A foundation for real recursive function theory

The class of recursive functions over the reals, denoted by REC(R), was introduced by Cristopher Moore in his seminal paper written in 1995. Since then many subsequent investigations brought new results: the class REC(R) was put in relation with the class of functions generated by the General Purpose Analogue Computer of Claude Shannon; classical digital computation was embedded in several ways into the new model of computation; restrictions of REC(R) were proved to represent different classes of recursive functions, e.g., recursive, primitive recursive and elementary functions, and structures such as the Ritchie and the Grzergorczyk hierarchies. The class of real recursive functions was then stratified in a natural way, and REC(R) and the analytic hierarchy were recently recognised as two faces of the same mathematical concept. In this new article, we bring a strong foundational support to the Real Recursive Function Theory, rooted in Mathematical Analysis, in a way that the reader can easily recognise both its intrinsic mathematical beauty and its extreme simplicity. The new paradigm is now robust and smooth enough to be taught. To achieve such a result some concepts had to change and some new results were added

sensitivity analysis

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Tabela Nacional de Funcionalidade (adulto em idade ativa com doença crónica). RELATÓRIO FINAL

Na sequência da Resolução da Assembleia da República n.º 90/2010, de 10 de agosto, o Ministério da Saúde incumbiu a Direção-Geral da Saúde de elaborar uma tabela nacional de funcionalidade para pessoas com doenças crónicas, de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) da Organização Mundial de Saúde (OMS). A Direção-Geral da Saúde, ainda em 2010, através do Departamento de Qualidade na Saúde, criou um grupo de trabalho, para a elaboração da proposta de construção de uma Tabela Nacional de Funcionalidade para pessoas adultas com doença crónica. A população alvo, nesta tabela, são adultos em idade ativa, entre os 18 e os 64 anos. Um dos fatores que justifica não incluir a população com idade igual ou superior a 65 anos, no desenho e validação desta tabela, é o facto de estarem a decorrer estudos nacionais que responderão a esta necessidade (Lopes M. J., et al., 2012 e 2013). Para a identificação das doenças crónicas, a utilizar no desenvolvimento desta tabela, os critérios utilizados foram a prevalência de doenças crónicas, o grau de incapacidade associado à doença crónica e a evidência disponível. Foram incluídas as seguintes entidades clínicas: doença cardíaca isquémica crónica, depressão, diabetes mellitus, obesidade, doença pulmonar obstrutiva crónica, acidente vascular cerebral, esclerose múltipla, esclerose lateral amiotrófica, doença de parkinson, paralisia cerebral, dor crónica generalizada, osteoartrose, osteoporose, artrite reumatóide, lombalgia, espondilite anquilosante e cancro da mama. As doenças crónicas, conforme descrito pela OMS, acarretam custos identificados e sentidos por toda a sociedade, nomeadamente para doentes e família. Os custos associados às doenças crónicas incluem por um lado os gastos monetários com os cuidados de saúde e por outro toda a despesa invisível associada à doença crónica como sejam a diminuição da esperança média de vida, a condição de incapacidade e participação diminuída de alguns grupos mais vulneráveis, a redução dos dias de trabalho, o absentismo, o desemprego e a diminuição da qualidade de vida. Uma sociedade saudável é uma sociedade que consegue optimizar todo o seu potencial de saúde, contribuindo de forma integrada e ativa para o seu desenvolvimento. Um dos aspetos inovadores deste projeto está associado ao facto de se tentar desenvolver um mecanismo de registo em saúde, centrado na pessoa e nas suas dimensões de funcionalidade, de forma a complementar os registos de doença, realizados por recurso à Classificação Internacional de Doenças (CID) e à Tabela Nacional de Funcionalidade. Um outro aspeto considerado inovador deste projeto centra-se no facto de se caracterizar a funcionalidade da pessoa com doença crónica em idade adulta, potencialmente produtiva e ativa e, não de uma doença ou de um conjunto de procedimentos, em particular. A implementação do registo sistemático da funcionalidade do adulto em idade ativa permite, ao longo do tempo, medir a evolução da funcionalidade, como indicador de saúde, contribuindo assim para uma mais adequada e racional alocação de recursos, monitorização de resultados das intervenções de saúde e sociais, assim como para uma melhoria da equidade na atribuição de benefícios fiscais e prestações sociais (Parrish, 2010). Bierman e Bickenbach (2003) defendem que o estado funcional, além de ser um indicador do estado de saúde, é um ótimo indicador de previsão dos custos dos cuidados de saúde. O Instituto de Estatísticas da Saúde do Canadá refere, desde 2001, que os cuidados de saúde de qualidade devem estar centrados na otimização do estado funcional, sendo esta a principal preocupação dos doentes e das suas famílias (Clauser, 2003). Referindo a experiência do Canadá, um dos países que contribuiu para a construção da Classificação Internacional da Funcionalidade, Incapacidade e Saúde (CIF), Bickenbach (2003) menciona que a introdução da CIF no sistema estatístico canadiano, permitiu expandir a informação de saúde das populações e, ainda, tratar a funcionalidade como uma variável demográfica. A variável funcionalidade é, também, usada para analisar o grau de participação do adulto com incapacidade em vários contextos de vida, incluídos nos inquéritos sociais, como educação, emprego e transportes. Atualmente, em alguns países membros da OMS, como a Austrália, Holanda e Itália, a avaliação da funcionalidade integra os programas de saúde e de ação social, com o objetivo de ser utilizada não só como indicador de necessidades e ganhos em saúde mas, também, como indicador do desempenho dos serviços e avaliação das consequências da deficiência. A longo prazo, esta informação de saúde sobre a funcionalidade da população adulta em idade ativa com doença crónica, possibilitará decisões políticas transversais aos diferentes setores

Stakeholders' perspectives on the regulation and integration of complementary and alternative medicine products in Lebanon: a qualitative study

<p>Abstract</p> <p>Background</p> <p>The regulation of the markets for Complementary and Alternative Medicine (CAM) products presents a global challenge. There is a dearth of studies that have examined or evaluated the regulatory policies of CAM products in the Eastern Mediterranean Region (EMR). We investigate the regulatory frameworks and the barriers for the proper regulation and integration of CAM products in Lebanon, as an example of an EMR country with a weak public infrastructure.</p> <p>Methods</p> <p>We utilized a qualitative study design involving a series of semi-structured interviews with stakeholders of the CAM market in Lebanon. Snowball sampling was used to identify interviewees; interviews continued until the "saturation" point was reached. A total of 16 interviews were carried out with decision makers, representatives of professional associations, academic researchers, CAM product importers, policy makers and a media representative. Interviews were transcribed and thematic analysis of scripts was carried out.</p> <p>Results</p> <p>There was a consensus among all stakeholders that the regulation of the market for CAM products in Lebanon needs to be strengthened. Thematic analysis identified a number of impediments jeopardizing the safety of public consumption and hindering the integration of CAM therapies into mainstream medicine; including: weak infrastructure, poor regulation, ineffective policies and politics, weak CAM awareness and sub-optimal coordination and cooperation among stakeholders. With respect to policy instruments, voluntary instruments (self regulation) were deemed ineffective by stakeholders due to poor awareness of both users and providers on safe use of CAM products. Stakeholders' rather recommended the adoption of a combination of mixed (enhancing public awareness and integration of CAM into medical and nursing curricula) and compulsory (stricter governmental regulation) policy instruments for the regulation of the market for CAM products.</p> <p>Conclusions</p> <p>The current status quo with respect to the regulation of CAM products in Lebanon is not conducive to public safety, nor does it support the integration of CAM products into the healthcare system. The Ministry of Health indeed plays a dominant role in the regulation of these products through a combination of mixed and compulsory policy instruments. Yet, the proper implementation of these regulations requires political resolve coupled with the cooperation of all CAM stakeholders.</p

Critical reflections on evidence, ethics and effectiveness in the management of tuberculosis: public health and global perspectives

BACKGROUND: Tuberculosis is a major cause of morbidity and mortality globally. Recent scholarly attention to public health ethics provides an opportunity to analyze several ethical issues raised by the global tuberculosis pandemic. DISCUSSION: Recently articulated frameworks for public health ethics emphasize the importance of effectiveness in the justification of public health action. This paper critically reviews the relationship between these frameworks and the published evidence of effectiveness of tuberculosis interventions, with a specific focus on the controversies engendered by the endorsement of programs of service delivery that emphasize direct observation of therapy. The role of global economic inequities in perpetuating the tuberculosis pandemic is also discussed. SUMMARY: Tuberculosis is a complex but well understood disease that raises important ethical challenges for emerging frameworks in public health ethics. The exact role of effectiveness as a criterion for judging the ethics of interventions needs greater discussion and analysis. Emerging frameworks are silent about the economic conditions contributing to the global burden of illness associated with tuberculosis and this requires remediation

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Background In Australia there have been many calls for government action to halt the effects of unhealthy food marketing on children\u27s health, yet implementation has not occurred. The attitudes of those involved in the policy-making process towards regulatory intervention governing unhealthy food marketing are not well understood. The objective of this research was to understand the perceptions of senior representatives from Australian state and territory governments, statutory authorities and non-government organisations regarding the feasibility of state-level government regulation of television marketing of unhealthy food to children in Australia.Method Data from in-depth semi-structured interviews with senior representatives from state and territory government departments, statutory authorities and non-government organisations (n=22) were analysed to determine participants\u27 views about regulation of television marketing of unhealthy food to children at the state government level. Data were analysed using content and thematic analyses.Results Regulation of television marketing of unhealthy food to children was supported as a strategy for obesity prevention. Barriers to implementing regulation at the state level were: the perception that regulation of television advertising is a Commonwealth, not state/territory, responsibility; the power of the food industry and; the need for clear evidence that demonstrates the effectiveness of regulation. Evidence of community support for regulation was also cited as an important factor in determining feasibility.Conclusions The regulation of unhealthy food marketing to children is perceived to be a feasible strategy for obesity prevention however barriers to implementation at the state level exist. Those involved in state-level policy making generally indicated a preference for Commonwealth-led regulation. This research suggests that implementation of regulation of the television marketing of unhealthy food to children should ideally occur under the direction of the Commonwealth government. However, given that regulation is technically feasible at the state level, in the absence of Commonwealth action, states/territories could act independently. The relevance of our findings is likely to extend beyond Australia as unhealthy food marketing to children is a global issue.<br /