A judicialização da assistência farmacêutica: análise da atuação da Defensoria Pública da União na Paraíba

A presente monografia parte da premissa da fundamentalidade atribuída ao direito à saúde pela Constituição de 1988 e as suas decorrências práticas derivadas da aplicabilidade imediata e eficácia plena. Conquanto, deva ser implementado pelo Estado, de acordo com o texto constitucional, o seu caráter de direito, precipuamente, prestacional, impede o seu atendimento integral. Ante a ausência de política sanitária que abarque todas as demandas de fármacos que chegam ao Sistema de Saúde, é comum a judicialização desse direito. Nesse contexto, esta pesquisa, por meio de uma abordagem hipotético-dedutivo e método quantitativo e qualitativo, visa analisar a atuação da Defensoria Pública da União na Paraíba (DPU/PB), mais especificamente, da unidade de João Pessoa/PB, no âmbito da judicialização da assistência farmacêutica. A justificativa para a escolha deste tema encontra-se no cenário de intensa judicialização do direito à saúde e da reiterada tentativa de fixação de critérios para a concessão judicial de medicamentos de alto custo, tendo em vista a existência da finitude dos recursos financeiros. Nessa linha, analisar-se-á os posicionamentos doutrinários, jurisprudenciais e os procedimentos instaurados na unidade da DPU/PB, em 2018, no município de João Pessoa. O objetivo é analisar o papel da atuação da Defensoria Pública da União em João Pessoa/PB na judicialização da assistência farmacêutica, sob a perspectiva da efetividade do direito fundamental à saúde e os argumentos doutrinários e jurisprudenciais relacionados à concessão judicial de fármacos.A presente monografia parte da premissa da fundamentalidade atribuída ao direito à saúde pela Constituição de 1988 e as suas decorrências práticas derivadas da aplicabilidade imediata e eficácia plena. Conquanto, deva ser implementado pelo Estado, de acordo com o texto constitucional, o seu caráter de direito, precipuamente, prestacional, impede o seu atendimento integral. Ante a ausência de política sanitária que abarque todas as demandas de fármacos que chegam ao Sistema de Saúde, é comum a judicialização desse direito. Nesse contexto, esta pesquisa, por meio de uma abordagem hipotético-dedutivo e método quantitativo e qualitativo, visa analisar a atuação da Defensoria Pública da União na Paraíba (DPU/PB), mais especificamente, da unidade de João Pessoa/PB, no âmbito da judicialização da assistência farmacêutica. A justificativa para a escolha deste tema encontra-se no cenário de intensa judicialização do direito à saúde e da reiterada tentativa de fixação de critérios para a concessão judicial de medicamentos de alto custo, tendo em vista a existência da finitude dos recursos financeiros. Nessa linha, analisar-se-á os posicionamentos doutrinários, jurisprudenciais e os procedimentos instaurados na unidade da DPU/PB, em 2018, no município de João Pessoa. O objetivo é analisar o papel da atuação da Defensoria Pública da União em João Pessoa/PB na judicialização da assistência farmacêutica, sob a perspectiva da efetividade do direito fundamental à saúde e os argumentos doutrinários e jurisprudenciais relacionados à concessão judicial de fármacos

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Serotype-associated immune response and network immunoclusters in children and adults during acute Dengue virus infection

Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.U.S. Food and Drug Administration. Center for Biologics Evaluation and Research. Office of Blood Research and Review. Silver Spring, MD, USA.U.S. Food and Drug Administration. Center for Biologics Evaluation and Research. Office of Blood Research and Review. Silver Spring, MD, USA.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil / Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e Sarampo. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brazil / Universidade Federal do Amazonas. Manaus, AM, Brazil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brazil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brazil.Universidade Federal do Amazonas. Manaus, AM, Brazil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brazil / Universidade Federal do Amazonas. Manaus, AM, Brazil / Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas. Manaus, AM, Brazil.Universidade Federal de Uberlândia. Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia. Laboratório de Bioinformática e Análises Moleculares. Campus Patos de Minas, MG, Brazil / Universidade Federal de Uberlândia. Faculdade de Engenharia Elétrica. Laboratório de Tecnologias Urbanas e Rurais. Campus Patos de Minas, MG, Brazil.Universidade Federal de Uberlândia. Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia. Laboratório de Bioinformática e Análises Moleculares. Campus Patos de Minas, MG, Brazil / Universidade Federal de Uberlândia. Faculdade de Engenharia Elétrica. Laboratório de Tecnologias Urbanas e Rurais. Campus Patos de Minas, MG, Brazil.Universidade Federal de Uberlândia. Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia. Laboratório de Bioinformática e Análises Moleculares. Campus Patos de Minas, MG, Brazil / Universidade Federal de Uberlândia. Faculdade de Engenharia Elétrica. Laboratório de Tecnologias Urbanas e Rurais. Campus Patos de Minas, MG, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Bioquímica e Imunologia. Belo Horizonte, MG, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade do Estado do Pará. Centro de Ciências Biológicas e da Saúde. Departamento de Patologia. Belém, PA, Brazil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brazil / Universidade Federal do Amazonas. Manaus, AM, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.The present study was designed as an exploratory investigation to characterize the overall profile of chemokines, growth factors, and pro-inflammatory/regulatory cytokines during acute DENV infection according to DENV-1, DENV-2, DENV-4 serotypes and age: children: 3x), except PDGF in which no fold change was observed. Moreover, despite the age ranges, DENV-1 and DENV-4 presented increased levels of VEGF, IL-6, and TNF-α in serum but decreased levels of PDGF, while DENV-2 exhibited increased levels of CXCL8, CCL4, and IL-12. Noteworthy was that DENV-2 showed increased levels of IL-12, IL-15, IL-17, IL-4, IL-9, and IL-13, and maintained an unaltered levels of PDGF at younger ages (<1–10 yo and 11–20 yo), whereas in older ages (21–40 yo and 41–75 yo), the results showed increased levels of CCL2, IL-6, and TNF-α, but lower levels of PDGF. In general, DENV infection at younger age groups exhibited more complex network immunoclusters as compared to older age groups. Multivariate analysis revealed a clustering of DENV cases according to age for a set of soluble mediators especially in subjects infected with DENV-2 serotype. Altogether, our findings demonstrate that the profile of circulating soluble mediators differs substantially in acute DENV according to age and DENV serotypes suggesting the participation of serotype-associated immune response, which may represent a potential target for development of therapeutics and could be used to assist medical directive for precise clinical management of severe cases

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora