Práticas e desafios da regulação do Sistema Único de Saúde

OBJECTIVE: To analyze the obstacles and challenges faced by managers and coordination professionals in their practices in municipal coordinating centers. METHODS: An exploratory descriptive study with a qualitative focus, applied in 40 managers and coordination professionals, from September 2017 to November 2018, with semi-structured interviews, resulting in two categories of analysis: limiting factors and factors that facilitate the management and operationalization of the Brazilian Unified Health System (SUS) coordinating sector. RESULTS: Analyzing the statements, we found evidence of the following limiting factors: failure in the criteria of referral, unavailability of beds, high demand, systemic difficulties in relation to the coordinating system, procedures of difficult scheduling and execution, increased repressed demand for elective procedures and difficulties in the flow of information between primary care and coordination. In the category of facilitating factors, the most significant possibilities were: expansion of the capability to know the user’s reality, improvement in primary care and increase in health financial resources, health training and education and restructuring, in addition to reorganizing internal coordinating procedures. CONCLUSION: The limiting factors of coordination show the need to promote actions that offer all SUS users full access to health services.OBJETIVO: Analisar os entraves e desafios enfrentados pelos gestores e profissionais de regulação em suas práticas nas centrais reguladoras municipais. MÉTODOS: Estudo descritivo exploratório com enfoque qualitativo, aplicado em quarenta gestores e profissionais de regulação, no período de setembro de 2017 e novembro de 2018, por meio de entrevista semiestruturada, resultando em duas categorias de análise: fatores limitantes e fatores facilitadores da gestão e operacionalização do setor de regulação do SUS. RESULTADOS: Na análise dos enunciados, foram encontradas evidências dos seguintes fatores limitantes: falha nos critérios de encaminhamento, indisponibilidade de leitos, grande demanda, dificuldades sistêmicas em relação ao sistema de regulação, procedimentos de difícil agendamento e execução, aumento da demanda reprimida de procedimentos eletivos e dificuldades no fluxo de informações entre a atenção primária e a regulação. Na categoria de fatores facilitadores, as possibilidades mais significativas foram: ampliação da capacidade de conhecer a realidade do usuário, melhoria na atenção primária e incrementos de recursos financeiros para a saúde, capacitação e formação em saúde e reestruturação, além de reorganização dos procedimentos internos de regulação. CONCLUSÃO: Os fatores limitantes da regulação demonstram a necessidade de fomentar ações que ofereçam a todos os usuários do SUS o acesso pleno aos serviços de saúde

Evolutionary strategy for practical design of passive optical networks

Passive optical networks (PONs) are an important and interesting technology for broadband access as a result of the growing demand for bandwidth over the past 10 years. An arduous and complex step in the design of such networks involves determining the placement of equipment, optical fiber cables and several other parameters relevant to the proper functioning of the network. In this paper, we propose an evolutionary strategy to optimize the infrastructure design of PONs by using genetic algorithm technique. This meta-heuristic is capable of elaborating fast, automatic and efficient solutions for the design and planning of PONs. Our proposal has been developed using real maps, aiming to minimize deployment costs and time spent to carry out PON projects, achieving pre-defined quality criteria. We considered, in our simulations, two scenarios (non-dense and dense), four possible topologies and two regions of interest. The non-dense consists of a scenario in which subscribers are distributed in a dispersed manner in the region of interest. The dense has a considerably higher number of subscribers distributed in a very close way to each other. Based on the obtained results, the potential of our proposal is quite clear, as well as its relevance from a technical, economic, and commercial point of view

Revisão bibliográfica: impactos em áreas nativas da caatinga causadas pelas atividades econômicas e as técnicas de reflorestamento / Bibliographic review: impacts on native areas the caatinga caused by economic activities and reforestation techniques

O desmatamento é um problema ambiental de destaque para países com grandes áreas de florestas tropicais, como o Brasil. Esse processo que começou de forma insignificante e hoje tomou proporções preocupante na medida em que as alterações na vegetação no ar atmosférico na absortividade na refletividade, na permeabilidade do solo e nas águas que compõem a superfície. O Bioma Caatinga apresenta um desmatamento acelerado ocasionado a redução das chuvas, e com isso vem as alterações nos fatores climáticos que poderão alcançar um ponto crítico de irreversibilidade causando empobrecimento da flora e da fauna por causa da exploração e ao consumo de lenha nativa de forma ilegal e insustentável para fins domésticos e industriais. Entretanto, o objetivo do presente trabalho foi avaliar os impactos causados pelas atividades econômicas: como o desmatamento de áreas nativas da Caatinga para a produção de lenha e carvão vegetal, bem como identificar as técnicas de reflorestamento. Uma das formas de recuperar as áreas degradadas é através da interferência das atividades humanas utilizando as espécies nativas lenhosas pioneiras que aparecem com mais frequência neste bioma com a Mimosa tenuiflora, o Croton sonderianus, a Caesalpinea bracteosa, a Bauhinia cheilantha e o Combretum leprosum, gerando atividades lucrativas e sustentáveis. As atividades econômicas realizadas no bioma Caatinga tem ocasionado impactos no meio ambiente que comprometem a fauna e a flora e as técnicas de reflorestamento são escassas e ineficientes para atender a economia de forma sustentável, prejudicando o equilíbrio do ecossistema e a perca da biodiversidade para as futuras gerações

Causas, consequências e métodos atribuídos para prevenir a desertificação na caatinga / Causes, consequences and methods attributed to prevent desertification in caatinga

A desertificação é um fenômeno que resulta da combinação de fatores naturais, principalmente as episódicas secas; e de fatores antrópicos, como sobrepastoreio, desmatamento e remoção da cobertura vegetal, juntamente com as atividades agrícolas que ocorrem acima da capacidade de suporte do ambiente. No Brasil o bioma Caatinga é o mais atingido, perdendo apenas para a Floresta Atlântica e o Cerrado. Estima-se que 80% da vegetação encontre-se completamente modificada, devido ao extrativismo e a agropecuária, apresentando-se a maioria dessas áreas em estádios iniciais ou intermediários de sucessão ecológica. Entretanto, o objetivo da presente pesquisa bibliográfica foi mostrar as causas e as consequências da desertificação da Caatinga e os métodos que são atribuídos para prevenção. É preciso ressaltar que as restrições físicas e químicas dos solos, a escassez de água no Semiárido nordestino, bem como a exploração intensiva dos recursos naturais e o super pastoreio tornam a Caatinga vulnerável à desertificação e à ameaça de extinção de espécies da fauna e da flora nativa da região, entretanto, esse processo pode ser controlado, evitado, e até mesmo revertido, desde que haja o envolvimento da população e que os órgãos governamentais proponham soluções, junto com as comunidades e as escolas e toda a sociedade para resolver, ou ao menos, buscar alternativas sustentáveis, oferecendo auxílio técnico para o manejo dessas áreas e incentivando a preservação ambiental de maneira que não ocorra uma sobrecarga de problemas nas áreas de risco. Nos locais onde o processo de desertificação já se instalou são necessários investimentos para sua contenção; porém, o custo é da ordem de bilhões de dólares

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy

Study on multi-ELVES in the Pierre Auger Observatory

Since 2013, the four sites of the Fluorescence Detector (FD) of the Pierre Auger Observatory record ELVES with a dedicated trigger. These UV light emissions are correlated to distant lightning strikes. The length of recorded traces has been increased from 100 μs (2013), to 300 μs (2014-16), to 900 μs (2017-present), to progressively extend the observation of the light emission towards the vertical of the causative lightning and beyond. A large fraction of the observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. The nature of the multi-ELVES is not completely understood but may be related to the different types of lightning in which they are originated. For example, it is known that Narrow Bipolar Events can produce double ELVES, and Energetic In-cloud Pulses, occurring between the main negative and upper positive charge layer of clouds, can induce double and even quadruple ELVES in the ionosphere. This report shows the seasonal and daily dependence of the time gap, amplitude ratio, and correlation between the pulse widths of the peaks in a sample of 1000+ multi-ELVES events recorded during the period 2014-20. The events have been compared with data from other satellite and ground-based sensing devices to study the correlation of their properties with lightning observables such as altitude and polarity