Análise estrutural de endividamento: um estudo das políticas de financiamento e investimento em hospitais filantrópicos brasileiros / Structural debt analysis: a study of financing and investment policies in brazilian philanthropic hospitals

O estudo apresenta a realidade de endividamento de hospitais filantrópicos brasileiros. Define uma estrutura de avaliação da gestão financeira organizacional, investiga a influência de fatores diversos sobre a gestão, bem como o padrão de investimento hospitalar e o uso ou não de passivo não oneroso como fonte alternativa de financiamento. A avaliação foi realizada por meio do cálculo de indicadores econômico-financeiros, análises horizontal e vertical e uso de modelos tradicional e dinâmico. A capacidade de geração de fluxo de caixa foi observada através de informações contidas em demonstrações contábeis disponíveis, notas explicativas e relatórios da administração publicados. Foram coletadas as informações de três hospitais filantrópicos selecionados aleatoriamente, a categoria hospitalar, em função da prestação de serviços comunitários, e filantrópica, por tenderem a apresentar maiores riscos financeiros, incertezas de fluxos de caixas e dependência por repasses governamentais e de doações para financiamento de atividades. Todos os hospitais apresentaram dificuldades financeiras significativas por receberem poucos recursos e ainda que beneficiados pelo governo com isenção de obrigações sociais, os métodos indicaram que os recursos de convênios e doações foram insuficientes para manutenção das atividades com crescimento anual do endividamento

Reproductive intentions of women who experienced high fertility in a major urban center

Neste estudo quantitativo e de base populacional objetivou-se identificar as intenções reprodutivas de mulheres com cinco ou mais filhos, residentes em Curitiba, Paraná. Foram entrevistadas 441 mulheres em seus domicílios entre os anos de 2006 a 2008. Calcularam-se frequências, e o teste t de Student e o coeficiente de Spearman para algumas variáveis. Para análise das perguntas abertas utilizou-se a análise de conteúdo e se elaboraram tabelas com as categorias e as respectivas frequências. O estudo revelou que para 51% das mulheres o número ideal de filhos seria dois; 10% tiveram o número de filhos que desejavam. Em 113 casos (40,4%) o marido preferia ter um número maior de filhos do que as mulheres. Identificaram-se dificuldades na definição e na conquista da fecundidade desejada, falhas na assistência à saúde reprodutiva e desigualdades sociais e de gênero. O monitoramento pelos gestores de saúde dos diferenciais de fecundidade é necessário para o alcance da justiça social e a garantia dos direitos humanos, sexuais e reprodutivos, no Brasil.This quantitative and population-based study aimed to identify reproductive intentions of women with five or more children living in Curitiba, Paraná. 441 women were interviewed in their homes between the years 2006 to 2008. Frequencies were calculated, as well as Student's t test and Spearman coefficient for some variables. To analyse the open questions it was used content analysis and worked out tables with categories , their frequencies and percentages. The study revealed that for 51% of women the ideal number of children would have been two children; 10% had the number of children they wanted. In 113 cases (40.4%) the husbands would rather have a larger number of children than women. Difficulties were identified in the definition and achievement of desired fertility, besides failures in reproductive health care and social and gender inequalities. Health managers should monitor the differentials in fertility rates in order to pursue social justice and ensure human rights, as well as sexual and reproductive rights in Brazil

Beating heart partial ventriculectomy in dogs

After valve endocardiosis, dilated cardiomyopathy is the most diagnosed cardiac affection in dogs. Sometimes this disease is unresponsible to medical therapy, in this way surgery becomes necessary to its correction. Unfortunately, dogs do not support cardiopulmonary bypass because its tendency in microtrombus formation in the capillary vessels of the lung circulation. Due to this condition, another surgical alternatives were developed, in order to correct the increase in ventricle size, as the ventricle plication or partial ventriculectomy with the inflow occlusion. However, this kind of technique has its complications, as well the ventricle plication. In plication, a part of necrotic heart tissue still remains, and if the necrosis does not happen, that portion of myocardium keeps its oxygen consumption, leading to heart failure. The partial ventriculectomy with the inflow occlusion is time dependent. For its execution it means that the surgeon gets only four minutes to perform the resection of the dilated ventricle and then suture the remaining defect after the inflow occlusion. The aim of this study is to develop a new technique of heart size reduction, called by the authors Beating Heart Partial Ventriculectomy

Environmental drivers of water use for Caatinga woody plant species: combining remote sensing phenology and sap flow measurements

Abstract: We investigated the water use of Caatinga vegetation, the largest seasonally dry forest in South America. We identified and analysed the environmental drivers of phenology in woody species and their relationship with transpiration. To monitor the phenological evolution we used remote sensing indices at different spatial and temporal scales: normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and green chromatic coordinate (GCC). To represent the phenology we used the GCC extracted from in-situ automated digital camera images; indices calculated based on sensors included NDVI, SAVI and GCC from Sentinel-2A and B satellites images, and NDVI products MYD13Q1 and MOD13Q1 from moderate-resolution imaging spectroradiometer (MODIS). Environmental drivers included continuously monitored rainfall, air temperature, soil moisture, net radiation, and vapour pressure deficit. To monitor soil water status and vegetation water use we installed soil moisture sensors along three soil profiles and sap flow sensors for five plant species. Our study demonstrated that the near-surface GCC data played an important role in allowing individual monitoring of species whereas the species’ sap flow data correlated better with NDVI, SAVI and GCC than with species’ near-surface GCC. The wood density appeared to affect the transpiration cessation times in the dry season given species with the lowest wood density reach negligible values of transpiration earlier in the season than those with high woody density. Our results show that soil water availability is the main limiting factor for transpiration during more than 80 % of the year, and that both the phenological response and water use are directly related to water availability when relative saturation of the soil profile falls below 0.25

Identificação de variantes genéticas associadas com a perda gestacional

Miscarriage can be associated with a variety of genetic factors, hematological disorders, including changes in the anatomy of the uterus. Furthermore, there is a relationship between maternal age and reproductive health.Epidemiological studies reveal high rates of subfertility and spontaneous abortions linked to a range of these factors. Therefore, this study aims to investigate the genetic factors associated with pregnancy loss and promote the dissemination of results in a language accessible to the population, through a podcast channel with the aim of increasing awareness and facilitating access to appropriate health services. The study was performed through a narrative literature review. The development of the podcast channel was performed through recordings in an audiovisual environment with scripts developed based on the research results. Cytogenetic abnormalities representing around 50% of fetal deaths in the first trimester and 6% to 13% of stillbirths. Among the main alterations are trisomies of chromosomes 13, 18, 16, 22 and monosomy of chromosome X. Mutations in genes related to the cell cycle are also related to pregnancy loss due to the fact that they trigger serious congenital and developmental defects in embryos. Furthermore, hematological changes, such as thrombophilia and antiphospholipid syndrome, are related to pregnancy loss. This research unveiled the complexity of genetic interactions in the context of miscarriage, emphasizing the urgent need for interdisciplinary collaborations. The identification of specific genetic markers holds the potential to enhance screening and therapeutic strategies, underscoring the importance and recognition of the interconnection between genetic factors and physiological events during pregnancy.A perda gestacional pode ser relacionada a uma variedade de fatores genéticos, alterações hematológicas, além de alterações na anatomia uterina. Ainda a idade materna avançada possui relação entre a genética e saúde reprodutiva. Estudos epidemiológicos revelam elevadas taxas de subfertilidade e abortos espontâneos recorrentes, associados a uma gama desses fatores. Assim, o presente estudo teve como objetivo investigar os fatores genéticos associados à perda gestacional e promover a divulgação dos resultados com uma linguagem acessível à população, através de um canal de podcast, com a finalidade de ampliar a conscientização e facilitar o acesso a serviços de saúde adequados. O estudo foi realizado através de uma revisão narrativa da literatura. O desenvolvimento do canal de podcast foi realizado através de gravações em ambiente audiovisual com roteiros desenvolvidos a partir dos resultados da pesquisa. Anormalidades citogenéticas representam cerca de 50% das mortes fetais no primeiro trimestre e de 6% a 13% dos natimortos. Dentre as principais alterações se encontram as trissomias dos cromossomos 13, 18, 16, 22 e monossomia do cromossomo X. Alterações em genes relacionados ao ciclo celular também estão relacionadas à perda gestacional pelo fato de desencadear defeitos congênitos e de desenvolvimento graves em embriões. Ainda, as alterações hematológicas, como trombofilia e síndrome antifosfolipídeo estão relacionadas à perda gestacional. O presente estudo revelou a complexidade das interações genéticas no contexto da perda gestacional, destacando a necessidade premente de colaborações interdisciplinares. A identificação de marcadores genéticos específicos tem o potencial de aprimorar as estratégias de triagem e terapêuticas, enfatizando, portanto, a importância e reconhecimento da interconexão entre fatores genéticos e eventos fisiológicos da gravidez.&nbsp

2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy

Study on multi-ELVES in the Pierre Auger Observatory

Since 2013, the four sites of the Fluorescence Detector (FD) of the Pierre Auger Observatory record ELVES with a dedicated trigger. These UV light emissions are correlated to distant lightning strikes. The length of recorded traces has been increased from 100 μs (2013), to 300 μs (2014-16), to 900 μs (2017-present), to progressively extend the observation of the light emission towards the vertical of the causative lightning and beyond. A large fraction of the observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. The nature of the multi-ELVES is not completely understood but may be related to the different types of lightning in which they are originated. For example, it is known that Narrow Bipolar Events can produce double ELVES, and Energetic In-cloud Pulses, occurring between the main negative and upper positive charge layer of clouds, can induce double and even quadruple ELVES in the ionosphere. This report shows the seasonal and daily dependence of the time gap, amplitude ratio, and correlation between the pulse widths of the peaks in a sample of 1000+ multi-ELVES events recorded during the period 2014-20. The events have been compared with data from other satellite and ground-based sensing devices to study the correlation of their properties with lightning observables such as altitude and polarity