O acesso aos exames de alta complexidade nos planos de saúde privados na perspectiva dos usuários

A dissertação trata do acesso aos serviços de alta complexidade, particularmente os exames diagnósticos e complementares, estudado entre usuários de planos de saúde privados que buscam atendimento e diagnóstico especializado. Desde a década de 80 o usuário do sistema público de saúde vem procurando a saúde suplementar. Contudo, afirmar que o acesso é garantido no domínio privado, através da contratação dos planos de saúde, é uma incerteza que rodeia a inspiração para esta pesquisa, que se justifica pela relevância de ações que possibilitem a melhora da qualidade regulatória dos planos de saúde, a partir do controle social de seus usuários. O objetivo geral é analisar as percepções do acesso aos exames de alta complexidade nos serviços de saúde privados entre usuários de planos de saúde. Os objetivos específicos são descrever as percepções dos usuários de planos de saúde acerca do acesso aos exames de alta complexidade; analisar as motivações dos usuários de planos de saúde privados para a realização de exames de alta complexidade através da rede privada de assistência; e analisar o nível de satisfação dos usuários de planos de saúde quanto ao acesso aos exames de alta complexidade. A metodologia é qualitativa-descritiva, onde a amostra foi de trinta usuários de planos de saúde, acima de 18 anos, selecionados no campo de estudo no ano de 2010. O cenário de estudo foi um laboratório privado de medicina diagnóstica no Rio de Janeiro. As técnicas de coleta de dados utilizadas foram formulário e entrevista individual estruturada. A análise do formulário foi realizada através de estatística descritiva, e as entrevistas através da análise de conteúdo temática-categorial. Os usuários de plano de saúde declararam que o acesso é garantido com facilidade para os exames de alta complexidade. Suas principais motivações para a realização desses exames na rede privada de assistência foram caracterizadas pela rapidez de atendimento, flexibilidade e facilidade de marcação pela internet, telefone ou pessoalmente no laboratório estudado, pronta entrega dos resultados, dificuldade e morosidade do atendimento do SUS, localização do prestador credenciado próxima de bairros residenciais ou do trabalho, resolutividade diagnóstica de imagem de excelência, possibilidade de escolha pelo usuário entre as modalidades aberta e fechada de ressonância magnética e tomografia computadorizada, além da densitometria óssea que foram facilmente acessíveis a todos os sujeitos da pesquisa. O nível de satisfação foi correspondido com a rapidez na realização dos exames em caráter eletivo e de urgência quase equiparados na escala de tempo de acordo com os usuários. Contudo, embora as notas de avaliação dos usuários quanto aos seus planos de saúde tenham sido altas, foram abordadas algumas dificuldades, tais como: prazos de validade dos pedidos médicos com datação prévia; solicitações de senhas de autorização pela operadora; burocracia nos procedimentos de agendamento; dificuldades de acesso para tratamentos como implantes, fisioterapia, RPG, pilates, home care, consultas de check up; negação de reembolsos; restrição de materiais cirúrgicos, em especial as próteses e órteses; e restrições específicas de grau para cirurgias de miopia. Conclui-se que o atendimento rápido dos exames de imagem de alto custo na amostra foi descrito como satisfatório, embora a percepção de rapidez possa variar em função do tipo de produto do plano de saúde privado contratado, com necessidade de melhoria regulatória em alguns aspectos pontuais da saúde suplementar.

Diagnosis of colorectal cancer using Raman spectroscopy of laser-trapped single living epithelial cells

A single-cell diagnostic technique for epithelial cancers is developed by utilizing laser trapping and Raman spectroscopy to differentiate cancerous and normal epithelial cells. Single-cell suspensions were prepared from surgically removed human colorectal tissues following standard primary culture protocols and examined in a near-infrared laser-trapping Raman spectroscopy system, where living epithelial cells were investigated one by one. A diagnostic model was built on the spectral data obtained from 8 patients and validated by the data from 2 new patients. Our technique has potential applications from epithelial cancer diagnosis to the study of cell dynamics of carcinogenesis. (c) 2006 Optical Society of America.

Rhythms of division of some algae in situ and in laboratory culture. [Translation from: Studii Cerc.Biol.(Bot.) 21, 61-65, 1969. ]

The rhythm of division of 9 species belonging to different groups of algae were analysed in situ and in the laboratory. The research which developed in different environmental conditions attempted to establish the capacity for multiplication and assimilation of chlorophyll on the part of the algae under study with a view to placing them in a culture. The results obtained showed that the green multicellular algae (eg. Ulothrix) and the blue algae (eg. Lyngbya, Oscillatoria) are able to produce an appreciable quantity of dry matter, just as the unicellular algae. At the same time it arises that amongst the numerous factors of the environment, temperature plays one of the most important roles in the process of multiplication.

Investigation of Fundamental Processes Governing Secondary Organic Aerosol Formation in Laboratory Chambers

Our understanding of the processes and mechanisms by which secondary organic aerosol (SOA) is formed is derived from laboratory chamber studies. In the atmosphere, SOA formation is primarily driven by progressive photooxidation of SOA precursors, coupled with their gas-particle partitioning. In the chamber environment, SOA-forming vapors undergo multiple chemical and physical processes that involve production and removal via gas-phase reactions; partitioning onto suspended particles vs. particles deposited on the chamber wall; and direct deposition on the chamber wall. The main focus of this dissertation is to characterize the interactions of organic vapors with suspended particles and the chamber wall and explore how these intertwined processes in laboratory chambers govern SOA formation and evolution.

A Functional Group Oxidation Model (FGOM) that represents SOA formation and evolution in terms of the competition between functionalization and fragmentation, the extent of oxygen atom addition, and the change of volatility, is developed. The FGOM contains a set of parameters that are to be determined by fitting of the model to laboratory chamber data. The sensitivity of the model prediction to variation of the adjustable parameters allows one to assess the relative importance of various pathways involved in SOA formation.

A critical aspect of the environmental chamber is the presence of the wall, which can induce deposition of SOA-forming vapors and promote heterogeneous reactions. An experimental protocol and model framework are first developed to constrain the vapor-wall interactions. By optimal fitting the model predictions to the observed wall-induced decay profiles of 25 oxidized organic compounds, the dominant parameter governing the extent of wall deposition of a compound is identified, i.e., wall accommodation coefficient. By correlating this parameter with the molecular properties of a compound via its volatility, the wall-induced deposition rate of an organic compound can be predicted based on its carbon and oxygen numbers in the molecule.

Heterogeneous transformation of δ-hydroxycarbonyl, a major first-generation product from long-chain alkane photochemistry, is observed on the surface of particles and walls. The uniqueness of this reaction scheme is the production of substituted dihydrofuran, which is highly reactive towards ozone, OH, and NO3, thereby opening a reaction pathway that is not usually accessible to alkanes. A spectrum of highly-oxygenated products with carboxylic acid, ester, and ether functional groups is produced from the substituted dihydrofuran chemistry, thereby affecting the average oxidation state of the alkane-derived SOA.

The vapor wall loss correction is applied to several chamber-derived SOA systems generated from both anthropogenic and biogenic sources. Experimental and modeling approaches are employed to constrain the partitioning behavior of SOA-forming vapors onto suspended particles vs. chamber walls. It is demonstrated that deposition of SOA-forming vapors to the chamber wall during photooxidation experiments can lead to substantial and systematic underestimation of SOA. Therefore, it is likely that a lack of proper accounting for vapor wall losses that suppress chamber-derived SOA yields contribute substantially to the underprediction of ambient SOA concentrations in atmospheric models.

On the structure of the seminal receptacle in cyclopids (Copepoda, Cyclopoida). [Translation from: Informatsionnyi Byulleten Biologiya Vnutrennikh Vod (6) 26-31, 1970.]

The seminal bag, or seminal receptacle, forms a characteristic organ of cyclopids, serving for retention of the sperms discharged from the spermatophores. The structure of the seminal receptacle, more precisely its form, is fairly widely used in diagnosis and undoubtedly can be more widely applied in the systematics of the group. Within the limits of the family Cyclopidae it is possible to distinguish crustaceans with three basic types of seminal bag. The differences consist of the position which this organ occupies in the genital segment. of one species, we carried out a series of observations on its formation in ontogenesis and during the life of the adult stage. As material for observation the study used laboratory cultures of three species; Acanthocyclops americanus (Marsh) from the plankton of the Moscow River, Cyclops vicinus Uljan and Mesocyclops leuckarti Glaus from the plankton of the channel section of the upper part of the Gorkovsk reservoir. The author concluded that the irreversibility of the changes in the seminal receptacle presents the possibility of utilising this structure as one of the indicators of the growth of the individual.

Plasma loop and strapping field dynamics: reproducing solar eruptions in the laboratory

Coronal mass ejections (CMEs) are dramatic eruptions of large, plasma structures from the Sun. These eruptions are important because they can harm astronauts, damage electrical infrastructure, and cause auroras. A mysterious feature of these eruptions is that plasma-filled solar flux tubes first evolve slowly, but then suddenly erupt. One model, torus instability, predicts an explosive-like transition from slow expansion to fast acceleration, if the spatial decay of the ambient magnetic field exceeds a threshold.

We create arched, plasma filled, magnetic flux ropes similar to CMEs. Small, independently-powered auxiliary coils placed inside the vacuum chamber produce magnetic fields above the decay threshold that are strong enough to act on the plasma. When the strapping field is not too strong and not too weak, expansion force build up while the flux rope is in the strapping field region. When the flux rope moves to a critical height, the plasma accelerates quickly, corresponding to the observed slow-rise to fast-acceleration of most solar eruptions. This behavior is in agreement with the predictions of torus instability.

Historically, eruptions have been separated into gradual CMEs and impulsive CMEs, depending on the acceleration profile. Recent numerical studies question this separation. One study varies the strapping field profile to produce gradual eruptions and impulsive eruptions, while another study varies the temporal profile of the voltage applied to the flux tube footpoints to produce the two eruption types. Our experiment reproduced these different eruptions by changing the strapping field magnitude, and the temporal profile of the current trace. This suggests that the same physics underlies both types of CME and that the separation between impulsive and gradual classes of eruption is artificial.

Field and Laboratory Studies of Atmospheric Organic Aerosol

This thesis is the culmination of field and laboratory studies aimed at assessing processes that affect the composition and distribution of atmospheric organic aerosol. An emphasis is placed on measurements conducted using compact and high-resolution Aerodyne Aerosol Mass Spectrometers (AMS). The first three chapters summarize results from aircraft campaigns designed to evaluate anthropogenic and biogenic impacts on marine aerosol and clouds off the coast of California. Subsequent chapters describe laboratory studies intended to evaluate gas and particle-phase mechanisms of organic aerosol oxidation.

The 2013 Nucleation in California Experiment (NiCE) was a campaign designed to study environments impacted by nucleated and/or freshly formed aerosol particles. Terrestrial biogenic aerosol with > 85% organic mass was observed to reside in the free troposphere above marine stratocumulus. This biogenic organic aerosol (BOA) originated from the Northwestern United States and was transported to the marine atmosphere during periodic cloud-clearing events. Spectra recorded by a cloud condensation nuclei counter demonstrated that BOA is CCN active. BOA enhancements at latitudes north of San Francisco, CA coincided with enhanced cloud water concentrations of organic species such as acetate and formate.

Airborne measurements conducted during the 2011 Eastern Pacific Emitted Aerosol Cloud Experiment (E-PEACE) were aimed at evaluating the contribution of ship emissions to the properties of marine aerosol and clouds off the coast of central California. In one study, analysis of organic aerosol mass spectra during periods of enhanced shipping activity yielded unique tracers indicative of cloud-processed ship emissions (m/z 42 and 99). The variation of their organic fraction (f₄₂ and f₉₉) was found to coincide with periods of heavy (f₄₂ > 0.15; f₉₉ > 0.04), moderate (0.05 < f₄₂ < 0.15; 0.01 < f₉₉ < 0.04), and negligible (f₄₂ < 0.05; f₉₉ < 0.01) ship influence. Application of these conditions to all measurements conducted during E-PEACE demonstrated that a large fraction of cloud droplet (72%) and dry aerosol mass (12%) sampled in the California coastal study region was heavily or moderately influenced by ship emissions. Another study investigated the chemical and physical evolution of a controlled organic plume emitted from the R/V Point Sur. Under sunny conditions, nucleated particles composed of oxidized organic compounds contributed nearly an order of magnitude more cloud condensation nuclei (CCN) than less oxidized particles formed under cloudy conditions. The processing time necessary for particles to become CCN active was short ( < 1 hr) compared to the time needed for particles to become hygroscopic at sub-saturated humidity ( > 4 hr).

Laboratory chamber experiments were also conducted to evaluate particle-phase processes influencing aerosol phase and composition. In one study, ammonium sulfate seed was coated with a layer of secondary organic aerosol (SOA) from toluene oxidation followed by a layer of SOA from α-pinene oxidation. The system exhibited different evaporative properties than ammonium sulfate seed initially coated with α-pinene SOA followed by a layer of toluene SOA. This behavior is consistent with a shell-and-core model and suggests limited mixing among different SOA types. Another study investigated the reactive uptake of isoprene epoxy diols (IEPOX) onto non-acidified aerosol. It was demonstrated that particle acidity has limited influence on organic aerosol formation onto ammonium sulfate seed, and that the chemical system is limited by the availability of nucleophiles such as sulfate.

Flow tube experiments were conducted to examine the role of iron in the reactive uptake and chemical oxidation of glycolaldehyde. Aerosol particles doped with iron and hydrogen peroxide were mixed with gas-phase glycolaldehyde and photochemically aged in a custom-built flow reactor. Compared to particles free of iron, iron-doped aerosols significantly enhanced the oxygen to carbon (O/C) ratio of accumulated organic mass. The primary oxidation mechanism is suggested to be a combination of Fenton and photo-Fenton reactions which enhance particle-phase OH radical concentrations.

Longitudinal dispersion in laboratory and natural streams

This study concerns the longitudinal dispersion of fluid particles which are initially distributed uninformly over one cross section of a uniform, steady, turbulent open channel flow. The primary focus is on developing a method to predict the rate of dispersion in a natural stream.

Taylor's method of determining a dispersion coefficient, previously applied to flow in pipes and two-dimensional open channels, is extended to a class of three-dimensional flows which have large width-to-depth ratios, and in which the velocity varies continuously with lateral cross-sectional position. Most natural streams are included. The dispersion coefficient for a natural stream may be predicted from measurements of the channel cross-sectional geometry, the cross-sectional distribution of velocity, and the overall channel shear velocity. Tracer experiments are not required.

Large values of the dimensionless dispersion coefficient D/rU* are explained by lateral variations in downstream velocity. In effect, the characteristic length of the cross section is shown to be proportional to the width, rather than the hydraulic radius. The dimensionless dispersion coefficient depends approximately on the square of the width to depth ratio.

A numerical program is given which is capable of generating the entire dispersion pattern downstream from an instantaneous point or plane source of pollutant. The program is verified by the theory for two-dimensional flow, and gives results in good agreement with laboratory and field experiments.

Both laboratory and field experiments are described. Twenty-one laboratory experiments were conducted: thirteen in two-dimensional flows, over both smooth and roughened bottoms; and eight in three-dimensional flows, formed by adding extreme side roughness to produce lateral velocity variations. Four field experiments were conducted in the Green-Duwamish River, Washington.

Both laboratory and flume experiments prove that in three-dimensional flow the dominant mechanism for dispersion is lateral velocity variation. For instance, in one laboratory experiment the dimensionless dispersion coefficient D/rU* (where r is the hydraulic radius and U* the shear velocity) was increased by a factory of ten by roughening the channel banks. In three-dimensional laboratory flow, D/rU* varied from 190 to 640, a typical range for natural streams. For each experiment, the measured dispersion coefficient agreed with that predicted by the extension of Taylor's analysis within a maximum error of 15%. For the Green-Duwamish River, the average experimentally measured dispersion coefficient was within 5% of the prediction.

Desenvolvimento e validação de modelo preditivo e avaliação de testes de diagnóstico por classe latente para o parasitismo por L. chagasi em cães atendidos no Hospital Veterinário Universitário da UFPI, Teresina

A leishmaniose visceral americana (LVA) é uma doença em expansão no Brasil, para a qual se dispõem de poucas, e aparentemente ineficientes, estratégias de controle. Um dos grandes problemas para a contenção da leishmaniose visceral americana é a falta de um método acurado de identificação dos cães infectados, considerados os principais reservatórios da doença no meio urbano. Neste sentido, a caracterização de marcadores clínico-laboratoriais da infecção neste reservatório e a avaliação mais adequada do desempenho de testes para diagnóstico da infecção podem contribuir para aumentar a efetividade das estratégias de controle da LVA. Com isso, o presente estudo tem dois objetivos principais: (1) desenvolver e validar um modelo de predição para o parasitismo por Leishmania chagasi em cães, baseado em resultados de testes sorológicos e sinais clínicos e (2) avaliar a sensibilidade e especificidade de critérios clínicos, sorológicos e parasitológicos para detecção de infecção canina por L. chagasi mediante análise de classe latente. O primeiro objetivo foi desenvolvido a partir de estudo em que foram obtidos dados de exames clínico, sorológico e parasitológico de todos os cães, suspeitos ou não de LVA, atendidos no Hospital Veterinário Universitário da Universidade Federal do Piauí (HVU-UFPI), em Teresina, nos anos de 2003 e 2004, totalizando 1412 animais. Modelos de regressão logística foram construídos com os animais atendidos em 2003 com a finalidade de desenvolver um modelo preditivo para o parasitismo com base nos sinais clínicos e resultados de sorologia por Imunofluorescência Indireta (IFI). Este modelo foi validado nos cães atendidos no hospital em 2004. Para a avaliação da área abaixo da curva ROC (auROC), sensibilidade, especificidade, valores preditivos positivo (VPP), valores preditivos negativo (VPN) e acurácia global, foram criados três modelos: um somente baseado nas variáveis clínicas, outro considerando somente o resultado sorológico e um último considerando conjuntamente a clínica e a sorologia. Dentre os três, o último modelo apresentou o melhor desempenho (auROC=90,1%, sensibilidade=82,4%, especificidade=81,6%, VPP=73,4%, VPN=88,2% e acurácia global=81,9%). Conclui-se que o uso de modelos preditivos baseados em critérios clínicos e sorológicos para o diagnóstico da leishmaniose visceral canina pode ser de utilidade no processo de avaliação da infecção canina, promovendo maior agilidade na contenção destes animais com a finalidade de reduzir os níveis de transmissão. O segundo objetivo foi desenvolvido por meio de um estudo transversal com 715 cães de idade entre 1 mês e 13 anos, com raça variada avaliados por clínicos veterinários no HVU-UFPI, no período de janeiro a dezembro de 2003. As sensibilidades e especificidades de critérios clínicos, sorológicos e parasitológicos para detecção de infecção canina por Leishmania chagasi foram estimadas por meio de análise de classe latente, considerando quatro modelos de testes e diferentes pontos de corte. As melhores sensibilidades estimadas para os critérios clínico, sorológico e parasitológico foram de 60%, 95% e 66%, respectivamente. Já as melhores especificidades estimadas para os critérios clínico, sorológico e parasitológico foram de 77%, 90% e 100%, respectivamente. Conclui-se que o uso do exame parasitológico como padrão-ouro para validação de testes diagnósticos não é apropriado e que os indicadores de acurácia dos testes avaliados são insuficientes e não justificam que eles sejam usados isoladamente para diagnóstico da infecção com a finalidade de controle da doença.

Aerodynamics of vertical-axis wind turbines in full-scale and laboratory-scale experiments

Within a wind farm, multiple turbine wakes can interact and have a substantial effect on the overall power production. This makes an understanding of the wake recovery process critically important to optimizing wind farm efficiency. Vertical-axis wind turbines (VAWTs) exhibit features that are amenable to dramatically improving this efficiency. However, the physics of the flow around VAWTs is not well understood, especially as it pertains to wake interactions, and it is the goal of this thesis to partially fill this void. This objective is approached from two broadly different perspectives: a low-order view of wind farm aerodynamics, and a detailed experimental analysis of the VAWT wake.

One of the contributions of this thesis is the development of a semi-empirical model of wind farm aerodynamics, known as the LRB model, that is able to predict turbine array configurations to leading order accuracy. Another contribution is the characterization of the VAWT wake as a function of turbine solidity. It was found that three distinct regions of flow exist in the VAWT wake: (1) the near wake, where periodic blade shedding of vorticity dominates; (2) a transition region, where growth of a shear-layer instability occurs; (3) the far wake, where bluff-body oscillations dominate. The wake transition can be predicted using a new parameter, the dynamic solidity, which establishes a quantitative connection between the wake of a VAWT and that of a circular cylinder. The results provide insight into the mechanism of the VAWT wake recovery and the potential means to control it.