Resumen: Introducción: Las hospitalizaciones por Ambulatory Care Sensitive Conditions es un indicador que mide la utilización de los servicios hospitalarios por problemas de salud que podrían haber sido prevenidos en el primer nivel de atención. El concepto se refiere a los procesos en que la atención ambulatoria efectiva puede ayudar a disminuir los riesgos de hospitalización, en un segundo nivel de atención. El objetivo del estudio fue construir y validar una lista uruguaya de problemas de salud sensibles a cuidados ambulatorios (PSSCA) según CIE-10. Metodología: Para la construcción de la lista inicial de códigos de PSSCA se realizó una revisión de los listados existentes y se propuso un listado inicial que fue validado a través del Método Delphi. Se propone un listado de 99 códigos diagnósticos de PSSCA adaptado a nuestro entono sanitario. Los mismos permiten identificar y cuantificar problemas de salud que pueden producir hospitalizaciones potenciamente evitables mediante cuidados ambulatorios accesibes y oportunos en el primer nivel de atención. Resultados: Se conformó un panel de 12 expertos. A partir de los datos obtenidos, considerando los 99 diagnósticos clasificados por CIE-10, éstos se pueden subclasificar en función de si la patología es infecciosa o no, obteniendo un resultado general de 62 patologías en un total de 99 que pueden ser clasificadas como infecciosas, lo que se corresponde a un 62 %. Discusión: De la comparación de la lista uruguaya de PSSCA a la que hemos arribado y las listas validadas utilizadas para la construcción inicial del listado de patologías propuesto, podemos decir que la primera presenta un mayor porcentaje de coincidencia con la lista de patologías de Bello Horizonte. Podemos mencionar que la mayoría de los problemas de salud identificados con base en el listado de PSSCA, son sensibles de ser resueltos con la atención primaria oportuna y de calidad que podría evitar o disminuir de una manera significativa su hospitalización. Conclusiones: Este trabajo describe el proceso de construcción y validación de una lista de códigos de PSSCA adaptados al contexto uruguayo a través del método Delphi. Hemos arribado a un listado que comprende un total de 99 diagnósticos, agrupadas en un total de diecinueve categorías que considera la especificidad del contexto uruguayo del indicador.

Abstract: Introduction: Hospitalizations for Ambulatory Care Sensitive Conditions is an indicator that measures the use of hospital services for health problems that could have been prevented at the first level of care. The concept refers to the processes in which effective outpatient care can help reduce the risks of hospitalization, at a second level of care. The objective of the study was to build and validate a Uruguayan list of health problems sensitive to outpatient care (PSS-CA) according to ICD-10. Methodology: To construct the initial list of PSSCA codes, a review of the existing lists was carried out and an initial list was proposed that was validated through the Delphi Method. A list of 99 PSSCA diagnostic codes adapted to our healthcare environment is proposed. They make it possible to identify and quantify health problems that can lead to potentially avoidable hospitalizations through accessible and timely outpatient care at the first level of care. Results: A panel of 12 experts was formed. From the data obtained, considering the 99 diagnoses classified by ICD-10, these can be subclassified depending on whether the pathology is infectious or not, obtaining a general result of 62 pathologies in a total of 99 that can be classified as infectious, which corresponds to 62%. Discussion: From the comparison of the Uruguayan list of PSSCA that we have arrived at and the validated lists used for the initial construction of the proposed list of pathologies, we can say that the first presents a higher percentage of coincidence with the list of pathologies of Bello Horizonte . We can mention that most of the health problems identified based on the PSSCA list are sensitive to being resolved with timely and quality primary care that could prevent or significantly reduce hospitalization. Conclusions: This work describes the process of construction and validation of a list of PSSCA codes adapted to the Uruguayan context through the Delphi method. We have arrived at a list that includes a total of 99 diagnoses, grouped into a total of nineteen categories that consider the specificity of the Uruguayan context of the indicator.

Resumo: Introdução: As Internações por Condições Sensíveis à Atenção Ambulatorial são um indicador que mede a utilização de serviços hospitalares para problemas de saúde que poderiam ter sido evitados no primeiro nível de atenção. O conceito refere-se aos processos em que um atendimento ambulatorial eficaz pode auxiliar na redução dos riscos de internação, em um segundo nível de atenção. O objetivo do estudo foi construir e validar uma lista uruguaia de problemas de saúde sensíveis à atenção ambulatorial (PSS-CA) segundo a CID-10. Metodologia: Para construir a lista inicial de códigos PSSCA foi realizada uma revisão das listas existentes e foi proposta uma lista inicial que foi validada através do Método Delphi. É proposta uma lista de 99 códigos de diagnóstico PSSCA adaptados ao nosso ambiente de saúde. Permitem identificar e quantificar problemas de saúde que podem levar a hospitalizações potencialmente evitáveis através de cuidados ambulatórios acessíveis e oportunos no primeiro nível de cuidados. Resultados: Foi formado um painel de 12 especialistas. A partir dos dados obtidos, considerando os 99 diagnósticos classificados pela CID-10, estes podem ser subclassificados consoante a patologia seja infecciosa ou não, obtendo-se um resultado geral de 62 patologias num total de 99 que podem ser classificadas como infecciosas, o que corresponde para 62%. Discussão: A partir da comparação da lista uruguaia de PSSCA a que chegamos e das listas validadas utilizadas para a construção inicial da lista de patologias proposta, podemos dizer que a primeira apresenta um maior percentual de coincidência com a lista de patologias de Belo Horizonte. Podemos mencionar que a maioria dos problemas de saúde identificados com base na lista PSSCA são sensíveis para serem resolvidos com cuidados primários oportunos e de qualidade que possam prevenir ou reduzir significativamente a hospitalização. Conclusões: Este trabalho descreve o processo de construção e validação de uma lista de códigos PSSCA adaptados ao contexto uruguaio através do método Delphi. Chegamos a uma lista que inclui um total de 99 diagnósticos, agrupados em um total de dezenove categorias que consideram a especificidade do contexto uruguaio do indicador.

Resumen: La investigación, con enfoque epistemológico cuantitativo y el paradigma positivista, tiene como objetivo definir la relación entre el marco regulatorio del sector financiero ecuatoriano y las condiciones de financiamiento a las pymes. Esta fue de tipo descriptivo-correlacional, permitiendo realizar un análisis descriptivo y factorial de variables vinculadas al conocimiento y aplicación de leyes y códigos regulatorios de 54 oficiales de crédito del sector bancario de El Oro, Ecuador. Se identificaron dos dimensiones: una relacionada con el marco regulatorio monetario y otra con códigos orgánicos. Las encuestas señalan que las leyes más aplicadas son: Ley General de Instituciones del Sector Financiero y Ley de Compañías. La primera regula la creación, funcionamiento y cierre de instituciones financieras privadas para proteger a la población y asegurar la estabilidad financiera; su cumplimiento es supervisado por la Superintendencia de Bancos. La segunda simplifica el proceso de constitución de empresas, permitiendo diversos tipos de compañías y flexibilidad en su estructura. Las regulaciones bancarias ecuatorianas han experimentado reformas para fortalecer la solidez y transparencia del sistema, como la Ley de Mercado de Valores y la Ley de Instituciones del Sistema de Seguros Privados, que contribuyen a la estabilidad, regulación, protección al consumidor financiero y promoción de la competencia, generando condiciones de financiamiento favorables, que incluyen confianza, tasas de interés competitivas y amplias opciones financieras.

Abstract: The research, with a quantitative epistemological approach and the positivist paradigm, aims to define the relationship between the regulatory framework of the Ecuadorian financial sector and the financing conditions for SMEs. This was of a descriptive-correlational type, allowing a descriptive and factorial analysis of variables linked to the knowledge and application of laws and regulatory codes of 54 credit officers from the banking sector of El Oro, Ecuador. Two dimensions were identified: one related to the monetary regulatory framework and another with organic codes. Surveys indicate that the most applied laws are: General Law of Financial Sector Institutions and Companies Law. The first regulates the creation, operation and closure of private financial institutions to protect the population and ensure financial stability; Its compliance is supervised by the Superintendency of Banks. The second simplifies the business incorporation process, allowing various types of companies and flexibility in their structure. Ecuadorian banking regulations have undergone reforms to strengthen the soundness and transparency of the system, such as the Securities Market Law and the Law of Institutions of the Private Insurance System, which contribute to stability, regulation, financial consumer protection and promotion of competition, generating favorable financing conditions, which include confidence, competitive interest rates and broad financial options.

Resumo A influência dos média sociais no campo do jornalismo, hoje incontornável, manifesta-se em várias vertentes, criando desafios que não podem ser ignorados pelos profissionais. Enquanto fontes, estão a ser cada vez mais utilizados, contribuindo para a emergência de novas dinâmicas de produção noticiosa, em particular na cobertura de acontecimentos em continuidade, nos quais impera a velocidade de transmissão e o imediatismo constitui um valor em si mesmo, incentivando a extração de conteúdos disponíveis na internet, sem tempo para escrutínio. Neste artigo, o fenómeno é enquadrado numa perspetiva ética. Através da análise de 32 códigos deontológicos - e instrumentos semelhantes - que incorporam esta realidade em partes específicas foram identificados valores e princípios jornalísticos neles inscritos acerca das modalidades de recolha de informação, sobretudo em redes sociais digitais. A exigência de verificação e validação do material e de identificação da fonte, procedimentos tradicionais, é predominante, atentos os potenciais riscos para o rigor de uma narrativa jornalística. Também é detetada, na maioria dos códigos integrados no corpus, a preocupação de acautelar o dano na esfera privada de cidadãos, eventualmente decorrente da difusão de material. Não se trata apenas de proteger a privacidade, em geral, mas de ponderar questões de grande sensibilidade a ela associáveis: a vulnerabilidade e dor em que possam encontrar-se os autores das postagens e a presença nas redes de vítimas ou cidadãos menores de idade.

Abstract The inescapable influence of social media on journalism has introduced a multitude of challenges that professionals in the field cannot afford to overlook. Increasingly used as sources, social media platforms contribute significantly to the evolution of new dynamics in news production. This is particularly evident in the coverage of unfolding events, prioritising speed of transmission and immediacy as inherent values. This emphasis often encourages the rapid extraction of content available on the internet, leaving minimal time for thorough scrutiny. This article delves into the phenomenon from an ethical standpoint. Through an analysis of 32 codes of ethics - and analogous instruments - that specifically address this evolving reality, it identifies journalistic values and principles concerning information-gathering methods, especially pertaining to digital social networks. The primary emphasis remains on the requirement to verify and validate the material while identifying sources following traditional procedures, given the potential risks to the integrity of journalistic narratives. Most codes in the corpus also prioritise safeguarding citizens’ private sphere, possibly stemming from the dissemination of material. This concern extends beyond general privacy protection, encompassing the highly sensitive issues associated with it: the vulnerability and emotional distress experienced by authors of social media posts and the presence of victims or minors on social networks.

Abstract The purpose of this work is to offer an approach to the use of letters of censorship and excommunication in New Spain during the 17th century. I maintain that the request for these legal documents served as a popular resource to demand justice from the ecclesiastical authorities due to damage against an individual or property. Thus, excommunication was regarded within the collective imagination as a penalty so terrible that, contrary to what was stipulated in the ecclesiastical codes, it implied the absolute condemnation of the accused both in earth and the hereafter. Derived from the study of sources located in various funds of the National General Archive (Archivo General de la Nación) in Mexico, and based on the approaches exposed by some theorists of the judicial history of the New Spain Catholic Church, I will outline a proposal regarding the use of letters of censorship, the role that excommunication could play within the collective imagination, as well as the work carried out by the ecclesiastical instance as a determining forum of justice against other secular organizations.

Resumen El propósito de este trabajo es ofrecer un acercamiento al uso de las cartas de censura y excomunión en la Nueva España durante el siglo XVII. Sostengo que la solicitud de estos documentos jurídicos funcionó como un recurso popular para exigir justicia a las autoridades eclesiásticas por causa de agravios en contra de individuos o de propiedades. En este sentido, la excomunión fue entendida dentro del imaginario colectivo como una pena tan terrible que, contrario a lo estipulado en los códigos eclesiásticos, implicaba la condena absoluta del acusado en la tierra y en el más allá. Derivado del estudio de estas fuentes localizadas en varios fondos del Archivo General de la Nación de México y con base en los planteamientos expuestos por algunos teóricos de la historia judicial de la Iglesia católica novohispana, esbozaré una propuesta en torno al uso de las cartas de censura; al papel que pudo desempeñar la excomunión en el imaginario colectivo, aunado a las labores realizadas por la instancia eclesiástica como determinante foro de justicia frente a otros organismos seculares.

Resumo Introdução: As patologias músculo-esqueléticas constituem um dos motivos mais frequentes de consulta em medicina geral e familiar. A elevada incidência destas patologias traduz-se também numa elevada necessidade de cuidados de reabilitação pelo que, em 2021, a prescrição de medicina física e reabilitação (MFR) destacou-se como o segundo maior gasto relativamente ao total da despesa com meios complementares de diagnóstico e terapêutica na região Norte. Assim, importa caracterizar os principais motivos de prescrição. Objetivos: Caracterizar a prescrição de consultas de MFR relativas a patologia osteoarticular e músculo-esquelética no Agrupamento de Centros de Saúde de Matosinhos (ACeS). Métodos: Estudo observacional e retrospetivo de todas as prescrições de MFR realizadas de janeiro a dezembro/2021 em todas as unidades de saúde constituintes de um ACeS, com caracterização sociodemográfica dos utentes e análise do número de prescrições e códigos de Classificação Internacional de Cuidados de Saúde Primários associados às mesmas. Resultados: O número médio de prescrições por USF foi de 1710,07. Verificou-se que 47,94% das prescrições corresponderam a primeira consulta de MFR, enquanto 52,06% corresponderam a consulta subsequente. A maioria das prescrições foi feita a utentes do sexo feminino (65,54%), com isenção do pagamento de taxas moderadoras (58,65%) e idade média de 57,15 anos. O problema de saúde mais frequentemente codificado foi L86 - Síndrome da Coluna com irradiação de dor, seguindo-se L92 - Síndrome do Ombro Doloroso, quer para primeira consulta quer para consulta subsequente. As patologias que originaram maior número de prescrições subsequentes/utente foram esclerose múltipla e parkinsonismo. Observou-se ainda que 46,76% das prescrições se acompanhavam de código ICPC-2 correspondente a diagnóstico passível de prescrição de fisioterapia. Conclusão: Trata-se de um estudo relevante que caracterizou as prescrições de MFR, permitindo conhecer as patologias que levaram à requisição destes cuidados, podendo constituir um ponto de partida para melhorar a adequação dos recursos em saúde.

Abstract Introduction: Musculoskeletal disorders are one of the most frequent reasons for medical appointments in primary care. The high incidence of these pathologies also translates into a high need for rehabilitation care. This is why, in 2021, the prescription of physical and rehabilitation medicine (PRM) stood out as the second highest expense in the total costs of complementary means of diagnostic and therapeutic, in the North of Portugal. Thus, it is important to describe the main reasons for prescription. Objective: To describe the prescriptions of PRM appointments related to osteoarticular and musculoskeletal pathology, in the Matosinhos group of Family Health Units (FHUs). Methods: Observational and retrospective study of all PRM prescriptions carried out from January to December 2021 in 14 FHUs, with sociodemographic characterization of users and analysis of the number of prescriptions and codes of the International Classification of Primary Health Care associated with them. Results: The mean number of prescriptions per FHU was 1710.07. It was found that 47.94% of the prescriptions corresponded to the first PRM appointment, while 52.06% corresponded to the subsequent appointments. Most prescriptions were made to female patients (65.54%), exempted from paying user fees (58.65%), and mean age of 57.15 years. The most frequently coded health problem was L86 - Painful Spine Syndrome, followed by L92 - Painful Shoulder Syndrome, both for first and subsequent appointments. The pathologies that originated the highest number of subsequent prescriptions per user were multiple sclerosis and parkinsonism. It was also observed that 46.76% of the prescriptions were accompanied by an ICPC-2 code corresponding to a valid diagnosis for physiotherapy prescription. Conclusion: This is a relevant study that characterized PRM prescriptions and allowed us to understand the pathologies that led to the need for this care, which may constitute a starting point for improving the adequacy of health resources.

ABSTRACT In Ecuador, there is evidence of a growing private proliferation of "Specialized Addiction Treatment Centers" - CETAD, since the State does not supply itself with its infrastructures. Establishments that carry very serious complaints for violation of human rights and bioethical standards. The purpose of this work includes an analysis of the ethical and human rights performance at the level of mental health within these "treatments". In this bibliographic review, 70 articles were explored, selecting the 31 main ones published between 2017 and 2022 from the databases: Scielo, MEDLINE, Dialnet, Psicodoc, PsycArticles. As a result, it stands out that the State must actively assume the rehabilitation processes for drug addictions, since the spread of private centers has become a business, where constitutional norms and bioethical parameters are violated. It is concluded that, at the health level, the violation of deontological, ethical, and human rights codes violates bioethical standards.

RESUMEN En Ecuador se evidencia una creciente proliferación privada de Centros Especializados de Tratamientos para Adicciones (CETAD), pues el Estado no satisface con sus infraestructuras. Establecimientos que acarrean gravísimas denuncias por violación a derechos humanos y normas bioéticas. El propósito de este artículo comprende un análisis del desempeño ético y en derechos humanos a nivel de la salud mental dentro de estos “tratamientos”. Se realiza una revisión bibliográfica donde se exploraron 70 artículos, seleccionando los 31 principales publicados entre el 2017 al 2022 de las bases de datos: Scielo, MEDLINE, Dialnet, Psicodoc, PsycArticles. Destaca como resultado, que existe coincidencia en que el Estado debe asumir activamente los procesos de rehabilitación para drogodependencias, pues la propagación de centros privados se ha convertido en un negociado, donde se vulneran normas constitucionales y parámetros bioéticos. Se concluye que, a nivel de la salud, la infracción de códigos deontológicos, éticos, y derechos humanos, atentan contra las normas bioéticas.

The sanctity of the doctor-patient relationship is deeply embedded in tradition - the Hippocratic oath, medical ethics, professional codes of conduct, and legislation - all of which are being disrupted by big data and 'artificial' intelligence (AI). The transition from paper-based records to electronic health records, wearables, mobile health applications and mobile phone data has created new opportunities to scale up data collection. Databases of unimaginable magnitude can be harnessed to develop algorithms for AI and to refine machine learning. Complex neural networks now lie at the core of ubiquitous AI systems in healthcare. A transformed healthcare environment enhanced by innovation, robotics, digital technology, and improved diagnostics and therapeutics is plagued by ethical, legal and social challenges. Global guidelines are emerging to ensure governance in AI, but many low- and middle-income countries have yet to develop context-specific frameworks. Legislation must be developed to frame liability and account for negligence due to robotics in the same way human healthcare providers are held accountable. The digital divide between high- and low-income settings is significant and has the potential to exacerbate health inequities globally.

ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman’s principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman’s method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson’s correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman’s principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.

BACKGROUND: In the realm of talent acquisition and supply chain management (SCM), the establishment of a standardised competency framework is pivotal. However, a lack of consensus in the supply chain management literature persists regarding the prioritisation of competencies for SCM professional recruitment in South Africa. This necessitates a re-evaluation of SCM competencies to align with the dynamic business environment. OBJECTIVES: To understand the competencies necessary for supply chain professionals in South Africa's SCM job market to inform curriculum development for the training of supply chain profession at higher education institutions. METHOD: A qualitative, grounded theory approach was followed. Content analysis was conducted on 29 SCM job advertisements posted on various employment agents' websites. Atlas was then used to create codes and code groups and themes describing the SCM job market needs and expectations. RESULTS: While technical competencies maintain their significance, strategic thinking and cognitive capabilities are increasing in their importance compared with interpersonal skills in the SCM job market. CONCLUSION: The required competencies for SCM roles are evolving, with an increasing emphasis on strategic and cognitive skills rather than just technical abilities. Interpersonal competencies, although still important, are becoming less crucial. Training institutions should adjust their curricula to ensure well-rounded SCM professionals. CONTRIBUTION: The literature reflecting the fast evolving nature of SCM competencies is sparse. This study challenges the prevailing narrative that emphasizes technical and interpersonal competencies thereby opening new pathways for curriculum development and professional training of SCM professionals.

Abstract Design loads for parking garages should be reviewed every few years due to changes in fleet characteristics and the impact of design loads on carbon emissions by the built environment. Specifically for Brazil, the authors are unaware of existing studies to justify the design values and corresponding exceedance probabilities stated in NBR 6120:2019 - Design Loads for Structures. In this paper, a simplified probabilistic model for live loads in parking garages is presented. A set of updated statistics characterizing the gross curb weight of the fleet in circulation was obtained based on technical specifications and sales reports between 2003 and 2022. These statistics and the probabilistic load model are employed to derive the equivalent uniform design load corresponding to a 30% probability of being exceeded in 50 years, according to the definition stated in NBR 6120:2019 and NBR 8681:2003. The results provide support for a significant reduction of the current design load for light-duty vehicle parking garages, from the current 3.0 kN/m2 to at least 2.5 kN/m2. Such a reduction has a significant impact on new building construction costs and carbon emissions and would not compromise the structural safety of parking garages built in Brazil.

Resumo Cargas de projeto para garagens devem ser periodicamente revisadas em função de mudanças nas características da frota de veículos, bem como devido ao impacto nas emissões de carbono do ambiente construído. Especificamente no caso do Brasil, os autores desconhecem estudos que justifiquem os valores de projeto e as probabilidades de excedência preconizados na NBR 6120:2019 - Ações para o cálculo de estruturas de edificações. Neste artigo, um modelo estocástico simplificado para cargas variáveis em garagens e estacionamentos é apresentado. Com base nas especificações técnicas dos veículos e em dados de vendas entre 2003 e 2022, foram obtidas estatísticas para caracterizar os pesos operacionais da frota de veículos em circulação. Estas estatísticas e o modelo probabilístico são utilizados para obter a carga uniforme equivalente que corresponde à probabilidade de 30% de ser ultrapassada em 50 anos, conforme a definição da NBR 6120:2019. Os resultados obtidos fornecem suporte para uma redução na carga de projeto para garagens, dos atuais 3.0 kN/m2 para pelo menos 2.5 kN/m2. Tal redução teria um impacto significativo no custo de novos edifícios-garagem/estacionamentos subterrâneos, bem como nas emissões de carbono, sem comprometer a segurança destas estruturas.

Abstract The challenging task of structural design under structural safety, economic efficiency and environmental sustainability constraints has led to the development of several efficient materials. In this context, steel fiber reinforced concrete (SFRC) stands out due to the post-cracking behavior related to its enhanced toughness. Recent structural design normative codes consider this composite, suggesting good structural performance and broadening its applicability. Nevertheless, literature still lacks a comprehensive constitutive model to precisely describe its tensile behavior. This paper analyzes and compares three of the main European constitutive models, investigating factors that possibly influence their behavior. This study was conducted based on the cross-sectional analysis method, so that load-CMOD graphs could be obtained. Statistical analysis was conducted to classify the models, regarding several relevant parameters, such as mean compressive strength of the matrix and fiber volume. Results show that the constitutive law proposed by the fib Model Code shows the best performance. Also, from the set of considered parameters, ultimate tensile fibers strength presents the greatest sensitivity concerning structural post-crack behavior.

Resumo A desafiadora tarefa de projetar estruturas com segurança, eficiência econômica e sustentabilidade ambiental levou ao desenvolvimento de diversos materiais eficientes. Nesse contexto, cabe destacar o concreto reforçado com fibras de aço (CRFA), dado o seu comportamento pós-fissuração propiciado pela incorporação de fibras no concreto. Códigos normativos recentes de projeto estrutural abordam esse compósito, sugerindo um bom desempenho estrutural o que colabora para ampliar a sua aplicabilidade. Apesar disso, a literatura ainda carece de um modelo constitutivo abrangente para descrever com precisão seu comportamento à tração. Este artigo analisa e compara três dos principais modelos constitutivos europeus, investigando fatores que possivelmente influenciam seu comportamento. Este estudo foi conduzido com base no método de análise de seção transversal, para que os gráficos de carga-CMOD pudessem ser plotados. Uma análise estatística foi realizada para classificar os modelos em relação a alguns parâmetros relevantes, tais como a resistência à compressão média da matriz e o volume de fibras. Os resultados mostram que a lei constitutiva proposta pela fib Model Code apresenta o melhor desempenho. Além disso, do conjunto de parâmetros considerados, a resistência à tração das fibras apresenta a maior sensibilidade com relação ao comportamento estrutural de pós-fissuração.

Abstract This paper presents a reliability analysis of the punching shear of flat slabs without shear reinforcement. The evaluation is performed for the codes ACI 318, Eurocode 2, Model Code 2010, and ABNT NBR 6118:2014. Six models were used for predicting the punching strength, the design models, the Critical Shear Crack Theory (CSCT), and a Nonlinear Finite Element Analysis (NLFEA) model. Reliability analysis was performed to evaluate the safety level of code provisions. Design code provisions were evaluated in terms of sufficient reliability criteria based on target reliability β=3.8. This target reliability was based in the Model Code 2010 criteria. This criterion represents an acceptable value level of safety in design of structures. The results showed that the reliability indexes β presented satisfactory for all slabs designed by the Model Code 2010. However, this paper also shows some of the tested slabs presented reliability index below 3.0, being the ACI 318 the code with the lowest reliability index.

Resumo Este artigo apresenta a análise de confiabilidade do dimensionamento à punção de lajes lisas sem armadura de cisalhamento. A pesquisa avaliou a confiabilidade obtida pela norma ACI 318, Eurocode 2, Código Modelo 2010 e pela norma brasileira ABNT NBR 6118:2014. Para a estimativa da resistência à punção seis modelos foram estudados, os modelos das normas, a Teoria da Fissura Crítica de Cisalhamento (TFCC) e um modelo não-linear em elementos finitos. A avaliação da confiabilidade foi realizada para avaliar o nível de segurança das prescrições normativas. Para isso, o critério utilizado é baseado na comparação dos índices de confiabilidade β com o índice de confiabilidade alvo, estipulado em 3,8, conforme critério do Código Modelo 2010. Esse critério representa um valor aceitável no nível de segurança do dimensionamento da estrutura. Os resultados obtidos a partir dessa metodologia mostrou que o Código Modelo 2010 é a norma que apresenta os índices mais elevados de confiabilidade. Por outro lado, a norma ACI 318 apresentou os menores índices de confiabilidade, alcançando índices de confiabilidade menores que 3,0.

BACKGROUND: Thirty-day readmission rate and 30-day reoperation rate are recognised indicators of perioperative quality of care. While these indicators have been reported in numerous studies from developed countries, little is known about readmission and reoperation following spinal surgery in South Africa. The main aim of this study was to describe the overall rate of 30-day reoperation and 30-day readmission following spine surgery in a large open medical scheme. Secondary aims were to describe the reasons for 30-day reoperation and 30-day reoperation by spine region and for certain procedures. METHODS: This retrospective cohort study was based on an anonymised dataset of spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. The dataset was processed to identify descriptors of each surgery, including the year of operation, patient demographics, spinal pathology, spine region and certain procedures. The primary outcome was reoperation within 30 days, which was identified based on the time to the second operation, diagnostic codes and procedure codes. RESULTS: A total of 49 395 spine surgeries were included in the study, of which at least 38 218 (77%) were for degenerative pathology. Overall, 3 204 (6.5%) surgeries were associated with 30-day readmission for any cause and 415 (0.8%) patients underwent a second unplanned spine surgery within 30 days of the initial spine procedure. The most common reasons for the 415 reoperations were neural compression (n = 160, 39%) and infection (n = 79, 19%). CONCLUSION: Spine surgery in the South African private sector is associated with low rates of 30-day readmission and reoperation, suggesting good quality of perioperative care. Furthermore, the findings compare favourably with those from developed countries. Future studies should investigate long-term reoperation following spinal surgery to provide more comprehensive insight into the quality of spinal surgery care in the South African private healthcare setting. Level of evidence: Level 3

BACKGROUND: Maternal electronic gatekeeping (eGK) codes for HIV viral load (VL) testing of pregnant and breastfeeding women were developed to permit increased frequency of maternal HIV VL testing without automated gatekeeping cancellation, and to enable virological surveillance. OBJECTIVES: This study describes the national uptake of maternal eGK codes and VL suppression (VLS) rates disaggregated by age during antenatal, delivery and postnatal periods in South Africa during 2022. METHOD: HIV VL tests associated with C#PMTCT (used for antenatal and postnatal testing) and C#DELIVERY (used at delivery) eGK codes between 01 January and 31 December 2022, were extracted from the National Institute for Communicable Diseases Data Warehouse. Uptake of eGK codes was calculated using indicators from the District Health Information System as denominators while HIV VLS rates (< 1000 copies/mL) were calculated as monthly and annual percentages. RESULTS: Overall, national maternal eGK code uptake was 41.8%, 24.5% and 0.12% for the antenatal, delivery and postnatal periods, respectively. The monthly antenatal eGK uptake increased from 27.5% to 58.5% while delivery uptake increased from 17.3% to 30.0%. The overall annual maternal HIV VLS rate was 86.7% antenatally and 87.2% during delivery. The monthly average HIV VLS for adolescent girls and young women (AGYW) was 76.1% antenatally and 79.6% during delivery. CONCLUSION: Although overall national uptake of maternal HIV VL eGK codes was low, antenatal and delivery uptake improved over time, thereby facilitating use of eGK codes for programmatic monitoring of maternal VLS rates for the first time. Quality of care among pregnant AGYW requires urgent attention.

Resumo O objetivo do artigo é analisar o conteúdo sorofóbico explicitado nas publicações veiculadas nas redes sociais digitais no contexto do HIV e da Aids no Brasil. Trata-se de um estudo qualitativo do tipo exploratório descritivo, de base documental. Os dados obtidos foram avaliados utilizando a metodologia de análise documental por meio da análise de conteúdo temático com auxílio do software NVivo®12 Plus (Windows). Foram gerados 187 códigos, posteriormente agrupados conforme a semântica das palavras, originando cinco categorias temáticas: #VivendoComHIV, #PrecisamosFalarSobreIsso, #OQueÉSOROFOBIA, #SorofobiaéCrime e #SorofobiaNÃO. Os resultados evidenciaram as principais manifestações acerca da sorofobia relacionada ao HIV e à Aids nas redes sociais. O conteúdo compartilhado debateu as dificuldades de viver com uma doença que apresenta dimensões sociais; a relevância de falar e difundir conteúdo sobre o HIV e a Aids; os elementos que compõem o processo de estigmatização e, consequentemente, estruturam a sorofobia na sociedade; os direitos sociais e civis das pessoas vivendo com HIV; as medidas de combate à sorofobia nas instituições de saúde; e as implicações da sorofobia no âmbito da saúde pública.

Abstract The aim of this article is to analyze the serophobic content explicit in the publications published in Digital Social Networks in the context of HIV and AIDS in Brazil. This is a qualitative study of the descriptive exploratory type, based on documents. The data obtained were evaluated using the methodology of documentary analysis through Thematic Content Analysis with the aid of NVivo®12 Plus (Windows). A total of 187 codes were generated, subsequently grouped according to the semantics of the words, originating five thematic categories: #LivingWithHIV, #WeNeedtoTalkAboutIt, #WhatISSEROPHOBIA, #SerophobiaIsACrime, and #NoSerophobia. The results showed the main manifestations of HIV and AIDS-related serophobia on social networks. The shared content discussed the difficulties of living with a disease that has social dimensions; the relevance of talking and disseminating content about HIV and AIDS; the elements that make up the stigmatization process and, consequently, structure serophobia in society; the social and civil rights of people living with HIV; measures to combat serophobia in health institutions; and the implications of serophobia in the field of public health.