VACINAÇÃO E ESCASSEZ: CRITÉRIOS ÉTICOS E JURÍDICOS PARA A ALOCAÇÃO DE RECURSOS NO CONTEXTO DA PANDEMIA DO NOVO CORONAVÍRUS

Objetivo: Esta pesquisa busca investigar a eticidade e a juridicidade do Plano Nacional de Imunização contra a Covid-19 (PNI) e propor critérios para a obtenção de justiça na distribuição vacinal.Método: O estudo utiliza o método teórico-dedutivo para a realização de uma pesquisa qualitativa com abordagem analítica e propositiva, mediante emprego de fontes indiretas de pesquisa como textos científicos e marcos normativos.Resultados: O estudo concluiu pela adoção parcial do critério das responsabilidades especiais, o que implicaria a disponibilização prioritária de imunizantes aos profissionais de saúde, desde que limitada àqueles que atuam no combate da pandemia ou em ações em defesa da vida. Sustentou a priorização de grupos vulneráveis sanitária ou socialmente, o que corresponde ao critério da morte iminente. Conduziu à percepção da validade da proteção de alguns grupos profissionais, à crítica da falta de especificação de critérios para a preferência de outros, e censurou a ausência de prioridade de algumas categorias. Por fim, foi proposta a organização do calendário vacinal, após a imunização dos grupos contemplados no PNI, em ordem decrescente à percepção de renda per capta, em virtude do maior risco inerente às classes financeiramente mais carentes.Conclusões: O PNI atende a alguns critérios de equidade consoantes ao Direito e aos valores potencialmente perfilhados pela sociedade brasileira, mas carece de aperfeiçoamento no processo distributivo vacinal para o alcance pleno da justiça sanitária.Palavras-chave: Vacina; Escassez severa; Direito à vida; Direito à saúde; Equidade. ABSTRACTObjective: This research seeks to investigate the ethic and the legality of the National Immunization Plan against Covid-19 (PNI) and propose criteria for obtaining justice in the vaccine distribution. Method: The study uses the theoretical-deductive method to conduct a qualitative research with analytical and propositional approach, through the use of indirect sources of research as scientific texts and normative frameworks. Results: The study concluded that the criterion of special responsibilities was partially adequate, which would imply the priority availability of immunizations to health professionals, since that they are limited to those who work in the fight against the pandemic or in actions in defense of life. It was the base for the prioritization of sanitaryly or socially vulnerable groups, which corresponds to the criterion of imminent death. It led to the perception of the validity of the protection of some professional groups, to the criticism of the lack of specification of criteria for the preference of others, and it criticized the lack of priority of some categories. Finally, it was proposed the organization of the vaccination calendar, after the immunization of the groups contemplated in the PNI, in decreasing order to the perception of income per capita, due to the greater risk inherent to the financially neediest classes.Conclusions: The PNI meets some criteria of equity in accordance with Law and the values potentially profiled by Brazilian society, but lacks improvement in the vaccine distributive process to fully achieve health justice. Keywords: Vaccine; Severe scarcity; Right to life; Right to health; Fairness

DOENÇAS RARAS E POLÍTICAS PÚBLICAS DE SAÚDE NO BRASIL E EM PORTUGAL: um estudo comparado

O presente artigo objetiva promover um estudo comparado entre Brasil e Portugal quanto à eficácia do direito fundamental à saúde em matéria de prestação de cuidados com doenças raras pelos sistemas públicos de saúde dos países. Para tanto, analisa o tratamento jurídico conferido pelas políticas públicas em ambos os países, sendo estudadas informações acerca do  funcionamento e do alcance das medidas implementadas. Considerando que a judicialização de políticas públicas é um instrumento de canalização das insatisfações da população quanto ao fornecimento de tratamentos de saúde no Brasil, o trabalho busca relacionar as decisões judiciais no âmbito do Supremo Tribunal Federal com os Protocolos Clínicos e Diretrizes Farmacêuticas presentes no âmbito do Sistema Único de Saúde, tendo como marco institucional a implementação da Política Nacional de Doenças Raras de 2014. Em Portugal, a análise dirige-se especialmente à avaliação de informações oficiais e não oficiais acerca dos tratamentos de saúde disponibilizados à população através do Sistema Nacional de Saúde, tendo como marco institucional a Estratégia Integrada para as Doenças Raras 2015-2020. As políticas públicas investigadas indicam a existência de esforços significativos no sentido de concretização das noções de integralidade e universalidade dos sistemas públicos de saúde

O DIREITO FUNDAMENTAL À SAÚDE E AS DOENÇAS RARAS: considerações acerca do controle de políticas públicas pelo Supremo Tribunal Federal

O artigo objetiva analisar a sindicabilidade judicial do direito fundamental à saúde no tocante aos pedidos de custeio estatal de tratamentos para doenças raras. A pesquisa propõe a investigação do núcleo essencial do direito à saúde e a análise das políticas públicas para pacientes com doenças raras no Brasil. Adota-se como arcabouço teórico o Pós-Positivismo Jurídico, representado por Dworkin (2002) e Alexy (2011). Sob a metodologia dedutiva, procedeu-se a uma pesquisa qualitativa. As investigações do trabalho conduzem à possibilidade de provisão judicial de pedidos de tratamentos não inseridos nas políticas públicas de saúde quando tutelar a vida e a dignidade

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Measurement of t(t)over-bar normalised multi-differential cross sections in pp collisions at root s=13 TeV, and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

Peer reviewe

Measurement of the top quark forward-backward production asymmetry and the anomalous chromoelectric and chromomagnetic moments in pp collisions at √s = 13 TeV

Abstract The parton-level top quark (t) forward-backward asymmetry and the anomalous chromoelectric (d̂ t) and chromomagnetic (μ̂ t) moments have been measured using LHC pp collisions at a center-of-mass energy of 13 TeV, collected in the CMS detector in a data sample corresponding to an integrated luminosity of 35.9 fb−1. The linearized variable AFB(1) is used to approximate the asymmetry. Candidate t t ¯ events decaying to a muon or electron and jets in final states with low and high Lorentz boosts are selected and reconstructed using a fit of the kinematic distributions of the decay products to those expected for t t ¯ final states. The values found for the parameters are AFB(1)=0.048−0.087+0.095(stat)−0.029+0.020(syst),μ̂t=−0.024−0.009+0.013(stat)−0.011+0.016(syst), and a limit is placed on the magnitude of | d̂ t| &lt; 0.03 at 95% confidence level. [Figure not available: see fulltext.

An embedding technique to determine ττ backgrounds in proton-proton collision data

An embedding technique is presented to estimate standard model tau tau backgrounds from data with minimal simulation input. In the data, the muons are removed from reconstructed mu mu events and replaced with simulated tau leptons with the same kinematic properties. In this way, a set of hybrid events is obtained that does not rely on simulation except for the decay of the tau leptons. The challenges in describing the underlying event or the production of associated jets in the simulation are avoided. The technique described in this paper was developed for CMS. Its validation and the inherent uncertainties are also discussed. The demonstration of the performance of the technique is based on a sample of proton-proton collisions collected by CMS in 2017 at root s = 13 TeV corresponding to an integrated luminosity of 41.5 fb(-1).Peer reviewe

Search for Physics beyond the Standard Model in Events with Overlapping Photons and Jets

Results are reported from a search for new particles that decay into a photon and two gluons, in events with jets. Novel jet substructure techniques are developed that allow photons to be identified in an environment densely populated with hadrons. The analyzed proton-proton collision data were collected by the CMS experiment at the LHC, in 2016 at root s = 13 TeV, and correspond to an integrated luminosity of 35.9 fb(-1). The spectra of total transverse hadronic energy of candidate events are examined for deviations from the standard model predictions. No statistically significant excess is observed over the expected background. The first cross section limits on new physics processes resulting in such events are set. The results are interpreted as upper limits on the rate of gluino pair production, utilizing a simplified stealth supersymmetry model. The excluded gluino masses extend up to 1.7 TeV, for a neutralino mass of 200 GeV and exceed previous mass constraints set by analyses targeting events with isolated photons.Peer reviewe

Search for dark matter in events with a leptoquark and missing transverse momentum in proton-proton collisions at 13 TeV

A search is presented for dark matter in proton-proton collisions at a center-of-mass energy of root s= 13 TeV using events with at least one high transverse momentum (p(T)) muon, at least one high-p(T) jet, and large missing transverse momentum. The data were collected with the CMS detector at the CERN LHC in 2016 and 2017, and correspond to an integrated luminosity of 77.4 fb(-1). In the examined scenario, a pair of scalar leptoquarks is assumed to be produced. One leptoquark decays to a muon and a jet while the other decays to dark matter and low-p(T) standard model particles. The signature for signal events would be significant missing transverse momentum from the dark matter in conjunction with a peak at the leptoquark mass in the invariant mass distribution of the highest p(T) muon and jet. The data are observed to be consistent with the background predicted by the standard model. For the first benchmark scenario considered, dark matter masses up to 500 GeV are excluded for leptoquark masses m(LQ) approximate to 1400 GeV, and up to 300 GeV for m(LQ) approximate to 1500 GeV. For the second benchmark scenario, dark matter masses up to 600 GeV are excluded for m(LQ) approximate to 1400 GeV. (C) 2019 The Author(s). Published by Elsevier B.V.Peer reviewe