Priorização de pacientes em emergências médicas: uma análise ética

Objetivo: Identificar e analisar, à luz de referencial ético, as escolhas e justificativas de profissionais de saúde pública em situações hipotéticas de priorização de pacientes em casos de limitações de recursos no atendimento de emergências médicas. Métodos: Pesquisa qualiquantitativa, mediante entrevistas com 80 profissionais de saúde pública, pós-graduandos (mestrado e doutorado) em Saúde Pública, aos quais foram apresentadas situações hipotéticas, envolvendo os critérios de sexo, idade e responsabilidade, sendo requeridos que escolhessem entre alternativas que se referiam à existência de pessoas, correndo risco igual de vida, que necessitam de atendimento em um serviço de emergência. Resultados: As escolhas priorizaram crianças, jovens, mulheres e casadas, com a tomada de decisão invocando os princípios éticos de vulnerabilidade, utilidade social e equidade. Conclusão: A pesquisa mostra clara tendência de justificativas das escolhas feitas, orientadas pela ética utilitarista.

Directions for advancing the study of work transitions in the 21st century

Objectives: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. Participants: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. Methods: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. Findings: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. Conclusions: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys

Background: In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys. Methods: A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces). Conclusion: The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.

Solitons in nonlinear Schrödinger equations.

Using a mathematical approach accessible to graduate students of physics and engineering, we show how solitons are solutions of nonlinear Schrödinger equations. Are also given references about the history of solitons in general, their fundamental properties and how they have found applications in optics and fiber-optic communications.