SINDICÂNCIA SIMULADA: UMA COLABORATIVA ESTRATÉGIA EDUCACIONAL PARA APRENDIZAGEM EM ÉTICA MÉDICA E BIOÉTICA

Medical teaching in Brazil must associate technical matters with ethical education by using active learning methods. It should allow the acquisition of knowledge, the development of attitudes, and critical reflection, for deliberations that could be technically correct and ethically appropriate to each situation. Complaints against possible ethical deviations are investigated in inquiries by Regional Medical Councils. The simulation of the investigation and judgement of ethical complaints is an educational strategy that aims to facilitate the acquisition of knowledge on current ethical, procedural and legal rules that regulate the medical profession in Brazil. Students may also develop skills of group deliberation, after informed reflection and appraisal, on situations with the eventual presence of ethical violations and thus develop ethically justifiable attitudes. The educational strategy could also help prevent future occurrences of ethical infractions and guide doctors to prepare their replies after complaints in Medical Councils. The paper discusses the characteristics of the educational analysis of disciplinary investigations and its potential to help in medical ethics teaching. The method also tries to link the needs of medical schools and graduate medical programs and the legal purpose of Brazilian Medical Councils. It could also allow effective collaboration between the medical profession's educational and regulatory bodies to develop the ethical decision-making process in the students.O ensino da medicina no Brasil deve associar o conteúdo técnico com a formação ética, valendo-se de métodos ativos de aprendizagem que permitam aquisição de conhecimentos, desenvolvimento de atitudes corretas,  reflexão crítica e consciente para deliberações que sejam tecnicamente acertadas e eticamente adequadas a cada situação. Queixas de usuários de serviços médicos, ou de profissionais da saúde, sobre eventuais desvios éticos são apuradas e depois julgadas em câmaras de sindicâncias nos Conselhos Regionais de Medicina.  O método da sindicância simulada se caracteriza por permitir a cada participante num grupo, de modo ativo e colaborativo, a análise ponderada sobre fatos e circunstâncias relatadas no exercício da profissão médica à luz das normas éticas vigentes no Brasil. A estratégia educacional da simulação de câmaras de sindicâncias visa facilitar a aquisição de conhecimentos sobre as vigentes normas éticas, processuais e legais aplicáveis à profissão médica no Brasil, favorecendo o desenvolvimento de atitudes eticamente justificáveis após reflexão, ponderação e deliberação colegiada  sobre situações descritas para apuração de eventual existência de infrações éticas.  Pode também auxiliar na prevenção de futuras ocorrências de desvios éticos e na preparação de manifestações dos médicos diante de eventuais denúncias. O artigo aborda as características das sindicâncias, possibilidades e limitações da aplicação do método da sindicância simulada e sua importância na conexão entre a finalidade legal dos Conselhos de Medicina e as necessidades de escolas médicas e programas de pós-graduação em medicina, ensejando uma efetiva colaboração entre as instâncias formadoras e reguladoras da profissão médica para desenvolver o processo de tomada de decisões éticas

CONTROLE SOCIAL, TRANSPARÊNCIA, INTEIREZA CIENTÍFICA E RESPONSABILIDADE EM PESQUISAS MÉDICAS

The CEP/CONEP System, submitted to social control, is responsible for the ethical approval of research in Brazil to protect research participants. The Informed Consent Form (ICF) is the public document that implements the protection of participants. The paper presents two cases of medical research in the Amazon region on malaria and the use of chloroquine for treating COVID-19. The participants were uninformed in the ICF on relevant aspects of the two studies, with serious health risks. For the sake of increasing transparency and social control, it is proposed the mandatory publication of the ICF in studies supported by public funds, presentation of an objective summary of the study at the beginning of the ICF, publication of central elements of the protocol of clinical trials in open access Brazilian virtual platforms, and promulgation of a dedicated law to improve scientific and ethical integrity in Brazilian medical research.El Sistema CEP/CONEP es responsable del análisis ético de la investigación en Brasil, sometida al control social, con la misión de proteger a los participantes en la investigación.  El Formulario de Consentimiento Libre e Informado es el documento público que implementa la protección de los participantes. El artículo presenta dos casos de investigación médica en la región amazónica sobre malaria y tratamiento con cloroquina para COVID-19, en que los participantes no fueron informados, en el documento de consentimiento informado, aprobado por el sistema CEP/CONEP, sobre aspectos relevantes de los estudios, con graves riesgos para la salud.  Para aumentar la transparencia y el control social, el artículo propone la divulgación obligatoria del modelo de consentimiento informado en estudios financiados con recursos públicos, la presentación de un resumen objetivo del estudio al inicio del documento de consentimiento, la publicación de elementos centrales del protocolo de ensayos clínicos en plataformas virtuales brasileñas de acceso abierto, y la promulgación de una ley para perfeccionar la integridad científica y ética en la investigación médica brasileña.O Sistema CEP/CONEP é responsável pela regulação ética de pesquisas no Brasil, comprometido com o controle social, para proteger os direitos dos participantes em pesquisas. O Termo de Consentimento Livre e Esclarecido (TCLE) é o documento público que concretiza a proteção dos participantes. O artigo aborda dois casos de pesquisas médicas na região amazônica, sobre malária e tratamento com cloroquina para COVID-19, em que os participantes foram desinformados no TCLE, aprovado pelo sistema CEP/CONEP, sobre aspectos relevantes dos estudos, com sérios riscos à saúde.  Para ampliar a transparência e  controle social, propõe-se a divulgação obrigatória do modelo de TCLE em pesquisas que usem recursos públicos, apresentação de resumo itemizado no início do TCLE, publicação de elementos centrais do protocolo de ensaios clínicos em plataformas virtuais brasileiras de acesso aberto e promulgação de lei para aprimorar a inteireza científica e ética nas pesquisas médicas brasileiras

Dynamic Reconfiguration of Distribution Network Systems Featuring Large-scale Intermittent Power Sources

The growing trend of variable energy source integration in power systems (especially at a distribution level) is leading to an increased need for flexibility in all levels of the energy flows in such systems: the supply, the network and the demand sides. This paper focuses on a viable flexibility option that can be provided by means of a dynamic network reconfiguration (DNR), an automatic changing of line statuses in response to operational conditions in the system. The ultimate aim is to assess the impacts of such flexibility on the utilization levels of variable power sources (mainly, solar and wind) integrated at a distribution level. To perform this analysis, a stochastic mixed integer linear programming (S-MILP) operational model is developed in this work. The objective of the optimization problem is to minimize the sum of the most relevant cost terms while meeting a number of model constraints. The proposed model dynamically finds an optimal configuration of an existing network system in accordance with the system's operational conditions. The operation scale in the current work is one day, but with the possibility of an hourly reconfiguration. The standard IEEE 41-bus system is employed to test the proposed model and perform the analysis. Numerical results generally show that DNR leads to a more efficient utilization of renewable type DGs integrated in the system, reduced costs and losses, and a substantially improved system performance especially the voltage profile in the system

Agua, sostenibilidad y Derecho (Brasil - España)

Libro electrónico. Estudios sobre gestión y gobernanza del agua. Sostenibilidad, medio ambiente. Derecho comparado español y brasileño. Incluye estudios multidisciplinares del ámbito del Derecho, la Economía, la Geografía, etc.UNIVALI, Universidad de Alicante, Instituto del Agua y de las Ciencias Ambientales U.A., Generatitat Valenciana, COEPA, INECA

Crescimento e produção do milho irrigadocom água salina

Corn (Zea mays L.) is an important crop in Brazil and is cultivated in all regions, including the semi-arid area of Brazil, where the occurrence of irrigation water with high concentration of salts is common. Evaluating the growth and yield of the maize hybrid 'AG 6690' irrigated with water of different salinity levels was the objective of this experiment. Sowing was performed in pots with 12 seeds on May 23, 2003, and seedlings were thinned to two plants per pot. Irrigation was accomplished when the mean soil matric potential of each treatment was approximately -30 kPa using water with seven different electrical conductivities (ECi), varying from 0.3 to 4.5 dS m-1, which were obtained by addition of NaCl and CaCl2 in the equivalent proportion of 1:1. The dry weights of all parts of the corn plants as well as their evapotranspiration and water use efficiency were reduced by salinity. Grain yield decreased by 21 and 20% for each unit increase of ECi and electrical conductivity of soil solution (ECs) above the respective threshold values of 1.7 and 4.3 dS m-1, respectivelly. Plants were able to maintain the leaf area index unaltered under moderate saline conditions.O milho (Zea mays L.) é uma importante cultura no Brasil, sendo cultivado em todas as regiões, incluindo a região do semi-árido, onde é comum a ocorrência de águas com alta concentração de sais. Avaliar o crescimento e a produção do milho, híbrido 'AG 6690', irrigado com águas de diferentes níveis de salinidade foi o objetivo deste trabalho. O plantio foi realizado em vasos com 12 sementes por vaso, em 23 de maio de 2003, e realizado o desbaste deixando-se apenas duas plantas por vaso. A irrigação foi realizada sempre que o potencial mátrico médio do solo de cada tratamento aproximava-se de -30 kPa, utilizando-se águas com sete diferentes condutividades elétricas (ECi) variando entre 0,3 e 4,5 dS m-1, as quais foram alcançadas pela adição de NaCl e CaCl2 na proporção equivalente de 1:1. O peso seco de todas as partes da planta foi reduzido pela salinidade, assim como a evapotranspiração e a eficiência de uso de água. A produção reduziu por 21 e 20% para cada aumento unitário de ECi e ECs (condutividade elétrica da solução do solo) acima dos valores limiares de 1,7 e 4,3 dS m-1, respectivamente. As plantas foram capazes de manter a área foliar constante sob condições de salinidade moderada

Emergência e crescimento do milho e da soja sob estresse salino

Emergence and seedling growth may be severely affected by salinity, mainly for sensitive crops. The objective of the present study was to verify the tolerance of corn and soybean to the irrigation water salinity (ECi) during the emergence and initial development stages. Seeds of corn, hybrid 'AG-6690', and soybean, cv. 'Conquista', were sown in pots containing material from a sandy-loam soil and irrigated with water of increasing salinity levels, from 0.3 to 5.9 dS m-1, giving nine levels of ECi obtained by the addition of an equivalent proportion of sodium and calcium chloride, except for ECi = 0.3 dS m-1 (tap water). Emergence of corn was not affected by salinity but seedling development was reduced for ECi above 1.5 dS m-1. Emergence and growth of soybean were reduced by water salinity and the crop was more tolerant during the emergence (ECi = 2.7 dS m-1) than in the initial development (ECi = 1.0 dS m-1) stage. Salinity of soil solution (ECs) was linearly correlated to ECi and affected the growth of corn and soybean for ECs higher than 3 and 2 dS m-1, respectively.A emergência e o crescimento inicial podem ser severamente afetados pela salinidade, principalmente para culturas sensíveis. O objetivo do presente estudo foi verificar a tolerância do milho e da soja à salinidade da água de irrigação (CEi) nas fases de emergência e desenvolvimento inicial das plantas. Sementes de milho, híbrido 'AG-6690', e soja, cv. 'Conquista', foram semeadas em vasos contendo material de solo franco-arenoso e irrigadas com água de níveis crescentes de salinidade, variando de 0,3 a 5,9 dS m-1, totalizando nove níveis de CEi obtidos pela adição de cloreto de sódio e de cálcio em proporções equivalentes, exceto para CEi = 0,3 dS m-1 (água de torneira). A emergência do milho não foi afetada pela salinidade da água, mas o desenvolvimento das plantas foi reduzido para CEi acima de 1,5 dS m-1. A emergência e o crescimento da soja foram reduzidos pela salinidade, sendo mais tolerante na fase de emergência (CEi = 2,7 dS m-1) do que no desenvolvimento inicial das plantas (CEi = 1.0 dS m-1). A salinidade da solução do solo (CEs) foi linearmente correlacionada à CEi e afetou o crescimento do milho e da soja para CEs acima de 3 e 2 dS m-1, respectivamente

Clinic-Pathological Aspects of Spleen Hemophagocytic Histiocytic Sarcoma in a Dog

Background: Histiocytes are cells that differentiate into macrophages and dendritic cell lines from bone marrow CD34+ stem cells. The hemophagocytic histiocytic sarcoma (HHS) is the only malignant neoplasm originating from macrophage lineages, being a variation of histiocytic sarcoma (HS), originated from dendritic cells. In general, the HHS shows aggressive biological behavior, due to the erythrophagocytosis characteristic of this disease and overall average survival around seven weeks, affecting mainly Bernese Mountain Dog, Rottweiler and Golden Retriever breeds. Therefore, the objective of this work is to report the case of a dog with HHS, emphasizing the clinical aspects and its diagnostic method.Case: An 8-year-old bitch Rottweiler, was attended with history of inappetence and prostration. The complete blood count showed normochromic normocytic anemia, monocytosis and thrombocytopenia, with serum urea levels below the reference value for the specie in the biochemical examination. The abdominal ultrasound highlighted splenomegaly, with heterogeneous parenchyma and presence of a vascularized mass and an enlarged splenic vein.  Thoracic radiographic examination showed multifocal and rounded radiopaque structures in the pulmonary parenchyma, suggesting metastatic formation. Rapid serological tests for detection of the main hemoparasitosis antibodies were negative, as well as negative Coombs test. The animal was submitted to exploratory laparotomy with medial line access and posterior splenectomy. The spleen microscopic evaluation revealed neoplastic proliferation cells in mantle arrangement and solid nests areas, supported by a fine fibrovascular stroma. The cells had broad and eosinophilic cytoplasm, round nuclei and some pleomorphism, rude chromatin and evident nucleoli. It was also observed the presence of marked anisocytosis and anisocariosis, hemophagocytic activity, and 27 mitoses in 10 fields (40 x). There were atypical mitoses and necrosis and extensive hemorrhaged areas. These histopathological findings suggested a histiocytic malignant neoplasia and immunohistochemical analysis   was performed to define a better histiocytic neoplasm origin. The neoplastic cells showed positive imunostaining for CD11d and Iba1 and negative imunostaining for CD3 and CD20, as well as a proliferative index of 80%, supporting the diagnosis of HHS in the animal's spleen. The following hematological analyzes demonstrated persistence of anemia, worsening of thrombocytopenia, prolongation of activated partial thromboplastin time, hypoproteinemia with hypoalbuminemia, serum increase of creatinine, alkaline phosphatase and total bilirubin. Myelogram showed erythrocyte and granulocytic lineage hypoplasia, thrombocytic aplasia and more than 50% of macrophages in bone marrow cell population. The animal’s clinical condition worsened rapidly, after successive transfusions and administration of chemotherapy with lomustine, leading to death 14 days after the surgery.Discussion: HHS is the most serious clinical presentation among histiocytic disorders, conferring an extremely unfavorable prognosis. In addition, the scientific literature that specifically addresses the HHS is rare, with therapeutic extrapolations being performed for the treatment of HS from dendritic cells. The racial predisposition and clinical findings, associated with hematological changes, histopathological analysis and confirmation by immunohistochemistry allowed the diagnosis of HHS, a rare and underreported neoplasm, with aggressive biological behavior and with still inefficient treatment in veterinary medicine