State capacity impact on COVID-19 mortality in Brazil.

This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.

State capacity impact on COVID-19 mortality in Brazil / Influência do Estado na mortalidade por COVID-19 no Brasil / Influencia del Estado en la mortalidad por COVID-19 en Brasil

Abstract: This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.

Resumo: Este estudo aborda a capacidade do Estado em lidar com a pandemia da COVID-19, bem como contribuir com a literatura sobre gestão de crises no setor da saúde. Analisamos se o nível de capacidade do Estado teve impacto na resposta à COVID-19 nas regiões de saúde brasileiras em 2020. O estudo utiliza um conjunto de técnicas de análise estatística e análise de impacto na saúde pública, incluindo o método de pareamento por escore de propensão (PSM). Os achados revelaram que o menor número de óbitos por COVID-19 esteve associado à participação em consórcios intermunicipais de saúde, ao nível de escolaridade dos gestores municipais de saúde e aos recursos repassados por meio do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Por outro lado, o número de unidades de terapia intensiva (UTI) e de equipamentos para manutenção da vida associou-se a um maior número de óbitos, uma vez que locais populacionais maiores concentraram capacidade operacional para atender os casos mais graves. Conclui-se, portanto, que os diferentes níveis de capacitação implementados pelo Estado nas regiões de saúde brasileiras levaram a resultados distintos no enfrentamento da pandemia. Isso reforça a importância da discussão sobre a capacitação implementada pelo Estado e a gestão de crises, destacando que o resultado do enfrentamento da COVID-19 no Brasil esteve relacionado ao nível de recursos existentes, principalmente em termos de capacidade do sistema de saúde, capacidade burocrática e associação em consórcios para compartilhar insumos e garantir a prestação de serviços de saúde à população.

Resumen: Este estudio aborda la capacidad del Estado para hacer frente a la pandemia del COVID-19 y busca contribuir a la literatura sobre gestión de crisis en el sector salud. Se analizó si el nivel de capacidad del Estado tuvo un impacto en la respuesta al COVID-19 en las regiones sanitarias brasileñas en 2020. Este estudio utilizó un conjunto de técnicas de análisis estadísticos y análisis de impacto en la salud pública, incluido el método de pareamiento por puntaje de propensión (PSM). Los hallazgos muestran que el menor número de muertes por el COVID-19 se asoció con la participación en consorcios intermunicipales de salud, el nivel de educación de los gestores municipales de salud y los recursos transferidos por el Programa Nacional de Mejoría y Acceso de la Calidad de la Atención Básica (PMAQ). Por otro lado, la cantidad de unidades de cuidados intensivos (UCI) y de equipos de soporte vital estuvo asociada a un mayor número de muertes, ya que los lugares con mayor población concentraron la capacidad operativa para tratar los casos más graves. Se concluye que los diferentes niveles de capacitación implementados por el Estado en las regiones sanitarias brasileñas llevaron a diferentes resultados para hacer frente a la pandemia. Esto refuerza la importancia de la discusión sobre la capacitación implementada por el Estado y la gestión de crisis, destacando que la respuesta al COVID-19 en Brasil estuvo relacionada con el nivel de recursos existentes, especialmente con relación a la capacidad del sistema de salud, la capacidad burocrática y la asociación en consorcios para compartir insumos y garantizar la prestación de servicios sanitarios a la población.

Chromosomal evolution in Cryptangieae Benth. (Cyperaceae): Evidence of holocentrism and pseudomonads.

Cryptangieae has recently been revised based on morphology and molecular phylogeny, but cytogenetic data is still scarce. We conducted this study with the aim of investigating the occurrence of holocentric chromosomes and pseudomonads, as well as understanding the mode of chromosomal evolution in the tribe. We performed analyses of meiotic behavior, chromosome counts, and reconstruction of the ancestral state for the haploid number. We present novel cytogenetic data for eight potentially holocentric species: Cryptangium verticillatum, Krenakia junciforme, K. minarum, Lagenocarpus bracteosus, L. griseus, L. inversus, L. rigidus, and L. tenuifolius. Meiotic abnormalities were observed, with parallel spindles being particularly noteworthy. Intra-specific variations in chromosome number were not found, which may indicate an efficient genetic control for the elimination of abnormal nuclei. The inferred ancestral haploid number was n = 16, with dysploidy being the main evolutionary mechanism. At least five chromosomal fissions occurred in Krenakia (n = 21), followed by a further ascending dysploidy event in Lagenocarpus (n = 17). As proposed for Cyperaceae, it is possible that cladogenesis events in Cryptangieae were marked by numerical and structural chromosomal changes.

BG2: Bayesian variable selection in generalized linear mixed models with nonlocal priors for non-Gaussian GWAS data.

BACKGROUND: Genome-wide association studies (GWASes) aim to identify single nucleotide polymorphisms (SNPs) associated with a given phenotype. A common approach for the analysis of GWAS is single marker analysis (SMA) based on linear mixed models (LMMs). However, LMM-based SMA usually yields a large number of false discoveries and cannot be directly applied to non-Gaussian phenotypes such as count data. RESULTS: We present a novel Bayesian method to find SNPs associated with non-Gaussian phenotypes. To that end, we use generalized linear mixed models (GLMMs) and, thus, call our method Bayesian GLMMs for GWAS (BG2). To deal with the high dimensionality of GWAS analysis, we propose novel nonlocal priors specifically tailored for GLMMs. In addition, we develop related fast approximate Bayesian computations. BG2 uses a two-step procedure: first, BG2 screens for candidate SNPs; second, BG2 performs model selection that considers all screened candidate SNPs as possible regressors. A simulation study shows favorable performance of BG2 when compared to GLMM-based SMA. We illustrate the usefulness and flexibility of BG2 with three case studies on cocaine dependence (binary data), alcohol consumption (count data), and number of root-like structures in a model plant (count data).

Bayesian model selection for generalized linear mixed models.

We propose a Bayesian model selection approach for generalized linear mixed models (GLMMs). We consider covariance structures for the random effects that are widely used in areas such as longitudinal studies, genome-wide association studies, and spatial statistics. Since the random effects cannot be integrated out of GLMMs analytically, we approximate the integrated likelihood function using a pseudo-likelihood approach. Our Bayesian approach assumes a flat prior for the fixed effects and includes both approximate reference prior and half-Cauchy prior choices for the variances of random effects. Since the flat prior on the fixed effects is improper, we develop a fractional Bayes factor approach to obtain posterior probabilities of the several competing models. Simulation studies with Poisson GLMMs with spatial random effects and overdispersion random effects show that our approach performs favorably when compared to widely used competing Bayesian methods including deviance information criterion and Watanabe-Akaike information criterion. We illustrate the usefulness and flexibility of our approach with three case studies including a Poisson longitudinal model, a Poisson spatial model, and a logistic mixed model. Our proposed approach is implemented in the R package GLMMselect that is available on CRAN.

BGWAS: Bayesian variable selection in linear mixed models with nonlocal priors for genome-wide association studies.

BACKGROUND: Genome-wide association studies (GWAS) seek to identify single nucleotide polymorphisms (SNPs) that cause observed phenotypes. However, with highly correlated SNPs, correlated observations, and the number of SNPs being two orders of magnitude larger than the number of observations, GWAS procedures often suffer from high false positive rates. RESULTS: We propose BGWAS, a novel Bayesian variable selection method based on nonlocal priors for linear mixed models specifically tailored for genome-wide association studies. Our proposed method BGWAS uses a novel nonlocal prior for linear mixed models (LMMs). BGWAS has two steps: screening and model selection. The screening step scans through all the SNPs fitting one LMM for each SNP and then uses Bayesian false discovery control to select a set of candidate SNPs. After that, a model selection step searches through the space of LMMs that may have any number of SNPs from the candidate set. A simulation study shows that, when compared to popular GWAS procedures, BGWAS greatly reduces false positives while maintaining the same ability to detect true positive SNPs. We show the utility and flexibility of BGWAS with two case studies: a case study on salt stress in plants, and a case study on alcohol use disorder. CONCLUSIONS: BGWAS maintains and in some cases increases the recall of true SNPs while drastically lowering the number of false positives compared to popular SMA procedures.

Long term temporal trends in synoptic-scale weather conditions favoring significant tornado occurrence over the central United States.

We perform a statistical climatological study of the synoptic- to meso-scale weather conditions favoring significant tornado occurrence to empirically investigate the existence of long term temporal trends. To identify environments that favor tornadoes, we apply an empirical orthogonal function (EOF) analysis to temperature, relative humidity, and winds from the Modern-Era Retrospective analysis for Research and Applications Version 2 (MERRA-2) dataset. We consider MERRA-2 data and tornado data from 1980 to 2017 over four adjacent study regions that span the Central, Midwestern, and Southeastern United States. To identify which EOFs are related to significant tornado occurrence, we fit two separate groups of logistic regression models. The first group (LEOF models) estimates the probability of occurrence of a significant tornado day (EF2-EF5) within each region. The second group (IEOF models) classifies the intensity of tornadic days either as strong (EF3-EF5) or weak (EF1-EF2). When compared to approaches using proxies such as convective available potential energy, our EOF approach is advantageous for two main reasons: first, the EOF approach allows for the discovery of important synoptic- to mesoscale variables previously not considered in the tornado science literature; second, proxy-based analyses may not capture important aspects of three-dimensional atmospheric conditions represented by the EOFs. Indeed, one of our main novel findings is the importance of a stratospheric forcing mode on occurrence of significant tornadoes. Other important novel findings are the existence of long-term temporal trends in the stratospheric forcing mode, in a dry line mode, and in an ageostrophic circulation mode related to the jet stream configuration. A relative risk analysis also indicates that changes in stratospheric forcings are partially or completely offsetting increased tornado risk associated with the dry line mode, except in the eastern Midwest region where tornado risk is increasing.

Mapping Genetic Variation in Arabidopsis in Response to Plant Growth-Promoting Bacterium Azoarcus olearius DQS-4T.

Plant growth-promoting bacteria (PGPB) can enhance plant health by facilitating nutrient uptake, nitrogen fixation, protection from pathogens, stress tolerance and/or boosting plant productivity. The genetic determinants that drive the plant-bacteria association remain understudied. To identify genetic loci highly correlated with traits responsive to PGPB, we performed a genome-wide association study (GWAS) using an Arabidopsis thaliana population treated with Azoarcus olearius DQS-4T. Phenotypically, the 305 Arabidopsis accessions tested responded differently to bacterial treatment by improving, inhibiting, or not affecting root system or shoot traits. GWA mapping analysis identified several predicted loci associated with primary root length or root fresh weight. Two statistical analyses were performed to narrow down potential gene candidates followed by haplotype block analysis, resulting in the identification of 11 loci associated with the responsiveness of Arabidopsis root fresh weight to bacterial inoculation. Our results showed considerable variation in the ability of plants to respond to inoculation by A. olearius DQS-4T while revealing considerable complexity regarding statistically associated loci with the growth traits measured. This investigation is a promising starting point for sustainable breeding strategies for future cropping practices that may employ beneficial microbes and/or modifications of the root microbiome.

Both male and female meiosis contribute to non-Mendelian inheritance of parental chromosomes in interspecific plant hybrids (Lolium × Festuca).

Some interspecific plant hybrids show unequal transmission of chromosomes from parental genomes to the successive generations. It has been suggested that this is due to a differential behavior of parental chromosomes during meiosis. However, underlying mechanism is unknown. We analyzed chromosome composition of the F2 generation of Festuca × Lolium hybrids and reciprocal backcrosses to elucidate effects of male and female meiosis on the shift in parental genome composition. We studied male meiosis, including the attachment of chromosomes to the karyokinetic spindle and gene expression profiling of the kinetochore genes. We found that Lolium and Festuca homoeologues were transmitted differently to the F2 generation. Female meiosis led to the replacement of Festuca chromosomes by their Lolium counterparts. In male meiosis, Festuca univalents were attached less frequently to microtubules than Lolium univalents, lagged in divisions and formed micronuclei, which were subsequently eliminated. Genome sequence analysis revealed a number of non-synonymous mutations between copies of the kinetochore genes from Festuca and Lolium genomes. Furthermore, we found that outer kinetochore proteins NDC80 and NNF1 were exclusively expressed from the Lolium allele. We hypothesize that silencing of Festuca alleles results in improper attachment of Festuca chromosomes to karyokinetic spindle and subsequently their gradual elimination.

Long-term recovery from opioid use disorder: recovery subgroups, transition states and their association with substance use, treatment and quality of life.

BACKGROUND AND AIMS: Limited information exists regarding individual subgroups of recovery from opioid use disorder (OUD) following treatment and how these subgroups may relate to recovery trajectories. We used multi-dimensional criteria to identify OUD recovery subgroups and longitudinal transitions across subgroups. DESIGN, SETTING AND PARTICIPANTS: In a national longitudinal observational study in the United States, individuals who previously participated in a clinical trial for subcutaneous buprenorphine injections for treatment of OUD were enrolled and followed for an average of 4.2 years after participation in the clinical trial. MEASUREMENTS: We identified recovery subgroups based on psychosocial outcomes including depression, opioid withdrawal and pain. We compared opioid use, treatment utilization and quality of life among these subgroups. FINDINGS: Three dimensions of the recovery process were identified: depression, opioid withdrawal and pain. Using these three dimensions, participants were classified into four recovery subgroups: high-functioning (minimal depression, mild withdrawal and no/mild pain), pain/physical health (minimal depression, mild withdrawal and moderate pain), depression (moderate depression, mild withdrawal and mild/moderate pain) and low-functioning (moderate/severe withdrawal, moderate depression and moderate/severe pain). Significant differences among subgroups were observed for DSM-5 criteria (P < 0.001) and remission status (P < 0.001), as well as with opioid use (P < 0.001), treatment utilization (P < 0.001) and quality of life domains (physical health, psychological, environment and social relationships; Ps < 0.001, Cohen's fs ≥ 0.62). Recovery subgroup assignments were dynamic, with individuals transitioning across subgroups during the observational period. Moreover, the initial recovery subgroup assignment was minimally predictive of long-term outcomes. CONCLUSIONS: There appear to be four distinct subgroups among individuals in recovery from OUD. Recovery subgroup assignments are dynamic and predictive of contemporaneous, but not long-term, substance use, substance use treatment utilization or quality of life outcomes.

Positivity of dengue, chikungunya, and Zika infections in women in Northeast Brazil post-Zika epidemic.

The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools.

BICOSS: Bayesian iterative conditional stochastic search for GWAS.

BACKGROUND: Single marker analysis (SMA) with linear mixed models for genome wide association studies has uncovered the contribution of genetic variants to many observed phenotypes. However, SMA has weak false discovery control. In addition, when a few variants have large effect sizes, SMA has low statistical power to detect small and medium effect sizes, leading to low recall of true causal single nucleotide polymorphisms (SNPs). RESULTS: We present the Bayesian Iterative Conditional Stochastic Search (BICOSS) method that controls false discovery rate and increases recall of variants with small and medium effect sizes. BICOSS iterates between a screening step and a Bayesian model selection step. A simulation study shows that, when compared to SMA, BICOSS dramatically reduces false discovery rate and allows for smaller effect sizes to be discovered. Finally, two real world applications show the utility and flexibility of BICOSS. CONCLUSIONS: When compared to widely used SMA, BICOSS provides higher recall of true SNPs while dramatically reducing false discovery rate.

RLPredictiOme, a Machine Learning-Derived Method for High-Throughput Prediction of Plant Receptor-like Proteins, Reveals Novel Classes of Transmembrane Receptors.

Cell surface receptors play essential roles in perceiving and processing external and internal signals at the cell surface of plants and animals. The receptor-like protein kinases (RLK) and receptor-like proteins (RLPs), two major classes of proteins with membrane receptor configuration, play a crucial role in plant development and disease defense. Although RLPs and RLKs share a similar single-pass transmembrane configuration, RLPs harbor short divergent C-terminal regions instead of the conserved kinase domain of RLKs. This RLP receptor structural design precludes sequence comparison algorithms from being used for high-throughput predictions of the RLP family in plant genomes, as has been extensively performed for RLK superfamily predictions. Here, we developed the RLPredictiOme, implemented with machine learning models in combination with Bayesian inference, capable of predicting RLP subfamilies in plant genomes. The ML models were simultaneously trained using six types of features, along with three stages to distinguish RLPs from non-RLPs (NRLPs), RLPs from RLKs, and classify new subfamilies of RLPs in plants. The ML models achieved high accuracy, precision, sensitivity, and specificity for predicting RLPs with relatively high probability ranging from 0.79 to 0.99. The prediction of the method was assessed with three datasets, two of which contained leucine-rich repeats (LRR)-RLPs from Arabidopsis and rice, and the last one consisted of the complete set of previously described Arabidopsis RLPs. In these validation tests, more than 90% of known RLPs were correctly predicted via RLPredictiOme. In addition to predicting previously characterized RLPs, RLPredictiOme uncovered new RLP subfamilies in the Arabidopsis genome. These include probable lipid transfer (PLT)-RLP, plastocyanin-like-RLP, ring finger-RLP, glycosyl-hydrolase-RLP, and glycerophosphoryldiester phosphodiesterase (GDPD, GDPDL)-RLP subfamilies, yet to be characterized. Compared to the only Arabidopsis GDPDL-RLK, molecular evolution studies confirmed that the ectodomain of GDPDL-RLPs might have undergone a purifying selection with a predominance of synonymous substitutions. Expression analyses revealed that predicted GDPGL-RLPs display a basal expression level and respond to developmental and biotic signals. The results of these biological assays indicate that these subfamily members have maintained functional domains during evolution and may play relevant roles in development and plant defense. Therefore, RLPredictiOme provides a framework for genome-wide surveys of the RLP superfamily as a foundation to rationalize functional studies of surface receptors and their relationships with different biological processes.

Mechanistic Aspects on [3+2] Cycloaddition (32CA) Reactions of Azides to Nitroolefins: A Computational and Kinetic Study.

[3+2] cycloadditions of nitroolefins have emerged as a selective and catalyst-free alternative for the synthesis of 1,2,3-triazoles from azides. We describe mechanistic studies into the cycloaddition/rearomatization reaction sequence. DFT calculations revealed a rate-limiting cycloaddition step proceeding via an asynchronous TS with high kinetic selectivity for the 1,5-triazole. Kinetic studies reveal a second-order rate law, and 13 C kinetic isotopic effects at natural abundance were measured with a significant normal effect at the conjugated olefinic centers of 1.0158 and 1.0216 at the α and ß-carbons of ß-nitrostyrene. Distortion/interaction-activation strain and energy decomposition analyses revealed that the major regioisomeric pathway benefits from an earlier and less-distorted TS, while intermolecular interaction terms dominate the preference for 1,5- over 1,4-cycloadducts. In addition, the major regioisomer also has more favorable electrostatic and dispersion terms. Additionally, while static DFT calculations suggest a concerted but highly asynchronous Ei-type HNO2 elimination mechanism, quasiclassical direct-dynamics calculations reveal the existence of a dynamic intermediate.

Secondary sclerosing cholangitis after critical COVID-19: Three case reports.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic has caused more than 5 million deaths. Multiorganic involvement is well described, including liver disease. In patients with critical COVID-19, a new entity called "post-COVID-19 cholangiopathy" has been described. CASE SUMMARY: Here, we present three patients with severe COVID-19 that subsequently developed persistent cholestasis and chronic liver disease. All three patients required intensive care unit admission, mechanical ventilation, vasopressor support, and broad spectrum antibiotics due to secondary infections. Liver transplant protocol was started for two of the three patients. CONCLUSION: Severe COVID-19 infection should be considered a potential risk factor for chronic liver disease and liver transplantation.

Mechanistic investigation of enolate/stabilized vinylogous carbanion-mediated organocatalytic azide (3 + 2) cycloaddition reactions for the synthesis of 1,2,3-triazoles.

Herein, we report a fully detailed mechanistic study involving an organocatalyzed 1,3-dipolar cycloaddition via enolate or stabilized vinylogous carbanion intermediates and azide for the synthesis of 1,2,3-triazoles. A detailed investigation of the elementary steps, intermediates, and transition states of the two organocatalyzed metal-free click reactions is supported by DFT calculations and 1H NMR monitoring experiments, providing detailed profiles for both reaction mechanisms. Distortion-interaction activation-strain (DIAS) analysis was also employed to further elucidate the regioselectivity in both reactions.

Genomic constitution, allopolyploidy, and evolutionary proposal for Cynodon Rich. based on GISH.

Polyploidy is the main mechanism for chromosome number variation in Cynodon. Taxonomic boundaries are difficult to define and, although phylogenetic studies indicate that some species are closely related, the degree of genomic similarity remains unknown. Furthermore, the Cynodon species classification as auto or allopolyploids is still controversial. Thus, this study aimed to investigate the genomic constitution in diploid and polyploid species using different approaches of genomic in situ hybridization (GISH). To better understand the hybridization events, we also investigated the occurrence of unreduced gametes in C. dactylon diploid pollen grains. We suggest a genomic nomenclature of diploid species as DD, D1D1, and D2D2 for C. dactylon, C. incompletus, and C. nlemfuensis, and DDD2D2 and DD2D1D1 for the segmental allotetraploids of Cynodon dactylon and C. transvaalensis, respectively. Furthermore, an evolutionary proposal was built based on our results and previous data from other studies, showing possible crosses that may have occurred between Cynodon species.

O papel do governo estadual no arranjo de implementação do Projeto Mais Médicos para o Brasil: uma análise em Minas Gerais / The role of the state government in the institutional arrangement for the implementation of the More Doctors for Brazil Project: an analysis in the state of Minas Gerais / El papel del gobierno del estado en la organización de la implementación del Proyecto Más Médicos para Brasil: un análisis en Minas Gerais

A literatura endossa o crescente papel central de coordenação do governo federal nas políticas de saúde. Porém, há poucos estudos sobre o papel dos entes subnacionais, em especial, dos estados. Assim, este artigo analisou o arranjo institucional de implementação do Projeto Mais Médicos para o Brasil (PMMB) no estado de Minas Gerais. O trabalho foi realizado com base em análise documental de 31 atas de reuniões da Comissão de Coordenação Estadual e oito entrevistas com atores-chave responsáveis por sua implementação. Os resultados evidenciaram a (i) centralidade decisória do projeto no âmbito federal, a (ii) pouca clareza do papel do governo estadual no arranjo de implementação, a (iii) crise orçamentária do governo mineiro e a (iv) instabilidade política, que resultaram em (v) trocas de governo estadual e federal. Tais fatores, em conjunto, impactaram na capacidade de implementação do projeto em Minas Gerais.(AU)

The literature evidences the growing central coordinating role played by the federal government in health policy. However, there is little research on the role of subnational entities, especially state governments. This article analyzes the institutional arrangement for the implementation of the More Doctors for Brazil Project in the state of Minas Gerais. The study drew on data from a documentary analysis of 31 minutes of meetings of the State Coordinating Commission and eight interviews with key actors responsible for the implementation of the project. The results highlight: (i) Centralized Project decision-making at federal level; (ii) Lack of clarity with regard to the role of the state government in the implementation arrangement; (iii) A state government funding crisis; and (iv) Political instability, which result in (v) Changes in the state and federal government. These combined factors had a negative impact on project implementation capacity in Minas Gerais.(AU)

La literatura endosa el creciente papel central de coordinación del gobierno federal en las políticas de salud. No obstante, hay pocos estudios sobre el papel de los entes subnacionales, en especial de los estados. Por lo tanto, este artículo analizó la organización institucional de implementación del proyecto Más Médicos para Brasil (PMMB) en el estado de Minas Gerais. El trabajo se realizó con base en el análisis documental de 31 actas de reuniones de la Comisión de Coordinación Estatal y ocho entrevistas con actores-clave responsables por su implementación. Los resultados pusieron en evidencia: (i) la centralidad de decisión del Proyecto en el ámbito federal; (ii) la poca claridad del papel del gobierno estatal en la organización de la implementación; (iii) la crisis presupuestaria del gobierno del Estado de Minas Gerais y (iv) la inestabilidad política, lo que resultó en (v) cambios de gobierno estatal y federal. Tales factores, en conjunto, tuvieron impacto sobre la capacidad de implementación del Proyecto en Minas Gerais.(AU)

Latissimus Dorsi Transfer to Irreparable Anterosuperior Lesions to the Rotator Cuff: Description of Surgical Technique.

Lesions to the shoulder rotator cuff may have several configurations, and are divided and classified according to the size of the lesion, the tendon involved, its combinations and whether there is possibility of repair. Irreparable subscapular lesions, as well as irreparable anterosuperior lesions, may generate shoulder dysfunction due to loss of humeral head depressants, causing pain and functional limitation. Myotendinous transfers are among the therapeutic alternatives, and the most studied and widespread in recent decades is the transfer of the pectoralis major to the minor tuberosity. However, some anatomical studies suggest that the latissimus dorsi is a more appropriate alternative for the treatment of these lesions because it presents force vectors more similar to those of the subscapularis, besides presenting promising results in the clinical evaluations with short follow-up. The present work aims to describe the surgical technique developed for transfer of the latissimus dorsi in cases of irreparable subscapular and anterossuperior lesions to the rotator cuff.