Humoral responses to multiple SARS-CoV-2 variants after two doses of vaccine in kidney transplant patients.

Background: The COVID-19 pandemic has led to millions of fatalities globally. Kidney transplant (KT) patients, given their comorbidities and under immunosuppressant drugs, are identified as a high-risk group. Though vaccination remains pivotal for pandemic control, some studies indicate that KT exhibits diminished immune reactions to SARS-CoV-2 vaccines. Therefore, evaluating the vaccine responses in KT, especially the humoral responses against emergent variants is crucial.Methods: We developed a multiplexed SARS-CoV-2 variant protein microarray, incorporating the extracellular domain (ECD) and the receptor binding domain (RBD) of the spike proteins from the variants. This was employed to investigate the collective humoral responses after administering two doses of mRNA-1273 and AZD1222 vaccines in KT under immunosuppressive drugs and in healthy controls.Results: After two doses of either mRNA-1273 or AZD1222, the KT generally showed lower surrogate neutralizing and total antibodies against spike ECD in multiple variants compared to healthy controls. Although two doses of mRNA-1273 induced 1.5-2 fold more surrogate neutralizing and total antibodies than AZD1222 in healthy controls, the KT subjects with two doses of mRNA-1273 generally exhibited higher surrogate neutralizing but similar total antibodies against spike ECD in multiple variants. There were moderate to high correlations between the surrogate neutralizing and total antibodies against spike ECDs.Conclusion: This study offers pivotal insights into the relative vulnerability of KT concerning humoral immunity and the evolving mutations of SARS-CoV-2. Such findings are useful for evaluating vaccine responses and recommending vaccine episodes for KT.

Reverse-Phase Protein Microarrays for Overexpressed Escherichia coli Lysates Reveal a Novel Tyrosine Kinase.

Tyrosine phosphorylation is one of the most important posttranslational modifications in bacteria, linked to regulating growth, migration, virulence, secondary metabolites, biofilm formation, and capsule production. Only two tyrosine kinases (yccC (etk) and wzc) have been identified in Escherichia coli. The investigation by similarity has not revealed any novel BY-kinases in silico so far, most probably due to their sequence and structural variability. Here we developed a reverse-phase protein array from 4126 overexpressed E. coli clones, lysed, and printed on coated glass slides. These high-density E. coli lysate arrays (ECLAs) were quality controlled by the reproducibility and immobilization of total lysate proteins and specific overexpressed proteins. ECLAs were used to interrogate the relationship between protein overexpression and tyrosine phosphorylation in the total lysate. We identified 6 protein candidates, including etk and wzc, with elevated phosphotyrosine signals in the total lysates. Among them, we identified a novel kinase nrdD with autophosphorylation and transphosphorylation activities in the lysates. Moreover, the overexpression of nrdD induced biofilm formation. Since nrdD is a novel kinase, we used E. coli proteome microarrays (purified 4,126 E. coli proteins) to perform an in vitro kinase assay and identified 33 potential substrates. Together, this study established a new ECLA platform for interrogating posttranslational modifications and identified a novel kinase that is important in biofilm formation, which will shed some light on bacteria biochemistry and new ways to impede drug resistance.

AI-Driven Design System for Fabrication of Inhalable Nanocatchers for Virus Capture and Neutralization.

The global pandemic presents a critical threat to humanity, with no effective rapid-response solutions for early-stage virus dissemination. This study aims to create an AI-driven entry-blocker design system (AIEB) to fabricate inhalable virus-like nanocatchers (VLNCs) fused with entry-blocking peptides (EBPs) to counter pandemic viruses and explore therapeutic applications. This work focuses on developing angiotensin-converting enzyme 2 (ACE2)-mimic domain-fused VLNCs (ACE2@VLNCs) using AIEB and analyzing their interaction with the SARS-CoV-2 receptor binding domain (RBD), demonstrating their potential to hinder SARS-CoV-2 infection. Aerosol-based tests show ACE2@VLNCs persist over 70 min in the air and neutralize pseudoviruses within 30 min, indicating their utility in reducing airborne virus transmission. In vivo results reveal ACE2@VLNCs mitigate over 67% of SARS-CoV-2 infections. Biosafety studies confirm their safety, causing no damage to eyes, skin, lungs, or trachea, and not eliciting significant immune responses. These findings offer crucial insights into pandemic virus prevention and treatment, highlighting the potential of the ACE2@VLNCs system as a promising strategy against future pandemics.

Rituximab, but not other biologics, impairs humoral immunity in patients with rheumatoid arthritis-a study using CoVariant protein arrays.

Objectives: RA is an autoimmune disease characterized by chronic inflammation and joint destruction. Biologics are crucial to achieving treat-to-target goals in patients with RA. The global spread and continuous variation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) necessitate the monitoring of variant-specific humoral responses post-vaccination. The aim of this study was to investigate how different biologic treatments for vaccinated RA patients might affect their neutralizing antibodies against multiple SARS-CoV-2 variants. Methods: We recruited RA patients who had received three doses of conventional SARS-CoV-2 vaccines and were treated with various biologics, e.g. TNF inhibitor (etanercept), IL-6 inhibitor (tocilizumab), CTLA4-Ig (abatacept) or anti-CD20 (rituximab). Serum samples were used to profile the binding and neutralizing antibodies using our own SARS-CoV-2 variant (CoVariant) protein array, developed previously. Results: Compared with healthy controls, only RA therapy with rituximab showed a reduction in neutralizing antibodies capable of targeting spike proteins in SARS-CoV-2 wild-type and most variants. This reduction was not observed in binding antibodies against SARS-CoV-2 wild-type or its variants. Conclusion: After receiving three doses of SARS-CoV-2 vaccination, RA patients who underwent rituximab treatment generated sufficient antibodies but exhibited lower neutralizing activities against wild-type and multiple variants, including current Omicron. Other biological DMARDs, e.g. TNF inhibitor, IL-6 inhibitor and CTLA4-Ig, did not show obvious inhibition.

Recovery of LiCoO2 and graphite from spent lithium-ion batteries by molten-salt electrolysis.

The recovery of spent lithium-ion batteries has not only economic value but also ecological benefits. In this paper, molten-salt electrolysis was employed to recover spent LiCoO2 batteries, in which NaCl-Na2CO3 melts were used as the electrolyte, the graphite rod and the mixtures of the spent LiCoO2 cathode and anode were used as the anode and cathode, respectively. During the electrolysis, the LiCoO2 was electrochemically reduced to Co, and Li+ and O2- entered into the molten salt. The O2- was discharged at the anode to generate CO2 and formed Li2CO3. After electrolysis, the cathodic products were separated by magnetic separation to obtain Co and graphite, and Li2CO3 was recovered by water leaching. The recovery efficiencies of Li, Co, and graphite reached 99.3%, 98.1%, and 83.6%, respectively. Overall, this paper provides a simple and efficient electrochemical method for the simultaneous recovery of the cathode and the anode of spent LiCoO2 batteries.

Antibody Profiling of Dengue Severities Using Flavivirus Protein Microarrays.

Dengue is a viral disease transmitted by Aedes aegypti mosquitoes. According to the World Health Organization, about half of the world's population is at risk of dengue. There are four serotypes of the dengue virus. After infection with one serotype, it will be immune to such a serotype. However, subsequent infection with other serotypes will increase the risk of severe outcomes, e.g., dengue hemorrhagic fever, dengue shock syndrome, and even death. Since severe dengue is challenging to predict and lacks molecular markers, we aim to build a multiplexed Flavivirus protein microarray (Flaviarray) that includes all of the common Flaviviruses to profile the humoral immunity and cross-reactivity in the dengue patients with different outcomes. The Flaviarrays we fabricated contained 17 Flavivirus antigens with high reproducibility (R-square = 0.96) and low detection limits (172-214 pg). We collected serums from healthy subjects (n = 36) and dengue patients within 7 days after symptom onset (mild dengue (n = 21), hospitalized nonsevere dengue (n = 29), and severe dengue (n = 36)). After profiling the serum antibodies using Flaviarrays, we found that patients with severe dengue showed higher IgG levels against multiple Flavivirus antigens. With logistic regression, we found groups of markers with high performance in distinguishing dengue patients from healthy controls as well as hospitalized from mild cases (AUC > 0.9). We further reported some single markers that were suitable to separate dengue patients from healthy controls (AUC > 0.9) and hospitalized from mild outcomes (AUC > 0.8). Together, Flaviarray is a valuable tool to profile antibody specificities, uncover novel markers for decision-making, and shed some light on early preventions and treatments.

Developing magnetic barcode bead fluorescence assay for high throughput analyzing humoral responses against multiple SARS-CoV-2 variants.

The continuous mutation of SARS-CoV-2 highlights the need for rapid, cost-effective, and high-throughput detection methods. To better analyze the antibody levels against SARS-CoV-2 and its variants in vaccinated or infected subjects, we developed a multiplex detection named Barcode Bead Fluorescence (BBF) assay. These barcode beads were magnetic, characterized by 2-dimensional edges, highly multiplexed, and could be decrypted with visible light. We conjugated 12 magnetic barcode beads with corresponding nine spike proteins (wild-type, alpha, beta, gamma, delta, and current omicrons), two nucleocapsid proteins (wild-type and omicron), and one negative control. First, the conjugated beads underwent serial quality controls via fluorescence labeling, e.g., reproducibility (R square = 0.99) and detection limits (119 pg via anti-spike antibody). Next, we investigated serums from vaccinated subjects and COVID-19 patients for clinical applications. A significant reduction of antibody levels against all variant beads was observed in both vaccinated and COVID-19 studies. Subjects with two doses of mRNA-1273 exhibited the highest level of antibodies against all spike variants compared to two doses of AZD1222 and unvaccinated. We also found that COVID-19 patients showed higher antibody levels against spike beads from wild-type, alpha, beta, and delta. Finally, the nucleocapsid beads served as markers to distinguish infections from vaccinated subjects. Overall, this study developed the BBF assay for analyzing humoral immune responses, which has the advantages of robustness, automation, scalability, and cost-effectiveness.

Profiling humoral responses to COVID-19 immunization in Kawasaki disease using SARS-CoV-2 variant protein microarrays.

Kawasaki disease (KD) is a form of acute systemic vasculitis syndrome that predominantly occurs in children under the age of 5 years. Its etiology has been postulated due to not only genetic factors but also the presence of foreign antigens or infectious agents. To evaluate possible associations between Kawasaki disease (KD) and COVID-19, we investigated humoral responses of KD patients against S-protein variants with SARS-CoV-2 variant protein microarrays. In this study, plasma from a cohort of KD (N = 90) and non-KD control (non-KD) (N = 69) subjects in categories of unvaccinated-uninfected (pre-pandemic), SARS-CoV-2 infected (10-100 days after infection), and 1-dose, 2-dose, and 3-dose BNT162b2 vaccinated (10-100 days after vaccination) was collected. The principal outcomes were non-KD-KD differences for each category in terms of anti-human/anti-His for binding antibodies and neutralizing percentage for surrogate neutralizing antibodies. Binding antibodies against spikes were lower in the KD subjects with 1-dose of BNT162b2, and mean differences were significant for the P.1 S-protein (non-KD-KD, 3401; 95% CI, 289.0 to 6512; P = 0.0252), B.1.617.2 S-protein (non-KD-KD, 4652; 95% CI, 215.8 to 9087; P = 0.0351) and B.1.617.3 S-protein (non-KD-KD, 4874; 95% CI, 31.41 to 9716; P = 0.0477). Neutralizing antibodies against spikes were higher in the KD subjects with 1-dose of BNT162b2, and mean percentage differences were significant for the 1-dose BNT162b2 B.1.617.3 S-protein (non-KD-KD, -22.89%; 95% CI, -45.08 to -0.6965; P = 0.0399), B.1.1.529 S-protein (non-KD-KD, -25.96%; 95% CI, -50.53 to -1.376; P = 0.0333), BA.2.12.1 S-protein (non-KD-KD, -27.83%; 95% CI, -52.55 to -3.115; P = 0.0195), BA.4 S-protein (non-KD-KD, -28.47%; 95% CI, -53.59 to -3.342; P = 0.0184), and BA.5 S-protein (non-KD-KD, -30.42%; 95% CI, -54.98 to -5.869; P = 0.0077). In conclusion, we have found that KD patients have a comparable immunization response to healthy individuals to SARS-CoV-2 infection and COVID-19 immunization.

Meta-Analysis of Electroencephalographic Correlates and Cognitive Performance for Acute Exercise-Induced Modulation.

INTRODUCTION: Although abundant research delving into the acute exercise-induced modulation of cognitive performance and the P300-ERP component has been conducted, there is a lack of consensus regarding whether or not this type of intervention has a beneficial effect on cognition and how it relates to the P300-ERP. METHODS: To examine the possible sources of this discrepancy, we conducted a meta-analysis of ERP results together with cognitive performance that were systemically stratified by relevant demographic and methodological moderators. RESULTS: Our results indicate that while acute exercise exerted an overall stable effect on cognitive improvement, associated with enlarged P300 amplitudes, the effect size varied across factors of age, biological sex, exercise intensity, exercise type, control type, and experimental design. Future research taking into consideration modulating factors as to avoid misestimating the beneficial effects of acute exercise are encouraged. CONCLUSION: All in all, and to our knowledge, this is the first meta-analysis quantitatively summarizing the relevant literature on the associations between P300-ERP correlates, acute exercise, and its positive influence on attention and cognitive performance in healthy individuals.

Profiling Humoral Immunity After Mixing and Matching COVID-19 Vaccines Using SARS-CoV-2 Variant Protein Microarrays.

In November 2022, 68% of the population received at least one dose of COVID-19 vaccines. Owing to the ongoing mutations, especially for the variants of concern (VOCs), it is important to monitor the humoral immune responses after different vaccination strategies. In this study, we developed a SARS-CoV-2 variant protein microarray that contained the spike proteins from the VOCs, e.g., alpha, beta, gamma, delta, and omicron, to quantify the binding antibody and surrogate neutralizing antibody. Plasmas were collected after two doses of matching AZD1222 (AZx2), two doses of matching mRNA-1273 (Mx2), or mixing AZD1222 and mRNA-1273 (AZ+M). The results showed a significant decrease of surrogate neutralizing antibodies against the receptor-binding domain in all VOCs in AZx2 and Mx2 but not AZ+M. A similar but minor reduction pattern of surrogate neutralizing antibodies against the extracellular domain was observed. While Mx2 exhibited a higher surrogate neutralizing level against all VOCs compared with AZx2, AZ+M showed an even higher surrogate neutralizing level in gamma and omicron compared with Mx2. It is worth noting that the binding antibody displayed a low correlation to the surrogate neutralizing antibody (R-square 0.130-0.382). This study delivers insights into humoral immunities, SARS-CoV-2 mutations, and mixing and matching vaccine strategies, which may provide a more effective vaccine strategy especially in preventing omicron.

Quando o Trabalho Invade a Casa: Percepções sobre o Teletrabalho / Cuando el Trabajo Invade el Hogar: Percepciones sobre el Teletrabajo / When Work Invades Home: Perceptions about Teleworking

O cenário da pandemia de COVID-19 no mundo trouxe inúmeras mudanças, entre elas, no Brasil, a opção de grande parte das organizações pelo teletrabalho, até então, não muito recorrente no país. Este artigo aborda a situação de quando, compulsoriamente, o trabalho invade a casa e relata a análise das percepções e das vivências de trabalhadores em teletrabalho compulsório, durante o período da pandemia de COVID-19, identificando fatores favoráveis e desfavoráveis à Qualidade de Vida no Trabalho (QVT). Fundamentada na Ergonomia da Atividade Aplicada à Qualidade de Vida no Trabalho ­ EAA_QVT, foi realizada uma pesquisa qualitativa com doze trabalhadores de diferentes organizações e cargos, dos setores público e privado, levantando suas percepções e vivências acerca do teletrabalho, de acordo com seis categorias teóricas investigadas pela EAA_QVT. Os resultados revelaram um equilíbrio: três categorias com predominância de bem-estar (Relações socioprofissionais, Reconhecimento e crescimento profissional e Uso da informática) e outras três categorias com predominância de mal-estar (Condições de trabalho, organização do trabalho e Sentimentos no trabalho), indicando focos para possíveis intervenções e cuidados no caso da manutenção desta modalidade de trabalho. Foram discutidas questões importantes como a indistinção entre os espaços públicos e privados, as características da atual sociedade do desempenho/cansaço e suas possíveis repercussões para os trabalhadores, sua saúde e as organizações.

The global coronavirus disease 2019 (COVID-19) pandemic has brought on many changes in Brazil, one of them being the option of most organizations for teleworking, which up until that time had not been a com-mon occurrence in the country. This article discusses the compulsory work-from-home scenario and ana-lyzes the perceptions and experiences of workers obliged to work from home during the COVID-19 pandem-ic, identifying favorable and unfavorable factors for Quality of Work Life (QWL). We conducted qualitative research based on Activity-Centered Ergonomics Applied to Quality of Life at Work (ACE-QLW) for 12 work-ers with varying positions in different public and private sector organizations. We analyzed their perceptions and experiences about working from home based on six categories examined by ACE-QLW. The results re-vealed a balance: three of the categories largely concerning well-being (socio-professional relationships, recognition and professional growth, and use of computers) and three other categories largely concerning malaise (working conditions, work organization, and opinions of work), indicating possible focal points for interventions and care in maintaining this type of work. Important issues were discussed, such as the lack of distinction between public and private spaces, current performance/fatigue characteristics, and the pos-sible repercussions this can have on workers, their health, and organizations

El escenario de la pandemia de la COVID-19 en el mundo trajo incontables cambios, entre ellos, en Brasil, la opción de la mayoría de las organizaciones por el teletrabajo, hasta entonces, poco recurrente en el país. Este artículo aborda la situación cuando, obligatoriamente, el trabajo invade el hogar y relata el análisis de las percepciones y experiencias de los trabajadores en domicilio obligatorio, durante el período de la pandemia del COVID-19, identificando factores favorables y desfavorables para la Calidad de Vida. Trabajo (QWL). Con base en la Ergonomía de la Actividad Aplicada a la Calidad de Vida en el Trabajo - EAA_QVT, se realizó una investigación cualitativa con doce trabajadores de diferentes organizaciones y cargos, del sector público y privado, elevando sus percepciones y experiencias sobre el teletrabajo, según teorías de seis categorías investigadas por EAA_QVT. Los resultados revelaron equilibrio: tres categorías con predominio del bienestar (Relaciones socioprofesionales, Reconocimiento y crecimiento profesional y Uso de la computadora) y otras tres categorías con predominio del malestar (Condiciones de trabajo, organización del trabajo y Sentimientos en trabajo), indicando focos de posibles intervenciones y cuidados en el caso de mantener este tipo de trabajo. Se discutieron temas importantes, como la falta de distinción entre espacios públicos y privados, las características de la actual sociedad del rendimiento/fatiga y sus posibles repercusiones para los trabajadores, su salud y las organizaciones.

Antibody Profiling in COVID-19 Patients with Different Severities by Using Spike Variant Protein Microarrays.

The disease progression of COVID-19 varies from mild to severe, even death. However, the link between COVID-19 severities and humoral immune specificities is not clear. Here, we developed a multiplexed spike variant protein microarray (SVPM) and utilized it for quantifying neutralizing activity, drug screening, and profiling humoral immunity. First, we demonstrated the competition between antispike antibody and ACE2 on SVPM for measuring the neutralizing activity against multiple spike variants. Next, we collected the serums from healthy subjects and COVID-19 patients with different severities and profile the neutralizing activity as well as antibody isotypes. We identified the inhibition of ACE2 binding was stronger against multiple variants in severe compared to mild/moderate or critical patients. Moreover, the serum IgG against nonstructural protein 3 was elevated in severe but not in mild/moderate and critical cases. Finally, we evaluated two ACE2 inhibitors, Ramipril and Perindopril, and found the dose-dependent inhibition of ACE2 binding to all the spike variants except for B.1.617.3. Together, the SVPM and the assay procedures provide a tool for profiling neutralizing antibodies, antibody isotypes, and reagent specificities.

Development of SARS-CoV-2 variant protein microarray for profiling humoral immunity in vaccinated subjects.

SARS-CoV-2 is quickly evolving from wild-type to many variants and spreading around the globe. Since many people have been vaccinated with various types of vaccines, it is crucial to develop a high throughput platform for measuring the antibody responses and surrogate neutralizing activities against multiple SARS-CoV-2 variants. To meet this need, the present study developed a SARS-CoV-2 variant (CoVariant) array which consists of the extracellular domain of spike variants, e.g., wild-type, D614G, B.1.1.7, B.1.351, P.1, B.1.617, B.1.617.1, B.1.617.2, and B.1.617.3. A surrogate virus neutralization on the CoVariant array was established to quantify the bindings of antibody and host receptor ACE2 simultaneously to spike variants. By using a chimeric anti-spike antibody, we demonstrated a broad binding spectrum of antibodies while inhibiting the bindings of ACE2 to spike variants. To monitor the humoral immunities after vaccination, we collected serums from unvaccinated, partial, or fully vaccinated individuals with either mRNA-1273 or AZD1222 (ChAdOx1). The results showed partial vaccination increased the surrogate neutralization against all the mutants while full vaccination boosted the most. Although IgG, IgA, and IgM isotypes correlated with surrogate neutralizing activities, they behave differently throughout the vaccination processes. Overall, this study developed CoVariant arrays and assays for profiling the humoral responses which are useful for immune assessment, vaccine research, and drug development.

Intraparenchymal subependymoma: Case report and literature review.

BACKGROUND: Intracranial subependymomas are rare slow-growing benign tumors typically located in the ventricular system, accounting for 0.07-0.7% of all intracranial neoplasms. Intraparenchymal subependymoma is extremely rare lesions, imposing a challenging diagnosis and management. CASE DESCRIPTION: We describe a case of a supratentorial intraparenchymal mass on left occipital lobe in a 26-year-old woman with progressive headache and visual impairment. Differential diagnosis mainly included gliomas, neuronal-glial tumors, ependymoma, and subependymoma. Complete surgical resection was performed and histopathology analysis confirmed diagnosis of subependymoma. Despite its benign behavior the Ki67/MIB-1 labeling index assessed by immunohistochemistry was 5%. After 1 year of follow-up she was free of tumor recurrence. CONCLUSION: Intraparenchymal subependymoma is extremely rare tumors and literature review showed only 11 cases reported. In general, they are misdiagnosed as other tumors, so careful attention on clinical and radiological features must be taken when looking at a tumor close to the ventricular system, even though it does not have any obvious direct connection to it. Despite its benign nature, total removal must be attempted given that there are reports of recurrence, especially in partially removed tumors with high proliferation index. The role of adjuvant therapy is still limited and new treatment options are being developed as our knowledge on biological and molecular characteristics advances.

Development and Application of Human Coronavirus Protein Microarray for Specificity Analysis.

Coronavirus is an enveloped RNA virus that causes mild to severe respiratory diseases in humans, including HKU1-CoV, 229E-CoV, NL63-CoV, OC43-CoV, SARS-CoV, MERS-CoV, and SARS-CoV-2. Due to the outbreak of SARS-CoV-2, it is important to identify the patients and investigate their immune responses. Protein microarray is one of the best platforms to profile the antibodies in the blood because of its fast, multiplexed, and sensitive nature. To fully understand the immune responses and biological specificities, this study developed a human coronavirus (HCoV) protein microarray and included all seven human coronaviruses and three influenza viruses. Each protein was printed in triplicate and formed 14 identical blocks per array. The HCoV protein microarray showed high reproducibility and sensitivity to the monoclonal antibodies against spike and nucleocapsid protein with detection limits of 10-200 pg. The HCoV proteins that were immobilized on the array were properly folded and functional by showing interactions with a known human receptor, e.g., ACE2. By profiling the serum IgG and IgA from 32 COVID-19 patients and 36 healthy patients, the HCoV protein microarray demonstrated 97% sensitivity and 97% specificity with two biomarkers. The results also showed the cross-reactivity of IgG and IgA in COVID-19 patients to spike proteins from various coronaviruses, including that from SARS-CoV, HKU1-CoV, and OC43-CoV. Finally, an innate immune protein named surfactant protein D showed broad affinities to spike proteins in all human coronaviruses. Overall, the HCoV protein microarray is multiplexed, sensitive, and specific, which is useful in diagnosis, immune assessment, biological development, and drug screening.

Large-scale environmental policy change: analysis of the Brazilian reality / Cambio de gran escala en la política ambiental: análisis de la realidad brasileña / Mudança de larga escala na política ambiental: análise da realidade brasileira

Abstract The Brazilian presidential elections of 2018 brought large-scale changes in the Brazilian environmental policy subsystem. The purpose of this article is to analyze these changes through the lenses of the Advocacy Coalition Framework - ACF. First, we introduced some of the main characteristics of this subsystem, then we presented a hemerographic analysis to describe and analyze the effects of four recent shocks in this subsystem. Two of these shocks were external: (i) the election of a new political elite in power that brought a clear discourse of denial of the relevance of environmental policy and (ii) calamitous environmental events that occurred in Brazil in 2019. The other two shocks were internal: (i) the capture of key positions and resources by dominant coalition members and (ii) the rise of conflict and polarization among the coalitions in the subsystem. The results showed: (i) the rise of a hyper-adversarial environmental policy subsystem; (ii) a realignment between non-dominant coalitions in a cooperative direction; (iii) the imposition of clear barriers to negotiation; (iv) changes in the use of scientific information by more politicized discourses with a high degree of bias. The article contributes to the understanding of the processes of institutional change in environmental policy, especially in contexts of large-scale change generated by increasing electoral polarization and fierce political disputes. It also contributes to the analysis of the limits and possibilities of the ACF in the Brazilian environmental agenda.

Resumen Las elecciones presidenciales brasileñas de 2018 introdujeron cambios de gran escala en el subsistema de política ambiental del país. El propósito de este documento es analizar estos cambios a través de las lentes del Advocacy Coalition Framework - ACF. Para ello, exponemos algunas de las características principales de este subsistema y, luego, presentamos un análisis hemerográfico para describir y analizar los efectos de cuatro shocks recientes en este subsistema. Dos de estos shocks fueron externos: (i) el ascenso de una nueva élite política al poder, la cual ha traído un claro discurso de negación de la relevancia de la política ambiental y (ii) catastróficos eventos ambientales que ocurrieron en Brasil durante 2019. Otros dos shocks fueron internos: (i) la captura de posiciones y recursos claves por los miembros de la coalición dominante y (ii) el surgimiento de conflictos y polarizaciones entre las coaliciones del subsistema. Los resultados mostraron: (i) el ascenso de un subsistema de política ambiental hipercontradictorio; (ii) el realineamiento de las coaliciones no dominantes en una dirección cooperativa; (iii) la imposición de claras barreras en los procesos de negociación; y (iv) cambios en el uso de información científica por discursos más politizados con un alto grado de sesgo. Este artículo contribuye a la comprensión de los procesos de cambio institucional en la política ambiental, especialmente en contextos de cambios de gran escala generados por un aumento en la polarización electoral e intensas disputas políticas. También contribuye al análisis de los límites y posibilidades del ACF en la agenda ambiental brasileña.

Resumo As eleições presidenciais brasileiras de 2018 trouxeram mudanças em larga escala no subsistema de política ambiental do país. O objetivo deste artigo é analisar essas mudanças através do Advocacy Coalition Framework - ACF. Para isso, introduzimos algumas das principais características do subsistema de política ambiental e, a seguir, apresentamos uma análise hemerográfica para descrever e analisar os efeitos de quatro choques recentes no subsistema em análise. Dois desses choques foram externos: (i) a ascensão ao poder de uma nova elite política que trouxe um discurso claro de negação da relevância da política ambiental e (ii) eventos ambientais calamitosos que ocorreram no Brasil em 2019. Dois outros choques foram internos: (i) a captura de posições e recursos importantes pelos membros da coalizão dominante e (ii) o surgimento de conflitos e polarizações entre as coalizões no subsistema. Os resultados mostraram: (i) a ascensão de um subsistema hiper-contraditório; (ii) o realinhamento entre coalizões não dominantes em direção à cooperação; (iii) a imposição de barreiras claras à negociação; e (iv) mudanças no uso da informação científica por discursos mais politizados com alto grau de viés. O artigo contribui para a compreensão dos processos de mudança institucional na política ambiental, especialmente em contextos de mudança em larga escala gerados pelo aumento da polarização eleitoral e intensas disputas políticas. Contribui também para a análise dos limites e possibilidades do ACF na agenda ambiental brasileira.

Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017. / Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017.

OBJECTIVE: To analyze the correlation between municipalities adhering to the Health Fitness Center Program, noncommunicable chronic disease (NCD) hospitalizations and socioeconomic levels from 2011 to 2017. METHODS: This was an ecological study; HFCP adherence indicators for 2,837 municipalities were calculated, as were NCD hospitalization indicators, according to funding categories and the Firjan Socioeconomic Development Index. RESULTS: The HFCP adherence indicator was higher for municipalities that received Congress funding (1.18), had moderate to high Firjan Socioeconomic Development Indices (0.94) and high NCD hospitalization indicators (1.03) (p<0.001). There were positive correlations (p<0.05) between the two indicators in municipalities receiving Ministry of Health funding (r=0.14) and those receiving both Congress and Ministry of Health funding (r=0.12); whereas correlation was negative in municipalities with moderate to low Firjan Socioeconomic Development Indices (r=-0.09; p=0.013). CONCLUSION: The main form of adherence to the HFCP, according to population size, was through Congress funding. Municipalities with poorer socioeconomic and NCD indicators had lower adherence to the HFCP.

Programa Academia da Saúde: um olhar quantitativo das adesões entre 2011 a 2017 / The Health Academy Program in Brazil: a quantitative view of adhesions between 2011 to 2017

O objetivo foi analisar a distribuição das adesões municipais ao Programa Academia da Saúde (PAS) no território nacional e o impacto da alteração do tipo de financiamento das obras no quantitativo de adesões. Foram utilizados dados secundários disponibilizados pelo Ministério da Saúde (MS) referentes às adesões ocorridas de 2011 a 2017 para compor as variáveis do estudo. Foram realizadas análises descritiva e inferencial, empregando-se o teste t pareado de Student para verificar diferenças entre adesões em diferentes anos e modalidades de financiamento (emenda parlamentar ­ EP e MS). Os resultados mostram que a maioria das macrorregiões apresentou mais de 50% de municípios participantes (municípios-PAS). As regiões Nordeste e Sudeste tiveram mais adesões, mas a região Norte destacou-se com o maior quantitativo de municípios-PAS proporcionalmente ao total de municípios. O período de maior expansão foi de 2011 a 2013. O número de adesões e municípios-PAS nos cinco anos de financiamento exclusivo por EP não superou o quantitativo aprovado de 2011 a 2012. Nos primeiros anos de financiamento por EP, ocorreu concentração das adesões nos mesmos municípios. Todas as macrorregiões apresentaram mais de 60% de obras concluídas, entretanto foi baixo o percentual de academias com custeio federal dentre as adesões aptas ao recebimento. Concluímos que o PAS está bem distribuído em todo o país, com diferentes situações de implantação. O período de maior expansão do programa foi em 2011 e 2012, quando as obras eram financiadas com recurso do MS. De 2013 a 2017, com financiamento exclusivo por EP, o quantitativo de adesões não superou o observado nos dois primeiros anos

This study aimed to analyze the adhesions of the Health Academy Program (HAP) in the country and the impact of the funding type alteration for the facilities building. Secondary data provided by the Minis-try of Health regarding the adhesions from 2011 to 2017 were used to compose the variables. Descriptive and inferential analyses were conducted, using the Student's paired t-test to verify differences between the number of adhesions to the HAP in different years and funding types. Most regions had more than 50% of participating municipalities. Northeast and Southeast presented greater adhesions numbers concerning the other regions, but the North was highlighted with the largest quantity proportional to the number of municipalities. The greatest expansion was from 2011 to 2013. The number of facilities and municipalities enrolled in the HAP during the years of exclusive funding by parliamentary amendments did not exceed the amount approved from 2011 to 2012. There was a concentration of adhesions in the same municipalities in 2012 and 2013 when the parliamentary amendments were included. In all regions, the rate of facility building completion was above 60%, however the percentage of facilities with the maintenance funding among those able to receive it is low. In conclusion, the HAP has been largely implemented in the country, with a variety of implementation status. From 2011 to 2012 occurred the greatest expansion of the HAP, period that the facilities where financed with funds from the Ministry of Health. In the others hand, from 2013 to 2017, with exclusive funding by EP, the number of facilities did not exceed that observed in the first two years

Health Academy Program: correlation between hospitalizations due to noncommunicable chronical diseases and adherence to the program in Brazilian municipalities, 2011-2017 / Programa Academia de la Salud: correlación entre las hospitalizaciones por enfermedades crónicas no transmisibles en la adherencia en los municipios brasileños, 2011-2017 / Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017

Objective. To analyze the relationship between municipalities adherence to the Health Academy Program (HAP) and the noncommunicable chronical diseases (NCDs) and socioeconomic levels from 2011 to 2017. Methods. Were analyzed the adherence indicator (ADH-indicator) to HAP in 2,837 municipalities and hospitalizations due to NCDs (NCDs-indicator) according to the funding types and the Firjan Socioeconomic Development Index (FSDI) from 2011 to 2017. Results. ADH-indicator presented higher values for municipalities that received congress funding (1.18), moderate to high FSDI (0.94) and high NCDs-indicator (1.03) (p<0.001). There were positive correlations (p<0.05) between the indicators in municipalities funded by the Ministry of Health´s budget (r=0.14) and mixed (r=0.12) and negative correlation for municipalities with moderate to low FSDI (r=-0.09; p=0.013). Conclusion. Congress funding was the main type of cities adherence to the HAP, adjusted by population. In the municipalities with critical socioeconomic and NCD indicators, there was less adherence to the HAP.

Objetivo: Analisar a correlação entre adesão dos municípios ao Programa Academia da Saúde (PAS), internações por doenças crônicas não transmissíveis (DCNT) e níveis socioeconômicos, 2011-2017. Métodos. Estudo ecológico; foram calculados indicadores de adesão (IND-ADE) de 2.837 municípios brasileiros ao PAS, e de internações por DCNT (IND-DCNT), segundo categorias de financiamento e o Índice Firjan de Desenvolvimento Socioeconômico (IFDM). Resultados. O IND-ADE foi maior nos municípios financiados por emendas parlamentares (1,18), com IFDM moderado a alto (0,94) e IND-DCNT alto (1,03) (p<0,001). Houve correlação positiva (p<0,05) entre IND-ADE e IND-DCNT em municípios contemplados com recursos do Ministério da Saúde (r = 0,14) e de ambos tipos, emendas parlamentares e programa ministerial (r=0,12); e correlação negativa em municípios com IFDM moderado a baixo (r=-0,09; p=0,013). Conclusão. A principal forma de adesão ao PAS, referenciada pelo porte populacional, foi emenda parlamentar. Municípios com piores indicadores socioeconômicos e de DCNT apresentaram menor adesão.

Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017 / Programa Academia de la Salud: correlación entre las hospitalizaciones por enfermedades crónicas no transmisibles y adhesión en los municipios brasileños, 2011-2017 / Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017

Objetivo: Analisar a correlação entre adesão dos municípios ao Programa Academia da Saúde, internações por doenças crônicas não transmissíveis (DCNT) e níveis socioeconômicos, no período 2011-2017. Métodos: Estudo ecológico; foram calculados indicadores de adesão (IND-ADE) de 2.837 municípios brasileiros ao PAS, e de internações por DCNT (IND-DCNT), segundo categorias de financiamento e o Índice Firjan de Desenvolvimento Socioeconômico (IFDM). Resultados: O IND-ADE foi maior nos municípios financiados por emendas parlamentares (1,18), com IFDM moderado a alto (0,94) e IND-DCNT alto (1,03) (p<0,001). Houve correlação positiva (p<0,05) entre IND-ADE e IND-DCNT em municípios contemplados com recursos do Ministério da Saúde (r = 0,14) e de ambos os tipos, emendas parlamentares e programa ministerial (r=0,12); e correlação negativa em municípios com IFDM moderado a baixo (r=-0,09; p=0,013). Conclusão: A principal forma de adesão ao PAS, referenciada pelo porte populacional, foi emenda parlamentar. Municípios com piores indicadores socioeconômicos e de DCNT apresentaram menor adesão.

Objetivo: Analizar la relación entre adhesión de los municipios al Programa Federal Academia de la Salud y las hospitalizaciones por enfermedades crónicas no trasmisibles (ECNT) y niveles socioeconómicos entre 2011 y 2017. Métodos: Estudio ecológico; se calcularon los indicadores de adhesión (IND-ADH) de 2.837 municípios brasileños al PAS y de hospitalizaciones por enfermedades crónicas no transmisibles (IND-ECNT) según las categorías de financiación y el Índice Firjan de Desarrollo Socioeconómico (IFDM). Resultados: El IND-ADH fue alto en municipios financiados mediante enmiendas parlamentarias (1,18), el IFDM moderado a alto (0,94) y el indicador ECNT alto (1,03) (p<0,001). Hubo correlaciones significativas (p<0,05) entre los indicadores IND-ADH e IND-DCNT en municipios con financiamiento del Ministerio de Salud (r = 0,14) y mixtos (r=0,12); hubo correlación negativa para municipios con IFDM moderado a bajo (r=-0,09; p=0,013). Conclusión: La enmienda parlamentaria fue la forma principal de adhesión al PAS de los municipios, cuando ajustada por la población. Los municipios con los peores indicadores socioeconómicos y de ENT tuvieron un IND-ADH más bajo.

Objective: To analyze the correlation between municipalities adhering to the Health Fitness Center Program, noncommunicable chronic disease (NCD) hospitalizations and socioeconomic levels from 2011 to 2017. Methods: This was an ecological study; HFCP adherence indicators for 2,837 municipalities were calculated, as were NCD hospitalization indicators, according to funding categories and the Firjan Socioeconomic Development Index. Results: The HFCP adherence indicator was higher for municipalities that received Congress funding (1.18), had moderate to high Firjan Socioeconomic Development Indices (0.94) and high NCD hospitalization indicators (1.03) (p<0.001). There were positive correlations (p<0.05) between the two indicators in municipalities receiving Ministry of Health funding (r=0.14) and those receiving both Congress and Ministry of Health funding (r=0.12); whereas correlation was negative in municipalities with moderate to low Firjan Socioeconomic Development Indices (r=-0.09; p=0.013). Conclusion: The main form of adherence to the HFCP, according to population size, was through Congress funding. Municipalities with poorer socioeconomic and NCD indicators had lower adherence to the HFCP.