What's on trial? The making of field experiments in international development.

In the last 20 years, the drive for evidence-based policymaking has been coupled with a concurrent push for the use of randomized controlled trials (RCTs) as the "gold-standard" for generating rigorous evidence on whether or not development interventions work. Drawing on content analysis of 63 development RCTs and 4 years of participant observation, I provide a rich description of the diverse set of actors and the transnational organizational effort required to implement development RCTs and maintain their "scientific status." Particularly, I investigate the boundary work that proponents of RCTs-also known as randomistas-do to differentiate the purposes and merits of testing development projects from doing them, as a way to bypass the political and ethical problems presented by adopting the experimental method with foreign aid beneficiaries in poor countries. Although randomistas have been mostly successful in differentiating RCTs from the projects evaluated, I also examine cases where they were not able to do so, as a means to highlight the controversies associated with implementing RCTs in international development.

Revisão Rápida para informar a Política Nacional de Medicamentos Biológicos no SUS / Rapid review to inform the National Policy on Biological Medicines in SUS

Contexto: O gasto elevado com medicamentos biológicos ameaça a sustentabilidade dos serviços de saúde. O objetivo da presente revisão rápida foi embasar a discussão da Política Nacional de Medicamentos Biológicos no âmbito do Sistema Único de Saúde (SUS), por meio da identificação de barreiras de acesso a esses medicamentos. Metodologia: Revisão rápida da literatura nas fontes de informação Medline via PubMed, EMBASE, Biblioteca Cochrane e Center for Review and Dissemination (CRD). Resultados: Foram incluídos nove estudos com delineamento transversal. No contexto do usuário, as barreiras foram a falta de conhecimento sobre o medicamento, a distância entre a moradia e o serviço de saúde, os longos períodos de espera por atendimento e a passividade sobre decisão de tratamento.

Effectiveness of whitening mouthwashes on tooth color: an in vitro study.

Products for tooth whitening (or tooth color maintenance) that improve smile esthetics have become increasingly popular due to their easy accessibility and low cost. This in vitro study assessed the effect of whitening mouthwash on bovine tooth color. Forty-eight bovine teeth were divided into 3 immersion groups: SL, artificial saliva (control); CLW, Colgate Luminous White; and OBW, Oral-B 3D White. After prophylaxis with pumice, the initial color was measured using the CIE L*a*b* system. Teeth were immersed in the solutions for 2 minutes, 3 times per day, for 30 days. Changes in color (ΔE*, ΔL*, Δa*, and Δb*) were measured at days 14 and 30. Data were analyzed with 2-way analysis of variance and Tukey test (P < 0.05). At day 30, values of ΔE* had significantly decreased in group SL and increased in group OBW; in addition, at day 30, the ΔE*values in group CLW were significantly greater than those in group SL. The ΔL* values for groups SL and OBW significantly decreased from day 14 to day 30. At day 30, the Δa* and Δb* values were lower in all 3 groups. The results showed that the whitening mouthwashes did not improve color after 14 and 30 days.

Orbinia (Polychaeta: Orbiniidae) from the Brazilian coast: two new species and two new records.

Representatives of the Family Orbiniidae are very common in marine sediments and are found in both shallow and deep waters. Currently, 26 species and 10 genera have been recorded along the Brazilian coast. The specimens examined in this study were collected at depths ranging from 25 to 400 m in the Campos Basin (20-24ºS; 39-42ºW), Rio de Janeiro, in the summer and winter of 2008 and 2009. We describe two new species, Orbinia sagitta n. sp. and Orbinia camposiensis n. sp., and record the occurrences of Orbinia johnsoni (Moore, 1909), which was originally described in California, and Orbinia oligopapillata (López, Cladera & San Martin, 2006), which was previously described from the Pacific coasts of Panama. We provide a key for all the species of Orbinia recorded in the Campos Basin.

Inteligência avaliativa em rede: construindo consenso em Avaliação de Tecnologias em Saúde / /Assessment intelligence network: consensus building in Health Technology Assessment / /Redes de inteligencia evaluativa: la construcción de un consenso sobre laEvaluación de Tecnologías en Salud

A Avaliação de Tecnologias em Saúde (ATS) é um campo multidisciplinar de estudo, que busca analisar as implicações clínicas, sociais, éticas e econômicas do desenvolvimento, difusão e uso da tecnologia em saúde. O processo de definição de diretrizes metodológicas em ATS exige a construção de consenso entre um amplo conjunto de experts e tomadores de decisão na elaboração de um documento com robustez científica. No Brasil, a partir de 2008 com a criação da Rede Brasileira de Avaliação de Tecnologias em Saúde(REBRATS), a elaboração de diretrizes em ATS passou a ser realizada por meio de um processo colaborativo no âmbito da rede. Este processo tem contribuído não apenas para a padronização metodológica em ATS, mas também para a estruturação da inteligência avaliativa em rede no Brasil. Este artigo tem por objetivo discutir a estrutura e a dinâmica desta inteligência avaliativa, bem com sua evolução ao longo do tempo...

Health Technology Assessment (HTA) is a multidisciplinary field of study that seeks to analyze healthtechnologies development, diffusion and use and their clinical, social, economic and ethical implications.The defining process of HTA methodological guidelines requires consensus building among a broad range ofexperts and decision makers in the elaboration of a scientific robust document. In Brazil, since the creationof the Brazilian Network for Health Technology Assessment (REBRATS) in 2008, the elaboration of HTAguidelines has been performed through a collaborative process between network members. This processhas contributed not only to the HTA methodological standardization, but also to structure an assessmentintelligence network in Brazil. This article aims to discuss the structure and dynamics of this evaluativeintelligence and how it has improved over time...

La Evaluación de Tecnologías (HTA) es un campo multidisciplinar de estudio que busca analizar lascaracterísticas clínicas, el desarrollo social, ético y económico, la difusión y el uso de la tecnología en la salud.El proceso de definición de directrices metodológicas en ATS requiere el consenso entre una amplia gamade expertos y tomadores de decisiones en la elaboración de un documento con solidez científica. En Brasil,a partir de 2008 con la creación de la Red Brasileña de Evaluación de Tecnologías Sanitarias (REBRATS)la elaboración de directrices sobre ATS ahora se lleva a cabo a través de un proceso de colaboración dentrode la red. Este proceso ha contribuido no sólo a la estandarización metodológica en ATS, sino también aestructurar la red de inteligencia evaluativa en Brasil. Este artículo tiene como objetivo discutir la estructuray dinámica de esta inteligencia de evaluación, así como su evolución en el tiempo...

Transcriptomic basis for an antiserum against Micrurus corallinus (coral snake) venom.

BACKGROUND: Micrurus corallinus (coral snake) is a tropical forest snake belonging to the family Elapidae. Its venom shows a high neurotoxicity associated with pre- and post-synaptic toxins, causing diaphragm paralysis, which may result in death. In spite of a relatively small incidence of accidents, serum therapy is crucial for those bitten. However, the adequate production of antiserum is hampered by the difficulty in obtaining sufficient amounts of venom from a small snake with demanding breeding conditions. In order to elucidate the molecular basis of this venom and to uncover possible immunogens for an antiserum, we generated expressed sequences tags (ESTs) from its venom glands and analyzed the transcriptomic profile. In addition, their immunogenicity was tested using DNA immunization. RESULTS: A total of 1438 ESTs were generated and grouped into 611 clusters. Toxin transcripts represented 46% of the total ESTs. The two main toxin classes consisted of three-finger toxins (3FTx) (24%) and phospholipases A(2) (PLA(2)s) (15%). However, 8 other classes of toxins were present, including C-type lectins, natriuretic peptide precursors and even high-molecular mass components such as metalloproteases and L-amino acid oxidases. Each class included an assortment of isoforms, some showing evidence of alternative splicing and domain deletions. Five antigenic candidates were selected (four 3FTx and one PLA(2)) and used for a preliminary study of DNA immunization. The immunological response showed that the sera from the immunized animals were able to recognize the recombinant antigens. CONCLUSION: Besides an improvement in our knowledge of the composition of coral snake venoms, which are very poorly known when compared to Old World elapids, the expression profile suggests abundant and diversified components that may be used in future antiserum formulation. As recombinant production of venom antigens frequently fails due to complex disulfide arrangements, DNA immunization may be a viable alternative. In fact, the selected candidates provided an initial evidence of the feasibility of this approach, which is less costly and not dependent on the availability of the venom.

Transcriptomic basis for an antiserum against Micrurus corallinus (coral snake) venom

Micrurus corallinus (coral snake) is a tropical forest snake belonging to the family Elapidae. Its venom shows a high neurotoxicity associated with pre- and post-synaptic toxins, causing diaphragm paralysis, which may result in death. In spite of a relatively small incidence of accidents, serum therapy is crucial for those bitten. However, the adequate production of antiserum is hampered by the difficulty in obtaining sufficient amounts of venom from a small snake with demanding breeding conditions. In order to elucidate the molecular basis of this venom and to uncover possible immunogens for an antiserum, we generated expressed sequences tags (ESTs) from its venom glands and analyzed the transcriptomic profile. In addition, their immunogenicity was tested using DNA immunization. Results: A total of 1438 ESTs were generated and grouped into 611 clusters. Toxin transcripts represented 46% of the total ESTs. The two main toxin classes consisted of three-finger toxins (3FTx) (24%) and phospholipases A2 (PLA2s) (15%). However, 8 other classes of toxins were present, including C-type lectins, natriuretic peptide precursors and even high-molecular mass components such as metalloproteases and L-amino acid oxidases. Each class included an assortment of isoforms, some showing evidence of alternative splicing and domain deletions. Five antigenic candidates were selected (four 3FTx and one PLA2) and used for a preliminary study of DNA immunization.

Bothrops insularis venomics: a proteomic analysis supported by transcriptomic-generated sequence data.

A joint transcriptomic and proteomic approach employing two-dimensional electrophoresis, liquid chromatography and mass spectrometry was carried out to identify peptides and proteins expressed by the venom gland of the snake Bothrops insularis, an endemic species of Queimada Grande Island, Brazil. Four protein families were mainly represented in processed spots, namely metalloproteinase, serine proteinase, phospholipase A(2) and lectin. Other represented families were growth factors, the developmental protein G10, a disintegrin and putative novel bradykinin-potentiating peptides. The enzymes were present in several isoforms. Most of the experimental data agreed with predicted values for isoelectric point and M(r) of proteins found in the transcriptome of the venom gland. The results also support the existence of posttranslational modifications and of proteolytic processing of precursor molecules which could lead to diverse multifunctional proteins. This study provides a preliminary reference map for proteins and peptides present in Bothrops insularis whole venom establishing the basis for comparative studies of other venom proteomes which could help the search for new drugs and the improvement of venom therapeutics. Altogether, our data point to the influence of transcriptional and post-translational events on the final venom composition and stress the need for a multivariate approach to snake venomics studies.

Expressed sequence tags (ESTs) from the salivary glands of the tick Amblyomma cajennense (Acari: Ixodidae).

The neotropical tick Amblyomma cajennense is a significant pest to domestic animals, the most frequently human-biting tick in South America and the main vector of Brazilian spotted fever (caused by Rickettsia rickettsii), a deadly human disease. The purpose of this study is to characterize the adult A. cajennense salivary gland transcriptome by expressed sequence tags (ESTs). We report the analysis of 1754 clones obtained from a cDNA library, which reveal mainly transcripts related to proteins involved in the hemostatic processes, especially proteases and their inhibitors. Remarkably, five types of possible serine protease inhibitors were found, including a molecule with a distinguished structure that contains repeats of the active motif of hirudin inhibitors. Besides, other components that may be active over the host immune system or acting as defensins against infecting microorganisms were also described, including a molecule similar to insect venom allergens. The conjunction of components from this transcriptome suggests a diverse strategy of A. cajennense tick during feeding, but emphasized in the coagulation system.

Saúde do adolescente: atenção integral no plano da utopia / Teen health

No Brasil, em meio ao processo de descentralização dos serviços de saúde, a ação do Programa de Saúde do Adolescente (Prosad) passa a ser questionada pela baixa cobertura alcançada e pela concentração da atenção na demanda espontânea. Como alternativa à proposta do Prosad, aparece a estratégia do Programa de Saúde da Família ao que se atribui a realização de ações junto ao público adolescente, uma vez que a maior parte dos problemas dessa população é resolvida na Atenção Básica. Dessa maneira, o princípio da integralidade se constitui como um elemento crítico a ser considerado no processo de incorporação dessa proposta, levando-se em consideração os diferentes níveis de atenção à saúde. Partindo-se dessa discussão, o objetivo desse estudo foi avaliar a integralidade na atenção à saúde dos adolescentes no Distrito Sanitário III do município de Recife, no contexto do processo de descentralização dos serviços. Foi utilizado o método de avaliação de processos, que tem como finalidade compreender como uma política ou programa é implementada. Esse tipo de avaliação se estrutura, em geral, em análises qualitativas e está mais preocupada com os fluxos do que com os resultados. As modalidades de técnicas utilizadas foram entrevistas semi-estruturadas, observação direta e análise de documentos. A discussão dos dados foi orientada a partir de dois eixos de investigação, a integralidade focalizada e a integralidade ampliada. Como resultados, no primeiro eixo avaliado destaca-se a importância da incorporação de novos saberes nas unidades de saúde da família, a fim de acrescentar a atual composição, basicamente calcada no saber biomédico. Ainda observa-se nessa dimensão que os adolescentes não são grupo prioritário nos serviços assistenciais oferecidos, porém são “beneficiados” com ações de promoção da saúde, como projeto denominado Adolescentes Educadores em Saúde (Aesa) – desenvolvido no Distrito III do município. Em relação à integralidade ampliada, observa-se que a prática da contra-referência não é realizada e no que diz respeito à atenção continuada entre os serviços, percebe-se grande preocupação com as gestantes adolescentes, em detrimento das necessidades outras dos e das adolescentes. Por fim, a relação entre o setor Saúde com outros setores encontra-se pouco sistematizada, necessitando de maior interlocução, a fim de alcançar a atenção integral para esse público