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Orientador: Sidney Piochi Bernardini Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo Resumo: O Estatuto da Cidade (Lei nº 10.257/2001) ampliou a gama de municípios obrigados a elaborar Plano Diretor, incluindo aqueles com menos de vinte mil habitantes em casos específicos. A Lei ampliou também a área de abrangência dos planos diretores, que passaram a ter de englobar toda a unidade territorial dos municípios, isto é, suas áreas urbanas e rurais. Entretanto, a prática de elaboração de planos diretores nos municípios de pequeno porte populacional, em especial daqueles com menos de vinte mil habitantes, tem revelado uma inadequação dos instrumentos disponíveis no Estatuto da Cidade para lidar com as demandas e dificuldades destes municípios. Paralelamente à discussão pelo viés do urbano, os estudiosos e formuladores de políticas públicas direcionadas aos espaços rurais também tem discutido normas e instrumentos voltados aos municípios de pequeno porte populacional, considerando tanto suas áreas rurais quanto urbanas. Nesse contexto, este trabalho tem como objetivos verificar a relevância dos planos diretores para os municípios de até vinte mil habitantes e a adequação do Estatuto da Cidade a estes municípios no que se refere ao instrumento do Plano Diretor. Para tanto, foi utilizada pesquisa bibliográfica, pesquisa documental e estudos de caso de seis municípios de diferentes "tipos regionais dos espaços rurais" e "tipologias das cidades". Concluiu-se que a relevância maior do Plano Diretor para os municípios de pequeno porte populacional concentra-se no regramento de uso e ocupação do solo (planejamento e gestão de enfoque físico-espacial) e que há a necessidade de acréscimos na Lei do Estatuto da Cidade de modo a melhor direcionar a elaboração e revisão dos planos diretores municipais nesse sentido. Os dados e análises também trazem ponderações sobre a (des)coordenação de competências federativa e a necessidade de políticas e normas de articulação microrregional com foco nos municípios de pequeno porte populacional Abstract: The City Statute (Law nº 10257/2001) expanded the range of municipalities required to prepare a Master Plan, including those with less than twenty thousand inhabitants in specific cases. The Law also expanded the scope of the master plans, which now have to encompass the entire territorial unit of the municipalities, that is, their urban and rural areas. However, the practice of preparing master plans in municipalities with small populations, especially those with less than twenty thousand inhabitants, has revealed an inadequacy of the instruments available in the City Statute to deal with the demands and difficulties of these municipalities. Parallel to the discussion from the urban perspective, the scholars and public policy makers linked to rural spaces has also discussed norms and instruments aimed at small-populated municipalities, considering both their rural and urban areas. In this context, this work aims to verify the relevance of master plans for municipalities with less than twenty thousand inhabitants and the adequacy of the City Statute to these municipalities with regard to the Master Plan instrument. For that, bibliographical research, documental research and case studies of six municipalities from different "regional types of rural spaces" and "typologies of cities" were used. It was concluded that the main relevance of the Master Plan for municipalities with small populations focuses on the regulation of land use and occupation (physical-spatial planning and management) and that there is a need for additions to the City Statute Law in order to better direct the elaboration and review of municipal master plans in this way. The data and analyzes also bring considerations about the (dis)coordination of federative competences and the need for policies and norms for micro-regional articulation with a focus on small-population municipalities Doutorado Arquitetura, Tecnologia e Cidade Doutora em Arquitetura, Tecnologia e Cidade CAPES 88882.435510/2019-01

A producao do espaco urbano contemporâneo manifesta-se de forma dispersa e fragmentada em diversas cidades pelo mundo afora. No Brasil, desde a decada de 1970, com os processos de desconcentracao produtiva e interiorizacao da ocupacao, verifica-se o crescimento populacional e territorial de varias cidades medias a partir deste padrao de producao do espaco urbano, a exemplo de Sao Jose do Rio Preto. Este municipio paulista, nas ultimas cinco decadas, tem produzido um espaco urbano nao apenas espraiado e fragmentado, mas tambem excludente. Este artigo tem como objetivo demonstrar as contradicoes e inconformidades da legislacao urbanistica rio-pretense em relacao a expansao urbana e como contribui, junto a outras acoes do poder publico municipal, para a inducao de tal padrao de ocupacao urbana. Como metodologia, sao analisadas as leis urbanisticas do municipio desde 1958 (primeira Lei de Zoneamento e Parcelamento do Solo de Sao Jose do Rio Preto) ate as atuais, confrontando seus objetivos com suas determinacoes e estas com as determinacoes legais de âmbito federal. Analisa-se a evolucao da mancha urbana nos ultimos cinquenta anos, dando enfoque ao crescimento do perimetro urbano do municipio, desde o Plano Diretor de 2006 ate 2016. Verifica-se que o crescimento espraiado, segmentado e excludente da cidade deve-se a atuacao omissa do poder publico municipal, que, atraves de leis contraditorias e flexiveis, permite a expansao urbana a partir da demanda do mercado imobiliario. PALAVRAS-CHAVE: legislacao urbanistica; expansao urbana; Sao Jose do Rio Preto - SP.

The first utopias associated to urban spaces are dated from the fifteenth century. Since then,many urban utopias have been arisen over the centuries, but the Postmodernity seems to havecaused the death of utopian ideas related to Urbanism. However, if we borrow the conceptionof Utopia advocated by Ernst Bloch, we can consider the urban-social movement called“Cidade que Queremos BH” (“The city we want, Belo Horizonte”) as an example ofcontemporary urban utopia. It is about an utopia that do not state only in the future, butmainly in the present, that is understood as the only temporality that holds the possibilities oftransformation of what may come. As primeiras utopias relativas aos espaços urbanos datam do séculoXV. Desde então, muitas foram as utopias urbanas elaboradas aolongo dos séculos, mas a Pós-Modernidade parece ter provocado amorte das ideias utópicas no Urbanismo. Entretanto, se tomarmos deempréstimo a concepção de “utopia” defendida por Ernst Bloch,podemos considerar o movimento social-urbano “Cidade queQueremos BH” como exemplo de utopia urbana contemporânea.Trata-se de uma utopia que não está apenas no futuro, mas,principalmente, no presente, entendido como única temporalidadedetentora das possibilidades de transformação do porvir.

INTRODUCTION AND OBJECTIVES: The extended-release formulation of tacrolimus (ERT) allows once-daily dosage, thus simplifying the immunosuppressive regimen. This study aimed to describe the safety and efficacy of the de novo and early use of ERT in heart transplantation. METHODS: This was an observational, retrospective, multicenter study comparing the safety and efficacy of the de novo use of ERT (ERT group [n=94]), standard-release tacrolimus (SRT group [n=42]) and early conversion (EC) from SRT to ERT (EC group [n=44]). Extended-release tacrolimus was used between 2007 and 2012. One-year incidence rates of acute rejection, infection, and cytomegalovirus infection were analyzed. Safety parameters were also evaluated. RESULTS: There were no significant between-group differences in the daily dose or trough levels of tacrolimus during the first year after transplantation. The rejection incidence rates were 1.05 (95%CI, 0.51-1.54), 1.39 (95%CI, 1.00-1.78), and 1.11 (95%CI, 0.58-1.65) episodes per patient-years in the SRT group, ERT group, and EC group, respectively (P=.48). The infection incidence rates were 0.75 (95%CI, 0.60-0.86), 0.62 (95%CI, 0.52-0.71), and 0.55 (95%CI, 0.40-0.68) in the SRT group, ERT group, and EC group, respectively (P=.46). Cytomegalovirus infection occurred in 23.8%, 20.2%, and 18.2% of the patients, respectively (P=.86). No significant between-group differences were found in laboratory tests or in allograft function. There was 1 death in the SRT group and 2 in the ERT group. CONCLUSIONS: Both de novo and early use of ERT seem to have similar safety and efficacy profiles to conventional SRT-based immunosuppression.

INTRODUCTION AND OBJECTIVES: We present the characteristics and outcomes of heart transplantation in Spain since it was first performed in 1984. METHODS: A descriptive analysis of the characteristics of recipients, donors, the surgical procedure, and the outcomes of heart transplantations performed in Spain until 31 December 2014. RESULTS: In 2014, 266 procedures were performed, making a time series of 7289 transplantations. The temporal analysis confirmed a significant worsening of the clinical profile of recipients (higher percentage of older patients, patients with severe renal failure, insulin-dependent diabetes, previous cardiac surgery, and previous mechanical ventilation), of donors (higher percentage of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations, reaching 41.4% in 2014, and ischemia time>240min). Mechanical assist devices were used less than in 2013; in 2014 they were used in 18.8% of all transplant recipients. Survival at 1, 5, 10, and 15 years was 76%, 65%, 52%, and 38%, respectively, and has remained stable since 1995. CONCLUSIONS: Cardiac transplantation activity in Spain has remained stable in recent years, at around 250 procedures per year. Despite a clear deterioration in donor and recipient characteristics and surgical times, the mortality outcomes have remained comparable to those of previous periods in our environment. The growing use of circulatory assist devices before transplantation is also confirmed.

The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 +/- 4.1 vs. 24.3 +/- 3.7; P < 0.01), and male donors were younger than female donors (33.4 +/- 12.7 vs. 38.2 +/- 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.

INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984. METHODS: We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013. RESULTS: During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulin-dependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995. CONCLUSIONS: Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed.

The present article reports the characteristics and results of heart transplantation in Spain since this therapeutic modality was first used in May 1984.