviews in companies that, through a process of internationalisation by exportation, have implemented themselves strongly in extern markets. This investigation allowed us to analyse the companies’ motivations to become international, as well as the selection criteria for the export destinations. It was also possible to identify the main obstacles to the internationalisation of Portuguese companies. We concluded that companies that choose exportation as a way to become international acquire specific skills that enable them to become competitive in international trade. However, studies have failed to answer the second initial question about whether the measures implemented by Customs potentiate exports.

Professional and community satisfaction with the Brazilian family health strategy

OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF) with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and caregiver perspective may serve to advance primary community healthcare in Brazil.

Outsourcing das actividades de marketing digital nas PME

Dissertação de Mestrado Apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Marketing Digital, sob orientação de Professor Doutor Freitas Santos

Improving quality-of-service in wireless sensor networks by mitigating “Hidden-Node Collisions”

Wireless sensor networks (WSNs) emerge as underlying infrastructures for new classes of large-scale networked embedded systems. However, WSNs system designers must fulfill the quality-of-service (QoS) requirements imposed by the applications (and users). Very harsh and dynamic physical environments and extremely limited energy/computing/memory/communication node resources are major obstacles for satisfying QoS metrics such as reliability, timeliness, and system lifetime. The limited communication range of WSN nodes, link asymmetry, and the characteristics of the physical environment lead to a major source of QoS degradation in WSNs-the ldquohidden node problem.rdquo In wireless contention-based medium access control (MAC) protocols, when two nodes that are not visible to each other transmit to a third node that is visible to the former, there will be a collision-called hidden-node or blind collision. This problem greatly impacts network throughput, energy-efficiency and message transfer delays, and the problem dramatically increases with the number of nodes. This paper proposes H-NAMe, a very simple yet extremely efficient hidden-node avoidance mechanism for WSNs. H-NAMe relies on a grouping strategy that splits each cluster of a WSN into disjoint groups of non-hidden nodes that scales to multiple clusters via a cluster grouping strategy that guarantees no interference between overlapping clusters. Importantly, H-NAMe is instantiated in IEEE 802.15.4/ZigBee, which currently are the most widespread communication technologies for WSNs, with only minor add-ons and ensuring backward compatibility with their protocols standards. H-NAMe was implemented and exhaustively tested using an experimental test-bed based on ldquooff-the-shelfrdquo technology, showing that it increases network throughput and transmission success probability up to twice the values obtained without H-NAMe. H-NAMe effectiveness was also demonstrated in a target tracking application with mobile robots - over a WSN deployment.

A capacity sharing and stealing strategy for open real-time systems

This paper focuses on the scheduling of tasks with hard and soft real-time constraints in open and dynamic real-time systems. It starts by presenting a capacity sharing and stealing (CSS) strategy that supports the coexistence of guaranteed and non-guaranteed bandwidth servers to efficiently handle soft-tasks’ overloads by making additional capacity available from two sources: (i) reclaiming unused reserved capacity when jobs complete in less than their budgeted execution time and (ii) stealing reserved capacity from inactive non-isolated servers used to schedule best-effort jobs. CSS is then combined with the concept of bandwidth inheritance to efficiently exchange reserved bandwidth among sets of inter-dependent tasks which share resources and exhibit precedence constraints, assuming no previous information on critical sections and computation times is available. The proposed Capacity Exchange Protocol (CXP) has a better performance and a lower overhead when compared against other available solutions and introduces a novel approach to integrate precedence constraints among tasks of open real-time systems.

H-NAMe: specifying, implementing and testing a hidden-node avoidance mechanism for wireless sensor networks

The hidden-node problem has been shown to be a major source of Quality-of-Service (QoS) degradation in Wireless Sensor Networks (WSNs) due to factors such as the limited communication range of sensor nodes, link asymmetry and the characteristics of the physical environment. In wireless contention-based Medium Access Control protocols, if two nodes that are not visible to each other transmit to a third node that is visible to the formers, there will be a collision – usually called hidden-node or blind collision. This problem greatly affects network throughput, energy-efficiency and message transfer delays, which might be particularly dramatic in large-scale WSNs. This technical report tackles the hidden-node problem in WSNs and proposes HNAMe, a simple yet efficient distributed mechanism to overcome it. H-NAMe relies on a grouping strategy that splits each cluster of a WSN into disjoint groups of non-hidden nodes and then scales to multiple clusters via a cluster grouping strategy that guarantees no transmission interference between overlapping clusters. We also show that the H-NAMe mechanism can be easily applied to the IEEE 802.15.4/ZigBee protocols with only minor add-ons and ensuring backward compatibility with the standard specifications. We demonstrate the feasibility of H-NAMe via an experimental test-bed, showing that it increases network throughput and transmission success probability up to twice the values obtained without H-NAMe. We believe that the results in this technical report will be quite useful in efficiently enabling IEEE 802.15.4/ZigBee as a WSN protocol.

H-NAMe: a hidden-node avoidance mechanism for wireless sensor networks

The hidden-node problem has been shown to be a major source of Quality-of-Service (QoS) degradation in Wireless Sensor Networks (WSNs) due to factors such as the limited communication range of sensor nodes, link asymmetry and the characteristics of the physical environment. In wireless contention-based Medium Access Control protocols, if two nodes that are not visible to each other transmit to a third node that is visible to the formers, there will be a collision – usually called hidden-node or blind collision. This problem greatly affects network throughput, energy-efficiency and message transfer delays, which might be particularly dramatic in large-scale WSNs. This paper tackles the hiddennode problem in WSNs and proposes H-NAMe, a simple yet efficient distributed mechanism to overcome it. H-NAMe relies on a grouping strategy that splits each cluster of a WSN into disjoint groups of non-hidden nodes and then scales to multiple clusters via a cluster grouping strategy that guarantees no transmission interference between overlapping clusters. We also show that the H-NAMe mechanism can be easily applied to the IEEE 802.15.4/ZigBee protocols with only minor add-ons and ensuring backward compatibility with the standard specifications. We demonstrate the feasibility of H-NAMe via an experimental test-bed, showing that it increases network throughput and transmission success probability up to twice the values obtained without H-NAMe. We believe that the results in this paper will be quite useful in efficiently enabling IEEE 802.15.4/ZigBee as a WSN protocol

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Bifacial dye-sensitized solar cells: a strategy to enhance overall efficiency based on transparent polyaniline electrode

Dye-sensitized solar cell (DSSC) is a promising solution to global energy and environmental problems because of its clean, low-cost, high efficiency, good durability, and easy fabrication. However, enhancing the efficiency of the DSSC still is an important issue. Here we devise a bifacial DSSC based on a transparent polyaniline (PANI) counter electrode (CE). Owing to the sunlight irradiation simultaneously from the front and the rear sides, more dye molecules are excited and more carriers are generated, which results in the enhancement of short-circuit current density and therefore overall conversion efficiency. The photoelectric properties of PANI can be improved by modifying with 4-aminothiophenol (4-ATP). The bifacial DSSC with 4-ATP/PANI CE achieves a light-to-electric energy conversion efficiency of 8.35%, which is increased by ,24.6% compared to the DSSC irradiated from the front only. This new concept along with promising results provides a new approach for enhancing the photovoltaic performances of solar cells.

Brazilian physical activity guidelines as a strategy for health promotion

Public health actions endorsed by the federal government, for instance, health promotion initiatives, usually have greater impact at population level compared to other types of initiatives. This commentary aims to instigate debate on the importance and necessity of producing federally endorsed brazilian physical activity guidelines as a strategy for health promotion.

A sensor classification strategy for robotic manipulators

In practice the robotic manipulators present some degree of unwanted vibrations. The advent of lightweight arm manipulators, mainly in the aerospace industry, where weight is an important issue, leads to the problem of intense vibrations. On the other hand, robots interacting with the environment often generate impacts that propagate through the mechanical structure and produce also vibrations. In order to analyze these phenomena a robot signal acquisition system was developed. The manipulator motion produces vibrations, either from the structural modes or from endeffector impacts. The instrumentation system acquires signals from several sensors that capture the joint positions, mass accelerations, forces and moments, and electrical currents in the motors. Afterwards, an analysis package, running off-line, reads the data recorded by the acquisition system and extracts the signal characteristics. Due to the multiplicity of sensors, the data obtained can be redundant because the same type of information may be seen by two or more sensors. Because of the price of the sensors, this aspect can be considered in order to reduce the cost of the system. On the other hand, the placement of the sensors is an important issue in order to obtain the suitable signals of the vibration phenomenon. Moreover, the study of these issues can help in the design optimization of the acquisition system. In this line of thought a sensor classification scheme is presented. Several authors have addressed the subject of the sensor classification scheme. White (White, 1987) presents a flexible and comprehensive categorizing scheme that is useful for describing and comparing sensors. The author organizes the sensors according to several aspects: measurands, technological aspects, detection means, conversion phenomena, sensor materials and fields of application. Michahelles and Schiele (Michahelles & Schiele, 2003) systematize the use of sensor technology. They identified several dimensions of sensing that represent the sensing goals for physical interaction. A conceptual framework is introduced that allows categorizing existing sensors and evaluates their utility in various applications. This framework not only guides application designers for choosing meaningful sensor subsets, but also can inspire new systems and leads to the evaluation of existing applications. Today’s technology offers a wide variety of sensors. In order to use all the data from the diversity of sensors a framework of integration is needed. Sensor fusion, fuzzy logic, and neural networks are often mentioned when dealing with problem of combing information from several sensors to get a more general picture of a given situation. The study of data fusion has been receiving considerable attention (Esteban et al., 2005; Luo & Kay, 1990). A survey of the state of the art in sensor fusion for robotics can be found in (Hackett & Shah, 1990). Henderson and Shilcrat (Henderson & Shilcrat, 1984) introduced the concept of logic sensor that defines an abstract specification of the sensors to integrate in a multisensor system. The recent developments of micro electro mechanical sensors (MEMS) with unwired communication capabilities allow a sensor network with interesting capacity. This technology was applied in several applications (Arampatzis & Manesis, 2005), including robotics. Cheekiralla and Engels (Cheekiralla & Engels, 2005) propose a classification of the unwired sensor networks according to its functionalities and properties. This paper presents a development of a sensor classification scheme based on the frequency spectrum of the signals and on a statistical metrics. Bearing these ideas in mind, this paper is organized as follows. Section 2 describes briefly the robotic system enhanced with the instrumentation setup. Section 3 presents the experimental results. Finally, section 4 draws the main conclusions and points out future work.

A sensor classification strategy for robotic manipulators using multidimensional scaling technique

This paper analyzes the signals captured during impacts and vibrations of a mechanical manipulator. To test the impacts, a flexible beam is clamped to the end-effector of a manipulator that is programmed in a way such that the rod moves against a rigid surface. Eighteen signals are captured and theirs correlation are calculated. A sensor classification scheme based on the multidimensional scaling technique is presented.

Strategies for price reduction of HIV medicines under a monopoly situation in Brazil

ABSTRACT OBJECTIVE To analyze Government strategies for reducing prices of antiretroviral medicines for HIV in Brazil. METHODS Analysis of Ministry of Health purchases of antiretroviral medicines, from 2005 to 2013. Expenditures and costs of the treatment per year were analyzed and compared to international prices of atazanavir. Price reductions were estimated based on the terms of a voluntary license of patent rights and technology transfer in the Partnership for Productive Development Agreement for atazanavir. RESULTS Atazanavir, a patented medicine, represented a significant share of the expenditures on antiretrovirals purchased from the private sector. Prices in Brazil were higher than international references, and no evidence was found of a relationship between purchase volume and price paid by the Ministry of Health. Concerning the latest strategy to reduce prices, involving local production of the 200 mg capsule, the price reduction was greater than the estimated reduction. As for the 300 mg capsule, the amounts paid in the first two years after the Partnership for Productive Development Agreement were close to the estimated values. Prices in nominal values for both dosage forms remained virtually constant between 2011 (the signature of the Partnership for Productive Development Agreement), 2012 and 2013 (after the establishment of the Partnership). CONCLUSIONS Price reduction of medicines is complex in limited-competition environments. The use of a Partnership for Productive Development Agreement as a strategy to increase the capacity of local production and to reduce prices raises issues regarding its effectiveness in reducing prices and to overcome patent barriers. Investments in research and development that can stimulate technological accumulation should be considered by the Government to strengthen its bargaining power to negotiate medicines prices under a monopoly situation.

Solving nonlinear equations by a tabu search strategy

Solving systems of nonlinear equations is a problem of particular importance since they emerge through the mathematical modeling of real problems that arise naturally in many branches of engineering and in the physical sciences. The problem can be naturally reformulated as a global optimization problem. In this paper, we show that a metaheuristic, called Directed Tabu Search (DTS) [16], is able to converge to the solutions of a set of problems for which the fsolve function of MATLAB® failed to converge. We also show the effect of the dimension of the problem in the performance of the DTS.