Dilemas morales y practicas de salud

El texto discute la emergencia de dilemas morales en las prácticas de salud, teniendo en cuenta la acelerada transición demográfica en los países en desarrollo y los crecientes costos de los sistemas públicos de salud. Se hace énfasis en dos dimensiones del cuidado de la salud que han ocupado un lugar importante en la generación de tales dilemas. La tensión entre las estrategias comerciales que contornan el mercado de productos de salud y la expansión del acceso a dichos productos, por un lado, y el aumento de la importancia de las tecnociencias en las prácticas de cuidado de la salud, por el otro. En conclusión, se discute la importancia del arbitraje político, social y jurídico en la codificación ética de los dilemas y el papel del Estado Democrático de Derecho en el arbitraje.The emergence of moral dilemmas in health care practices, in view of the rapid demographic transition in developing countries, and skyrocketing public health care costs, is discussed. The focus is on two aspects of health care that have occupied an important place in the generation of these dilemmas. On the one hand, the tension between commercial strategies involving the health products market and the expansion of access to them and, on the other, the growth of techno-sciences in health care practices. In conclusion, the importance of the political, social and juridical arbitration on the ethical codifi cation of those dilemmas and the role of a Democratic State of Law in that arbitration is discussed.Discute-se a emergência de dilemas morais nas práticas de saúde, tendo em vista a acelerada transição demográfica nos países em desenvolvimento e os crescentes custos dos sistemas públicos de saúde. São focalizadas duas dimensões do cuidado à saúde que têm ocupado um lugar importante na geração desses dilemas: a tensão entre as estratégias comerciais que contornam o mercado de produtos de saúde e a expansão do acesso a esses produtos, por um lado, e o aumento da importância das tecnociências nas práticas de cuidado à saúde, por outro. Em conclusão, é discutida a importância da arbitragem política, social e jurídica na codificação ética desses dilemas e o papel do Estado Democrático de Direito nessa arbitragem

Information to the eye of the beholder: data visualization for many-objective optimization

The visualization gap is one of the important challenges posed by many-objective optimization problems (MaOPs). In this paper, we present an integrated data visualization method for MaOPs, called CAP-vis plot, combining the Chord diagram, the Angular mapping and the Parallel coordinates in the same visualization. The method follows the circular design layout, showing different levels of information. This new approach allows the spatial location of points in high dimensional spaces, the visualization of harmony and conflict between objectives, as well as the comparison of the approximation sets provided by different algorithms. With this work, we try to fill the visualization gap and bring information to the eye of the decision-maker and the optimizer, with an intuitive overview of the obtained results. Some experiments were performed using the Benchmark Functions proposed for the IEEE-CEC 2018 Competition on Many-Objective Optimization. We used the tool to visualize the results obtained by NSGA-III, HypE, RVEA, MOEA/DD, PICEA-g, using the PlatEMO MATLAB platform, with the same parameter settings of the competition. The results on the Benchmark Problems show the importance of the qualitative analysis of the data. The experiments show how visualization can help interpretation of the results and identification of strengths and drawbacks of MOEA.The authors would like to thank the Brazilian agencies CAPES, CNPq and FAPEMIG for the financial support

Evidence for overdensity around z_em > 4 quasars from the proximity effect.

MNRAS (accepted) 11 pages, 12 figuresInternational audienceWe study the density field around z_em > 4 quasars using high quality medium spectral resolution ESI-Keck spectra (R~4300, SNR > 25) of 45 high-redshift quasars selected from a total of 95 spectra. This large sample considerably increases the statistics compared to previous studies. The redshift evolution of the mean photo-ionization rate and the median optical depth of the intergalactic medium (IGM) are derived statistically from the observed transmitted flux and the pixel optical depth probability distribution function respectively. This is used to study the so-called proximity effect, that is, the observed decrease of the median optical depth of the IGM in the vicinity of the quasar caused by enhanced photo-ionization rate due to photons emitted by the quasar. We show that the proximity effect is correlated with the luminosity of the quasars, as expected. By comparing the observed decrease of the median optical depth with the theoretical expectation we find that the optical depth does not decrease as rapidly as expected when approaching the quasar if the gas in its vicinity is part of the standard IGM. We interpret this effect as revealing gaseous overdensities on scales as large as ~15 Mpc/h. The mean overdensity is of the order of two and five within, respectively, 10 and 3 Mpc/h. If true, this would indicate that high redshift quasars are located in the center of overdense regions that could evolve with time into massive clusters of galaxies. The overdensity is correlated with luminosity: brighter quasars show higher overdensities

Damped and sub-damped Lyman-α absorbers in z > 4 QSOs

We present the results of a survey for damped (DLA, log N(H I) > 20.3) and sub-damped Lyman-α systems (19.5 2.55 along the lines-of-sight to 77 quasars with emission redshifts in the range 4 19.5 are detected of which 40 systems are damped Lyman-α systems for an absorption length of ∆X = 378. About half of the lines of sight of this homogeneous survey have never been investigated for DLAs. We study the evolution with redshift of the cosmological density of the neutral gas and find, consis- tently with previous studies at similar resolution, that ΩDLA,H I decreases at z > 3.5. The overall cosmological evolution of ΩHI shows a peak around this redshift. The H I column density distribution for log N(H I) ≥ 20.3 is fitted, consistently with previous surveys, with a single power-law of index α ∼ -1.8±0.25. This power-law overpredicts data at the high-end and a second, much steeper, power-law (or a gamma function) is needed. There is a flattening of the function at lower H I column densities with an index of α ∼ −1.4 for the column density range log N(H I) = 19.5−21. The fraction of H I mass in sub-DLAs is of the order of 30%. The H column density distribution does not evolve strongly from z ∼ 2.5 to z ∼ 4.5

The current challenges of the fight for a universal right to health in Brazil

Desde a promulgação da Constituição federal de 1988, o Brasil mudou muito. Na saúde, embora tenham ocorrido avanços importantes, persistem problemas antigos e novos têm surgido. O objetivo maior de assegurar o direito universal à saúde não foi alcançado. Em 2019, realiza-se a 16ª Conferência Nacional de Saúde, momento oportuno para analisar a história, o momento presente e as tendências que se anunciam. Este texto busca contribuir para essa análise, com base nos resultados de estudos sobre a evolução das condições de saúde da população e do sistema de saúde brasileiro nos últimos 30 anos. Identifica o fortalecimento do setor privado e do capital na área da saúde, em detrimento do interesse público e do SUS. Por fim, discute as estratégias de luta pelo direito à saúde necessárias e possíveis no contexto atual24827832792Brazil has changed a lot since the enactment of the 1988 Federal Constitution. Although substantial advances have occurred in the health sector, old problems persist and new ones arise. The main goal of ensuring the universal right to health has not been achieved. The 16th National Health Conference will be held in 2019, an opportune moment to analyze the history, the present moment and the announcing trends. This text seeks to contribute to this analysis based on the results of studies on the developing health conditions of the population and the Brazilian health system in the last 30 years. It identifies the strengthening of the private sector and capital in the health sector, to the detriment of the public interest and the SUS. Finally, it discusses the strategies of the struggle for the right to health necessary and possible in the current contex

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

Conferencia internacional. Desafíos de la Investigación e innovación en tiempos de Covid-19

En 2018, Treinta y nueve estudiantes femeninas del X ciclo del periodo 2018-1 de la escuela de Psicología de una universidad particular del cono norte de Lima, ellas han descrito el romance de su personas cercanas a ellas. Se analizaron los 266 casos de parejas de enamorados estaban el rango de 17 a 25 años. El instrumento que se usó fue una CUESTIONARIO CUPIDO que es una escala nominal de conductas donde las estudiantes de psicología clasificaban los comportamientos en categorías preestablecidas, claramente definidas y mutuamente excluyentes. La conclusión más importante del estudio observacional fue que las parejas analizadas en un 64.4 % la mujer ero atrajo al varón y después el varón emo conectó con la mujer. También han observado otro estilo de romance cuando el varón ero atrajo a la mujer por su cuerpo atracción y después la mujer fue la que emo conectó con el varón y observaron este hecho en un 35.6 % de los casos

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt