O Contratualismo e seu legado nas teorias de Relações Internacionais: um olhar a partir do Brasil

Este trabalho apresenta o pensamento contratualista da Teoria Política Moderna, com o objetivo geral de enfatizar alguns de seus reflexos nas Relações Internacionais. Metodologicamente, utiliza-se o estilo de pesquisa qualitativo, para selecionar somente obras contratualistas que impactam as teorias de Relações Internacionais. Esse recorte é feito a partir de epistemologia aplicada no Brasil. Assim, analisam-se as obras contratualistas de Baruch de Espinosa, Immanuel Kant, Jean-Jacques Rousseau, John Locke e Thomas Hobbes, com o intuito de, comparativamente, expor sua relação com as teorias internacionalistas

Percepções de gestores de um hospital universitário sobre a qualidade em saúde

Objective: to describe the perceptions of managers of a university hospital about quality in health. Method: this is a descriptive study, with a qualitative approach, carried out in a university hospital in Northeast Brazil. The study population was composed of 60 managers. Data were collected between 2017 and 2018, based on a semi-structured interview. Lexicographic textual analysis was performed with the support of the IRaMuTeQ software. Results: 593 text segments were analyzed and classified in the following categories: "Influence of the management model", "Quality management tools", "Conceptions of quality in health" and "Health promotion actions". The managers understood that the management model adopted influences care, and, consequently, its quality. Conclusion: it was found that managers related quality to the problem-solving service provided to users, as well as to a good relationship between professionals and the consequent improvement in the work process.Objetivo: descrever as percepções de gestores de um hospital universitário sobre a qualidade em saúde. Método: trata-se de estudo do tipo descritivo, com abordagem qualitativa, realizado em hospital universitário do Nordeste do Brasil. A população de estudo foi composta por 60 gestores. Os dados foram coletados entre 2017 e 2018, a partir de entrevista semiestruturada. Realizou-se análise textual lexicográfica com suporte do software IRaMuTeQ. Resultados: foram analisados 593 segmentos de texto com elucidação das classes: “Influência do modelo de gestão”, “Ferramentas de gestão da qualidade”, “Concepções de qualidade em saúde” e “Ações de promoção em saúde”. Os gestores compreendiam que o modelo de gestão adotado influencia na assistência e, consequentemente, na qualidade do atendimento. Conclusão: verificou-se que os gestores relacionaram a qualidade à resolutividade do atendimento aos usuários, bem como a um bom relacionamento entre profissionais e à consequente melhoria no processo de trabalho

Joint use of data and modeling in coastal wave transformation

In the framework of a research project entitled "BRISA-BReaking waves and Induced SAnd transport", a methodology was devised to characterize the waves joining together in-situ measurements and numerical wave propagation models. With this goal in mind, a number of in-situ measurements were made, for selected positions in front of Praia de Faro (South Portugal), during four days (25th to 28th March, 2009) by using different types of equipments (e.g., resistive wave gauges, pressure sensors, currentmeters and a new prototype pore pressure sensor using optical fibre). Wave records were obtained simultaneously offshore (at a water depth of 11.7 m below mean sea level, MSL) and at the surf and swash zones. The data processing and analysis were made by applying classical time domain techniques. Numerical simulations of the wave propagation between offshore and inshore for the measurement period were performed with two numerical models, a 1D model based on linear theory and a nonlinear Boussinesq-type model, COULWAVE, both forced by the measured offshore wave conditions of 27th March 2009. Comparisons between numerical results and field data for the pressure sensors placed in the surf and swash zones were made and discussed. This approach enables to evaluate the performance of those models to simulate those specific conditions, but also to validate the models by gaining confidence on their use in other conditions.Science and Technology Foundation of the Ministry of Science, Technology and Higher Education, Portugal [SFRH/BPD/20508/2004]info:eu-repo/semantics/publishedVersio

Assessment of runup predictions by empirical models on non-truncated beaches on the south-east Australian coast

This paper assesses the accuracy of 11 existing runup models against field data collected under moderate wave conditions from 11 non-truncated beaches in New South Wales and Queensland, Australia. Beach types spanned the full range of intermediate beach types from low tide terrace to longshore bar and trough. Model predictions for both the 2% runup exceedance (R-2%) and maximum runup (R-max) were highly variable between models, with predictions shown to vary by a factor of 1.5 for the same incident wave conditions. No single model provided the best predictions on all beaches in the dataset. Overall, model root mean square errors are of the order of 25% of the R-2% value. Models for R-2% derived from field data were shown to be more accurate for predicting runup in the field than those developed from laboratory data, which overestimate the field data significantly. The most accurate existing models for predicting R-2% were those developed by Holman [12] and Vousdoukas et al. [40], with mean RMSE errors of 0.30 m or 25%. A new model-of-models for R-2% was developed from a best fit to the predictions from six existing field and one large scale laboratory R-2% data derived models. It uses the Hunt [17] scaling parameter tan beta root H0L0 and incorporates a setup parameterisation. This model is shown to be as accurate as the Holman and Vousdoukas et al. models across all tidal stages. It also yielded the smallest maximum error across the dataset. The most accurate predictions for R-max were given by Hunt [17] but this tended to under predict the observed maximum runup obtained for 15-min records. Mase's [22] model has larger errors but yielded more conservative estimates. Greater observed values of R-max are expected with increased record length, leading to greater differences in predicted values. Given the large variation in predictions across all models, however, it is clear that predictions by uncalibrated runup models on a given beach may be prone to significant error and this should be considered when using such models for coastal management purposes. It should be noted that in extreme events, which are lacking in the dataset, runup may be truncated by beach scarps, cliffs, and dunes, or may overtop, and as a result, the probability density functions will have different tail shapes. The uncertainty already present in current models is likely to increase in such conditions

VISÃO PAISAGÍSTICA SOBRE O EMPREENDIMENTO “MINA GUAÍBA” (RS) - PARECER TÉCNICO SOBRE OS VOLUMES II E IV DO EIA “MINA GUAÍBA”

Documento elaborado a partir do debate sobre os volumes II e IV do EIA, do empreendimento Mina Guaíba. Esforço conjunto de graduandos, pós-graduandos e professores universitários, visando compor o painel de especialistas elaborada pelo Comitê de Combate à Megamineração no Rio Grande do Sul (CCMRS)

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning