Análise do processo de implementação de políticas de saúde: Um estudo de caso baseado no enfoque da política institucional

O processo de implementação de políticas públicas tem se apresentado como o elo perdido da ação governamental. Apesar da importância desse processo, esta etapa carece de métodos de análises que deem conta de sua complexidade como forma de lhe garantir uma posição chave dentro do ciclo da análise de políticas públicas. A partir da adaptação do referencial da política institucional, proposta pelo grupo Francês Strategor, que analisa uma instituição sob quatro determinantes – estratégia, estrutura, decisão e identidade-, este estudo propõe-se a analisar o processo de implementação de uma política municipal de saúde voltada para Hipertensos e Diabéticos no município de Venda Nova do Imigrante/ES, avaliada como uma estratégia exitosa. Como resultado, esse estudo evidenciou que o processo exitoso de implementação da política avaliada pautou-se numa decisão participava e colegiada, no reconhecimento e valorização da autonomia profissional e na discussão democrática. Além disso, a estrutura institucional analisada proporcionou uma coordenação menos normativa, que favoreceu momentos de encontro entre o núcleo estratégico e os centros operacionais, rompendo com a excessiva verticalização das estruturas tradicionais. A análise do determinante identidade demonstrou uma apropriação dos valores e da missão institucional e um importante envolvimento dos atores, indicado pelo fortalecimento de parcerias e sinergias internas. A estratégia de implementação dessa política municipal mostrou-se potente no sentido de inverter a lógica do modelo de atenção, dentro de um processo de aprendizado, sendo este o grande diferencial competitivo de sucesso da instituição. A partir desses resultados, o referencial de Strategor se afirma como importante método de análise do processo de implementação, além de sua potência para indicar questões que colaborem para garantir à etapa de implementação uma posição de destaque dentro do ciclo da política pública.

Structure formation in an expanding universe : I José Plínio Baptista School of Cosmology

José Plínio Baptista School of Cosmology (1. : 2012 : Anchieta, ES). Seminário realizado no período de 14 a 19 de outubro de 2012.

Five generations of peace operations: from the "thin blue line" to "painting a country blue"

This article combines both international practice and analytical contributions into a systematic and synthetic presentation of the evolution of peace operations from their modern inception in 1948 to the present. It seeks to serve a didactic purpose in proposing a basic structure for Brazilian scholars' burgeoning debate on peace operations and intervention, rather than a definitive characterization of blue helmet practice. Peace operations' progression is traced through five analytical "generations," each adding a crucial factor distinguishing it from its predecessors. Each generation is placed in relation to changes in the nature of conflict and in the interpretation of the foundational principles of peace operations, and links to broader theoretical issues in International Relations are made explicit at each stage.

Improving the environmental performance of bedding products by using life cycle assessment at the design stage

Improvement of the environmental performance of processes and products is a common objective in industry, and has been receiving increased attention in recent years. The main objective of this work is to evaluate the potential environmental impact of two bedding products, a polyurethane foam mattress (PFM) and a pocket spring mattress (PSM). These two types are the most common mattresses used in Europe. A Life Cycle Assessment (LCA) shows that the PFM has a higher environmental impact than the PSM. For both products the main cause of environmental impact is the manufacturing process, respectively the polyurethane foam block moulding process for the PFM, and the pocket spring nucleus process for the PSM. A scenario analysis shows the possibility of reducing the environmental impact of the products’ life cycle using an alternative End-of-Life scenario, resorting to incineration rather than landfill. Two strategies were also studied in order to reduce the environmental impact of the PFM: (1) reutilization of foam that was sent to the waste system management, and (2) a 20% weight reduction of the polyurethane foam. The second strategy has proven to be the most effective.

Mechanical Behavior of the Lamellar Structure in Semi-Crystalline Polymers

We have employed molecular dynamics simulations to study the behavior of virtual polymeric materials under an applied uniaxial tensile load. Through computer simulations, one can obtain experimentally inaccessible information about phenomena taking place at the molecular and microscopic levels. Not only can the global material response be monitored and characterized along time, but the response of macromolecular chains can be followed independently if desired. The computer-generated materials were created by emulating the step-wise polymerization, resulting in self-avoiding chains in 3D with controlled degree of orientation along a certain axis. These materials represent a simplified model of the lamellar structure of semi-crystalline polymers,being comprised of an amorphous region surrounded by two crystalline lamellar regions. For the simulations, a series of materials were created, varying i) the lamella thickness, ii) the amorphous region thickness, iii) the preferential chain orientation, and iv) the degree of packing of the amorphous region. Simulation results indicate that the lamella thickness has the strongest influence on the mechanical properties of the lamella-amorphous structure, which is in agreement with experimental data. The other morphological parameters also affect the mechanical response, but to a smaller degree. This research follows previous simulation work on the crack formation and propagation phenomena, deformation mechanisms at the nanoscale, and the influence of the loading conditions on the material response. Computer simulations can improve the fundamental understanding about the phenomena responsible for the behavior of polymeric materials, and will eventually lead to the design of knowledge-based materials with improved properties.

LEARNING ENVIRONMENTS IN THE CONTEXT OF A MASTER DEGREE IN ANIMATION AND ILLUSTRATION

This paper aims to describe the processes of teaching illustration and animation, together, in the context of a masters degree program. In Portugal, until very recently, illustration and animation higher education courses, were very scarce and only provided by a few private universities, which offered separated programs - either illustration or animation. The MA in Illustration and Animation (MIA) based in the Instituto Politécnico do Cávado e Ave in Portugal, dared to join these two creative areas in a common learning model and is already starting it’s third edition with encouraging results and will be supported by the first international conference on illustration and animation (CONFIA). This masters program integrates several approaches and techniques (in illustration and animation) and integrates and encourages creative writing and critique writing. This paper describes the iterative process of construction, and implementation of the program as well as the results obtained on the initial years of existence in terms of pedagogic and learning conclusions. In summary, we aim to compare pedagogic models of animation or illustration teaching in higher education opposed to a more contemporary and multidisciplinary model approach that integrates the two - on an earlier stage - and allows them to be developed separately – on the second part of the program. This is based on the differences and specificities of animation (from classic techniques to 3D) and illustration (drawing the illustration) and the intersection area of these two subjects within the program structure focused on the students learning and competencies acquired to use in professional or authorial projects.

The structure of domination today: a lacanian view

Na era da sensibilidade extrema em relação ao assédio do Outro é cada vez mais comum submeter à crítica, injunções éticas, que nos aterrorizam com a sua imposição brutal do universal. Lacan explica esta violência ética através da passagem do discurso do Amo para o discurso da Universidade enquanto discurso hegemónico da sociedade contemporânea.

Synthesis, structure, and optical properties of an alternating calix[4]arene-based meta-linked phenylene ethynylene copolymer

Novel alternating copolymers comprising biscalix[4]arene-p-phenylene ethynylene and m-phenylene ethynylene units (CALIX-m-PPE) were synthesized using the Sonogashira-Hagihara cross-coupling polymerization. Good isolated yields (60-80%) were achieved for the polymers that show M-n ranging from 1.4 x 10(4) to 5.1 x 10(4) gmol(-1) (gel permeation chromatography analysis), depending on specific polymerization conditions. The structural analysis of CALIX-m-PPE was performed by H-1, C-13, C-13-H-1 heteronuclear single quantum correlation (HSQC), C-13-H-1 heteronuclear multiple bond correlation (HMBC), correlation spectroscopy (COSY), and nuclear overhauser effect spectroscopy (NOESY) in addition to Fourier transform-Infrared spectroscopy and microanalysis allowing its full characterization. Depending on the reaction setup, variable amounts (16-45%) of diyne units were found in polymers although their photophysical properties are essentially the same. It is demonstrated that CALIX-m-PPE does not form ground-or excited-state interchain interactions owing to the highly crowded environment of the main-chain imparted by both calix[4]arene side units which behave as insulators inhibiting main-chain pi-pi staking. It was also found that the luminescent properties of CALIX-m-PPE are markedly different from those of an all-p-linked phenylene ethynylene copolymer (CALIX-p-PPE) previously reported. The unexpected appearance of a low-energy emission band at 426 nm, in addition to the locally excited-state emission (365 nm), together with a quite low fluorescence quantum yield (Phi = 0.02) and a double-exponential decay dynamics led to the formulation of an intramolecular exciplex as the new emissive species.

Grid structure impact in sparse point representation of derivatives

In the Sparse Point Representation (SPR) method the principle is to retain the function data indicated by significant interpolatory wavelet coefficients, which are defined as interpolation errors by means of an interpolating subdivision scheme. Typically, a SPR grid is coarse in smooth regions, and refined close to irregularities. Furthermore, the computation of partial derivatives of a function from the information of its SPR content is performed in two steps. The first one is a refinement procedure to extend the SPR by the inclusion of new interpolated point values in a security zone. Then, for points in the refined grid, such derivatives are approximated by uniform finite differences, using a step size proportional to each point local scale. If required neighboring stencils are not present in the grid, the corresponding missing point values are approximated from coarser scales using the interpolating subdivision scheme. Using the cubic interpolation subdivision scheme, we demonstrate that such adaptive finite differences can be formulated in terms of a collocation scheme based on the wavelet expansion associated to the SPR. For this purpose, we prove some results concerning the local behavior of such wavelet reconstruction operators, which stand for SPR grids having appropriate structures. This statement implies that the adaptive finite difference scheme and the one using the step size of the finest level produce the same result at SPR grid points. Consequently, in addition to the refinement strategy, our analysis indicates that some care must be taken concerning the grid structure, in order to keep the truncation error under a certain accuracy limit. Illustrating results are presented for 2D Maxwell's equation numerical solutions.

Gestão integrada de resíduos de construção e demolição: análise de estudo

A actividade de construção civil é responsável por grande parte dos resíduos produzidos, nomeadamente em obras de construção, demolições de edifícios ou derrocadas, operações de manutenção, restauro, remodelação e reabilitação de construções. A gestão dos resíduos deste sector, abreviadamente designada por resíduos de construção e demolição (RCD), passou a estar regulada, através de regime de operações de gestão de RCD. Este diploma, define entre outras, a responsabilidade dos vários intervenientes no processo de gestão de resíduos, fase de projecto, execução, transporte e recepção. Com a evolução das preocupações ambientais da população e maior envolvência das empresas na contribuição para uma gestão integrada de resíduos, existe um crescente desenvolvimento de estudos no âmbito de caracterização de quantidades e tipos de resíduos produzidos pelo sector. Neste contexto, e por ser importante uma economia integrada com a gestão de resíduos, os principais desafios passam pelo planeamento e preparação de Obra desde da fase de projecto à fase de execução, com vista à prevenção, redução, reutilização e valorização dos RCD. O presente trabalho pretende contribuir para este desenvolvimento do sector, mais concretamente na obtenção de indicadores de resíduos de construção (RC), resíduos de demolição (RD) e caracterização da tipologia destes. Para tanto, foi feita uma avaliação dos estudos desenvolvidos no âmbito de caracterização dos tipos de resíduos e indicadores de RC e RD, como método comparativo. Os indicadores deste estudo foram obtidos com base na análise de dados de casos de estudo, no caso concreto RC, de obras de estruturas, e RD de edifícios com execução de demolição selectiva. Na parte final deste estudo apresentam-se algumas conclusões e recomendações.

Quality of life in dilated cardiomyopathy with refractory chronic heart failure undergoing devices implantation

Heart failure is the final stage of most of cardiac diseases. It is a complex syndrome in which the patients should have the following features: symptoms of heart failure, typically shortness of breath at rest or during exertion, and/or fatigue; signs of fluid retention such as pulmonary congestion or ankle swelling; and objective evidence of an abnormality of the structure or function of the heart at rest. This progressive syndrome as a high incidence and prevalence and poor prognosis: four-year mortality is around 50% with 40% of the patients admitted to hospital dying or readmitted within a year. With ageing, many patients will develop chronic heart failure, which, because of its symptoms, patient’s awareness of their risk of dying, and the effects of therapy, together with frequent hospitalizations, has considerable impact on patient’s health-related quality of life.

Human case of gastric infection by a fourth larval stage of Pseudoterranova decipiens (Nematoda, Anisakidae)

Only three cases of human infection by anisakid nematodes have been reported in Chile since 1976. In the present case, an anisakid worm, identified as a fourth-stage Pseudoterranova decipiens larva, was removed with a gastroendoscopic biopsy clipper from the stomach of a 45 year-old man from southern Chile. The patient, who presented acute epigastric pain and a continuous sensation of having an empty stomach, reported having eaten smoked fish. The worm was fixed in 70% ethanol and cleaned in lactophenol for morphological study. The morphometric characteristics of the worm are described and drawn. Anisakid larvae in fish flesh can be killed by freezing or cooking.

From unthinned continent to ocean: The deep structure of the West Iberia passive continental margin at 38 degrees N

The crustal and lithospheric mantle structure at the south segment of the west Iberian margin was investigated along a 370 km long seismic transect. The transect goes from unthinned continental crust onshore to oceanic crust, crossing the ocean-continent transition (OCT) zone. The wide-angle data set includes recordings from 6 OBSs and 2 inland seismic stations. Kinematic and dynamic modeling provided a 2D velocity model that proved to be consistent with the modeled free-air anomaly data. The interpretation of coincident multi-channel near-vertical and wide-angle reflection data sets allowed the identification of four main crustal domains: (i) continental (east of 9.4 degrees W); (ii) continental thinning (9.4 degrees W-9.7 degrees W): (iii) transitional (9.7 degrees W-similar to 10.5 degrees W); and (iv) oceanic (west of similar to 10.5 degrees W). In the continental domain the complete crustal section of slightly thinned continental crust is present. The upper (UCC, 5.1-6.0 km/s) and the lower continental crust (LCC, 6.9-7.2 km/s) are seismically reflective and have intermediate to low P-wave velocity gradients. The middle continental crust (MCC, 6.35-6.45 km/s) is generally unreflective with low velocity gradient. The main thinning of the continental crust occurs in the thinning domain by attenuation of the UCC and the LCC. Major thinning of the MCC starts to the west of the LCC pinchout point, where it rests directly upon the mantle. In the thinning domain the Moho slope is at least 13 degrees and the continental crust thickness decreases seaward from 22 to 11 km over a similar to 35 km distance, stretched by a factor of 1.5 to 3. In the oceanic domain a two-layer high-gradient igneous crust (5.3-6.0 km/s; 6.5-7.4 km/s) was modeled. The intra-crustal interface correlates with prominent mid-basement, 10-15 km long reflections in the multi-channel seismic profile. Strong secondary reflected PmP phases require a first order discontinuity at the Moho. The sedimentary cover can be as thick as 5 km and the igneous crustal thickness varies from 4 to 11 km in the west, where the profile reaches the Madeira-Tore Rise. In the transitional domain the crust has a complex structure that varies both horizontally and vertically. Beneath the continental slope it includes exhumed continental crust (6.15-6.45 km/s). Strong diffractions were modeled to originate at the lower interface of this layer. The western segment of this transitional domain is highly reflective at all levels, probably due to dykes and sills, according to the high apparent susceptibility and density modeled at this location. Sub-Moho mantle velocity is found to be 8.0 km/s, but velocities smaller than 8.0 km/s confined to short segments are not excluded by the data. Strong P-wave wide-angle reflections are modeled to originate at depth of 20 km within the lithospheric mantle, under the eastern segment of the oceanic domain, or even deeper at the transitional domain, suggesting a layered structure for the lithospheric mantle. Both interface depths and velocities of the continental section are in good agreement to the conjugate Newfoundland margin. A similar to 40 km wide OCT having a geophysical signature distinct from the OCT to the north favors a two pulse continental breakup.