Núcleo Ampliado de Saúde da Família: potencialidades, desafios e impasses para a afirmação de um paradigma emergente em saúde.

RESUMO O Núcleo Ampliado de Saúde da Família (NASF) tem como atribuição proporcionar a ampliação do escopo das ações das equipes de Atenção Básica (AB), buscando promover o cuidado integral. Objetivou-se nesta tese conhecer as concepções e os significados conferidos pelos profissionais de saúde sobre o NASF. Com base nos pensamentos de Boaventura de Souza Santos, parte-se do pressuposto de que o campo da saúde vivencia um período de transição paradigmática, gerada a partir da constatação de que o paradigma dominante da saúde/modelo biomédico se mostra insuficiente para responder a complexidade que perpassa o processo saúde-doença. Diante desse cenário, buscou-se compreender se o NASF pode ser caracterizado como um dos dispositivos presentes no SUS, que irá contribuir para a afirmação do paradigma emergente. Trata-se de uma pesquisa de natureza qualitativa. Participaram do estudo oito equipes NASF do município de Vitória-ES. Para a coleta de dados utilizou-se da técnica de grupo focal. O tratamento dos dados foi realizado com base na proposta de análise de conteúdo. Foram encontradas regularidades discursivas que delinearam quatro categorias: a implantação do NASF no município de Vitória-ES; as concepções dos profissionais do NASF sobre suas atribuições de trabalho; as mudanças produzidas no processo do trabalho diante da implantação dos NASF e, por fim, as potencialidades e as dificuldades vivenciadas a partir da implantação dos NASF. Os resultados deste estudo demonstraram que: ora os NASF caminham no sentido de conservar os preceitos do paradigma dominante, ora consegue-se negociar a elaboração do cuidado de forma mais coerente com o que se almeja no paradigma emergente, ora são estabelecidas convivências conflituosas ou complementares entre os diferentes modos do cuidar em saúde. Assim, ziguezagueando entre os paradigmas coexistentes, o NASF pode se caracterizar como um dispositivo capaz fomentar a emergência do novo paradigma da saúde. Palavras-chave: Políticas públicas de saúde; Serviços de saúde; Atenção Básica; Sistema Único de Saúde

ENCONTROS de Matriciamento: Cartografando Seus Efeitos na Rede de Cuidados de Saúde Mental

RESUMO O trabalho visa analisar os encontros de matriciamento realizados no município de Cariacica-ES, procurando conhecer os efeitos e as contribuições que a interlocução da Saúde Mental com a Atenção Básica pode proporcionar no fortalecimento da rede de cuidados e no processo de desinstitucionalização da loucura. Para tanto, realizamos uma revisão bibliográfica de alguns documentos que relatam um pouco sobre a história, as conquista e os desafios que acompanham o Movimento da Reforma Psiquiátrica, bem como, apresentamos as diretrizes atuais, que regem a Atenção Básica e a lógica de funcionamento do Apoio Matricial. Na sequência, contextualizamos o leitor sobre a paisagem estudada e apresentamos alguns conceitos advindos do pensamento de Espinosa, que sustentaram essa pesquisa. Optou-se pela cartografia como uma postura ética para acompanhar os movimentos de transformação da paisagem psicossocial, que foi sendo desenhada através dos encontros de matriciamento. Utilizamos o diário de pesquisa como uma ferramenta metodológica, que proporcionou a atualização da linguagem desses movimentos, priorizando a análise dos afetos. Em seguida, apresentamos uma cartografia das marcas produzidas nesses encontros de matriciamentos e concluímos que o Apoio Matricial pode ser um dispositivo importante quando esse possibilita a criação de práticas capazes de proporcionar uma abertura para a experimentação de novos modos de viver, de trabalhar, de se relacionar, enfim, de se encontrar. Palavras - Chave: Apoio Matricial; Saúde Mental; Atenção Básica

An efficient all-optical switch using a lambda atom in a cavity QED system

We propose an all-optical switch constructed from a two-mode optical resonator containing a strongly coupled, three-state system. The coupling allows a weak, continuous wave laser drive to incoherently control the transmission of a much stronger, continuous wave signal laser into (and through) the resonator. We demonstrate that in this simple setup the presence of a control drive with one tenth the power of the signal drive can induce near complete reflection of the signal, while its absence allows for near complete transmission. The switch can also be operated as a set-reset relay with two control inputs that efficiently drive the switch into either the reflecting or the transmitting state.Comment: 9 pages, 10 figures, v2: published versio

Differential Hox expression in murine embryonic stem cell models of normal and malignant hematopoiesis

The Hox family are master transcriptional regulators of developmental processes, including hematopoiesis. The Hox regulators, caudal homeobox factors (Cdx1-4), and Meis1, along with several individual Hox proteins, are implicated in stem cell expansion during embryonic development, with gene dosage playing a significant role in the overall function of the integrated Hox network. To investigate the role of this network in normal and aberrant, early hematopoiesis, we employed an in vitro embryonic stem cell differentiation system, which recapitulates mouse developmental hematopoiesis. Expression profiles of Hox, Pbx1, and Meis1 genes were quantified at distinct stages during the hematopoietic differentiation process and compared with the effects of expressing the leukemic oncogene Tel/PDGFR;2. During normal differentiation the Hoxa cluster, Pbx1 and Meis1 predominated, with a marked reduction in the majority of Hox genes (27/39) and Meis1 occurring during hematopoietic commitment. Only the posterior Hoxa cluster genes (a9, a10, a11, and a13) maintained or increased expression at the hematopoietic colony stage. Cdx4, Meis1, and a subset of Hox genes, including a7 and a9, were differentially expressed after short-term oncogenic (Tel/PDGFR;2) induction. Whereas Hoxa4-10, b1, b2, b4, and b9 were upregulated during oncogenic driven myelomonocytic differentiation. Heterodimers between Hoxa7/Hoxa9, Meis1, and Pbx have previously been implicated in regulating target genes involved in hematopoietic stem cell (HSC) expansion and leukemic progression. These results provide direct evidence that transcriptional flux through the Hox network occurs at very early stages during hematopoietic differentiation and validates embryonic stem cell models for gaining insights into the genetic regulation of normal and malignant hematopoiesis

Electrochemically Generated Luminescence of Luminol and Luciferin in Ionic Liquids

Electrochemiluminescence (ECL) is the generation of light triggered by an electrochemical reaction. ECL has been extensively studied in solvent-based electrolytes, but there is a lack of data on using electrode reactions to populate an excited-state light emitter in room temperature ionic liquids (RTILs). This work explores the current response, light intensity (photon counting), and spectral signatures of the cathodic ECL of luminol and firefly's luciferin in imidazolium-based RTILs. We have demonstrated that the cathodic (superoxide-triggered) ECL of both luminol and adenylate-ester of firefly's luciferin is viable in RTILs, explored the effect of water contaminations, and importantly, shown that the ECL signal persists for up to about 700 s after the removal of the external cathodic pulse, which is probably due to the stabilization of superoxide by double-layer cation-rich structures. Long-lived RTIL double-layer structures and their endogenous fields are detected as stable and discrete open-circuit potential plateaus

Technical Note: Regularization performances with the error consistency method in the case of retrieved atmospheric profiles

International audienceThe retrieval of concentration vertical profiles of atmospheric constituents from spectroscopic measurements is often an ill-conditioned problem and regularization methods are frequently used to improve its stability. Recently a new method, that provides a good compromise between precision and vertical resolution, was proposed to determine analytically the value of the regularization parameter. This method is applied for the first time to real measurements with its implementation in the operational retrieval code of the satellite limb-emission measurements of the MIPAS instrument and its performances are quantitatively analyzed. The adopted regularization improves the stability of the retrieval providing smooth profiles without major degradation of the vertical resolution. In the analyzed measurements the retrieval procedure provides a vertical resolution that, in the troposphere and low stratosphere, is smaller than the vertical field of view of the instrument

P-Glycoprotein Expression in Acute Myeloid Leukaemia Cells at Diagnosis: Its relationship to Daunorubicin or Idarubicin Induction Therapy and Survival.

We investigated the expression of P-glycoprotein (P-gp) in 50 adults with de novo diagnosed acute myeloid leukaemia (AML) and the relationship between presence of P-gp in leukaemic cells and efficacy, as remission induction and survival rate, of two different anthracyclines, daunorubicin (DNR) and idarubicin (IDR). We found that 30 out of 50 patients (60%) were negative (Group 1) and 20 (40%) were positive (Group 2) for P-gp expression evaluated by mean of MRK16 MoAb using a cut-off of 10% positive cells. Thirty-five out of 50 patients (70%) obtained complete remission (CR); depending on P-gp expression, the CR rate was 80% for group 1 and 45% for group 2 (p < 0.005). The median duration of overall survival was 20 months for patients in Group 1 as compared with 10 months for patients of Group 2 (p < 0.005). Regarding the anthracycline used, no significant difference in CR was observed in patients of Group 1 (75% of CR with DNR vs. 90% with IDR); Group 2 obtained 40% of CR with DNR vs. 70% with IDR (p < 0.005). The median duration of overall survival (OS) with the two regimens was comparable in Group 1, while it was significantly longer in patients of Group 2 treated with IDR compared with DNR regimen (p < 0.005). These results confirm the prognostic value of P-gp expression in AML at first appearance and we suggest that idarubicin could be a valid anthracycline drug in the treatment of AML to be evaluated as potential drug of choice in patients with primary or drug-induced multidrug resistance

A Gray-Box Approach for Curriculum Learning

Curriculum learning is often employed in deep reinforcement learning to let the agent progress more quickly towards better behaviors. Numerical methods for curriculum learning in the literature provides only initial heuristic solutions, with little to no guarantee on their quality. We define a new gray-box function that, including a suitable scheduling problem, can be effectively used to reformulate the curriculum learning problem. We propose different efficient numerical methods to address this gray-box reformulation. Preliminary numerical results on a benchmark task in the curriculum learning literature show the viability of the proposed approach

Extended Formulations in Mixed-integer Convex Programming

We present a unifying framework for generating extended formulations for the polyhedral outer approximations used in algorithms for mixed-integer convex programming (MICP). Extended formulations lead to fewer iterations of outer approximation algorithms and generally faster solution times. First, we observe that all MICP instances from the MINLPLIB2 benchmark library are conic representable with standard symmetric and nonsymmetric cones. Conic reformulations are shown to be effective extended formulations themselves because they encode separability structure. For mixed-integer conic-representable problems, we provide the first outer approximation algorithm with finite-time convergence guarantees, opening a path for the use of conic solvers for continuous relaxations. We then connect the popular modeling framework of disciplined convex programming (DCP) to the existence of extended formulations independent of conic representability. We present evidence that our approach can yield significant gains in practice, with the solution of a number of open instances from the MINLPLIB2 benchmark library.Comment: To be presented at IPCO 201

Not All Children with Under-Control Asthma are Controlled

Subclinical lung function alterations can sometimes be discovered in asthmatic patients under clinical control. This study aimed to identify the burden of asthmatic children with subclinical airways abnormalities who may benefit from an adjustment in asthma therapy. 134 6-to-17-year-old asthmatic children were enrolled. Of them, 98 presented apparently under clinical control disease and all performed spirometry before and after bronchodilation: 17 (17.3%) had a positive bronchodilation test, in addition to significantly lower lung function indexes as compared to those with under-control asthma who had a negative bronchodilation test. These patients were randomized and re-evaluated: patients (n=8) receiving an adjustment in their therapy showed an improvement in lung function tests and quality of life indexes as compared to 7 without therapy adjustment. In conclusion, a substantial number of apparently-under-control asthmatic children show airways alterations that can be improved by adjusting their therapy, which also seems to enhance their quality of life