Falhas de mercado e redes em políticas públicas: desafios e possibilidades ao Sistema Único de Saúde

Os princípios e as diretrizes do Sistema Único de Saúde (SUS) impõem uma estrutura de assistência baseada em redes de políticas públicas que, combinada ao modelo de financiamento adotado, conduz a falhas de mercado. Isso impõe barreiras à gestão do sistema público de saúde e à concretização dos objetivos do SUS. As características institucionais e a heterogeneidade dos atores, aliadas à existência de diferentes redes de atenção à saúde, geram complexidade analítica no estudo da dinâmica global da rede do SUS. Há limitações ao emprego de métodos quantitativos baseados em análise estática com dados retrospectivos do sistema público de saúde. Assim, propõe-se a abordagem do SUS como sistema complexo, a partir da utilização de metodologia quantitativa inovadora baseada em simulação computacional. O presente artigo buscou analisar desafios e potencialidades na utilização de modelagem com autômatos celulares combinada com modelagem baseada em agentes para simulação da evolução da rede de serviços do SUS. Tal abordagem deve permitir melhor compreensão da organização, heterogeneidade e dinâmica estrutural da rede de serviços do SUS e possibilitar minimização dos efeitos das falhas de mercado no sistema de saúde brasileiro.

New insights in osteogenic differentiation revealed by mass spectrometric assessment of phosphorylated substrates in murine skin mesenchymal cells

Abstract Background Bone fractures and loss represent significant costs for the public health system and often affect the patients quality of life, therefore, understanding the molecular basis for bone regeneration is essential. Cytokines, such as IL-6, IL-10 and TNFα, secreted by inflammatory cells at the lesion site, at the very beginning of the repair process, act as chemotactic factors for mesenchymal stem cells, which proliferate and differentiate into osteoblasts through the autocrine and paracrine action of bone morphogenetic proteins (BMPs), mainly BMP-2. Although it is known that BMP-2 binds to ActRI/BMPR and activates the SMAD 1/5/8 downstream effectors, little is known about the intracellular mechanisms participating in osteoblastic differentiation. We assessed differences in the phosphorylation status of different cellular proteins upon BMP-2 osteogenic induction of isolated murine skin mesenchymal stem cells using Triplex Stable Isotope Dimethyl Labeling coupled with LC/MS. Results From 150 μg of starting material, 2,264 proteins were identified and quantified at five different time points, 235 of which are differentially phosphorylated. Kinase motif analysis showed that several substrates display phosphorylation sites for Casein Kinase, p38, CDK and JNK. Gene ontology analysis showed an increase in biological processes related with signaling and differentiation at early time points after BMP2 induction. Moreover, proteins involved in cytoskeleton rearrangement, Wnt and Ras pathways were found to be differentially phosphorylated during all timepoints studied. Conclusions Taken together, these data, allow new insights on the intracellular substrates which are phosphorylated early on during differentiation to BMP2-driven osteoblastic differentiation of skin-derived mesenchymal stem cells.

Skyddandets förnuft : En studie om anhöriga till hjälpbehövande äldre som invandrat sent i livet

This dissertation aims to examine and deepen the knowledge of family member caregiving where the care recipient is an elderly person who immigrated late in life. It also aims to contribute to the knowledge of the complexities underlying informal care giving and add to our understandings of what it means to be an immigrant in Sweden. The caregiver is in focus. The research conducted is explorative and partly inductive. The main material used is a qualitative interview study carried out with family members from different countries who are providing informal care to elderly immigrant relatives. The analysis gives three patterns of caregiving. One shows help from informal caregivers only who are not compensated economically. Another shows help from family members who are compensated. The third shows help from family members and staff from the public care system. Three ideal-typical informal caregiver roles show different positions vis-à-vis the new: “guardian”, “filter” and “reinterpreter of traditional care ideals”. Swedish born and immigrated informal caregivers are also compared through analysis of data gathered in telephone interviews with a representative selection of inhabitants in the County of Stockholm. A philosophy of action together with theory on integration and multiculturalism serves as theoretical frameworks to understand discrepancies and ambiguities in the data. Young immigrants experience different integration processes than do the older ones. They strive to protect older family members from changes linked to the migration experience. Talk about dependence on culture underlines family feelings and legitimates the processes of protection. Preconceptions about great differences between Swedish born and immigrant families are not supported by quantitative data. A conclusion is that protection can be understood in relation both to the traditional and the new, the latter in the forms of meetings with Swedish society where unequal relations prevail. It is a kind of counter-strategy where the range of actions is diminished, and thus it has its own logic. Protection can be loosened up when the circumstances change and the range of actions grow.

Malaspina 2010: observaciones de R/ETS

[EN]Respiratory electron transport system (ETS) activities have been used, in the past, to study respiration in many marine organisms and many different environments. The methodology follows standard practices of enzymology, by attempting to measure the maximum velocity of the enzyme reaction (Vmax) sensu Michaelis-Menten. Under controlled conditions of nutritional state the ETS method is well correlated with in situ respiration. In the interdisciplinary Expedition MALASPINA 2010, that circumnavigated the planet, we had the chance in three of seven transects (Cape Town to Perth; Perth to Sydney and Cartagena de Indias to Cartagena) to take zooplankton samples from the southern Indian Ocean and from North Atlantic Ocean. From these samples we measured protein and 150 ratios between in vivo respiration and potential respiration (ETS activity) in three size-classes of zooplankton between 100?m to > 1000?m, in the upper 150 meters of the water column. Normally, the measurements were made on fresh naturally nourished zooplankton (in situ). When biomass permitted, measurements were also made on zooplankton starved for 24 h. With this data we are investigating the variations in the R/ETS ratio and Kleiber?s law under different nutritional conditions, different oceanographic conditions, and different oceanographic regions. This analysis will help our ongoing investigation of ETS activity as an index of both respiration and of living biomass. The information acquired will facilitate the calculation of zooplankton respiration for some relatively unexplored areas of the Indian and Atlantic oceans. This data will then be available for integration with results of other Malaspina research programs

Behavior of respiratory metabolism and pyridine nucleotide levels in Oxyrrhis marina during starvation

Máster en Oceanografía

Potential Respiration in Oxyrrhis marina and Rhodomonas salina

Máster en Oceanografía

Zooplankton oxygen consumption and nutrient release in relation to species composition, animals size and enviromental conditions in the Baltic Sea during May and August

[EN] Zooplankton metabolism in terms of oxygen consumption and ñutrient reléase (ammonia, phosphate) were measiu'ed in the Baltic Sea, a températe área with high envirormiental changes both in space and in time. Plankton of the surface layer were analysed with balance measurements in 4 size classes between 50 and 1000 nm during spring in 1988, 1990 and 1991, in summer 19^8 and 1990 as well. The use of electrón transport system (ETS), and the Glutamate Dehydrogenase (GDH) activity as indicators for respiration and ammonia reléase respectively, enlarged the data density and made a three dimensional resolution available (May 1990, 1991). Data are in the range of the latitudinal dependend magnitude. They reflect slight interannual, more seasonal and regional aspects. Animáis size, temperature, food concentration, and species composition influence the specific rates

Avances en ecofisiología planctónica y oceanografía bioquímica en la ULPGC

[EN] This seminar will report the latest activities of the ULPGC»s Plankton Ecophysiology group (PEG). This group studies respiration, growth, nitrogen metabolism, oceanic carbon flux, deep ocean metabolism, and plankton cultivation. It works with zooplankton, phytoplankton, bacteria, and macroalgae. The premise behind the group»s investigations is that enzyme biochemistry controls an organism»s physiology that, in turn, has a strong impact on ocean chemistry and ecology. This research team (PEG) uses as foils, the metabolic theory of ecology (MTE) and Kleiber»s law to argue the fact that respiratory metabolism is controlled not by biomass, but by the respiratory electron transport system (R-ETS). It has pointed out that the reason, zooplankton respiration statistically correlates with biomass, is because biomass packages mitochondria and mitochondria package the R-ETS. It has demonstrated, experimentally with Artemia salina, the superiority of using ETS as a respiration proxy rather than using biomass. Working with bacteria it has shown the inadequacy of the MTE in describing respiration in different growth phases of bacteria and has shown that a rival model based on enzyme kinetics works much better.

La lunga storia dell'idrovia Padova - Venezia

The present dissertation focuses on an unfinished project for the construction of an inland waterway between Padua and Venice, in northern Italy. The history of this channel is analysed in the context of the general debate for the development of a waterway network in the Padanian plain. The project of reconstructing and enlarging the existing ancient channels for the development of a modern river transport system was born at the beginning of the 20th century as an attempt to withstand the railway’s concurrency. The main project aimed at transforming the Po river and other small rivers and channels in a big waterway for the connection of the most important northern industrial cities with Venice’s harbour and the Adriatic sea. Even if the idea of restoring the historical channel between Padua and Venice arose at the end of the First World War, it was only during the years 50s that a new project was conceived and the waterway was included in a global project for the construction of a whole new channel from Venice to Milan. The new project, strongly supported by the local Christian Democratic Party, was managed for more than twenty years causing a huge expenditure of money. After a great investment by both the central State and the local bodies (more than 100 millions euro) the project was finally abandoned. This research reconstructs the historical process and the economical motivations that sustained that project until its failure. Moreover, with the aim of understanding the reasons and the differences of such a failure, the history of inland waterway transport in Italy is compared with contemporary developments in Germany.

Transportation theory and planning

The aim of this research is to analyze the transport system and its subcomponents in order to highlight which are the design tools for physical and/or organizational projects related to transport supply systems. A characteristic of the transport systems is that the change of their structures can recoil on several entities, groups of entities, which constitute the community. The construction of a new infrastructure can modify both the transport service characteristic for all the user of the entire network; for example, the construction of a transportation infrastructure can change not only the transport service characteristics for the users of the entire network in which it is part of, but also it produces economical, social, and environmental effects. Therefore, the interventions or the improvements choices must be performed using a rational decision making approach. This approach requires that these choices are taken through the quantitative evaluation of the different effects caused by the different intervention plans. This approach becomes even more necessary when the decisions are taken in behalf of the community. Then, in order to understand how to develop a planning process in Transportation I will firstly analyze the transport system and the mathematical models used to describe it: these models provide us significant indicators which can be used to evaluate the effects of possible interventions. In conclusion, I will move on the topics related to the transport planning, analyzing the planning process, and the variables that have to be considered to perform a feasibility analysis or to compare different alternatives. In conclusion I will perform a preliminary analysis of a new transit system which is planned to be developed in New York City.

Il concetto di sezione nel metodo compositivo di Aldo Rossi.

Purpose of this research is to deepen the study on the section in architecture. The survey aims as important elements in the project Teatro Domestico by Aldo Rossi built for the XVII Triennale di Milano in 1986 and, through the implementation on several topics of architecture, verify the timeliness and fertility in the new compositional exercises. Through the study of certain areas of the Rossi’s theory we tried to find a common thread for the reading of the theater project. The theater is the place of the ephemeral and the artificial, which is why his destiny is the end and the fatal loss. The design and construction of theater setting has always had a double meaning between the value of civil architecture and testing of new technologies available. Rossi's experience in this area are clear examples of the inseparable relationship between the representation of architecture as art and design of architecture as a model of reality. In the Teatro Domestico, the distinction between representation and the real world is constantly canceled and returned through the reversal of the meaning and through the skip of scale. At present, studies conducted on the work of Rossi concern the report that the architectural composition is the theory of form, focusing compositional development of a manufacturing process between the typological analysis and form invention. The research, through the analysis of some projects few designs, will try to analyze this issue through the rules of composition both graphical and concrete construction, hoping to decipher the mechanism underlying the invention. The almost total lack of published material on the project Teatro Domestico and the opportunity to visit the archives that preserve the drawings, has allowed the author of this study to deepen the internal issues in the project, thus placing this search as a first step toward possible further analysis on the works of Rossi linked to performance world. The final aim is therefore to produce material that can best describe the work of Rossi. Through the reading of the material published by the same author and the vision of unpublished material preserved in the archives, it was possible to develop new material and increasing knowledge about the work, otherwise difficult to analyze. The research is divided into two groups. The first, taking into account the close relationship most frequently mentioned by Rossi himself between archeology and architectural composition, stresses the importance of tipo such as urban composition reading system as well as open tool of invention. Resuming Ezio Bonfanti’s essay on the work of the architect we wanted to investigate how the paratactic method is applied to the early work conceived and, subsequently as the process reaches a complexity accentuated, while keeping stable the basic terms. Following a brief introduction related to the concept of the section and the different interpretations that over time the term had, we tried to identify with this facility a methodology for reading Rossi’s projects. The result is a constant typological interpretation of the term, not only related to the composition in plant but also through the elevation plans. The section is therefore intended as the overturning of such elevation is marked on the same plane of the terms used, there is a different approach, but a similarity of characters. The identification of architectural phonemes allows comparison with other arts. The research goes in the direction of language trying to identify the relationship between representation and construction, between the ephemeral and the real world. In this sense it will highlight the similarities between the graphic material produced by Ross and some important examples of contemporary author. The comparison between the composition system with the surrealist world of painting and literature will facilitate the understanding and identification of possible rules applied by Rossi. The second part of the research is characterized by a focus on the intent of the project chosen. Teatro Domestico embodies a number of elements that seem to conclude (assuming an end point but also to start) a curriculum author. With it, the experiments carried out on the theater started with the project for the Teatrino Scientifico (1978) through the project for the Teatro del Mondo (1979), into a Laic Tabernacle representative collective and private memory of the city. Starting from a reading of the draft, through the collection of published material, we’ve made an analysis on the explicit themes of the work, finding the conceptual references. Following the taking view of the original materials not published kept at Aldo Rossi's Archive Collection of the Canadian Center for Architecture in Montréal, will be implemented through the existing techniques for digital representation, a virtual reconstruction of the project, adding little to the material, a new element for future studies. The reconstruction is part of a larger research studies where the current technologies of composition and representation in architecture stand side by side with research on the method of composition of this architect. The results achieved are in addition to experiences in the past dealt with the reconstruction of some of the lost works of Aldo Rossi. A partial objective is to reactivate a discourse around this work is considered non-principal, among others born in the prolific activities. Reassessment of development projects which would bring the level of ephemeral works most frequented by giving them the value earned. In conclusion, the research aims to open a new field of interest on the part not only as a technical instrument of representation of an idea but as an actual mechanism through which composition is formed and the idea is developed.

Funktionelle und morphologische Untersuchungen der Silikataufnahme und Nadelbildung im marinen Schwamm Suberites domuncula

Die für Metazoen einzigartige Fähigkeit, hochdifferenzierte Silikatstrukturen herzustellen und als Gerüstsubstanz zu verwenden, steht bei den Porifera in einem scheinbaren Gegensatz zu der niedrigen Konzentration an Silizium in dem die Schwämme umgebenden Medium. In der zweiten bedeutenden silikatpolymerisierenden Species, den einzelligen Kieselalgen (Diatomeen), konnte bereits ein Silikattransporter identifiziert werden, dessen Sequenzdaten jedoch aufgrund der phylogenetisch geringen Verwandtschaft der Demospongien mit den Diatomeen keine Verwendung finden konnte Im Zuge der Suche nach einem Silikat-Transportsystem im Schwamm Suberites domuncula wurde ein potentielles Kandidatengen mittels molekularbiologischer Techniken aus einer cDNA Bank des Instituts isoliert, vervollständigt und analysiert. Es zeigte sich, dass dieser Transporter durch seine Sequenzdaten der Familie der Bikarbonattransporter angehörte, und somit membranständig war. Seine Transportfunktion zeigte sich mittels spezifischer Inhibitoren hemmbar. Damit der Schwamm in der Lage ist, eine regulierbare und schnelle Anreicherung von Silikat durchführen zu können, lag eine Annahme einer Induzierbarkeit der Transportergene durch das Substrat Silikat nahe. Mittels Northern-Blot Analyse konnte in einem Primmorphensystem des Schwammes eine Hochregulation der Transkription der Transportergene festgestellt werden. Die Lokalisation der Exprimierung des Transporters innerhalb des Schwammgewebes konnte mittels In situ Hybridisierung untersucht werden und zeigte eine direkte Nähe zu den Polysilikatstrukturen des Schwammes. Um Hinweise auf eine Bifunktionalität des Transporters aufgrund der Ähnlichkeit von Carbonat und Silikat zu erhärten, wurden fluoreszenzmikroskopische Studien an isolierten Zellkulturen des Schwammes durchgeführt. Es kam zu einer intensive Reaktion der Zellen auf Silikat als Substrat. Dieser Effekt konnte nicht nur durch einen spezifischen Transportinhibitor (DIDS) gehemmt werden, sondern zeigt auch eine deutliche Temperaturabhängigkeit. Um den potentiellen Silikattransporter in Zusammenhang mit dem Gesamtmechanismus der Silikatnadelherstellung in Schwämmen zu bringen, wurden zusätzliche elektronenmikroskopische Studien angestellt. Hier konnte zunächst gezeigt werden, wie sich das die Polykondensation auslösende und dirigierende Proteinfilament des Schwammes bei der Nadelbildung entwickelt. Mittels einer darauf folgenden Immunogold-Markierung des Hauptaxialfilamentproteins des Schwammes in elektronenmikroskopischen Gewebepräparaten, konnte dessen Vorkommen nicht nur im Zentrum der Silikatnadel, sondern auch in den die Nadel umgebenden Strukturen nachgewiesen werden

Un approccio innovativo alla pianificazione della mobilità ciclabile

L’approccio innovativo di questa tesi alla pianificazione ciclabile consiste nell’integrare le linee guida per la redazione di un biciplan con aspetti, metodologie e strumenti nuovi, per rendere più efficace la programmazione di interventi. I limiti del biciplan risiedono nella fase di pianificazione e di monitoraggio, quindi, nel 1° capitolo, vengono esaminate le differenze esistenti tra la normativa americana (AASHTO) e quella italiana (D.P.R. 557/99). Nel 2° capitolo vengono analizzati gli indicatori usati nella fase di monitoraggio e la loro evoluzione fino alla definizione degli attuali indici per la determinazione del LOS delle infrastrutture ciclabili: BLOS e BCI. L’analisi è integrata con le nuove applicazioni di questi indici e con lo studio del LOS de HCM 2010. BCI e BISI sono stati applicati alla rete di Bologna per risolvere problemi di pianificazione e per capire se esistessero problemi di trasferibilità. Gli indici analizzati prendono in considerazione solo il lato offerta del sistema di trasporto ciclabile; manca un giudizio sui flussi, per verificare l’efficacia delle policy. Perciò il 3° capitolo è dedicato alla metodologia sul monitoraggio dei flussi, mediante l’utilizzo di comuni traffic counter per le rilevazioni dei flussi veicolari. Dal monitoraggio è possibile ricavare informazioni sul numero di passaggi, periodi di punta, esistenza di percorsi preferiti, influenza delle condizioni climatiche, utili ai progettisti; si possono creare serie storiche di dati per controllare l’evoluzione della mobilità ciclabile e determinare l’esistenza di criticità dell’infrastruttura. L’efficacia della pianificazione ciclabile è legata al grado di soddisfazione dell’utente e all’appetibilità delle infrastrutture, perciò il progettista deve conoscere degli elementi che influenzano le scelte del ciclista. Nel 4° capitolo sono analizzate le tecniche e gli studi sulle scelte dell’itinerario dei ciclisti, e lo studio pilota fatto a Bologna per definire le variabili che influenzano le scelte dei ciclisti e il loro peso.

The informal market of education in Egypt: Private tutoring and its implications /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 88

Education is generally perceived as a public good which should be provided by the state. In Egypt, free and equal access to education has been guaranteed to all citizens since President Nasser’s socialist reforms in the 1950s. However, due to high population growth rates and a lack of financial resources, the public education system has been struggling to accommodate rapidly increasing numbers of students. While enrolment rates have risen steadily, the quality of state-provided services has deteriorated. Teachers and students have to cope with high class densities, insufficient facilities, a rigid syllabus and a centralized examination system. Today, teaching is among the lowest-paying occupations in the public sector. One strategy to cope with this situation is the widespread practice of private tutoring, which usually takes place at students’ homes or in commercial tutoring centers. Based on research carried out in Cairo in 2004/05 and 2006, I use an actor-centered approach to analyze the motivations of Egyptian teachers and students for participating in private tutoring and the impact that this practice has on the relationship between teachers and students. Students of all socio-economic backgrounds resort to tutoring in order to succeed in a highly competitive and exam-oriented education system. However, the form and quality of tutoring that can be accessed depends on the financial means of the family. For teachers, tutoring provides a good opportunity not only to supplement their income, but also, in the case of renowned “star teachers”, to improve their professional status and autonomy. On the informal “market of education” that has developed in Egypt during the last decades, the educational responsibilities of the state are increasingly being taken over by private actors, i.e. the process of teaching and learning is dissociated from the direct control of the state and from school as an institution. At the same time, education is turned into a marketable commodity. Despite the government’s efforts to provide free education to all citizens, the quality of social services that can be accessed in Egypt, thus, depends mainly on the financial means of the individual or the family.

Gli affidamenti c.d. in house nell'ordinamento comunitario e nazionale con particolare riferimento al settore dei trasporti pubblici

Il presente progetto di ricerca analizza quella particolare forma di affidamento diretto dei servizi pubblici denominata in house providing e si articola in tre sezioni. Nella prima sezione viene analizzata la disciplina dei servizi pubblici locali nell’ordinamento italiano mediante un excursus normativo dai primi del 900 ad oggi; la seconda sezione è dedicata alla disciplina dell’affidamento dei servizi pubblici locali di trasporto; la terza sezione, infine, descrive l’in house providing e l’elaborazione pretoria di tale istituto operata dalla giurisprudenza comunitaria. Come noto, la pubblica amministrazione può soddisfare le sue esigenze secondo due diverse modalità: ricorrendo al libero mercato come qualsiasi altro operatore economico oppure auto-producendo i beni e i servizi di cui necessita. Infatti, nonostante il diritto comunitario imponga il rispetto del principio di tutela della concorrenza, lascia impregiudicato il potere di auto-organizzazione in capo alle pubbliche amministrazioni negli Stati membri, le quali potranno scegliere di agire “in economia” o di ricorrere alle prestazioni di operatori terzi. Con la locuzione di derivazione comunitaria in house providing si definisce quel modello organizzativo mediante il quale le pubbliche amministrazioni realizzano le attività di loro competenza attraverso i propri organismi, cioè senza ricorrere al libero mercato per procurarsi i lavori, i servizi e le forniture ad esse occorrenti o per erogare alla collettività prestazioni di pubblico servizio, in deroga ai principi comunitari sulla tutela della concorrenza stabiliti nel Trattato istitutivo della Comunità Europea, che invece imporrebbero lo svolgimento di gare ad evidenza pubblica per l'affidamento di tali servizi. Tuttavia, come chiarito dalla giurisprudenza comunitaria e nazionale, affinché la procedura di gara non sia necessaria, occorre che tra l’amministrazione e il prestatore ci sia sostanziale identità, nonostante le distinte personalità giuridiche, in modo tale da configurare il contratto tra le stesse intercorso come un atto di organizzazione interna.