769 resultados para Barriers to access


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Scrapie is a transmissible neurodegenerative disease that appears to result from an accumulation in the brain of an abnormal protease-resistant isoform of prion protein (PrP) called PrPsc. Conversion of the normal, protease-sensitive form of PrP (PrPc) to protease-resistant forms like PrPsc has been demonstrated in a cell-free reaction composed largely of hamster PrPc and PrPsc. We now report studies of the species specificity of this cell-free reaction using mouse, hamster, and chimeric PrP molecules. Combinations of hamster PrPc with hamster PrPsc and mouse PrPc with mouse PrPsc resulted in the conversion of PrPc to protease-resistant forms. Protease-resistant PrP species were also generated in the nonhomologous reaction of hamster PrPc with mouse PrPsc, but little conversion was observed in the reciprocal reaction. Glycosylation of the PrPc precursors was not required for species specificity in the conversion reaction. The relative conversion efficiencies correlated with the relative transmissibilities of these strains of scrapie between mice and hamsters. Conversion experiments performed with chimeric mouse/hamster PrPc precursors indicated that differences between PrPc and PrPsc at residues 139, 155, and 170 affected the conversion efficiency and the size of the resultant protease-resistant PrP species. We conclude that there is species specificity in the cell-free interactions that lead to the conversion of PrPc to protease-resistant forms. This specificity may be the molecular basis for the barriers to interspecies transmission of scrapie and other transmissible spongiform encephalopathies in vivo.

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Acompanhando a tendência mundial, o Brasil apresenta um processo de envelhecimento de sua população, caracterizado pelo aumento das condições crônicas, inclusive do câncer. O quadro convoca mudanças profundas nos sistemas de saúde, demandando a implantação de Redes de Atenção, a fim de garantir acesso a todos os níveis de atenção, superando a fragmentação do cuidado. Com o intuito de conhecer os avanços no que se refere à atenção oncológica em rede, analisou-se o acesso ao tratamento do câncer em São Paulo, especialmente a partir do surgimento da Lei dos sessenta dias. Foram considerados os sistemas de monitoramento da atenção oncológica no município, além de analisados os itinerários assistenciais de usuárias, utilizando o câncer de mama como condição traçadora. Não foi possível identificar uma redução do tempo de espera para iniciar o tratamento, a partir do banco do Registro Hospitalar de Câncer de são Paulo, considerando que não há completude na base a partir de 2013, sendo observado que o tempo indicado na lei foi ultrapassado nos dois anos anteriores. Da mesma forma, notou-se um aumento da proporção de estádios avançados nesse período. Ainda com relação à variável tempo, as informações no SIGA demonstraram que, em 2013, o tempo médio para uma consulta em Onco-mastologia nos serviços de gestão municipal que estão sob regulação foi de apenas 4 dias. Por meio dos Sistemas de Informação Ambulatorial e Hospitalar, observou-se um aumento estatisticamente significativo na produção de radioterapia e de cirurgias oncológicas entre os anos 2011 e 2014, e uma tendência de redução dos procedimentos quimioterápicos. O Sistema de Informação sobre Câncer de Mama demonstrou aumento no percentual de mamografias alteradas, aspecto que, ao ser analisado em conjunto com o aumento da proporção de estadiamentos avançados, pode ser indicativo de maior dificuldade no acesso ao diagnóstico precoce do câncer de mama. Observou-se que a judicialização esteve muito relacionada a acesso a medicamentos quimioterápicos, de prescrição após a entrada nos serviços especializados, o que confirma que o acesso ao tratamento de câncer de mama no município não apresenta grandes barreiras. Um importante efeito visualizado com o surgimento da Lei foi a padronização dos protocolos de acesso aos serviços de gestão municipal e estadual. Entretanto, a rede de oncologia em São Paulo continua fragmentada dentre seus componentes estruturais, as ações permanecem no plano da construção de fluxos de encaminhamento, ficando restrita à atenção especializada. A atenção oncológica na cidade é atravessada pelo setor privado, o que deixa na dependência dos prestadores a disponibilização de vagas para acesso e o fluxo interno de cada serviço. O poder ainda continua com os grandes prestadores, não sendo bem conhecidos os caminhos para o acesso a algumas instituições, nem publicizadas as informações sobre fila e tempo de espera. A legislação sozinha não é indutora de melhoria de acesso, nem muito menos de garantia de integralidade. Um importante desafio para o SUS é a integração dos serviços e a construção de redes de atenção com centralidade na APS, garantindo, acima de tudo, o diagnóstico em tempo oportuno e a efetiva gestão sobre os serviços privados contratados de média e alta complexidade.

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Introdução O comportamento alimentar do indivíduo resulta de decisões, conscientes ou não, relacionadas à cultura alimentar de sua região, à tradição alimentar de seu convívio social e às transformações decorridas do acesso à informação científica e popular. Objetivo Analisar a alimentação de adolescentes, residentes na região Norte do município de São José dos Campos (SP), na perspectiva da família. Materiais e métodos Estudo qualitativo, realizado em 2014 e 2015, com mães e adolescentes do 6o ano do ensino fundamental municipal. Dados sobre percepção, conhecimento, comportamento e barreiras para uma alimentação saudável dos adolescentes foram produzidos por meio de grupos focais. Entrevistas semiestruturadas foram realizadas com as mães dos estudantes para investigar aspectos sobre alimentação da família e relação com formação de práticas e comportamentos alimentares dos filhos. Os discursos foram registrados com auxílio de um gravador de voz, e transcritos posteriormente para análise, por meio da técnica de análise de conteúdo temática. Foram realizados 4 grupos focais com 6 estudantes cada, e 15 entrevistas com mães. Resultados e discussão Os discursos foram classificados em temas: comportamento alimentar, preferências alimentares e conhecimentos e crenças. Verificou-se que a alimentação dos adolescentes pode ser influenciada pelo comportamento alimentar dos pais. Mães e adolescentes percebemse conscientes e julgam sobre o que comem. Entretanto, a fala muitas vezes está distante da prática, seja por negligencia, dificuldade em perceber possibilidades de ação, questões emotivas ou pelo hábito formado, considerado a maior dificuldade para mudanças relacionadas à alimentação, tanto das mães quanto adolescentes. Possibilidades de soluções, quando referidas, eram por vezes permeadas por conflitos, causando insatisfação em mães e filhos. O contexto no qual esses individuos estão inseridos deve ser considerado, como o bairro e a escola, os quais contribuem para a determinação das escolhas alimentares. Conclusão a família exerce importante papel no comportamento alimentar de adolescentes, entretanto, a compreensão sobre o tema deve considerar, sobretudo, a cultura e o meio social em que a dinâmica familiar está contextualizada.

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The number of seniors in the U.S. today is growing rapidly because of longer life expectancies and the aging Baby Boomer generation. This age groups' travel behavior will have substantial impacts on transportation, economics, safety, and the environment. This research used a mixed-methods approach to address issues of mobility and aging in Denver, Colorado. A quantitative approach was used to answer broad questions about travel behavior and the effects of age, gender, work status, disability, residential location and socio-economic status on mobility. Qualitative interviews with seniors in the Denver metro area were conducted to identify barriers to mobility, decision-making processes and travel decisions, and seniors' perceptions of public transit. The results of the quantitative and qualitative analyses show that residential location is an important variable for determining seniors' travel behaviors and transportation options. Perceptions of public transit were positive, but accessibility and information barriers exist that prevent older adult from using transit. The findings of this study will help to provide transportation and service recommendations to policymakers and planners in the Denver area as well as to inform studies of other North American cities with large aging populations.

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The aim of this paper is to extend the existing literature and propose an alternative perspective on bereavement counseling with Chinese Americans. This aim is achieved by integrating William Worden's (2009) grief counseling model with several cultural components that are relevant to counseling with Chinese Americans, including: (a) the barriers to seeking counseling, (b) the clinical presentations of Asian Americans, (c) the common coping styles among Asian Americans, (d) the major Chinese religions and philosophies, and (e) the bereavement-related cultural practices. The corresponding treatment recommendations will be explored following the discussion of each cultural element. Finally, a culturally responsive grief counseling model for Chinese Americans will be proposed in the last section, along with a discussion of important caveats.

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Highways can be effective barriers to animal migration. Where highways cross over streams, a passageway, typically a culvert, not designed for fish access can cut off an organism from miles of habitat. Traditional methods of culvert design, to convey floodwaters, reduced access to aquatic and riparian range. The Colorado Department of Transportation likely has numerous culverts that restrict aquatic passage. This paper provides guidance to CDOT for assessment of stream geomorphic conditions affecting culvert performance for fish passage, understanding aquatic organism habitat requirements, and incorporating ecological parameters into culvert designs that benefit fish and other organisms. A case study illustrates culvert problems in a difficult geomorphic setting including a fish passage assessment to evaluate stream stability for long-term culvert reliability.

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Objetivo: Comparar la prevalencia de la violencia de género entre mujeres inmigrantes y españolas. Describir sus respuestas ante esta situación y posibles diferencias entre ellas. Identificar intervenciones ya existentes en España sobre prevención y atención sociosanitaria de violencia de género dirigidas a inmigrantes. Métodos: Estudio transversal mediante encuesta autoadministrada en 10.202 mujeres que acudieron a centros de atención primaria en España (2006-2007). Análisis de contenido del informe de seguimiento de la ley 1/2004 de medidas de protección integral contra la violencia de género remitido por las comunidades autónomas (CC.AA.) (2005) y las leyes y planes autonómicos más recientes. Resultados: La prevalencia de violencia de género en las españolas es del 14,3% y en las inmigrantes del 27,3%. La probabilidad de violencia de género en las inmigrantes es mayor (odds ratio ajustada: 2,06; intervalo de confianza del 95%: 1,61–2,64). Las inmigrantes dijeron haber denunciado a su pareja con más frecuencia, así como que no sabían resolver su situación. Algunas CC.AA. ya han emprendido intervenciones para superar las barreras de acceso a los servicios sociosanitarios, pero sólo tres facilitan el número de mujeres inmigrantes beneficiarias de ayudas económicas y laborales hasta 2005. Conclusiones: Existe una desigual distribución en la prevalencia de la violencia de género según el país de origen, afectando en mayor medida a las mujeres inmigrantes. Éstas denuncian con más frecuencia que las españolas, pero tal actuación no supone una garantía de resultados efectivos. Aunque se han identificado otras intervenciones específicas en algunas CC.AA., sería necesario evaluarlas para asegurar que las mujeres inmigrantes se están beneficiando.

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Copyright © 2016 Frederico Rosário et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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European-wide data concerning both companies and households indicate that the credit rationing phenomenon, which has been predicted by theory, does in fact occur to a significant degree in the European credit market. Among SMEs, micro companies are most vulnerable and the current economic crisis has only made these concerns more pressing. Top-down use of the monetary transmission mechanism alone is insufficient to counter the problem. The other solution consists of a bottom-up, microeconomic stimulation of lending transactions, by focusing on collateral and guarantees. The data confirm the high importance that lenders – especially individual households and micro companies – attach to collateral and guarantees when making their lending decisions. As a consequence, we would argue that those parts of the law governing security interests and guarantees should be one of the primary targets for government policy aimed at improving credit flows, especially in avoiding a conflict between consumer protection measures and laws on surety and guarantees. This policy brief firstly aims to give an overview of the problem of credit rationing and to show that low-income households and SMEs are most concerned by the phenomenon. Focusing solely on loans as a way of financing and on the issues related to access to finance by micro and small companies as well households, it then sketches possible solutions focused on guarantees. This paper brings together data from the Eurosystem Household Finance and Consumption survey (HFCS), Eurostat, and both the latest wave of the extended biennial EC/ECB Survey on the access to finance of SMEs (EC/ECB SAFE 2013) and the latest wave of the smaller semi-annual ECB SAFE Survey, covering the period between October 2012 and March 2013.

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A deep, comprehensive and ambitious TTIP should not undermine or otherwise negatively affect the WTO and its signatories. Among other things, this means that trade diversion ought to be minimised and positive spillovers stimulated. The present CEPS Special Report provides some elementary quantification, which helps to understand the economic incentives for third countries to seek regulatory alignment with TTIP results, where relevant, and for which TTIP should be ‘open’. It focuses on ‘indirect’ spillovers and employs a rather aggregate economic approach. We find that, of three groups of countries that are important for trade with the EU and the US, the ‘closest’ neighbours (NAFTA, EEA, Switzerland and Turkey) exhibit powerful incentives to align so as to benefit from positive spillovers. This is less clear for two other groups. Of the (seven) ‘biggest traders’ (in manufactured goods, for which spillovers matter most), China turns out to have the greatest interest in alignment in selected sectors, followed by Israel, Japan and South Korea. Whereas the latter three either have or are negotiating FTAs with the US and the EU, precisely China has none and remains outside TPP as well. In terms of sectors, the chemical sector followed by electronic equipment are by far the most important, with agro-products and fish as a good third (SPS issues). However, in chemicals and electrical equipment, the TTIP negotiations so far, and recent US/EU regulatory cooperation, do not indicate an ambitious approach, which could reduce regulatory barriers to market access drastically.

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Within recent years, increasing international competition has caused an increase in job transitions worldwide. Many countries find it difficult to manage these transitions in a way that ensures a match between labour and demand. One of the countries that seem to manage the transitions in a successful way is Denmark, where unemployment has been dropping dramatically over the last decade without a drop in job quality. This success is ascribed the so-called Danish flexicurity model, where an easy access to hiring and firing employees (flexibility) is combined with extensive active and passive labour market policies (security). The Danish results have gained interest not only among other European countries, where unemployment rates remain high, but also in the US, where job loss is often related to lower job quality. It has, however, been subject to much debate both in Europe and in the US, whether or not countries with distinctively different political-economic settings can learn from one another. Some have argued that cultural differences impose barriers to successful policy transfer, whereas others see it as a perfectly rational calculus to introduce 'best practices' from elsewhere. This paper presents a third strategy. Recent literature on policy transfer suggests that successful cross national policy transfer is possible, even across the Atlantic, but that one must be cautious in choosing the form, content and level of the learning process. By analysing and comparing the labour market policies and their settings in Denmark and the US in detail, this paper addresses the question, what and how the US can learn from the Danish model. Where the US and Denmark share a high degree of flexibility, they differ significantly on the level of security. This also means that the Danish budget for active and passive labour market policies is significantly higher than the American, and it seems unlikely that political support for the introduction of Danish levels of security in the US can be established. However, the paper concludes that there is a learning potential between the US and Demnark in the different local level efficiency of the money already spent. A major reason for the Danish success has been the introduction of tailor made initiatives to the single displaced worker and a stronger coordination between local level actors. Both of which are issues, where a lack of efficiency in the implementation of American active labour market policies has been reported.

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This paper studying the 1995 EU-Turkey Customs Union (CU) reveals that the CU has been a major instrument of integration of the Turkish economy into the EU and global markets, offering powerful tools to reform the Turkish economy. Turkish producers of industrial goods are protected by tariffs from external competition to exactly the same extent as EU producers, and they face competition from duty-free imports of industrial goods from world-class pan-European firms. In return, Turkish industrial producers have duty-free market access to the European Economic Area, which was recently extended to certain Mediterranean countries. Trade liberalisation achieved through the CU has thus successfully moved the Turkish economy from a government-controlled regime to a market-based one, and Turkish producers of industrial goods have performed remarkably well. The paper further shows that market access conditions for Turkish producers are determined, in addition to tariffs, by standards, conformity assessment procedures, competition policy, industrial property rights and contingent protectionism measures. The CU also offered Turkey the opportunity to establish new institutions, and modernise and upgrade rules and disciplines required for the elimination of technical barriers to trade, and for the implementation of the EU’s competition, industrial property rights, and contingent protectionism policies.

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The research team reviewed numerous several multi- sectoral entities and identified nine GGNs that became the subject of our case studies. The research team conducted semi-structured interviews with executives and staff from each of these GNNs and prepared a profile, including a description of the unique evolution of the organization, goals and objectives, organizational structure and governance arrangements for each GGN. The following list provides an overview of the nine GGNs profiled: 1. Every Woman Every Child is an unprecedented global effort that mobilizes and amplifies action by governments, multilaterals, the private sector, research centers, academia and civil society to address life-threatening health challenges facing women and children globally. 2. HERproject catalyzes global partnerships and local Networks to improve female workers’ general and reproductive health in eight emerging economies. 3. R4 Rural Resilience Initiative is a cutting-edge, strategic, large-scale partnership between the public and private sectors to innovate and develop better tools to help the world’s most vulnerable people build resilient livelihoods. 4. Extractive Industry Transparency Initiative is a coalition of governments, companies, civil society groups, investors and international organizations that aims to improve transparency and accountability in the extractives sector. 5. Global Network for Neglected Tropical Diseases works with international partners at the highest level of government, business and society to break down the logistical and financial barriers to delivering existing treatments for the seven most common neglected tropical diseases. 6. Global Alliance for Improved Nutrition is an alliance that supports public-private partnerships to increase access to the missing nutrients in diets necessary for people, communities and economies to be stronger and healthier. 7. Inter-Agency Network For Education in Emergencies is a global Network of individuals and representatives from NGOs, United Nations and donor agencies, governments, academic institutions, schools and affected populations working to ensure all persons have the right to a quality and safe education in emergencies and post- crisis recovery. 8. mHealth Alliance works with diverse partners to advance mobile-based or mobile-enhanced solutions that deliver health through research, advocacy, support for the development of interoperable solutions and sustainable deployment models. 9. The Rainforest Alliance is a global non-profit that focuses on environmental conservation and sustainable development and works through collaborative partnerships with various stakeholders.

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After years of unchallenged commercial domination of a sizeable portion of the EU's gas market, Gazprom is confronted with a statement of objections issued on 22 April by the EU Commission for abusing its dominant market position. The company was already prevented from going ahead with its South Stream project aimed at consolidating Gazprom's grip on Southeast Europe's markets by bypassing Ukraine – due to alleged non-compliance of intergovernmental agreements with the EU regulatory framework. Furthermore, it walked away from negotiations that could have allowed it to access more than 50% of the OPAL pipeline – an onshore branch of the offshore Russian German Nord Stream pipeline –, whilst its attempts to go downstream through the acquisition of European distribution and transmission operators, such as Wingas and DESFA, failed due to current political tensions and the risk of a negative Commission ruling on the operation. Does this mean that the Russian gas behemoth – so often portrayed as the energy arm of the Kremlin – is not so powerful after all? This Policy Brief aims to frame the erosion of Gazprom's power in a wider perspective, analysing its peculiar position at a time of transition, with the global gas business going from a sellers' to a buyers' market, and providing recommendations on how Europe should deal with it. It will be argued that Gazprom – despite still being affected by the Kremlin's political priorities – is moving towards more commercially sound behavior. The EU should profit from this evolution without being tempted by mercantilist options, and rather use the political momentum provided by the energy union to remove barriers to solidarity and to increase competition on the trading platforms.

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Healthcare-associated infections (HAI) are a major public health problem being Klebsiella pneumoniae and nontuberculous mycobacteria, both with high antibiotic resistance rates, among their etiological agent. Since biofilme assembly is pointed as one of the mechanisms involved in emergence of antibiotic resistance understanding bacteria organization within the biofilm and the identification of differences between planktonic and sessile forms of bacteria will be a step forward to fight HAI. In the present work we used SEM as a tool to characterize the internal structure of biofilm assembled on different surfaces. For SEM analysis, biofilms were allowed to form either on six-well cell culture plates, silicon or metallic disks placed inside the wells for different incubation periods at 37 °C. The biofilm assembled on the cell culture dish was for both secondary and backscattered electron analysis as described before. Biofilms assembled on silicon disks instead of being sectioned were prepared as metallographic samples, by grinding with grit SIC paper and polishing with diamond particles. Samples were cleaned (70% ethanol), dried with hot air, further coated and analysed. A preliminary study using FIB-SEM has been performed to access the ultrastructure of biofilms assembled on metallic surfaces. The results obtained showed that the same bacteria assembled biofilms with different ratios of biomass and extracellular matrix depending on the surface. SEM performed on thin sections of biofilms is a powerful tool to elucidate biofilm structure allowing the quantification of the major components. FIB-SEM is also a promising tool in this field.