The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: A Markov model informed by a randomised controlled trial

Objectives: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. Design: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. Setting: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. Participants: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. Data sources: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. Main outcome measures: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. Results: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. Conclusions: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. Trial registration number: Australian Clinical Trials Registry; ACTRN12611000481976.

Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury

This study aimed to determine: 1) the spatial patterns of hamstring activation during the Nordic hamstring exercise (NHE); 2) whether previously injured hamstrings display activation deficits during the NHE, and; 3) whether previously injured hamstrings exhibit altered cross-sectional area. Ten healthy, recreationally active males with a history of unilateral hamstring strain injury underwent functional magnetic resonance imaging (fMRI) of their thighs before and after 6 sets of 10 repetitions of the NHE. Transverse (T2) relaxation times of all hamstring muscles (biceps femoris long head, (BFlh); biceps femoris short head (BFsh); semitendinosus (ST); semimembranosus (SM)), were measured at rest and immediately after the NHE and cross-sectional area (CSA) was measured at rest. For the uninjured limb, the ST’s percentage increase in T2 with exercise was 16.8, 15.8 and 20.2% greater than the increases exhibited by the BFlh, BFsh and SM, respectively (p<0.002 for all). Previously injured hamstring muscles (n=10) displayed significantly smaller increases in T2 post-exercise than the homonymous muscles in the uninjured contralateral limb (mean difference -7.2%, p=0.001). No muscles displayed significant between limb differences in CSA. During the NHE, the ST is preferentially activated and previously injured hamstring muscles display chronic activation deficits compared to uninjured contralateral muscles.

Low-frequency electrical stimulation combined with a cooling vest improves recovery of elite kayakers following a simulated 1000-m race in a hot environment

This study compared the effects of a low-frequency electrical stimulation (LFES; Veinoplus® Sport, Ad Rem Technology, Paris, France), a low-frequency electrical stimulation combined with a cooling vest (LFESCR) and an active recovery combined with a cooling vest (ACTCR) as recovery strategies on performance (racing time and pacing strategies), physiologic and perceptual responses between two sprint kayak simulated races, in a hot environment (∼32 wet-bulb-globe temperature). Eight elite male kayakers performed two successive 1000-m kayak time trials (TT1 and TT2), separated by a short-term recovery period, including a 30-min of the respective recovery intervention protocol, in a randomized crossover design. Racing time, power output, and stroke rate were recorded for each time trial. Blood lactate concentration, pH, core, skin and body temperatures were measured before and after both TT1 and TT2 and at mid- and post-recovery intervention. Perceptual ratings of thermal sensation were also collected. LFESCR was associated with a very likely effect in performance restoration compared with ACTCR (99/0/1%) and LFES conditions (98/0/2%). LFESCR induced a significant decrease in body temperature and thermal sensation at post-recovery intervention, which is not observed in ACTCR condition. In conclusion, the combination of LFES and wearing a cooling vest (LFESCR) improves performance restoration between two 1000-m kayak time trials achieved by elite athletes, in the heat.

Rakenteiset sanakirjat

Sanakirjat ovat rakenteisia tekstejä. Sana-artikkeleissa on nähtävissä selvästi erotettavissa olevia rakenneosia. Painetun sanakirjan muuntaminen rakenteiseen muotoon ei kuitenkaan ole aivan suoraviivaista. Tässä tutkielmassa kerrotaan sanakirjan rakennekuvauksen määrittelyn ja painetun sanakirjan rakenteistuksen ongelmista. Esimerkkinä käytetään Kotimaisten kielten tutkimuskeskuksessa (Kotus) kirjoitettavan Suomen murteiden sanakirjan (SMS) rakenteistusprojektia ja sen yhteydessä määriteltyä rakennekuvausta. SMS:n rakennekuvausta verrataan kielitieteellisten aineistojen koodaamisessa yleisesti käytetyn Text Encoding Initiative -suosituksen sekä uuden ISO 1951:2007 -sanakirjastandardin määrittelemiin rakennekuvauksiin. Muuntamista testataan käytännössä kirjoittamalla XSL-muunnosskripti, joka muuntaa SMS:n aineiston ISOstandardimuotoon. Muunnosprosessin voi todeta olleen hyödyllinen, koska sen aikana paljastui ongelmia sekä SMS:n rakennekuvauksessa että itse standardin määrittelyssä. Tulosten avulla SMS:n koodausta voidaan kehittää edelleen. Lopuksi tarkastellaan standardien käytöstä yleisesti saatavia hyötyjä ja mahdollisuuksia soveltaa niitä Kotuksen sanakirjatyöhön.

A Study on the Success Potential of Multiple Mobile Payment Technologies

Payment systems all over the world have grown into a complicated web of solutions. This is more challenging in the case of mobile based payment systems. Mobile based payment systems are many and consist of different technologies providing different services. The diffusion of these various technologies in a market is uncertain. Diffusion theorists, for example Rogers, and Davis suggest how innovation is accepted in markets. In the case of electronic payment systems, the tale of Mondex vs Octopus throws interesting insights on diffusion. Our paper attempts to understand the success potential of various mobile payment technologies. We illustrate what we describe as technology breadth in mobile payment systems using data from payment systems all over the world (n=62). Our data shows an unexpected superiority of SMS technology, over other technologies like NFC, WAP and others. We also used a Delphi based survey (n=5) with experts to address the possibility that SMS will gain superiority in market diffusion. The economic conditions of a country, particularly in developing countries, the services availed and characteristics of the user (for example number of un-banked users in large populated countries) may put SMS in the forefront. This may be true more for micro payments using the mobile.

Simultaneous MultiStreaming for complexity-effective VLIW architectures

Very Long Instruction Word (VLIW) architectures exploit instruction level parallelism (ILP) with the help of the compiler to achieve higher instruction throughput with minimal hardware. However, control and data dependencies between operations limit the available ILP, which not only hinders the scalability of VLIW architectures, but also result in code size expansion. Although speculation and predicated execution mitigate ILP limitations due to control dependencies to a certain extent, they increase hardware cost and exacerbate code size expansion. Simultaneous multistreaming (SMS) can significantly improve operation throughput by allowing interleaved execution of operations from multiple instruction streams. In this paper we study SMS for VLIW architectures and quantify the benefits associated with it using a case study of the MPEG-2 video decoder. We also propose the notion of virtual resources for VLIW architectures, which decouple architectural resources (resources exposed to the compiler) from the microarchitectural resources, to limit code size expansion. Our results for a VLIW architecture demonstrate that: (1) SMS delivers much higher throughput than that achieved by speculation and predicated execution, (2) the increase in performance due to the addition of speculation and predicated execution support over SMS averages around 12%. The minor increase in performance might not warrant the additional hardware complexity involved, and (3) the notion of virtual resources is very effective in reducing no-operations (NOPs) and consequently reduce code size with little or no impact on performance.

Improvement of protein structure comparison using a structural alphabet

The three dimensional structure of a protein provides major insights into its function. Protein structure comparison has implications in functional and evolutionary studies. A structural alphabet (SA) is a library of local protein structure prototypes that can abstract every part of protein main chain conformation. Protein Blocks (PBS) is a widely used SA, composed of 16 prototypes, each representing a pentapeptide backbone conformation defined in terms of dihedral angles. Through this description, the 3D structural information can be translated into a 1D sequence of PBs. In a previous study, we have used this approach to compare protein structures encoded in terms of PBs. A classical sequence alignment procedure based on dynamic programming was used, with a dedicated PB Substitution Matrix (SM). PB-based pairwise structural alignment method gave an excellent performance, when compared to other established methods for mining. In this study, we have (i) refined the SMs and (ii) improved the Protein Block Alignment methodology (named as iPBA). The SM was normalized in regards to sequence and structural similarity. Alignment of protein structures often involves similar structural regions separated by dissimilar stretches. A dynamic programming algorithm that weighs these local similar stretches has been designed. Amino acid substitutions scores were also coupled linearly with the PB substitutions. iPBA improves (i) the mining efficiency rate by 6.8% and (ii) more than 82% of the alignments have a better quality. A higher efficiency in aligning multi-domain proteins could be also demonstrated. The quality of alignment is better than DALI and MUSTANG in 81.3% of the cases. Thus our study has resulted in an impressive improvement in the quality of protein structural alignment. (C) 2011 Elsevier Masson SAS. All rights reserved.

Low-Cost Cloud-Based Design of Smart Rural Energy Device in Microgrid: Perspective India An Energy-On-Demand Service for Rural India

In this paper we present a combination of technologies to provide an Energy-on-Demand (EoD) service to enable low cost innovation suitable for microgrid networks. The system is designed around the low cost and simple Rural Energy Device (RED) Box which in combination with Short Message Service (SMS) communication methodology serves as an elementary proxy for Smart meters which are typically used in urban settings. Further, customer behavior and familiarity in using such devices based on mobile experience has been incorporated into the design philosophy. Customers are incentivized to interact with the system thus providing valuable behavioral and usage data to the Utility Service Provider (USP). Data that is collected over time can be used by the USP for analytics envisioned by using remote computing services known as cloud computing service. Cloud computing allows for a sharing of computational resources at the virtual level across several networks. The customer-system interaction is facilitated by a third party Telecom Service provider (TSP). The approximate cost of the RED Box is envisaged to be under USD 10 on production scale.

A recursive multi-scaling approach to regional flood frequency analysis

Scaling approaches are widely used by hydrologists for Regional Frequency Analysis (RFA) of floods at ungauged/sparsely gauged site(s) in river basins. This paper proposes a Recursive Multi-scaling (RMS) approach to RFA that overcomes limitations of conventional simple- and multi-scaling approaches. The approach involves identification of a separate set of attributes corresponding to each of the sites (being considered in the study area/region) in a recursive manner according to their importance, and utilizing those attributes to construct effective regional regression relationships to estimate statistical raw moments (SMs) of peak flows. The SMs are then utilized to arrive at parameters of flood frequency distribution and quantile estimate(s) corresponding to target return period(s). Effectiveness of the RMS approach in arriving at flood quantile estimates for ungauged sites is demonstrated through leave-one-out cross-validation experiment on watersheds in Indiana State, USA. Results indicate that the approach outperforms index-flood based Region-of-Influence approach, simple- and multi-scaling approaches and a multiple linear regression method. (C) 2015 Elsevier B.V. All rights reserved.

Evaluación de la mortalidad del síndrome de la muerte súbita en condiciones comerciales de la linea genética arbor acres vs. hubbard

La actividad avícola ha alcanzado un gran desarrollo en estos últimos años, pero como toda actividad está sujeta a riesgos o factores que inciden en su labor, en este caso nos referimos al síndrome de muerte súbita (SMS) que desde su aparición se han realizados diversos estudios para encontrar los factores que influyen en la presentación de este síndrome por tal razón en este estudio se evalúa la incidencia del síndrome de muerte súbita en condiciones comerciales en dos líneas como son: Arbor Acres y Hubbard . Con el objetivo de determinar la línea más susceptible en presentar este síndrome como también evaluar las pérdidas económicas que causo este factor en la granja donde se realizó el experimento, tomando en cuenta los parámetros productivos de ambas líneas para lo cual se utilizaron tres galeras de pollos de engorde con una cantidad de 14406,14406 y14295 respectivamente , evaluando las siguientes galeras galera 3, galera 4, y galera 6 equivalente a la suma de 43107 pollos de un día de nacido de la línea arbor acres la galera 3 y 4 representando el tratamiento 1 y de la línea Hubbard la galera 6 representando el tratamiento 2 ,ambos tratamientos con el mismo manejo implementado en les granjas de la empresa TIPTOP . Planteando como variable las siguientes: mortalidad, peso vivo, consumo, conversión alimenticia y ganancia media diaria. Dichos valores obtenidos fueron analizados a través de un diseño estadístico de bloques completos al azar, en el caso de la variable que resultara con significancia estadística se sometió a una prueba de rangos múltiples tukey para encontrar la mejor línea para la actividad de engorde. En el cual el análisis estadístico arrojó los siguientes resultados: Para la variable la mortalidad no se encontró diferencia significativa (p<0.05) entre ambos tratamientos. Al igual que la variable consumo, conversión alimenticia y ganancia media diaria no mostró diferencia significativa (p<0.05) en tanto la variable peso mostró diferencia significativa (p> 0.05) entre ambas líneas , la que fue sometida a la prueba de rango múltiples Tukey en donde se obtuvo que la línea hubbard está más predispuesta a obtener un peso mayor que la línea Arbor Acres. En cuanto a las pérdidas por síndrome de muerte súbita se refiere que la raza hubbard presentó mayor mortalidad por síndrome por muerte súbita , que la raza Arbor Acres, por lo cual la línea hubbard presenta mayores pérdidas económicas aunque cabe mencionar que la línea hubbard presentó una menor mortalidad en general que la línea Arbor Acres y también esta línea ( hubbard) obtuvo un mayor peso vivo que la línea Arbor Acres , indicando que es más viable económicamente explotar esta línea ya que muestra una diferencia de 3.8% entre ambos tratamiento, teniendo un mayor ingreso , el tratamiento 2 (hubbard ). En grandes cantidades este porcentaje es realmente significativo. Como conclusión del presente estudio podemos afirmar lo siguiente la línea más susceptible en presentar el síndrome por muerte súbita es la línea hubbard aunque estadísticamente no muestre diferencia significativa (p< 0.05). Entre los parámetros productivo (variables) como , mortalidad , consumo, conversión alimenticia y ganancia media diaria no existe diferencia estadística , por lo cual ambas líneas poseen similares índice productivo. , Mientras la variable peso muestra diferencia de donde deducimos que la raza hubbard posee un peso mayor que la línea Arbor Acres. En tanto las pérdidas económicas son mayores en el tratamiento 2 (hubbard) y obteniendo en este un mayor rendimiento en producción y en rentabilidad.

Disminución del síndrome de muerte súbita en pollos de engorde a través de diferentes niveles de afrecho de trigo incluido en el alimento iniciador

El trabajo investigativo nace como una necesidad de encontrar bajo las condiciones tanto ambientales como de manejo , alternativas alimenticias que nos lleven a reducir el Síndrome de muerte súbita (SMS) que ocasiona grandes pérdidas económicas en explotaciones tanto lllfesanales (pequeftos productores) y las grandes industrias avícolas. La investigación se realizó en la granja avícola LA TRINIDAD propiedad de la empresa Tip­ Top, S.A Ubicada en Níndiri municipio de Masaya, para el experimento se emplearon 700 pollos de engorde de la raza Piterson hubbard, de día de nacido, que se distribuyeron en una galera experimental, en grupos de 175 pollos los cuales se subdividieron en 5 sub grupo de 35 pollos cada uno para estudiante el efecto de una restricción cualitativa del alimento iniciador en un periodo de 6 días partiendo del 5 a 11 día de edad en los siguientes tratamientos: TI 25 % de afrecho de trigo incluido en el concentrado iniciador, T2 15 %de afrecho de trigo incluido en el concentrado iniciador, T3 O % de afrecho de trigo incluido en el concentrado iniciador, T4 20 % de afrecho de trigo inclusión en el concentrado iniciador. Para disminuir la incidencia del SMS. Las variables estudiadas y evaluadas fueron las siguientes: Consumo de alimento, Peso vivo, Conversión alimenticia, Mortalidad vs. Viabilidad y Rendimiento en canal. Los datos que se registraron fueron evaluados a través de análisis estadístico Bifactorial y las medias a través de la prueba de rango múltiples de Tukey exceptuando la mortalidad y rendimiento en canal. Con el análisis estadístico no se encon traron diferencias significativas en todos los tratamiento evaluados (P>0.05) La tasa de mortalidad de los diferentes tratamientos fue analizada a través de una prueba de hipótesis para diferencias entre las proporciones de dos poblaciones no encontrando diferencias estadísticas entre las tasas de mortalidad, para los altos tratamientos evaluados en las diferentes semanas (P>0.05). El análisis económico fue evaluado auxiliándose de los presupuestos parciales para estudiar el beneficio entre los diferentes tratamientos, así también de presupuestos tipo empresa, con los cuales llegamos a la conclusión que el Tratamiento dos tuvo el mejor comportamiento.

Wnt and FGF signaling in C. elegans vulval cell lineage polarity

The interpretation of extracellular cues leading to the polarization of intracellular components and asymmetric cell divisions is a fundamental part of metazoan organogenesis. The C. elegans vulva, with its invariant cell lineage and interaction of multiple cell signaling pathways, provides an excellent model for the study of cell polarity within an organized epithelial tissue. Herein I discuss the interaction of Wnt and FGF signaling in controlling vulval cell lineage polarity with emphasis on the posterior-most cell that forms the vulva, P7.p.

The mirror symmetry of the C. elegans vulva is achieved by the opposite division orientation of the vulval precursor cells (VPCs) flanking the axis of symmetry. Opposing Wnt signals control the division patterns of the VPCs by controlling the localization of SYS-1/ β-catenin toward the direction of the Wnt gradient. Multiple Wnt signals, expressed at the axis of symmetry, promote the wild-type, anterior-facing, P7.p orientation, whereas Wnts EGL-20 and CWN-1 from the tail and posterior body wall muscle, respectively, promote the daughter cells of P7.p to face the posterior. EGL-20 acts through a member of the LDL receptor superfamily, LRP-2, along with Ror/CAM-1 and Van Gogh/VANG-1. All three transmembrane proteins control orientation through the localization of the SYS-1.

The Fibroblast Growth Factor (FGF) pathway acts in concert with LIN-17/Frizzled to regulate the localization of SYS-1. The source of the FGF ligand is the 1° VPC, P6.p, which controls the polarity of the neighboring 2° VPC, P7.p, by signaling through the sex myoblasts (SMs), activating the FGF pathway. The Wnt, cwn-1, is expressed in the posterior body wall muscle of the worm as well as the SMs, making it the only Wnt expressed on the posterior and anterior sides of P7.p at the time of the polarity decision. Both sources of cwn-1 act instructively to influence P7.p polarity in the direction of the Wnt gradient. The FGF pathway leads to the regulation of cwn-1 transcripts in the SMs. These results illustrate the first evidence of the interaction between FGF and Wnt in C. elegans development and vulval cell lineage polarity as well as highlight the promiscuous nature of Wnt signaling within C. elegans.

A via L-arginina-óxido nítrico no transtorno depressivo e sua associação com a função plaquetária e o estresse oxidativo

O transtorno depressivo (TD) é um fator de risco cardiovascular independente que apresenta elevada morbi-mortalidade. Recentes evidências sugerem a participação do óxido nítrico (NO), potente vasodilatador e anti-agregante plaquetário, na patogênese de doenças cardiovasculares e psiquiátricas. A síntese do NO ocorre através da conversão do aminoácido L-arginina em L-citrulina e NO, pela ação da enzima NO sintase (NOS). Esta tese aborda o papel da via L-arginina-NO em plaquetas de pacientes com TD e sua associação com a função plaquetária e estresse oxidativo. Para análise comportamental da depressão em modelo animal, foi utilizado o modelo de estresse pós-natal de separação única (SMU). Os animais foram divididos em quatro grupos para a realização do estudo: Grupo Controle Sedentário (GCS), Grupo Controle Exercício (GCE), Grupo SMU Sedentário (SMUS) e Grupo SMU Exercício (SMUE). O treinamento físico (TF) dos animais englobou 8 semanas, com duração de 30 minutos e uma velocidade de treinamento estabelecida pelo teste máximo (TE). Para o estudo em humanos, 10 pacientes com TD com score Hamilton: 201, (média de idade: 384anos), foram pareados com 10 indivíduos saudáveis (média de idade: 383anos). Os estudos em humanos e animais foram aprovados pelos Comitês de Ética: 1436 - CEP/HUPE e CEUA/047/2010, respectivamente. Foi mensurado em humanos e em animais: transporte de L-arginina, concentração GMPc, atividade das enzimas NOS e superóxido dismutase (SOD) em plaquetas e cortisol sistêmico. Experimentos realizados somente em humanos: expressão das enzimas NOS, arginase e guanilato ciclase através de Western Blotting. A agregação plaquetária foi induzida por colágeno e foi realizada análise sistêmica de proteína C-reativa, fibrinogênio e L-arginina. Para o tratamento estatístico utilizou-se três testes estatísticos para avaliar as diferenças das curvas de sobrevida: Kaplan-Meier, e os testes de Tarone-Ware e Peto-Prentice. Em humanos, houve uma redução do transporte de L-arginina, da atividade das enzimas NOS e SOD, e da concentração de GMPc em plaquetas, e nas concentrações plasmáticas de L-arginina no grupo com TD em relação ao grupo controle. Foi observado um aumento dos níveis plasmáticos de fibrinogênio no TD. Esses resultados demonstram uma inibição da via L-arginina-NO-GMPc e da enzima anti-oxidante SOD em pacientes com TD sem afetar a função plaquetária. Em relação ao TF, para o modelo animal, foram encontradas alterações iniciais quanto à distância percorrida e tempo de execução do TE entre os grupos controles e o grupos SMUs, apresentando estes últimos menores valores para o TE. Após 8 semanas de TF, verificou-se um maior influxo no transporte de L-arginina para o SMUE em comparação ao grupo SMUS. As diferenças observadas para o tempo e a distância percorrida no TE inicial entre os grupos controle e no modelo de estresse foram revertidas após as 8 semanas de TF, demonstrando o efeito benéfico do exercício físico na capacidade cardiorespiratória em modelos de depressão.

Specklegram in a grapefruit fiber and its response to external mechanical disturbance in a single-multiple-single mode fiber structure

Specklegram in multimode fiber has successfully been used as a sensor for detecting mechanical disturbance. Speckles in a multimode pure silica grapefruit fiber are observed and compared to that of a step-index multimode fiber, showing different features between them. The sensitivities to external disturbance of two kinds of fiber were measured, based on single-multiple-single mode (SMS) fiber structure. Experimental results show that the grapefruit fiber shows higher sensitivity than does the step-index multimode fiber. The transmission spectrum of the grapefruit fiber was measured as well, showing some oscillation features that are significantly different from that of a step-index multimode fiber. The experiments may provide suggestions to understand the mechanisms of light propagation in grapefruit fibers. (D 2008 Optical Society of America.

Agenda única de saúde: a busca do acesso universal e a garantia do direito à saúde

Este trabalho visa identificar os determinantes da ampliação de demandas judiciais contra os gestores do SUS. Em sua maioria (85%) relacionam-se ao fornecimento de medicamentos e são geradas, no âmbito do Judiciário, pelo entendimento daquele órgão que o Poder Público está descumprindo o direito à saúde constitucionalmente adquirido. Foi realizada uma revisão bibliográfica acerca de sistemas nacionais de saúde com princípios constitutivos básicos semelhantes aos do SUS, tendo sido selecionados o Canadá, Colômbia e Espanha. O objetivo foi observar se àqueles sistemas apresentam as dificuldades experimentadas pelo SUS, ou se existe, no sistema nacional, alguma peculiaridade. Foram analisados os artigos da Constituição de 1988 relativos à saúde, observando-se em vários deles pouca clareza na descrição de conceitos que parecem dar margem a múltiplos entendimentos dos atores envolvidos com a implementação do SUS. Desenvolveuse uma pesquisa quali-quantitativa: o 1 componente foi realizado por meio de entrevistas com atores chave, representantes do Executivo, Legislativo, Judiciário, Órgãos de Classe, Conselhos de Saúde e Gestores. A etapa quantitativa foi realizada a partir da coleta, sistematização e análise de dados acerca das demandas judiciais chegadas aos gestores do SUS localizados no Rio de Janeiro (SMS, SESDEC e NERJ). Os entendimentos dos entrevistados mostraram-se muito distintos e bastante relacionados com seus locais de atuação. Foi observado que o Judiciário, grosso modo, ratifica as prescrições médicas, determinando aos gestores, tornados réus, o fornecimento de produtos de saúde que vão desde os medicamentos essenciais até os de dispensação excepcional e mesmo, algumas substâncias importadas. As liminares não atendem as padronizações definidas pelas Políticas Nacionais de Assistência Farmacêutica, nem as que dizem respeito às relações pactuadas entre os gestores nem a responsabilização existente por nível de gestão. Tais questões têm gerado um tensionamento permanente entre o Executivo da saúde, Judiciário e população, uma vez que o cumprimento das determinações judiciais representa, para o gestor, uma necessidade de realocação orçamentária para a aquisição de medicamentos não planejados, que pode determinar a não realização de ações programáticas prioritárias. Parece que estas ações do Judiciário, ainda que legítimas, não necessariamente favorecem a equidade de acesso ao SUS. Por último, foram definidos 3 núcleos causais para a ampliação das demandas judiciais de saúde: o 1, derivado da pouca clareza de alguns conceitos constitucionais determinada pela falta de consenso político quando dos trabalhos da ANC, que deixaram estas definições para regulamentações posteriores, que não ocorreram; o 2, representado pela não contestação da maior parcela das prescrições médicas, pelo Judiciário, o que parece demonstrar o poder das profissões, medicina e direito, e, a inexistência de regulação do exercício profissional pelo Estado e o 3, determinado pela pouca articulação no SUS entre a gestão financeira e da atenção à saúde, o que parece impedir que os gestores atuem como protagonistas destas situações, deixando de promover articulações entre os Poderes do Estado, Instituições, Órgãos de Classe e a sociedade para definição de estratégias comuns voltadas à resolução dos problemas apontados neste estudo.