Foi realizado um estudo de farmacocinética da polimixina B em pacientes críticos com desenvolvimento de um modelo populacional. Os critérios de inclusão foram pacientes internados em Unidade de Terapia Intensiva, com idade igual ou superior a 18 anos e em uso de polimixina B intravenosa por um período mínimo de 48 horas. Amostras de sangue, urina e dialisato foram coletadas durante um intervalo de doses no estado de equilíbrio. A concentração de polimixina B no plasma foi medida por meio de cromatografia líquida de alta performance associada à espectrometria de massas acoplada à espectrometria de massas, sua ligação às proteínas plasmáticas foi determinada por meio de diálise de equilíbrio rápido e a fração livre foi calculada. Foram realizadas análise farmacocinética populacional e Simulações de Monte Carlo. Foram incluídos 24 pacientes, dos quais dois estavam em hemodiálise contínua; 54,2% eram do sexo masculino e as medianas da idade, do escore APACHE e do peso corporal total foram de 61,5 anos, 21,5 e 62,5kg, respectivamente. As doses de polimixina B, conforme prescrição do médico assistente, variaram entre 0,45-3,38mg/kg/dia. O clearance estimado da creatinina nos 22 pacientes sem hemodiálise variou entre 10-143mL/min. A mediana da fração livre plasmática da polimixina B foi de 0,42 e a média (± desvio padrão) da fração livre da área sob a curva ao longo de um dia (fAUC0-24h) da polimixina B foi de 29,2±12,0mg•h/L, incluindo os pacientes em hemodiálise. A polimixina B foi excretada predominantemente por vias não renais e as medianas de sua recuperação urinária de forma inalterada foi de 4,04% e do seu clearance renal foi de 0,061L/hora. Nos pacientes 1 e 2 em hemodiálise foram identificados, respectivamente, clearance corporal total de 0,043 e 0,027L/h/kg, clearance da hemodiálise de 0,0052 e 0,0015L/h/kg; no dialisato foram recuperados 12,2% e 5,62% da dose como polimixina B não modificada. O clearance corporal total da polimixina B não mostrou nenhuma relação com o clearance da creatinina, escore APACHE II ou idade. A disposição da polimixina B no tempo foi adequadamente descrita pelo modelo de dois compartimentos com eliminação linear. O modelo farmacocinético populacional proporcionou ajustes excelentes para os perfis observados de concentração-tempo para pacientes individuais e as concentrações individuais e populacionais ajustadas foram precisas. O ajuste dos clearances e dos volumes de distribuição para o peso corporal total reduziu a variabilidade intersujeitos em 3,4% para o clearance e 41,7% para o volume de distribuição central; nos pacientes em diálise, após esse ajuste, os parâmetros estimados se assemelharam aos dos demais pacientes. As Simulações de Monte Carlo foram feitas com seis diferentes regimes de doses clinicamente relevantes escalonados pelo peso corporal total. O regime de doses de 1,5mg/kg 12/12h forneceu uma AUC0-24h de polimixina B no dia 4 de 90.4mg•hora/L para 50% dos pacientes, adequada para erradicação bacteriana em infecções graves por Pseudomonas aeruginosa ou Acinetobacter baumannii com concentração inibitória mínima para a polimixina B ≤2mg/L. Nas Simulações de Monte Carlo também foi possível identificar que uma melhor área sob a curva só foi atingida no dia 4 de tratamento. Este estudo mostrou que a dose de polimixina B intravenosa deve ser ajustada ao peso corporal total, que o melhor regime de doses é o de 1,5mg/kg 12/12h precedido de dose de ataque de 2,5mg/kg e que não há indicação de ajuste para a função renal, mesmo em pacientes em hemodiálise contínua. / A polymyxin B pharmacokinetics study in critically ill patients was conducted with the development of a population modeling. The inclusion criteria were patients from Intensive Care Unit, aged ≥18 years who received intravenous polymyxin B for ≥ 48 hours. Blood, urine and dialysate samples were collected over a dosing interval at steady state. Polymyxin B concentrations was measured by liquid chromatography- tandem mass spectrometry, its plasma protein binding was determined by rapid equilibrium dialysis and unbound fraction was calculated. Population pharmacokinetic analysis and Monte Carlo Simulations were conducted. Twenty four patients were enrolled, two of whom on continuous hemodialysis; 54.2% were male; the median of age, APACHE II score and total body weight were 61.5years, 21.5 and 62.5kg, respectively. The physician-selected dose of polymyxin B was 0.45- 3.38mg/kg/day. The creatinine clearance of the 22 patients without hemodialysis ranged from 10 to 143mL/min. The median unbound fraction in plasma of polymyxin B was 0.42 and the mean (± standard deviation) of the area under the curve over a day for unbound (fAUC0-24h) polymyxin B was 29.2±12.0mg•hour/L, including hemodialysis patients. Polymyxin B was predominantly nonrenally cleared with median unchanged urinary recovered of 4.04%; the median renal clearance was 0.061L/hour. Patients 1 and 2 in hemodialysis presented, respectively, total body clearance of 0.043 and 0.027L/h/kg, hemodialysis clearance of 0.0052 and 0.0015L/h/kg; 12.2% and 5.62% of the polymyxin dose were recovered intact in the dialysate. Polymyxin B total body clearance did not show any relationship with creatinine clearance, APACHE II score, or age. The time course of polymyxin B concentrations was well described by a 2-compartment disposition model with linear elimination. The population pharmacokinetics model provided excellent fits to the observed concentration-time profiles for individual patients and the individual-fitted and population-fitted concentrations were adequately precise. Linear scaling of clearances and volumes of distribution by total body weight reduced the between subject variability in 3.4% for clearance and 41.7% for the central volume of distribution; after this scaling, the estimated parameters in hemodialysis patients were within the range of estimates from the other patients. The population mean of the total body clearance of polymyxin B when scaled by total body weight (0.0276L/hour/kg) showed remarkably low interindividual variability. The Monte Carlo Simulations were performed for six different clinically relevant dosage regimens scaled by total body weight. The regimen of 1.5mg/kg/12 hours provided an AUC0- 24h of polymyxin B of 90.4 mg•h/L in day 4 for 50% of patients which is appropriate considering severe infections by Pseudomonas aeruginosa or Acinetobacter baumannii with minimal inhibitory concentration for polymyxin B ≤2mg/L. In Monte Carlo Simulations we also identified that the best area under the curve was attained only in the day 4 of the treatment. This study showed that doses of intravenous polymyxin B are best scaled by total body weight, that the best regimen of doses is 3mg/kg/day with a loading dose of 2.5mg/kg and that its dosage selection should not be based on renal function, even in patients in continuous hemodialysis.

INTRODUÇÃO: O transplante de pulmão é parte fundamental no tratamento das doenças terminais do pulmão, constituindo uma modalidade terapêutica eficaz para pacientes com doença pulmonar incapacitante, progressiva e em estágio final. No entanto, as drogas imunossupressoras usadas para evitar a rejeição do enxerto podem causar efeitos colaterais em diversos tecidos. O sistema mucociliar, presente nas vias aéreas, é um dos principais mecanismos de defesa do trato respiratório e pode ser alterado por ação das drogas imunossupressoras. Desta forma, o objetivo deste estudo foi avaliar o sistema mucociliar traqueobrônquico de ratos submetidos a dois esquemas de terapia tríplice imunossupressora. MÉTODOS: Foram utilizados 90 ratos machos Wistar distribuídos em 3 grupos conforme o tratamento: controle (C) = solução salina; terapia 1 (TI) = tacrolimus + micofenolato de mofetil + prednisona; terapia 2 (TII) = ciclosporina + azatioprina + prednisona. Após o período de tratamento (7, 15 ou 30 dias), os animais foram sacrificados e realizadas as seguintes medidas: transportabilidade do muco (TM), frequência de batimento ciliar (FBC), quantificação de muco neutro e ácido, velocidade de transporte mucociliar (VTMC), e contagem total e diferencial de células no lavado broncoalveolar (LBA). RESULTADOS: A TM não foi afetada pelas terapias em nenhum dos tempos estudados. Ambas as terapias causaram significativa redução da FBC dos animais tratados por 7 e 15 dias. A produção de muco neutro foi menor nos animais tratados com a TI por 7, 15 e 30 dias. Porém, com a TII, essa redução ocorreu apenas aos 7 dias. Por outro lado, a quantidade de muco ácido foi significativamente maior em todos os animais tratados com as duas terapias. Todos os animais tratados com as terapias imunossupressoras apresentaram redução da VTMC nos três tempos. Houve aumento do número total de células e de macrófagos e neutrófilos no grupo TI em 7 dias. CONCLUSÕES: Ambas as terapias imunossupressoras foram prejudiciais ao transporte mucociliar das vias aéreas de ratos, tanto pela redução da FBC e da VTMC, quanto pela maior produção de muco ácido e menor produção de muco neutro. A TI foi mais prejudicial ao sistema mucociliar em comparação à TII / INTRODUCTION: Lung transplantation is an essential part in the treatment of terminal lung diseases, providing an effective therapeutic modality for patients with disabling, progressive and final stage lung disease. However, the immunosuppressant drugs used to prevent graft rejection may cause side effects in several tissues. The mucociliary system, present in the airways, is a major defense mechanism of the respiratory tract and can be changed by action of immunosuppressive drugs. Thus, the aim of this study was to evaluate the tracheobronchial mucociliary system of rats submitted to two triple immunosuppressive therapy regimens. METHODS: We used 90 male Wistar rats divided into 3 groups according to treatment: control (C) = saline solution; therapy 1 (TI) = tacrolimus + mycophenolate mofetil + prednisone therapy; therapy 2 (TII) = cyclosporine + azathioprine + prednisone. After the period of treatment (7, 15, or 30 days), the animals were sacrificed and the following measures taken: mucus transportability (MT), ciliary beating frequency (CBF), quantification of neutral and acid mucus, mucociliary transport velocity (MCTV), and total and differential counting of cells in bronchoalveolar lavage (BAL). RESULTS: MT was not affected by treatments in any of the periods studied. Both therapies have caused significant reduction of CBF of animals treated for 7 and 15 days. The neutral mucus production was lower in animals treated with TI for 7, 15 and 30 days. But with TII, this reduction occurred only at 7 days. Moreover, the amount of acid mucus was significantly higher in all animals treated with both therapies. All animals treated with immunosuppressive therapies had reduced MCTV at the three times. There was an increase of total cells and macrophages and neutrophils in the TI group in 7 days. CONCLUSIONS: Both immunosuppressive therapies were harmful to the mucociliary clearance of the airways of rats, either by reducing the CBF and MCTV, as by the increased production of acid mucus and decreased production of neutral mucus. TI was more harmful to the mucociliary system in comparison to TII

No description available.

The introduction of artemisinin-based combination therapy (ACT) substantially reduced malaria-related mortality and morbidity during the past decade. Despite the widespread use of ACT, there is still a considerable knowledge gap with regards to safety, efficacy and pharmacokinetic properties of these drugs, particularly in vulnerable populations like children and pregnant women. In addition, there is growing evidence of widespread artemisinin-resistance across the Greater Mekong Subregion. Expedited delivery of novel antimalarial drugs with different mechanisms of action to the clinical setting is still far off; therefore, it is crucial to improve the use of existing antimalarial drugs for optimal outcome in order to prolong their therapeutic life span. This thesis focuses on utilizing pharmacometric tools to support this effort for malaria prevention and treatment. An extensive simulation framework was used to explore alternative malaria chemopreventive dosing regimens of a commonly used ACT, dihydroartemisinin-piperaquine. Different monthly and weekly dosing regimens were evaluated and this allowed an understanding of the interplay between adherence, loading dose and malaria incidence. A weekly dosing regimen substantially improved the prevention effect and was less impacted by poor adherence. This is also expected to reduce selection pressure for development of resistance to piperaquine. Population pharmacokinetics-pharmacodynamic models were developed for artesunate and the active metabolite dihydroartemisinin, effect on parasite clearance, in patients with artemisinin-resistant and -sensitive malaria infections in Southeast Asia. The modeling identified an association between parasite density and drug bioavailability. It predicted the presence of high levels of artemisinin resistant infection among patients in Cambodia and its spread into Myanmar. A nomogram to identify patients with artemisinin resistant infections was developed. Furthermore, the model was used to demonstrate the need for extended treatment duration to treat patients with artemisinin resistant infections. A population pharmacokinetic model developed from data on pregnant women in East Africa allowed further understanding of artemether-lumefantrine exposure in pregnant populations. It also suggested that the lumefantrine exposure in this population is not compromised. In summary, the results presented in this thesis demonstrate the value of pharmacometric approaches for improving antimalarial drug treatment and prevention. This ultimately contributes to overcoming the prevailing challenges to malaria control.

La phagocytose, fonction fondamentale des macrophages, est un processus qui se décompose en deux étapes bien distinctes : les étapes précoces d’internalisation menant à la formation du phagosome et les étapes tardives de maturation du phagosome. Le virus de l’immunodéficience humaine de type I (VIH-1) infecte les macrophages, ce qui perturbe leurs fonctions. L’effet de l’infection virale dans ces cellules est peu caractérisé en comparaison des lymphocytes T. Des travaux antérieurs ont montré d’une part que l’étape précoce d’internalisation de larges particules et bactéries était bloquée de moitié dans les macrophages primaires humains infectés par le VIH-1 via Nef, la protéine de virulence majeure du virus et d’autres part, que la réponse cytokinique était atténuée chez les patients infectés. Ainsi, nous avons étudié l’effet du VIH-1 sur les étapes tardives de la phagocytose : la maturation du phagosome et l’activation des macrophages qui en résulte. Nous avons montré que le VIH-1 altère les étapes tardives de la phagocytose en inhibant la maturation du phagosome, définie par le recrutement de marqueurs tardifs de la voie d’endocytose, d’hydrolases et la production d’espèces réactives oxygénées. Malgré une pré-activation basale, les macrophages infectés par le VIH-1 sont incapables de répondre efficacement à une stimulation induite par phagocytose, ce qui conduit à une modulation de la réponse transcriptionnelle et cytokinique. La dynamique des microtubules et la migration centripète des phagosomes sont profondément affectées par le virus. De façon inattendue, la protéine virale Vpr est impliquée dans ces perturbations, alors que Nef ne joue pas de rôle notable. Nos résultats indiquent que les composants intracellulaires de la machinerie de tri endosomal sont détournés par le compartiment viral dans les macrophages infectés. Par cette étude, nous avons donc identifié la protéine Vpr comme nouveau modulateur de la dynamique des microtubules et du trafic intracellulaire, entraînant ainsi une altération profonde de la maturation du phagosome et de la clairance bactérienne dans les macrophages infectés. Ce travail contribue à mieux comprendre l’établissement d’infections opportunistes chez les patients infectés. / Phagocytosis, a crucial function of macrophages, is composed of two well defined steps : the early step of internalization leading to phagosome formation and the late step of phagosome maturation. The immunodeficiency virus type I (HIV-1) infects macrophages, which disturbs theirs functions. The effects of HIV-1 infection are poorly characterized in this cell type compared to T lymphocytes. Previous results have already shown that the early step of internalization of large particles and bacteria are half blocked by Nef in HIV-1 infected primary macrophages and that the cytokine response is attenuated in infected patients. Thus, we have studied the effect of HIV-1 infection on the late step of phagocytosis : phagosome maturation and the resulting macrophage activation. We shown that HIV-1 impairs late phagocytic events affecting the phagosome maturation, as defined by late endocytic markers and hydrolases recruitment, and reactives oxygens species production. HIV-1 infected macrophages exhibited a basal preactivation but appeared unable to respond efficiently to phagocytic triggers leading to cytokine and transcriptional modifications. Centripetal migration of phagosomes and microtubule dynamics were deeply altered upon viral infection. Surprisingly, the Vpr viral protein was implicated in these pertubations, while Nef was not. Our results revealed that elements of the endosomal sorting machinery were hijacked to the virus-containing compartments in HIV-infected macrophages. With this study, we identify Vpr as a modulator of the microtubule dynamics and intracellular trafficking, leading to alterations in phagosome maturation and bacterial clearance in HIV-1 infected macrophages. This work contribute to better understanding of the establishment of opportunistic infections in HIV-infected patients.

The present study investigated the relationship between level of security clearance in engineering occupations and stress. A total of 63 male employees in the field of engineering and design with varying levels of security clearance employed by a large Southwestern defense company participated in the study. Data was obtained utilizing the Engineering Stress Questionnaire which measures sources of stress, work locus of control, social support, job difficulty, job characteristics, perceived stress, and demographic variables. T-tests revealed no statistically significant differences between employees with low security clearances and high security clearances with regard to perceived stress level. However, correlational support was found for hypotheses involving social support, job difficulty, job characteristics, sources of stress, and perceived stress. Path analysis was performed to investigate the impact of variable relationships.

I arbetet för en hållbar utveckling är frågorna angående mark- och vattenområdens användning högst central. För att uppnå effektiv användning är det grundläggande att mark- och vattenområden används för de ändamål som de anses mest lämpade för. I vissa fall kan åtgärder behöva utföras för att ett område ska bli lämpligt för sitt ändamål. För att säkerställa att åtgärderna utförs, innan användningen av marken ändras, kan villkor om detta läggas in som planbestämmelse i detaljplan. Planbestämmelsen kallas villkor för lov eller startbesked. I denna studie behandlas villkor som är beroende av att en anläggning byggs ut. Paragrafen för detta återfinns i plan- och bygglagen (PBL) 4 kap. 14 § 1.  Det huvudsakliga syftet med studien är att undersöka om och i så fall hur Sveriges kommuner använder sig av planbestämmelsen. För att komma fram till detta kartlägger studien vilka kommuner som använder sig av planbestämmelsen och i vilken utsträckning. Vidare studeras också i vilka sammanhang som planbestämmelsen används. Studien undersöker dessutom definitioner av begrepp i PBL, förarbeten och rättspraxis samt hur kommunerna tolkat några av begreppen. För att undersöka detta användes både en kvantitativ, kvalitativ och juridisk metod. I studien granskas samtliga 290 kommuners detaljplaner som vann laga kraft under år 2016. Resultatet av studien visar att bland totalt 1142 detaljplaner återfanns planbestämmelsen i 36 utav planerna. Användning av planbestämmelsen förekommer bland 25 kommuner med en geografisk spridning över nästan hela landet, med viss koncentration vid Sveriges landsgräns. I detaljplaner vid strand- samt fjällnära lägen syntes en frekvent användning av villkorade lov eller startbesked. I resultatet framkom även att planbestämmelser avseende anläggningar för avlopp finns högst representerade, därefter anläggningar för vatten följt av trafik. Användning av villkor avseende energi finns med i endast ett sammanhang. De begrepp som berörs i resultatet är komma till stånd och väsentlig ändring. Utredningar av definitioner för de olika begreppen i paragrafen visar att det i PBL, förarbeten eller rättspraxis inte finns tydliga definitioner. Resultatet visar att kommunernas tolkning av begreppet komma till stånd i de flesta fall överensstämmer med det som kan bedömas rimligt för att uppfylla syftet med planbestämmelsen. / The questions about the use of land and water plays a central part in the work for a sustainable development. To achieve an efficient usage, it’s important that land and water is used for the purpose it’s most suited for. In some cases, different actions are necessary for an area to be suitable for its purpose. To ensure that actions are executed, before the usage of land changes, different conditions can be established as a plan regulation in detail development plans. The plan regulation is called conditions for permit or starting clearance. This study address the conditions dependent of a facility development. The paragraph can be found in the Planning and Building Act 4 Chap. 14 § 1. The main purpose of this study is to investigate if and in such case how the municipalities of Sweden use the plan regulation. To achieve this the study mapped which municipalities that use plan regulations and in what extent. It’s also investigated in what context the plan regulations are used. The study also examines definitions of terms stated in the Planning and Building Act, preparatory work or legal praxis and how the municipality interpret some of these terms. To investigate this fact both a quantitative, qualitative and legal method were used. The study covers all the detail development plans that went into legal force during 2016 among all the 290 municipalities in Sweden.  The result of the study discovered that 36 out of 1142 detail development plans included plan regulations. The use of the plan regulation was discovered in 25 municipalities almost all over the country, with certain concentration at the border of Sweden. The study shows that plan regulations was frequently used in detail development plans close to waterfronts and alps. The result also shows that plan regulations were most represented in cases of sewerage facilities, followed by water supply facilities and traffic. The use of plan regulations when it comes to energy facilities was only represented in one case. The terms that is concerned in the result is carry out and significant changes. Investigations of the definitions of the different terms in the paragraph shows that there weren’t any clear definitions in either Planning and Building Act, preparatory work or legal praxis. Most of the cases shows that the municipality interpret the term carry out according with what is reasonable to fulfil the purpose of the plan regulation.

>Magister Scientiae - MSc / The aim of this study was to compare the trough plasma levels of Aspen-Vancomycin® (AV); and Sandoz-Vancocin CP® (SV) in premature infants with suspected Methicillin Resistant Staphylococcus aureus (MRSA) infection. The study was designed as a prospective, double blind, randomised trial involving male and female premature infants admitted in the Neonatal Intensive care Unit (NICU) at Netcare Blaauwberg and N1-city Hospitals for treatment of suspected MRSA-infection between April 2012 and June 2013. The inclusion criteria were: 29-35 weeks postmenstrual age (PMA), informed and written consent from parents of each premature infant enrolled in the study. Blood samples (0.3-0.4ml) were collected for renal function test and vancomycin trough levels determination. Blood samples for vancomycin trough level assay were collected thirty minutes prior to the administration of the third dose of vancomycin. Statistical analysis was performed and estimation was made giving an indication of how many infants will be needed to make the study statistically significant. Wilcoxon Two-Sample test was performed to determine the p-values and Spearman correlation coefficients were used to determine the correlation between trough levels and variables. P-values < 0.05 were considered significant. A total of 19 premature infants met with study criteria, 10 (5 females and 5 males) received AV and 9 (6 females and 3 males) receive d SV. There was no statistical significant difference between the demographic (GA, BW, PMA, PNA, weight at trial entry, height at trial entry) and biological (albumin, serum creatinine concentration and glomerular filtration rate) parameters of the premature infants in the AV and SV group. There were no statistical significant difference between trough level 1 of AV and SV, although trough level 1 had a lower trend in the SV group (p=0.118). No AV trough level 1 was below the minimum effective concentration (<5μg/ml). It was found that 30% of AV trough level 1 was within the therapeutic range (5-10μg/ml) and 70% of AV trough level 1, were above minimum toxic concentration (>10mg/l). It was found that 22.2% of SV trough level 1 was below minimum effective concentration, 44.4% of SV trough level 1 was within therapeutic range and 33.3% of trough level 1 was above minimum toxic concentration. No correlation was found between trough level 1 and the demographic and biological parameters of the premature infants in the AV group. SV had a positive correlation with GA, BBW, PMA and a negative correlation with PNA

Normalmente associado à fase pós-decisão da AIA, o processo de follow-up é amplamente reconhecido como a parte mais fraca dos processos de AIA. Dada sua relevância ao criar oportunidades para o aprimoramento do processo e dos sistemas de AIA a partir da incorporação de lições aprendidas, a prática do follow-up foi investigada neste trabalho com vistas ao estabelecimento de potenciais contribuições para o seu aperfeiçoamento no Brasil. Para tanto, optou-se por analisar a organização e operação do sistema de AIA a partir da perspectiva do órgão regulador, compreendido como elemento central na gestão do processo de tomada de decisão. A realização da pesquisa foi embasada na elaboração de dois modelos conceituais, para compreensão do follow-up da AIA de projetos e para a interpretação da aprendizagem através da AIA. A abordagem metodológica utilizada para dar suporte à busca por evidências da prática do follow-up no âmbito da Coordenação Geral de Petróleo e Gás (CGPEG) do Instituto Brasileiro do Meio Ambiente e Recursos Renováveis (IBAMA), consistiu na triangulação entre a revisão de literatura, análise documental de normas e processos de licenciamento previamente selecionados e entrevistas semiestruturadas realizadas com analistas do órgão ambiental. Os resultados encontrados no contexto estudado colocam a CGPEG em posição de destaque no cenário brasileiro em relação à prática do follow-up conduzida por outros Estados, como Bahia e São Paulo, tendo-se verificado um processo bem conduzido, estruturado e em consonância com grande parte dos princípios internacionais de boas práticas do follow-up da AIA apresentados na literatura. Destacam-se os grupos temáticos como mecanismo de comunicação e aprendizagem organizacional, as evidências de aprendizagem single e double loop identificadas, a capacidade técnica e recursos investidos na condução do follow-up, a consideração (ainda que incipiente) dos efeitos cumulativos dos empreendimentos e introdução de iniciativas para inclusão da participação pública nesse processo. Há que se destacar também a importância dos fatores contextuais e regionais sobre os resultados da prática do follow-up verificados no cenário estudado, que vêm refletindo negativamente sobre a prática atual e podem trazer prejuízos à prática futura do follow-up como mecanismo da gestão, aprendizagem e efetividade da AIA nesse contexto. / Usually related to the EIA post-decision stage, the follow-up process is widely recognized as the weakest part of EIA processes. Due to its capacity of creating feedback opportunities for lessons learned on EIA process and system levels, the follow-up practice was explored in order to contribute for its improvement in Brazil. Therefore, the structure and operation of the EIA system was analysed from the perspective of the regulator, a central stakeholder in managing the decision making process. As a first step, a literature review supported the construction of two frameworks to underlie this work regarding EIA follow-up and learning through EIA. The methodological approach used to investigate the follow-up practice within the Oil and Gas General Coordination (CGPEG) from the Brazilian Institute of Environment and Renewable Resources (IBAMA) consisted in the triangulation of literature review, documental analysis of regulations and licensing processes previously selected and semi structured interviews with environmental analysts of the regulator body. The outcomes place CGPEG in a high position in the Brazilian scenario when comparing its follow-up practice to other states, like Bahia and São Paulo. The organization showed a well conducted follow-up process, in line with most part of the international best practice principles for EIA follow-up presented in the literature. Results highlight the thematic groups as organization learning and communication mechanisms, the identification of single and double loop learning evidences, investment of resources and technical capacity in follow-up practice, consideration (although incipient) of cumulative effects of the activities and introduction of public participation initiatives. It is important to emphasize the influence of contextual and regional factors on the results of follow-up practice: a negative influence was noted in the studied scenario and these factors have also the potential to harm the future follow-up practice as a mechanism of management, learning and effectiveness of EIA in this context.

O tabagismo é um problema mundial de saúde pública e é considerado a principal causa de morte evitável no mundo associado com câncer de pulmão, doença pulmonar obstrutiva crônica e infarto agudo do miocárdio. O tabagismo induz alterações morfológicas e funcionais no sistema respiratório. O transporte mucociliar (TMC) é um dos principais mecanismos de defesa do sistema respiratório que pode ser alterado com a fumaça e outros produtos do cigarro. O objetivo desse estudo foi avaliar os efeitos do tabagismo e da cessação do tabagismo no TMC nasal, nas propriedades do muco e sobre marcadores inflamatórios. Trinta e três indivíduos tabagistas foram incluídos no estudo após concordância com o termo de consentimento livre e esclarecido. O recrutamento de voluntários foi realizado na Faculdade de Medicina da Universidade de São Paulo (FMUSP) e no Ambulatório de Cessação do Tabagismo da Disciplina de Pneumologia do Hospital das Clínicas da FMUSP. As variáveis desfecho foram o TMC nasal analisado por meio do teste de trânsito da sacarina, as propriedades do muco por meio do ângulo de contato e da transportabilidade da tosse por alto fluxo e a quantificação de células inflamatórias e concentração de interleucinas (IL)-6 e IL-8 em lavado nasal. Vinte cessadores (idade média: 51 anos, 9 do sexo masculino) foram avaliados no tempo basal do estudo, 1o mês, 3o mês e 12o mês de cessação do tabagismo e 13 tabagistas (média de idade: 52 anos, 6 do sexo masculino) foram avaliados no tempo basal e 12 meses após o basal. As características demográficas, hábito tabágico inicial e morbidades de tabagistas e de cessadores foram similares. No tempo basal do estudo, os tabagistas e cessadores apresentaram disfunção do TMC nasal (17,9 ± 10,1 min e 17,4 ± 7,7 min, respectivamente, p=0,880). A cessação do tabagismo induziu melhora significativa do TMC nasal no 1o mês, 3º mês e 12o mês em 63%, 76% e 85% dos indivíduos, respectivamente. Somente aos 12 meses, foi possível observar melhora na transportabilidade do muco por alto fluxo (~ 23%), porém com aumento do número de macrófagos (2x) em lavado nasal. Não observamos alterações no ângulo de contato do muco e nas concentrações de citocinas em lavado nasal. Concluímos que a cessação do tabagismo induz melhora rápida no TMC nasal, porém melhora nas propriedades do muco foi observada somente após 12 meses de cessação do tabagismo / Smoking is a health problem in the world. It is considered a main cause of preventable death and is associated with lung cancer, chronic obstructive pulmonary disease and myocardium infarction. Smoking induces morphological and functional changes in the respiratory system. Mucociliary clearance (MCC) is one of the main defense mechanisms of the respiratory system that can be affected by smoke and other cigarette products. The aim of this study was to assess the effects of smoking and smoking cessation on nasal MCC, mucus properties and inflammatory biomarkers. Thirty three smokers were included in this study after agreement with the written informed consent. Subject´s recruitment was performed at Faculdade de Medicina da Universidade de São Paulo (FMUSP) and Ambulatório de Cessação do Tabagismo da Disciplina de Pneumologia do Hospital das Clínicas da FMUSP. The outcome variables were nasal MCC evaluated by saccharin transit test, mucus properties using contact angle and mucus transportability by high airflow and quantification of inflammatory cells number and interleukin (IL)-6 and IL-8 in the nasal lavage fluid. Twenty volunteers in the smoking cessation program (mean age: 51 years, 9 male) were assessed at baseline, month 1, month 3 and month 12 after of the smoking cessation and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and 12 months after baseline. Demographic characteristics, smoking history and morbidities were similar between the two groups. At baseline, smokers showed impaired nasal MCC (17.9 ± 10.1 min and 17.4 ± 7.7 min, respectively, p=0.880). Smoking cessation significantly improved nasal MCC at 1 month, 3 months and 12 months in 63%, 76% and 85% of the subjects, respectively. Only after 12 months of smoking cessation, improvement in mucus transportability by high airflow (~ 23%) was observed, however, with increased number of macrophages (2-fold) in nasal lavage fluid. No changes were observed in mucus contact angle and cytokines concentrations in nasal lavage fluid. We concluded that smoking cessation induces rapid improvement in nasal MCC, however, improvement in mucus properties were observed only after 12 months of smoking cessation