nÃo hà / Este trabalho tem por finalidade avaliar o comportamento das despesas sociais em relaÃÃo ao crescimento dos indicadores sociais nos municÃpios nordestinos no perÃodo de 1991- 2000. Para tanto, as variÃveis foram agrupadas em trÃs modelos. No primeiro modelo, como variÃvel dependente o IDH-M dos municÃpios foi comparado com os determinantes de despesas sociais, Produto Interno Bruto e orientaÃÃo partidÃria dos municÃpios analisados. No segundo, as variÃveis determinantes foram comparadas ao Ãndice de pobreza. Por Ãltimo, foi verificado o impacto destas variÃveis ao Ãndice GINI de desigualdade. De posse dos dados, foram realizadas estimaÃÃes economÃtrica para os 9 estados do nordeste. Os resultados obtidos mostram que: i) as despesas sociais, em geral, melhoram as condiÃÃes de vida da populaÃÃo; ii) hà uma forte influÃncia das despesas na reduÃÃo da pobreza; iii) os dispÃndios municipais elevam as desigualdades da populaÃÃo. / This work has the objective of evaluating the behavior of social expenses related to the rising of social indicators in northeastern cities in the period between 1991-2000.For that,the variables were put together in 3 different models .In the first model the dependent variable called IDH-M of those cities was compared to social expenses, the intern gross product and the political orientation of the researched cities. In the second one these variables were compared to the poverty index. And for last, it was verified the analysis of those variables to the GINI index of social unevenness. With all the data It was possible to make econometric estimative for the other 9 states of the northeast of Brazil. The obtained results showed that: i: The social expenses improve the life conditions of the population; ii: There is a strong influence of the expenses in the decrease of poverty; iii: The city expenses elevate the social gap.

Universidade Federal do Cearà / As IndÃstrias de PanificaÃÃo constituem-se em um segmento do varejo de alimentos com atuaÃÃo diferenciada, uma vez que agrupam as atividades de indÃstria e comÃrcio. Estas indÃstrias estÃo passando por um intenso processo de transformaÃÃo para adaptarem-se ao mercado globalizado, cada vez mais competitivo. Diante deste cenÃrio, as panificadoras assumiram uma nova postura frente à concorrÃncia, diversificando o mix de produtos, adaptando-se a uma maior flexibilidade dos processos produtivos e investindo em qualidade, higiene e atendimento. Neste contexto, o presente trabalho aborda os aspectos mais relevantes do setor de panificaÃÃo nacional e fornece uma visÃo dos aspectos gerenciais, mercadolÃgicos e econÃmicos da empresa de panificaÃÃo cearense. à abordada, tambÃm, a diferenÃa entre Sistemas, MÃtodos e Formas de custeio, evidenciando as caracterÃsticas fundamentais dos principais mÃtodos de custeio, com destaque para o ABC. Na Ãltima parte do trabalho à apresentado um estudo de caso, abordando uma aplicaÃÃo do mÃtodo de Custeio Baseado em Atividades (ABC), numa empresa de panificaÃÃo cearense, proporcionando um enfoque detalhado das caracterÃsticas do processo de produÃÃo dos produtos da panificaÃÃo, possibilitando uma visÃo clara da conexÃo recursos-atividades-produto e permitindo uma atuaÃÃo dos gestores no sentido de otimizar processos e conseqÃentemente resultados. Demonstrando que a metodologia baseada em atividades (mÃtodo ABC) à uma forte aliada na gestÃo da entidade. / The bakery industries consist in a food segment with differentiated performance, a time that the industry and commerce activities are grouped. These industries are passing for an intense process of transformation in order to adapt themselves to the global market, which is more competitive each day. Ahead of this scene, the bakery industries had assumed a new position front to the competition, diversifying mix of products, adapting themselves to a bigger flexibility of the productive processes and investing in quality, hygiene and attendance. In this context, this work presents the most important aspects of the bakery national sector , and supplies a vision of the managemental, marketing and economic aspects of the bakery companies in CearÃ. It is also demonstrated the difference between Systems, Methods and Forms of expenditure, evidencing the basic characteristics of the main studied and used methods of expenditure world-wide, with prominence for the ABC. In the last part of the work it is presented a case study, approaching a simulation of the method of Activities Based in Coast (ABC), in a bakery company in Cearà , evidencing a detailed vision of the process characteristics of the bakery production , making possible a clear vision of the connection resource-activity-product and allowing a performance of the managers in order to optimize processes and its results. It demonstrates that the activities based on coast (ABC method) is very important to the company management.

O presente trabalho tem por objetivo avaliar como os gastos pÃblicos no Ãmbito dos municÃpios cearenses afetam a variaÃÃo do Ãndice de Desenvolvimento Humano â IDH. à iniciado com uma discussÃo sobre desenvolvimento humano, bem-estar e a sua mensuraÃÃo. Faz-se uma explanaÃÃo sobre polÃticas de combate à pobreza no Brasil e no CearÃ, discutindo-se o efeito da polÃtica de gastos pÃblicos sobre indicadores de bem-estar. Um modelo economÃtrico à desenvolvido e estimado para se examinar o impacto dos gastos pÃblicos sobre o IDH. A principal conclusÃo desse trabalho à que os gastos totais (e gastos correntes) per capita pouco influenciam o IDH, enquanto que os gastos destinados à EducaÃÃo e HabitaÃÃo impactam positivamente o IDH dos municÃpios cearenses. Esse resultado fornece subsÃdios para o Gestor PÃblico e aos cidadÃos no sentido da definiÃÃo das polÃticas pÃblicas que determinam o direcionamento dos gastos nos municÃpios. / This research examines the impact of the public expenditure on the Human Development Index â HDI of municipalities in Ceara State. This study discusses the concepts and quantitative ways of measuring human development and welfare. It also presents an overview of the impact of the poverty eradication policies on welfare at the national level and also in Ceara State. It is developed and estimated an econometric model to assess how public expenditure impacts the HDI. The main conclusion of this study is that total expenditure has only a weakly influence on the IDH, while public expenditures on education and housing have a positive and statistically significant impact on the HDI. This finding has important policy implication since it may help policymakers to design and implement public policies.

O desenvolvimento de adipócitos termogênicos/bege no tecido adiposo branco (TAB) pode reduzir os efeitos adversos da obesidade e melhorar a saúde metabólica. Certos agentes farmacológicos e nutricionais podem promover esses efeitos ativando fatores de transcrição ou vias regulatórias, promovendo o browning do TAB. Como suplemento nutricional ou dietético, os compostos presentes no chá verde (CV) têm demonstrado fortes correlações entre o metabolismo energético e a perda de peso corporal (PC), no entanto, sua potencial contribuição para o desenvolvimento de células termogênicas/bege foram fracamente investigadas. O objetivo principal deste estudo foi avaliar a relação entre as alterações metabólicas induzidas por uma dieta obesogênica e a indução de células termogênicas/bege em camundongos obesos tratados com CV. Além disso, foi avaliado o efeito de uma mistura contendo as principais catequinas do CV (EGCG (2 <font face = \"symbol\">mM), EGC (1 <font face = \"symbol\">mM), ECG (0,6 <font face = \"symbol\">mM) e EC (0,4 <font face = \"symbol\">mM)) (Sigma) em uma concentração final de 4 <font face = \"symbol\">mM e o extrato de CV a 0,19% na indução de fenótipo bege in vitro (pré-adipócitos 3T3-F442A). Nós demonstramos que os camundongos induzidos à obesidade (dieta de cafeteria/16 semanas) e tratados com CV (500 mg/kg de PC) durante 12 semanas mostraram uma redução significativa nos indicadores de obesidade, ganho de peso, depósitos de gordura, hiperlipidemia e incremento nos níveis plasmáticos de adiponectina sem alteração na ingestão alimentar. A taxa metabólica basal foi aumentada, assim como, os genes envolvidos na oxidação de AG, termogênese e marcadores de células bege no TA subcutâneo de animais obesos tratados com CV. O CV também diminuiu a inflamação e o estresse de retículo endoplasmático induzido pela dieta e a resistência à insulina (RI). Nós também sugerimos pela primeira vez que o tratamento com CV induz um ciclo fútil que envolve a de novo lipogênese para ativação da via termogênica in vivo e in vitro. A mistura de catequinas e o extrato de CV demonstraram redução significativa no acúmulo de lipídios, além de induzir a expressão de marcadores termogênicos relacionados à oxidação de AG e ativação mitocondrial, bem como o consumo de oxigênio. O efeito termogênico do CV e do mix de catequinas ocorre de maneira autônoma e dependente da modulação temporal de fatores adipogênicos como o PPAR<font face = \"symbol\">g. Nosso estudo identificou que as alterações metabólicas promovidas pela ingestão de CV induzem o gasto energético e comprometem o destino final da célula adiposa, ainda em etapas iniciais do processo de adipogênese, com modulações que envolvem a via do PPAR<font face = \"symbol\">g, associado à ativação de um ciclo fútil e indução do fenótipo bege. Essas alterações culminam em uma estratégia terapêutica eficiente de combate à obesidade e suas co-morbidades. / The development of thermogenic/beige adipocytes in white adipose tissue (WAT) might reduce the adverse effects of obesity and could help to improve metabolic health. Certain pharmacological and nutritional agents can promote those effects by activating transcription factors or regulatory signaling pathways furthering WAT browning. As a nutritional or dietary supplement, compounds present in green tea (GT) has demonstrated remarkable correlations between energy metabolism and body weight (BW) loss, however, their potential contributions to the development of thermogenic/beige cells have been scarcely investigated. The aims of this study were to evaluate the relationship between metabolic alterations induced by an obesogenic diet and the induction of thermogenic/beige cells in GT-treated obese mice. We also evaluated the effect of a mix containing the main catechins found in GT (EGCG (2<font face = \"symbol\">mM), EGC (1<font face = \"symbol\">mM), ECG (0.6<font face = \"symbol\">mM) and EC (0.4<font face = \"symbol\">mM)) (Sigma) in a final concentration of 4<font face = \"symbol\">mM and a GT extract at 0.19%.in the induction of beige phenotype in vitro (3T3-F442A preadipocytes). Here, we show that obese-induced mice (cafeteria diet/16 weeks) that were treated with GT (500 mg/kg of BW) for 12 weeks showed a significant reduction in indicators of obesity such as BW gain, fat depots, hyperlipidemia and an increment in plasma adiponectin levels without alteration in food intake. The basal metabolic rate was increased as well as genes involved in FA oxidation, thermogenesis and beige cells markers in the subcutaneous AT of obese animals treated with GT. GT also decreased inflammation and endoplasmic reticulum stress induced by the diet and relief insulin resistance (IR). We also find that our treatment was able to induce a futile cycle through de novo lipogenesis to activate the thermogenic pathway in vivo and in vitro. The mix of catechins or the GT showed significant reduction of lipid accumulation and upregulated the expression of thermogenic markers related to FA oxidation and mitochondrial activation, as well as, oxygen consumption. The effects of GT and the mix of catechins occur in an autonomous manner and seems to be dependent on initial mechanism in adipogenesis through PPAR<font face = \"symbol\">g participation. Our study identified that the metabolic alterations caused by GT ingestion induce energetic expenditure and compromise the final commitment of adipose cell, still in the initial stages of the adipogenesis process, with modulations involving the PPAR<font face = \"symbol\">g pathway, associated to the activation of the futile cycle and induction of beige phenotype. These alterations culminate in an effective therapeutic strategy to combat obesity and its comorbidities.

Adolescência é o período de transição entre a infância e a vida adulta, caracterizado pelos impulsos do desenvolvimento físico, mental, emocional, sexual e social. Essa faixa etária, ao longo dos anos tem apresentado aumento da prevalência de sobrepeso e obesidade e danos e agravos à saúde provocados pelas comorbidades associadas. Os fatores que contribuem para esse processo são a alimentação e a inatividade física, portanto conhecer e saber escolher o melhor método para avaliar gasto energético basal e total, atividade física e a composição corporal dessa população ajuda os profissionais da saúde a trilharem soluções mais promissoras para o combate da obesidade e a formação de adultos mais saudáveis. O objetivo principal do presente estudo foi avaliar Gasto Energético e fatores diretamente relacionados como Consumo Alimentar e Padrão de Atividade Física em Adolescentes Obesos e Eutróficos. Foram estudados 86 adolescentes obesos e eutróficos de idade de 11 a 14 anos de ambos os sexos de escolas públicas e particulares de Ribeirão Preto. Foi avaliada a atividade física por meio do acelerômetro tri-axial, a composição corporal por absorcimetria de raio X de dupla energia, bioimpedância elétrica e óxido de deutério e gasto energético basal por calorimetria indireta e gasto energético total por água duplamente marcada. Os dados foram analisados pelo teste de normalidade Kolmogorov Smirnov, teste Anova com pós teste de Tukey e comparações por método Bland-Altman. O peso muscular pelo DXA de adolescentes obesos foi maior do que em adolescentes eutróficos. Houve diferença estatística entre obesos e eutróficos nas variáveis MMkg, MM%, MGkg e MG%. Analisando a composição corporal por BIA e OD podemos ver que a BIA superestima os resultados. Quanto ao gasto energético, não houve diferença estatística entre os grupo em relação ao GEB e GET, para o GET ser maior independe da atividade física em número de passos no dia, pois o GEB em X obesos (meninos e meninas) é maior quando comparado com eutróficos. O nível de atividade física dos adolescentes se mostrou semelhante entre os obesos e eutróficos, apesar dos obesos darem muito menos passos ao longo do dia. Em nosso estudo todas as variáveis foram diferentes entre os grupos. Foi constatado que os adolescentes obesos apresentam maior GEB por terem maior massa muscular, o que já eleva o GET, apesar de apresentarem AF menos intensa que os eutróficos, confirmando nossa hipótese inicial. / Adolescence is the transitional period between childhood and adulthood, characterized by the impulses of the physical, mental, emotional, sexual and social development. This age group, all over the years, has shown increasing prevalence of overweight and obesity, damage and health problems caused by associated comorbidities. Factors that contribute to this process are the diet and physical inactivity, so knowing how to choose the best method to assess basal and total energy expenditure, physical activity and body composition of this population helps health professionals to find the best solutions to deal with obesity and how to guide their patients on how to become healthier adults. The main objective of this study was to evaluate Energy Expenditure and directly related factors such as Food Consumption and Physical Activity in Adolescents Obese and Eutrophic. We studied 86 adolescents aged between 11 and 14 years of both genders, obese and non-obese, from public and private schools in Ribeirão Preto. Physical Activity was evaluate by tri-axial accelerometer, body composition by dual-energy X-ray absorptiometry, electric bioimpedance and deuterium oxide, and basal energy expenditure was evaluate by indirect calorimetry and total energy expenditure by doubly labeled water. Data was analysed by Kolmogorov Smirnov to check normality, Anova with post test Tukey and comparisons by Bland-Altman method. The muscle weight by DXA of obese adolescents was higher than in normal weight adolescents. There was statistical difference between obese and normal weight in MMkg variables, MM % BFkg and BF %. Analyzing body composition by BIA and OD we can see that the BIA overestimates the results. In relation to the energy expenditure, there was no statistical difference between the groups in relation to the REE and TEE to the TEE be most independent of physical activity in number of steps in the day, because the REE in obese (boys and girls) is higher as compared with eutrophic. XII The level of physical activity in adolescents was similar between the obese ones and normal weight ones, while obese ones had much less steps throughout the day. In our study all the variables were different between the grupos. We found that obese adolescents have higher REE because they have more muscle mass, which already raises the TEE, despite having less intense physical activity that eutrophic adolescents, confirming our initial hypothesis.

O total de gasto social do governo somou cerca de R$800 bilhões em 2009, quase 25% do PIB brasileiro. Dado este volume crescente e expressivo, esta dissertação apresenta uma análise do efeito do gasto social sobre a pobreza no Brasil das três instâncias de governo: federal, estadual e municipal. Para tanto, foram estimados três modelos com dados em painel de 20 anos (1987 a 2009) analisando os gastos estaduais e federais. Adicionalmente, estimou-se o efeito da despesa municipal utilizando dados de 1991, 2000 e 2010 para 5.058 municípios. Procurou-se tratar o viés de simultaneidade entre o gasto do governo e a pobreza aplicando-se o modelo de mínimos quadrados em dois estágios, utilizando variáveis de ideologia política como instrumento. Os resultados mostraram que o gasto das três instâncias de governo tem efeito sobre a queda da pobreza no Brasil. Particularmente, as funções orçamentárias de gasto que apresentaram maior efetividade sobre a queda da pobreza foram: gasto federal e municipal com saúde e saneamento e gastos agregados estaduais e municipais. Analisou-se também o efeito da interação do gasto estadual com dados das condições iniciais de cada estado em 1980 - renda familiar per capita, desigualdade, proporção de pobres, grau de educação e mortalidade infantil. Concluiu-se que tanto as condições iniciais de cada estado como suas características específicas influenciam o grau em que o seu gasto afeta a pobreza. / The total public social spending in Brazil reached about R$800 billion in 2009, almost 25% of Brazilian GDP. Giving this increasing and expressive volume, this dissertation analyzes the effect of the three levels of government social spending on poverty in Brazil - federal, state and municipal. Three models were estimated with a 20 year\'s state panel data (1987 to 2009) analyzing the federal and state spending effect. We also estimated the municipal expenditure effect on poverty using data from 1991, 2000 and 2010 in 5.058 municipalities. The simultaneity bias between government spending and poverty was treated by applying the two stages least squares method, using the political ideology as instrumental variables. The results showed that the spending of the three levels of government reduce poverty in Brazil. Particularly, the spending budget functions with higher effectiveness on reduce poverty are: federal and municipal spending on health and sanitation, state and local aggregated spending. In addition, we also analyzed the effect of the state spending data interacting with its initial conditions in 1980 - per capita income, inequality, poverty, level of education and infant mortality. We concluded that the states initial conditions as well as its specific characteristics influence the extent to which their spending affects poverty.

This study measured total daily energy expenditure (TDEE) in adults at least 50 years of age. The goal was to determine the effect of the estimate of resting metabolic rate (RMR) on the relationship between energy expenditure estimates made using (a) self-reports of physical activity and (b) food intake records. The objectives were to determine if (a) RMR estimates based on body composition, body weight, and the 111 metabolic cart were strongly related to each other, and (b) TDEE estimates based on a 7- day physical activity diary and a 7-day food intake record were more strongly related to each other when an RMR was used that was based on body composition, body weight, or the met cart. This was a three-phase study. In phases I and II, the Pearson r was computed for all combinations of methods . If r > .80, the most practical method for field use was used in the next phase. Phase I: Estimated body composition using bioimpedance (BIA), skinfold (SKF), and girth. Phase II: Measured RMR using a met cart and three equations. Phase III: Computed TDEE using the self-reports. The Pearson r was computed to determine which methods of estimating RMR resulted in the strongest relationships. Forty-four older adults participated. Phase I: r = .88 for SKF, girth; r = .64 for SKF, BIA. Phase II: rs ranged from .47 to .59 between the met cart-RMR and all the other methods; rs ranged from .84 to .98 for the remaining methods. Phase III: r = .41 between the two estimates of TDEE that used a body weight -RMR; r = .59 between estimates using a met cart-RMR; and r = .58 between estimates using a body composition-RMR. Even though r = .59 and r = .58 are similar, the average individual difference between the two estimates for each participant was smaller for the metabolic cart- RMR (372 calories /day) than for the body composition-RMR (1,045 calories /day), which suggests that body composition is not as useful as a met cart when estimating TDEE for older adults . When estimating clients' daily calorie needs, health professionals ought to consider using a met cart to estimate RMR and TDEE instead of other methods .

The Bermuda health care system involves predominately private insurance based coverage. With private premiums, healthcare costs continually increase. Additionally, the Public Health System financing for those disproportionately affected by the high costs offer little support. The study examines the impact of a government subsidized health care policy implemented in 2009 on the health outcomes of the population. Specifically, the policy targets senior citizens aged 65 and older who often face disadvantaged costs in meeting the needs of their health. Chappell and Penning (1996) demonstrate the role of economic factors as a significant influence on health service utilizations. Using evidence from Chappell and Penning, the study provides a fixed effect regression analysis on health conditions before and after implementation of the program. Results reveal that senior citizens are significantly more likely to report having better health after the policy was implemented. Findings imply that increased government subsidized programs, such as FutureCare, have a significantly beneficial impact on the welfare of individuals in Bermuda.

The free-roaming ruminant requires energy for the demands of vii grazing, traveling and thermoregulation that are not required by its confined counterpart. Literature estimates of these additional costs range from 10 to 170 percent above maintenance. The uncertain magnitude of this increased demand and the factors that contribute to it impede the ability of the rangeland ruminant nutritionist to establish guidelines for the energy requirements of the free-roaming herbivore. This study was designed to estimate the energy expenditure of yearling Angus heifers while grazing a declining supply of available crested wheatgrass forage (Agropyron cristatum) on rangeland in west-central Utah. Free-ranging energy expenditure was estimated twice for four heifers during each of five ten-day periods during June, July August and early September, 1979. These estimates were obtained using the carbon dioxide entry rate technique. In addition, total fecal output, dietary crude protein and dietary in vitro organic matter digestibility were estimated for animals grazing the 20- hectare crested wheatgrass pasture. From these data, daily forage intake was calculated. The level of available forage during each period was estimated using the ocular weight-estimate technique applied on forty 1 m2 circular plots. Energy expenditure was estimated as 161 (with a confidence interval of ±43) kcal·kg body weight-.75.d-1 (n=10), and was independent of the decline in available forage from 880 to 284 kg dry matter·hectare-1 that occurred over the course of the grazing season. Daily intake was 54.5 grams (organic matter basis) per unit body weight.75 for the 305 kg heifers. Daily intake was independent of the supply of available forage. During early July, 1980, crested wheatgrass was harvested as hay and fed to 260 kg yearling Angus heifers in metabolism stalls in a thermoneutral and constantly illuminated laboratory. Daily feeding levels were set at 54.5 grams (organic matter basis) per unit body weight.75. Energy expenditure under these conditions was estimated as 111 (±12) kcal·kg body weight-.75·day-1 , 6 kcal per unit body weight.75 greater than the mean estimate of the fasting metabolism rate. The latter estimate was obtained following a 48-hour fast. These estimates of maintenance and fasting metabolism were combined to provide a mean estimate of 110 (±10) kcal·kg body weight-.75·day-1 (n=14). Of the 45 percent (51 kcal·kg body weight-.75·day-1) increase in the estimated energy expenditures by heifers under free-roaming conditions, 50 percent was attributed to the energetic cost of grazing. A daily average 9.2 hours were spent in this activity. The energetic cost of grazing was assumed as 0.82 kcal·kg body weight-1·hour-1 spent grazing. Daily travel was estimated as 3.9 km at an assumed energetic cost of 0.58 kcal·kg body weight-1·km-1. This accounted for a 20 percent estimated increase in energy expenditure. Average daily temperatures were generally between 12°C and 30°C and thermoregulatory demands were not considered as a substantial energetic expense. The remaining 30 percent (12 kcal) of the additional increment due to free-roaming conditions could not be explained.

The objective of this study is to compare the caloric expenditure and oxidative sources of underwater treadmill running and land-based treadmill running at maximal and submaximal levels. Underwater running has emerged as a low load bearing form of supplementary training for cardiovascular fitness, as a way to promote recovery from strenuous exercise while maintaining aerobic fitness, and as a way to prevent injury. Prior studies have reported conflicting results as to whether underwater treadmill running elicits similar cardiorespiratory responses to land-based running. It is important to further investigate the similarities and differences between the two to determine if underwater running is as efficient as land-based running for maintenance of fitness and for rehabilitative purposes. Purpose: To compare the caloric expenditure and oxidative sources of underwater treadmill running and land treadmill running during both maximal treadmill trials to exhaustion and during 30 minute submaximal treadmill trials. Methods: 11 volunteer experienced male triathletes, ages 18-45 were recruited as participants. Each completed 6 trials total which included a maximal and submaximal oxygen consumption trial for each of three conditions: running on a water treadmill with AQx® water running shoes, running on a water treadmill without shoes, and running on a land-based treadmill. Data analysis: Data was analyzed using repeated measures ANOVAs, paired t-tests, pairwise comparisons with bonferroni adjustments, and descriptive statistics were reported. Results: For maximal oxygen consumption trials VO2, RPE, RER, and BP were not significantly different between modalities. Maximal HR was found to be significantly different between modalities, and was shown to be greater on land than in the water. For submaximal VO2, trials HR, RPE, RER, and post BP were not found to be significantly different between modalities. Average VO2, total calories expended, and pre systolic BP were found to be significantly different, and were shown to be greater on land than in water. Conclusions: While maximal exertion running on underwater treadmills seems to elicit similar cardiorespiratory responses to running on land-based treadmills, differences were seen at submaximal exertion levels. It remains unclear whether underwater treadmill running can elicit similar training stimuli as land running at submaximal levels.