Health in Brazil 6 Health conditions and health-policy innovations in Brazil: the way forward

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

Imprints of fast-rotating massive stars in the Galactic Bulge

The first stars that formed after the Big Bang were probably massive(1), and they provided the Universe with the first elements heavier than helium (`metals`), which were incorporated into low-mass stars that have survived to the present(2,3). Eight stars in the oldest globular cluster in the Galaxy, NGC 6522, were found to have surface abundances consistent with the gas from which they formed being enriched by massive stars(4) (that is, with higher alpha-element/Fe and Eu/Fe ratios than those of the Sun). However, the same stars have anomalously high abundances of Ba and La with respect to Fe(4), which usually arises through nucleosynthesis in low-mass stars(5) (via the slow-neutron-capture process, or s-process). Recent theory suggests that metal-poor fast-rotating massive stars are able to boost the s-process yields by up to four orders of magnitude(6), which might provide a solution to this contradiction. Here we report a reanalysis of the earlier spectra, which reveals that Y and Sr are also over-abundant with respect to Fe, showing a large scatter similar to that observed in extremely metal-poor stars(7), whereas C abundances are not enhanced. This pattern is best explained as originating in metal-poor fast-rotating massive stars, which might point to a common property of the first stellar generations and even of the `first stars`.

The effect of a single supernova explosion on the cuspy density profile of a small-mass dark matter halo

Some observations of galaxies, and in particular dwarf galaxies, indicate a presence of cored density profiles in apparent contradiction with cusp profiles predicted by dark matter N-body simulations. We constructed an analytical model, using particle distribution functions (DFs), to show how a supernova (SN) explosion can transform a cusp density profile in a small-mass dark matter halo into a cored one. Considering the fact that an SN efficiently removes matter from the centre of the first haloes, we study the effect of mass removal through an SN perturbation in the DFs. We find that the transformation from a cusp into a cored profile occurs even for changes as small as 0.5 per cent of the total energy of the halo, which can be produced by the expulsion of matter caused by a single SN explosion.

Bayesian Estimation of the Logistic Positive Exponent IRT Model

A Bayesian inference approach using Markov Chain Monte Carlo (MCMC) is developed for the logistic positive exponent (LPE) model proposed by Samejima and for a new skewed Logistic Item Response Theory (IRT) model, named Reflection LPE model. Both models lead to asymmetric item characteristic curves (ICC) and can be appropriate because a symmetric ICC treats both correct and incorrect answers symmetrically, which results in a logical contradiction in ordering examinees on the ability scale. A data set corresponding to a mathematical test applied in Peruvian public schools is analyzed, where comparisons with other parametric IRT models also are conducted. Several model comparison criteria are discussed and implemented. The main conclusion is that the LPE and RLPE IRT models are easy to implement and seem to provide the best fit to the data set considered.