Computational methodology to support functional vision assessment in premature infants: A viability study.

BACKGROUND: Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE: To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS: This experimental study was carried out with children up to two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants' visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS: Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION: The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children.

A new strategy for risk assessment of PM2.5-bound elements by considering the influence of wind regimes.

For regulatory purposes, air pollution has been reduced to management of air quality control regions (AQCR), by inventorying pollution sources and identifying the receptors significantly affected. However, beyond being source-dependent, particulate matter can be physically and chemically altered by factors and elements of climate during transport, as they act as local environmental constraints, indirectly modulating the adverse effects of particles on the environment and human health. This case study, at an industrial site in a Brazilian coastal city - Joinville, combines different methodologies to integrate atmospheric dynamics in a strategic risk assessment approach whereby the influence of different wind regimes on environmental and health risks of exposure to PM2.5-bound elements, are analysed. Although Joinville AQCR has been prone to stagnation/recirculation events, distinctly different horizontal wind circulation patterns indicate two airsheds within the region. The two sampling sites mirrored these two conditions and as a result we report different PM2.5 mass concentrations, chemical profiles, geo-accumulation, and ecological and human health risks. In addition, feedback mechanisms between the airsheds seem to aggravate the air quality and its effects even under good ventilation conditions. Recognizably, the risks associated with Co, Pb, Cu, Ni, Mn, and Zn loadings were extremely high for the environment as well as being the main contributors to elevated non-carcinogenic risks. Meanwhile, higher carcinogenic risks occurred during stagnation/recirculation conditions, with Cr as the major threat. These results highlight the importance of integrating local airshed characteristics into the risk assessment of PM2.5-bound elements since they can aggravate air pollution leading to different risks at a granular scale. This new approach to risk assessment can be employed in any city's longer-term development plan since it provides public authorities with a strategic perspective on incorporating environmental constraints into urban growth planning and development zoning regulations.

Electronic Waste Low-Temperature Processing: An Alternative Thermochemical Pretreatment to Improve Component Separation.

The production of electronic waste due to technological development, economic growth and increasing population has been rising fast, pushing for solutions before the environmental pressure achieves unprecedented levels. Recently, it was observed that many extractive metallurgy alternatives had been considered to recover value from this type of waste. Regarding pyrometallurgy, little is known about the low-temperature processing applied before fragmentation and subsequent component separation. Therefore, the present manuscript studies such alternative based on scanning electron microscopy characterization. The sample used in the study was supplied by a local recycling center in Rio de Janeiro, Brazil. The mass loss was constant at around 30% for temperatures higher than 300 °C. Based on this fact, the waste material was then submitted to low-temperature processing at 350 °C followed by attrition disassembling, size classification, and magnetic concentration steps. In the end, this first report of the project shows that 15% of the sample was recovered with metallic components with high economic value, such as Cu, Ni, and Au, indicating that such methods could be an interesting alternative to be explored in the future for the development of alternative electronic waste extraction routes.

Risk management in occupational safety: A systematic mapping.

BACKGROUND: Occupational safety risk management is a systemic process capable of promoting technical engineering solutions, considering a wide range of predictable, unexpected and subjective factors related to accident occurrences. In Brazil, the behavior of managers in relation to risk management tends to be reactive, and facilitates access to information for crucial practical and academic purposes when it comes to changing the attitude of managers, so that their actions become increasingly more proactive. OBJECTIVE: To identify, classify, analyze, and discuss the existing literature related to the topic, produced from 2008 to 2020, besides contributing to a broader understanding of risk management in occupational safety. METHODS: We did a systematic literature mapping. The research process was documented starting by the planning stage. Afterwards, the focus was on research conduction and information synthesis. RESULTS: Knowledge systematization and stratification about OHS risk management through various perspectives to identify, analyze and manage risks in the workplace. Were identified 37 tools for identifying and analyzing risks, management-related practices and future research trends. CONCLUSIONS: The set of tools and management practices identified can be used as a support for decision making in the selection process of tools and practices to reduce risks and improve occupational safety. Also, the results can help target future research.

Resistance of soil to penetration as a parameter indicator of subsolation in crop areas of sugar cane.

Sugarcane is a very important economic crop that relies heavily on agricultural machinery, which contributes to soil compaction and a consequent decline in productivity. Subsoiling operation reduces the problems caused by compression; however, it is necessary to know its location and intensity. Accordingly, the aim of this work is to present a compression diagnostic method based on soil resistance to penetration as the parameter that indicates need for intervention in the subsoil. Measurements of penetration resistance was carried out in areas of sugarcane, located in the municipalities of Goianésia, Barro Alto and Santa Isabel, in the Brazilian state of Goiás. The Falker penetrometer (PLG 1020) was used, adjusted to a maximum depth of 40 cm and adopted as a critical resistance value of 4.0 MPa. The data were interpolated using kriging and adjusted in AutoCAD 2013 (Autodesk). The methodology proved effective in areas of compacted soil, and the surface layer had less resistance. The reduction in soil preparation was 96.54% and when considering the topographic adjustments, the reduction was 74.07%, showing the viability and importance of the diagnosis to show the proper management.

Lipid Assessment, Cholesterol and Fatty Acid Profile of meat from broilers raised in four different rearing systems.

Evaluated lipid and cholesterol concentration and fatty acid profile of raw breast, thigh and drumstick meat from broilers raised in different rearing systems. Were used 200 male broiler carcasses from four different rearing systems (n=50 from conventional intensive; n=50 from organic; n=50 from free-range; and n=50 from antibiotic-free) distributed in a completely randomized design with four rearing systems and 50 replications (carcasses). Breast meat from conventional broilers showed higher lipid (1.47) and cholesterol (34.13) concentration. Thigh and drumstick meat from free-range broilers had higher lipid (7.53/4.73) and cholesterol (45.55/53.65) concentration. Fat contained in breast, thigh and drumstick meat from free-range broilers showed higher levels of polyunsaturated fatty acids. Fat from breast and thigh meat from free-range broilers showed higher total concentration of ω3 and ω6 fatty acids. Fat from thigh meat from organic broilers showed higher levels of EPA (C20:5n3) and DHA (C22:6n3). Fat from drumstick meat from free-range broilers showed higher total concentration of ω3 and ω6 fatty acids. Meat from chickens raised in alternative rearing systems offers less risk to cardiovascular health because it presents lower concentrations of lipids and cholesterol, greater amounts of polyunsaturated fatty acids, which are beneficial for human health.

The influence that different urban development models has on PM2.5 elemental and bioaccessible profiles.

Limited studies have reported on in-vitro analysis of PM2.5 but as far as the authors are aware, bioaccessibility of PM2.5 in artificial lysosomal fluid (ALF) has not been linked to urban development models before. The Brazilian cities Manaus (Amazon) and Curitiba (South region) have different geographical locations, climates, and urban development strategies. Manaus drives its industrialization using the free trade zone policy and Curitiba adopted a services centered economy driven by sustainability. Therefore, these two cities were used to illustrate the influence that these different models have on PM2.5 in vitro profile. We compared PM2.5 mass concentrations and the average total elemental and bioaccessible profiles for Cu, Cr, Mn, and Pb. The total average elemental concentrations followed Mn > Pb > Cu > Cr in Manaus and Pb > Mn > Cu > Cr in Curitiba. Mn had the lowest solubility while Cu showed the highest bioaccessibility (100%) and was significantly higher in Curitiba than Manaus. Cr and Pb had higher bioaccessibility in Manaus than Curitiba. Despite similar mass concentrations, the public health risk in Manaus was higher than in Curitiba indicating that the free trade zone had a profound effect on the emission levels and sources of airborne PM. These findings illustrate the importance of adopting sustainable air quality strategies in urban planning.

The Organization of Secondary Outpatient Care at SHS-DF. / A organização da atenção ambulatorial secundária na SESDF.

Secondary Outpatient Care (SOC) is a subject seldom studied in the literature, but of great importance for the strengthening of Primary Health Care (PHC) and the structuring of the Health Care Network. After the increase of PHC coverage following the Family Health Strategy (FHS) model, through the "CONVERTE APS" project, the State Health Secretariat of the Federal District (SHS-DF) identified the need to organize this level of care throughout the Federal District. SHS-DF has, as its Health Care Planning basis, the knowledge experienced in one of its regions, in addition to the theoretical framework produced and systematized by the National Council of Health Secretariats (CONASS) in recent years, as well as successful experiences in other regions of Brazil and countries with public health systems. The strategies to be used include the following: diagnosis and organization of facility structures, creation of a regional managerial level for Secondary Care, personnel sizing, development of the legal framework for level of care regulation, creation of technical milestones, regulation of medical and non-medical consultations in health regions and matrix support as an education strategy, but also of connection between levels of care.

A Atenção Ambulatorial Secundária (AASE) é um tema pouco estudado na literatura, porém de grande importância no fortalecimento da APS e na estruturação da Rede de Atenção à Saúde. Após a ampliação de cobertura da APS no modelo de eSF, por meio do CONVERTE APS, a SESDF, identificou-se a necessidade de organização deste nível de atenção em todo o Distrito Federal. Assim, tem como laboratório a experiência de Planificação da Atenção à Saúde vivenciada em uma de suas regiões, além de todo arcabouço teórico produzido e sistematizado pelo CONASS nos últimos anos, assim como experiências positivas em outras regiões do Brasil e de países com sistemas públicos de saúde. Para isso tem-se como estratégias o diagnóstico e a organização das estruturas físicas, criação de nível gestor regional da Atenção Secundária, dimensionamento de pessoal, desenvolvimento de marco legal para regulamentação do nível de atenção, criação de marcos técnicos, regulação das consultas médicas e não médicas nas regiões de saúde e o matriciamento como estratégia educação, mas também de vinculação entre os níveis de atenção.

Dental Status and Treatment Needs of Children in Foster Care.

Purpose: This study compared the dental status and treatment needs of children in foster care with other children enrolled in Florida Medicaid. Methods: The study was a retrospective dental records review of patients who were associated with a foster care agency and an age-matched group of other Medicaid recipients in 2016. Results: We abstracted the electronic dental records of 548 two- to 18-year-olds in foster care and an age-matched group of 548 Medicaid-enrolled children not in foster care. Compared with other Medicaid-enrolled children, those in foster care were more likely to have experienced dental caries overall (75.7 percent versus 58.8 percent; P<.0001), in the permanent dentition (63.6 percent versus 45.1 percent; P<.0001), and in the primary dentition (32.7 percent versus 18.8 percent; P<.0001). Children in foster care had 1.6 times greater prevalence of pulpitis, 1.4 times as many root canal treatments, 5.8 times more diagnoses of severe gingivitis, 3.5 times more diagnoses of periodontitis, and 1.3 times more treatment-planned extractions. Conclusions: Children in foster care had more dental needs, higher caries prevalence, and received more dental care than other Medicaid-enrolled children. Poor oral health status is a public health concern for children in the foster care system. (Pediatr Dent 2019;41(3):206-10) Received December 18, 2018 | Last Revision March 12, 2019 | Accepted March 14, 2019.

A organização da atenção ambulatorial secundária na SESDF / The Organization of Secondary Outpatient Care at SHS-DF

Resumo A Atenção Ambulatorial Secundária (AASE) é um tema pouco estudado na literatura, porém de grande importância no fortalecimento da APS e na estruturação da Rede de Atenção à Saúde. Após a ampliação de cobertura da APS no modelo de eSF, por meio do CONVERTE APS, a SESDF, identificou-se a necessidade de organização deste nível de atenção em todo o Distrito Federal. Assim, tem como laboratório a experiência de Planificação da Atenção à Saúde vivenciada em uma de suas regiões, além de todo arcabouço teórico produzido e sistematizado pelo CONASS nos últimos anos, assim como experiências positivas em outras regiões do Brasil e de países com sistemas públicos de saúde. Para isso tem-se como estratégias o diagnóstico e a organização das estruturas físicas, criação de nível gestor regional da Atenção Secundária, dimensionamento de pessoal, desenvolvimento de marco legal para regulamentação do nível de atenção, criação de marcos técnicos, regulação das consultas médicas e não médicas nas regiões de saúde e o matriciamento como estratégia educação, mas também de vinculação entre os níveis de atenção.

Abstract Secondary Outpatient Care (SOC) is a subject seldom studied in the literature, but of great importance for the strengthening of Primary Health Care (PHC) and the structuring of the Health Care Network. After the increase of PHC coverage following the Family Health Strategy (FHS) model, through the "CONVERTE APS" project, the State Health Secretariat of the Federal District (SHS-DF) identified the need to organize this level of care throughout the Federal District. SHS-DF has, as its Health Care Planning basis, the knowledge experienced in one of its regions, in addition to the theoretical framework produced and systematized by the National Council of Health Secretariats (CONASS) in recent years, as well as successful experiences in other regions of Brazil and countries with public health systems. The strategies to be used include the following: diagnosis and organization of facility structures, creation of a regional managerial level for Secondary Care, personnel sizing, development of the legal framework for level of care regulation, creation of technical milestones, regulation of medical and non-medical consultations in health regions and matrix support as an education strategy, but also of connection between levels of care.

Radiografia das transferências federais para municípios por meio do bloco de gestão do Fundo Nacional de Saúde (2013-2016)

Este estudo - de caráter descritivo - procurou investigar o perfil das transferências federais por meio do bloco de gestão do Fundo Nacional de Saúde (FNS). A análise foi elaborada para todos os municípios brasileiros, no nível dos dois componentes do bloco de gestão do FNS e também no nível mais desagregado: ação/estratégia/serviço. Contemplou 2013 a 2016, correspondente ao mandato dos prefeitos eleitos em 2012. Foi efetuada também uma breve análise de indicadores relacionados a capacidades administrativas e fiscais dos municípios para 2014. A análise do bloco de gestão do FNS em seus subníveis indica que, dentre as ações previstas, há grande número daquelas relacionadas à atenção psicossocial. Entretanto, a ação que se mostrou mais espalhada geograficamente foi o Programa de Financiamento das Ações de Alimentação e Nutrição. Quanto às outras ações apoiadas, para muitas delas há reduzido contingente de municípios beneficiados e/ou valores pouco expressivos. A análise espacial indicou que não há uma concentração, das transferências desse bloco, em municípios de regiões mais ricas. Pelo contrário, vários municípios da região Norte e de um dos estados mais pobres do Brasil, o Maranhão, obtiveram repasses por meio do bloco. Esse espalhamento geográfico se dá em maior grau por conta do componente de implantação de ações e serviços de saúde, mais do que por meio do componente de Qualificação da Gestão do Sistema Único de Saúde (SUS).

User Assessment of "InsuOnLine," a Game to Fight Clinical Inertia in Diabetes: A Pilot Study.

OBJECTIVE: We performed a pilot study to assess usability and playability of "InsuOnLine," a serious game for education of primary care physicians on insulin therapy for diabetes mellitus. MATERIALS AND METHODS: A multidisciplinary team has designed and developed "InsuOnLine," using Andragogy and Problem-Based Learning principles, with game elements to improve players' motivation. The prototype was tested by four medical doctors and two medical students, using the System Usability Scale (SUS) and a questionnaire to assess playability. These results were used to guide corrections, after which the beta version was retested by 14 medical students and 6 residents. RESULTS: Out of a maximum score of 100 on the SUS, the "InsuOnLine" prototype was rated 88, and some areas for improvement were identified (game instructions, controls). After corrections, the beta version was rated 92.5 on the SUS. Users have found the beta version to be fun, engaging, challenging, relevant, and realistic. Users said that the game has increased their knowledge on diabetes and insulin, that it has made them feel more confident for prescribing insulin, and that it would have impact on how they treated patients with diabetes. Most users said they have learned more from the game than they would have from a lecture. Lessons learned were the need of early piloting, preferably by users with very little or very much gaming experience, on their own computers and free patterns of use. CONCLUSIONS: "InsuOnLine" was rated by users as easy to play, fun, and useful for learning. Further studies will assess its educational effectiveness. "InsuOnLine" is a promising tool for large-scale continuing medical education on insulin, helping to fight clinical inertia in diabetes.

Active pharmaceutical ingredients for antiretroviral treatment in low- and middle-income countries: a survey.

Active pharmaceutical ingredients (APIs) are the molecular entities that exert the therapeutic effects of medicines. This article provides an overview of the major APIs that are entered into antiretroviral therapy (ART), outlines how APIs are manufactured, and examines the regulatory and cost frameworks of manufacturing ART APIs used in low- and middle-income countries (LMICs). Almost all APIs for ART are prepared by chemical synthesis. Roughly 15 APIs account for essentially all of the ARTs used in LMICs. Nearly all of the ART APIs purchased through the Global Fund for AIDS, TB and Malaria (GFATM) or the United States President's Emergency Plan for AIDS Relief (PEPFAR) are produced by generic companies. API costs are very important because they are the largest contribution to the overall cost of ART. Efficient API production requires substantial investment in chemical manufacturing technologies and the ready availability of raw materials and energy at competitive prices. Generic API production is practiced in only a limited number of countries; the API market for ART is dominated by Indian companies. The quality of these APIs is ensured by manufacturing under good manufacturing practice (GMP), including process validation, testing against previously established specifications and the demonstration of clinical bioequivalence. The investment and personnel costs of a quality management system for GMP contribute significantly to the cost of API production. Chinese companies are the major suppliers for many advanced intermediates in API production. Improved chemistry of manufacturing, economies of scale and optimization of procurement have enabled drastic cost reductions for many ART APIs. The available capacity for global production of quality-assured APIs is likely adequate to meet forecasted demand for 2015. The increased use of ART for paediatric treatment, for second-line and salvage therapy, and the introduction of new APIs and combinations are important factors for the future of treatment in LMICs. The introduction of new fixed-dose combinations for ART and use of new drug delivery technologies could plausibly provide robust, durable ART for all patients in need, at an overall cost that is only moderately higher than what is presently being spent.

A publicidade de alimentos e o direito à saúde / Food publicity and right to health

Este trabalho analisa a monitoração e fiscalização da propaganda de produtos sujeitos à vigilância sanitária, um processo influenciado por mudanças sociais e econômicas, pela evolução da ciência e pelo ordenamento jurídico. O artigo mostra como o ordenamento jurídico e seus operadores têm acompanhado as questões relacionadas ao tema, utilizando como diretrizes básicas a proteção efetiva aos direitos primordiais do ser humano como a vida, a integridade física, entre outras. Neste sentido, a produção de normas regulamentadoras neste ramo tem buscado cada vez mais refletir as necessidades da sociedade civil, abrangendo assim os anseios da coletividade.