Resumen: Esta investigación tiene como objetivo analizar la configuración, distribución y equidad de los recursos humanos de enfermería en la provincia de Sichuan, China, proporcionando una referencia para el desarrollo futuro de la atención de enfermería en la región. Se realizó un análisis descriptivo para detallar la configuración de los recursos humanos de enfermería durante 2010, 2015 y 2020. Para evaluar los cambios y la equidad en la configuración de los recursos humanos de enfermería se utilizó como recurso metodológico la curva de Lorenz, el coeficiente de Gini, el índice de densidad de recursos de salud y los mapas de densidad de distribución. El resultado de esta investigación determinó que la relación enfermera-población fue de 1,17, 2,09 y 3,42 en 2010, 2015 y 2020, y el personal de enfermería representó el 24%, 49% y 35% del personal técnico de salud. La relación enfermera-médico fue de 1:0,72, 1:1,05 y 1:1,22 en los tres años. Los coeficientes de Gini de asignación de recursos de enfermería para población permanente y área fueron 0,24, 0,20 y 0,12 y 0,74, 0,72 y 0,72, respectivamente. El índice de densidad de recursos de enfermería fue 0,50, 0,91 y 1,42, respectivamente. En conclusión, el estudio muestra que la equidad de los recursos de enfermería en función de la población aumentó, mientras que la equidad en función de la región mostró disparidad, con un aumento sostenido en la densidad de recursos humanos de enfermería desde 2010 a 2020. Sin embargo, es necesario seguir aumentando el número de enfermeras y mejorando la accesibilidad geográfica de la atención de enfermería.

Resumo: Objetivos: Analisar a configuração, distribuição e equidade de recursos humanos de enfermagem na Província de Sichuan, China, fornecendo uma referência para o futuro desenvolvimento de cuidados de enfermagem na região. Materiais e Métodos: Foi realizada uma análise descritiva da situação atual de configuração de recursos humanos de enfermagem na Província de Sichuan em 2010, 2015 e 2020. Curva Lorenz, coeficiente Gini, índice de densidade de recursos de saúde e mapas de densidade da distribuição foram utilizados para avaliar as mudanças e equidade na configuração de recursos humanos de enfermagem. Resultados: A proporção enfermeiro-população foi 1,17, 2,09 e 3,42 em 2010, 2015 e 2020, respectivamente, com a equipe de enfermagem representando 24%, 49% e 35% do pessoal técnico de cuidados à saúde. A proporção enfermeiromédico foi 1:0,72, 1:1,05 e 1:1,22 nos três anos, respectivamente. Os coeficientes de alocação de recursos de enfermagem para a população permanente e área foram 0,24, 0,20 e 0,12 e 0,74, 0,72 e 0,72, respectivamente. O índice de densidade de recursos de enfermagem foi 0,50, 0,91 e 1,42, respectivamente. Conclusão: O estudo mostra que a equidade de recursos de enfermagem com base na população aumentou enquanto a equidade com base na região ainda apresentava disparidade, com um contínuo aumento na densidade de recursos humanos de enfermagem ao longo dos anos de 2010 a 2020. Todavia, há necessidade de continuar aumentando o número de enfermeiros e melhorar a acessibilidade a cuidados de enfermagem.

Abstract: This research aims to analyze the configuration, distribution, and equity of nursing human resources in Sichuan Province, China, providing a reference for the future development of nursing care in the region. A descriptive analysis was conducted to describe the configuration of nursing human resources in 2010, 2015, and 2020. The Lorenz curve, Gini coefficient, health resource density index, and distribution density maps were used as resources and methodology to evaluate the changes and equity in the configuration of nursing human resources. The result of this research determined that the nurse-to-population ratio was 1.17, 2.09, and 3.42 in 2010, 2015, and 2020, and nursing staff accounted for 24%, 49%, and 35% of technical health personnel. The nurse-to-physician ratio was 1:0.72, 1:1.05, and 1:1.22 in the three years. The Gini coefficients of nursing resource allocation for permanent population and area were 0.24, 0.20, and 0.12 and 0.74, 0.72, and 0.72, respectively. The nursing resource density index was 0.50, 0.91, and 1.42, respectively. In conclusion, the study shows that the equity of nursing resources based on population increased, while the equity based on region still showed disparity, with a sustained increase in nursing human resource density from 2010 to 2020. However, it is necessary to continue increasing the number of nurses and improving the geographical accessibility of nursing care.

SIGNIFICANCE: A census provides a snapshot of a population at a point in time. In addition to describing the basic demographic and socio-economic characteristics of a population, census data provide denominators for estimating rates; inform resource allocation and policy, development and infrastructural investment; and are used to define sampling frames for other national inquiries. Although the 2022 South African census attempted to correct for a national undercount of over 30%, it was not entirely successful. We identify a number of concerns with the estimates released, which suggest that the data may not be fit for purpose.

Digital information and data are crucial drivers of progress in various industries, including mining, where data-driven decision making optimizes resource extraction, enhances safety, and ensures sustainability. The adoption of digital technologies like artificial intelligence (AI) and the Internet of Things has amplified the importance of digital information. However, the integrity and security of this information are paramount, leading to the exploration of blockchain technology as a potential solution for secure digital value exchange in mining. This research examines blockchain's capabilities, drawing insights from its applications in sectors like banking, government, healthcare, and entertainment, and evaluates their relevance to mining's core value chain processes. The study identifies blockchain's distributed ledger technology, cryptographic security, and decentralization as unique advantages that can revolutionize mining by enhancing transaction speed, reducing costs, and improving supply chain transparency and compliance with sustainability standards. Blockchain's transparent and auditable records can enhance business transparency, fostering trust among stakeholders, including investors and regulatory bodies. The technology's consensus mechanisms and smart contracts further promote trust in collaborative ventures. This research provides a foundational understanding for decision-makers in the mining industry to evaluate blockchain's feasibility and potential return on investment, guiding strategic planning and resource allocation for blockchain applications. By leveraging blockchain, mining companies can optimize operations, improve sustainability practices, and establish a robust foundation for future growth, positioning blockchain as a transformative technology in the sector.

ABSTRACT: This paper provides pioneering estimates of the impact of loan-to-value (LTV) ratios, also known as leverage, on Bolivia’s GDP. The empirical evidence reveals the pro-cyclicality between the economic and financial cycles, which affects the intertemporal resource allocation processes between the financial and real sectors. The findings from the RBC model demonstrate that shocks in the loan-to-value (LTV) ratios trigger a rise in housing prices and greater consumption by entrepreneurs, leading to an increase in investment, employment, and output. Additionally, the study confirms that LTV ratios can be a double-edged instrument, as excessive use can potentially destabilize the economy.

RESUMEN: El objetivo de la presente investigación es evidenciar los efectos del loan- to-value (LTV, apalancamiento) en el PIB de Bolivia. Los hechos estilizados muestran una relación procíclica entre el ciclo económico y financiero, aspecto que influye en los procesos intertemporales de asignación de recursos del sector financiero hacia el sector real. Los resultados del modelo RBC revelan que choques positivos (impulso-respuesta) en el LTV generan precios más elevados de los activos, un ciclo financiero positivo, reflejado en un incremento del nivel de créditos y depósitos; lo que se traduce en mayores niveles de inversión, empleo y producto. Asimismo, se corrobora que el LTV es un instrumento de doble filo y el uso excesivo puede desestabilizar la economía.

The structure of climate finance flows from donors (multilateral sources) to recipients (sub-Saharan African countries) was studied. This is the first study to provide a comprehensive network structure of the climate finance flows into Africa, based on the global public climate finance governance system. Network theory and decision tree techniques were employed. The results obtained generally fit the multilateral funding units (MFUs) into two categories: central funding units (CFUs), which simultaneously attend to the climate-related projects of many African countries, and the boundary funding units (BFUs), which cater to only a few countries at once. An isolated region with no BFUs was identified. African countries within this group could be more exposed to climate financial risk as they rely on only the CFUs. In general, with the exception of mitigation REDD (reducing emissions from deforestation and forest degradation) climate finance, a disproportionate distribution of climate themes, with particular reference to adaptation finance, was observed across sub-Saharan Africa. This has real implications for equitable resource allocation of climate funds. The need for African-bred region-wide MFUs is recommended. SIGNIFICANCE: Insights from this analysis expose the presence of contagion effects within the sub-Saharan African climate finance network structure and, consequently, the flow of climate finance-related risks. This knowledge is critical for future planning as it can provide African governments and interested stakeholders with informed evidence upon which they can make reliable and justifiable decisions, such as shaping of sectoral strategies and improving of climate finance flow coordination.

This article deals with the nature of social cost-benefit analysis (SCBA) and economic impact analysis (ECIA) of road projects and describes the coherence of and distinctions between the two types of analysis. In the final part of the article, the reasons are given for not including in an SCBA the economic impacts of a road as determined through an ECIA, regardless of how positive they may be. The SCBA of a road project is a systematic procedure to determine the economic viability of the road project by considering the costs and benefits that accrue when the road is constructed and during the service period of the project. The cost component in the SCBA of a road project is the once-off investment or capital cost of taking the road into service or improving it. The benefit component in the SCBA of a road is the difference between recurring costs associated with an improved road and without the road improvement. Recurring costs of a road include (a) road user costs, (b) external costs arising from road use and (c) maintenance costs to protect and preserve the usefulness of the road. The beneficiaries in an SCBA are the road users. The following road user groups can be distinguished: (i) Normal traffic (consisting of existing, normal-growth and non-induced development traffic; (ii) diverted traffic; and (iii) induced traffic (consisting of generated, induced development, and transferred traffic.) To assess the efficiency of resource allocation, an SCBA is based on the consideration of social cost. From the perspective of allocative efficiency, as determined by an SCBA, a road project is regarded as economically viable when the current value of the reduction in recurring costs associated with the road during its service life exceeds the current value of the once-off investment cost of taking the road into service. Road provision and use have economic impacts. Unlike an SCBA, which focuses on the efficiency with which a road project increases accessibility for and the mobility of road users, a regional economic impact analysis (ECIA) focuses on the effectiveness of a project to affect the performance of the economy of a region by enhancing time and place utilities creation by non-road-users. Consequently, an analysis of the effect construction, operation and use of a road will have on regional economic performance should focus on their expected income multiplier and accelerator effects on the number and size of activities in the economy of a region. The following non-road-user groups can be distinguished: (a) The public, (b) landowners, occupants and land users, (c) roadside enterprises, (d) utility enterprises and (e) goods consignors and consignees (in their capacity as non-road-users). An ECIA is based on a consideration of market prices. In an ECIA the following objectives serve as criteria for judging the impact of a road project on the performance of the economy: • Economic growth (including economic development) • Full employment • Price stability • Balance of payments stability • Equitable distribution of income These impacts, regardless of how positive they may be, are not included in an SCBA for the following reasons: • A comprehensive economic assessment consists of two components that are performed in tandem, namely an SCBA and an ECIA. An SCBA relies on allocative efficiency as assessment criterion, while an ECIA relies on output effectiveness as assessment criterion. The inclusion of effectiveness criteria among efficiency criteria in an SCBA will result in a misrepresentation of project viability. • Double counting of benefits will occur when road user cost savings and economic impacts are combined. • Not all the economic benefits obtained through coordinated investment in various sectors, one of which may be a road, can be ascribed to the investment in the road alone. The reason for conducting an ECIA of a road project is to determine to what measure the analysed road is expected to affect the performance of the economy of the region concerned. Although the results of an ECIA do not form part of the outcome of an SCBA, an ECIA can be used as an instrument in the pursuit of the economic policy objectives of a government.

Die hoofdoel van die sosialekoste-voordeel-ontleding (SKVO) van 'n pad is om die inligting oor die koste en voordele te verskaf wat nodig is om die lewensvatbaarheid, al dan nie, van die voorsiening en gebruik van die pad te beraam. Die kostekomponent in die SKVO is die eenmalige investeringskoste om die pad tot stand te bring, en die voordeelkomponent is die daling van die herhalende koste wat uit die gebruik en instandhouding van die pad sal spruit. Die hoofdoel van die ekonomiese-impakontleding (EKIO) van 'n pad behels dat die verwagte gevolge van die voorsiening en gebruik van die pad op die ekonomiese vertoning van 'n bepaalde streek geïdentifiseer en bereken word. Dié ontleding berus hoofsaaklik op die volgende: (a) die beraming van die verwagte eenmalige streeksinkome-vermenigvuldigereffek wat uit die investeringsbesteding aan die pad sal spruit, en (b) die beraming van die herhalende streeksinkome-versnellereffek wat uit die gebruik en instandhouding van die pad sal spruit. Die ekonomiese uitwerking van 'n padprojek word nie by 'n SKVO ingereken nie. Die rede hiervoor is drievoudig: Eerstens berus 'n SKVO op toewysingsdoelmatigheid as beoordelingsnorm, en 'n EKIO op doeltreffendheid as beoordelingsnorm. Die kombinering van doeltreffendheidsnorme en doelmatigheidsnorme sal tot 'n wanvertolking van 'n projek se ekonomiese lewensvatbaarheid lei. Tweedens sal voordele dubbeld getel word indien padgebruikerskostebesparings en ekonomiese impakte saamgevoeg word. Derdens kan ekonomiese voordele wat verkry word deur gekoördineerde investering in verskeie sektore, waarvan een 'n pad is, nie alles aan investering in die pad toegeskryf word nie.

Resumen Antecedentes: El cáncer de mama es la principal causa mundial de muerte por neoplasias. Por lo tanto, los centros médicos deben estar preparados para evaluar la gestión óptima de sus recursos, buscando el mejor resultado clínico. Objetivo: Presentar un modelo aplicado para la cuantificación y toma de decisiones informadas por parte de un servicio de cáncer de mama en México. Método: La información primaria necesaria para calibrar el modelo de esta metodología fue proporcionada por el Servicio de Tumores de Mama del Instituto Nacional de Cancerología de la Ciudad de México y el Hospital Centenario Miguel Hidalgo de la ciudad de Aguascalientes. El análisis de datos se realizó para cada una de las instituciones de salud debido a que el algoritmo de tratamiento, el número de pacientes y la distribución de pacientes por estadio con cáncer de mama difieren entre ambas instituciones. Resultados: La metodología permitió evaluar el costo del manejo actual del cáncer de mama en cada institución, así como el impacto clínico y económico que genera la inclusión de nuevos fármacos innovadores al algoritmo de tratamiento actual. Conclusión: La metodología propuesta permite optimizar la asignación de recursos, así como estimar escenarios potenciales para la inclusión de nuevas tecnologías en salud.

Abstract Background: Breast cancer is worldwide the leading cause of death from neoplasia. Therefore, health-care centers must be prepared for assessing the most optimal management of resources while seeking the best clinical outcome. Objective: To present a currently applied model for quantification and informed decision-making by a breast cancer service in Mexico. Method: The primary information necessary to calibrate this methodology's model was provided by the Breast Tumors Service of the National Cancer Institute of Mexico City and the Centennial Hospital Miguel Hidalgo in the city of Aguascalientes. The data analysis was carried out for each one of the health institutions because the treatment algorithm, the number of patients, and the distribution of patients by stage with breast cancer differ between both institutions. Results: The methodology allowed the assessment of the cost of the current management of breast cancer in each institution, as well as the clinical and economic impact generated by the inclusion of new innovative drugs to the current treatment algorithm. Conclusion: The proposed methodology allows the allocation of resources to be optimized, as well as estimating potential scenarios for the inclusion of new health technologies.

RESUMEN Este artículo analiza la productividad en la asignación de recursos del Fondo para el Mantenimiento y Desarrollo de la Educación Básica y para la Valorización de los Profesionales de la Educación de 2010 a 2019 con datos de panel, a través del Índice de Malmquist, en los 16 municipios del estado de Amapá, al 5to año de primaria. Los resultados mostraron una importante desigualdad entre los municipios, sin embargo, aun así, los puntajes del Índice de Desarrollo de la Educación Básica mejoraron en un 31,88% en los diez años analizados. La productividad de 2010 a 2019 aumentó un 3,8%. El período de mayor crecimiento de la productividad fue entre 2010 y 2011, con un crecimiento del 17,1%. El período con peor resultado fue de 2012 a 2013, con una caída de -6,8% en la productividad total. 201 panel Malmquist 1 Amapá to primaria embargo así 3188 31 88 31,88 analizados 38 3 8 3,8% 2011 171 17 17,1% 2013 6,8% 68 6 -6,8 total 20 318 31,8 3,8 17,1 6,8 -6, 2 31, 3, 17, 6, -6 -

ABSTRACT This article analyzes the productivity in the allocation of resources from the Fund for the Maintenance and Development of Basic Education and the Valorization of Education Professionals from 2010 to 2019 with panel data, through the Malmquist Index, in the 16 municipalities of the state of Amapá, for the 5th year of elementary school. The results showed a significant inequality between the municipalities, however, even so, the Basic Education Development Index scores improved by 31.88% in the ten years analyzed. Productivity from 2010 to 2019 increased by 3.8%. The period of greatest productivity growth was between 2010 and 2011, with 17.1% growth. The period with the worst result was from 2012 to 2013, with a decline of -6.8% in total productivity. 201 data 1 Amapá th school however so 3188 31 88 31.88 analyzed 38 3 8 3.8% 2011 171 17 17.1 2013 6.8% 68 6 -6.8 20 318 31.8 3.8 17. 6.8 -6. 2 31. 3. 6. -6 -

RESUMO Este artigo analisa a produtividade na alocação dos recursos do Fundo de Manutenção e Desenvolvimento da Educação Básica e de Valorização dos Profissionais da Educação no período de 2010 a 2019 com dados em painel, por meio de Índice de Malmquist, nos 16 municípios do estado do Amapá, para o 5º ano do ensino fundamental. Os resultados apontaram uma expressiva desigualdade entre os municípios, contudo, ainda assim, as notas do Índice de Desenvolvimento da Educação Básica melhoraram 31,88% nos dez anos analisados. A produtividade de 2010 a 2019 aumentou 3,8%. O período de maior crescimento da produtividade foi entre 2010 e 2011, com 17,1% de crescimento. O período que apresentou o pior resultado foi de 2012 para 2013, com declínio de -6,8% na produtividade total. 201 painel Malmquist 1 Amapá º fundamental contudo assim 3188 31 88 31,88 analisados 38 3 8 3,8% 2011 171 17 17,1 2013 6,8% 68 6 -6,8 total 20 318 31,8 3,8 17, 6,8 -6, 2 31, 3, 6, -6 -

ABSTRACT Objective: To develop and validate predictive models to estimate the number of COVID-19 patients hospitalized in the intensive care units and general wards of a private not-for-profit hospital in São Paulo, Brazil. Methods: Two main models were developed. The first model calculated hospital occupation as the difference between predicted COVID-19 patient admissions, transfers between departments, and discharges, estimating admissions based on their weekly moving averages, segmented by general wards and intensive care units. Patient discharge predictions were based on a length of stay predictive model, assessing the clinical characteristics of patients hospitalized with COVID-19, including age group and usage of mechanical ventilation devices. The second model estimated hospital occupation based on the correlation with the number of telemedicine visits by patients diagnosed with COVID-19, utilizing correlational analysis to define the lag that maximized the correlation between the studied series. Both models were monitored for 365 days, from May 20th, 2021, to May 20th, 2022. Results: The first model predicted the number of hospitalized patients by department within an interval of up to 14 days. The second model estimated the total number of hospitalized patients for the following 8 days, considering calls attended by Hospital Israelita Albert Einstein’s telemedicine department. Considering the average daily predicted values for the intensive care unit and general ward across a forecast horizon of 8 days, as limited by the second model, the first and second models obtained R² values of 0.900 and 0.996, respectively and mean absolute errors of 8.885 and 2.524 beds, respectively. The performances of both models were monitored using the mean error, mean absolute error, and root mean squared error as a function of the forecast horizon in days. Conclusion: The model based on telemedicine use was the most accurate in the current analysis and was used to estimate COVID-19 hospital occupancy 8 days in advance, validating predictions of this nature in similar clinical contexts. The results encourage the expansion of this method to other pathologies, aiming to guarantee the standards of hospital care and conscious consumption of resources. Objective COVID19 COVID 19 COVID-1 notforprofit not profit Paulo Brazil Methods developed departments discharges averages COVID19, 19, devices series 36 20th th 2021 2022 Results 1 Einsteins Einstein s R 0900 0 900 0.90 0996 996 0.996 8885 885 8.88 2524 2 524 2.52 beds Conclusion advance contexts pathologies resources COVID1 COVID- 3 202 090 90 0.9 099 99 0.99 888 88 8.8 252 52 2.5 20 09 9 0. 8. 25 5 2.

El artículo tiene como objetivo analizar los efectos de la ampliación de la transferencia de recursos federal de enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud (APS) en el Sistema Único de Salud brasileño (SUS), en el período del 2015 al 2020. Se realizó un estudio longitudinal con datos secundarios de transferencias de recursos por enmiendas parlamentarias del Ministerio de Salud y de gastos con recursos propios de los municipios, aplicados a acciones y servicios públicos de salud y a la APS. El efecto de la transferencia de recursos de enmiendas parlamentarias sobre el financiamiento municipal se verificó de forma estratificada por tamaño de población de los municipios, utilizando modelos de ecuaciones de estimaciones generalizadas. La transferencia de recursos de enmiendas parlamentarias para la APS mostró una gran discrepancia en los valores per cápita entre municipios de diferente tamaño poblacional. No hubo correlación con el gasto municipal en acciones y servicios públicos de salud en aquellos con más de 10.000 habitantes y asociación inversa con el gasto en APS (p < 0,050) en todos los grupos de municipios. Se concluye que el aumento en la transferencia de recursos de enmiendas parlamentarias por parte del Ministerio de Salud favoreció la reducción de la asignación de ingresos municipales a la APS, que pueden haber sido dirigidos a otros fines de gasto en el SUS. Tales cambios parecen reflejar prioridades establecidas para el gasto presupuestario municipal, que repercuten en las condiciones locales para garantizar la estabilidad del financiamiento de la APS en Brasil. (APS SUS, SUS , (SUS) 201 2020 generalizadas poblacional 10000 10 000 10.00 p 0,050 0050 0 050 Brasil (SUS 20 202 1000 1 00 10.0 0,05 005 05 2 100 10. 0,0 0,

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities’ own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil. (PHC SUS, SUS , (SUS) 201 2020 models sizes 10000 10 000 10,00 inhabitants p 0.050 0050 0 050 Therefore Brazil (SUS 20 202 1000 1 00 10,0 0.05 005 05 2 100 10, 0.0 0.

O objetivo deste artigo é analisar os efeitos da ampliação do repasse federal de emendas parlamentares no financiamento municipal da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS), no período de 2015 a 2020. Foi realizado estudo longitudinal com dados secundários de transferências por emendas parlamentares do Ministério da Saúde e de despesas com recursos próprios dos municípios, aplicadas em ações e serviços públicos de saúde e na APS. O efeito do repasse de emendas parlamentares no financiamento municipal foi verificado de forma estratificada por porte populacional dos municípios, por meio de modelos de equações de estimativas generalizadas. O repasse de emendas parlamentares para a APS apresentou grande discrepância de valores per capita entre os municípios de diferentes portes populacionais. Observou-se inexistência de correlação com a despesa municipal em ações e serviços públicos de saúde nos municípios com mais de 10 mil habitantes e associação inversa com a despesa em APS (p < 0,050) em todos os grupos. Conclui-se que o aumento do repasse de emendas parlamentares pelo Ministério da Saúde favoreceu a redução da alocação de receitas municipais com APS, que podem ter sido direcionados para outras finalidades de gasto no SUS. Tais mudanças parecem refletir prioridades estabelecidas para a despesa orçamentária dos municípios, que repercutem sobre as condições locais para a garantia da estabilidade do financiamento da APS no Brasil. (APS SUS, SUS , (SUS) 201 2020 generalizadas populacionais Observouse Observou se 1 p 0,050 0050 0 050 grupos Concluise Conclui Brasil (SUS 20 202 0,05 005 05 2 0,0 00 0,

Resumen La gestión del agua implica cuestiones complejas relacionadas a la asignación justa y sostenibilidad. Aunque han surgido enfoques integrados incorporando diversos interesados, como el enfoque global dominante para el siglo XXI, es difícil evaluar la participación e integración de los mismos. Este estudio generó datos primarios, a partir de cuestionarios y entrevistas, y realizó análisis de redes sociales para revelar y mapear la dinámica de interacción entre diez grupos interesados en los recursos hídricos en un parque estatal en Brasil. Los resultados indican que la interacción entre los grupos se concentró en dos conglomerados distintos, siendo que la alta interacción se correlacionó con el poder político, mientras que los más dependientes de los recursos se caracterizaron por una influencia limitada en decisiones y una baja interacción con otros grupos. Estos resultados proporcionan información sobre la gobernanza equitativa y sostenible de recursos hídricos y la evaluación de la participación e interacción entre grupos de interesados. sostenibilidad XXI mismos primarios entrevistas Brasil distintos político

Abstract The management of water involves complex issues related to just allocation and sustainability. While integrated approaches incorporating diverse stakeholders have emerged as the dominant global framework for 21st-century challenges, policymakers face difficulties in assessing stakeholder participation and integration. This study generated primary data from a survey and interviews and used social network analysis to reveal and map the dynamics of interaction among ten groups holding stakes in the water resources of the Açu Lake State Park, a Brazilian coastal estuary. The results indicate that stakeholder group interaction was concentrated within two distinct clusters, such that high interaction correlated positively with political power, while those most dependent on the resources were characterized by limited decision-making influence and low interaction with other groups. These results offer insight for the equitable and sustainable governance of water resources and the assessment of participation and interaction among stakeholder groups. sustainability 21stcentury stcentury 21st century st challenges integration Park estuary clusters power decisionmaking decision making

Resumo A gestão da água envolve questões complexas relacionadas à justa alocação e sustentabilidade. Embora abordagens integradas incorporando diversos interessados tenham surgido como a abordagem global dominante para os desafios do século 21, ainda se enfrenta dificuldades para avaliar a participação e integração de stakeholders. Este estudo gerou dados primários com questionário e entrevistas e usou a análise de redes sociais para revelar e mapear as dinâmicas de interação entre dez grupos interessados nos recursos hídricos de um parque estadual no Brasil. Os resultados indicam que a interação entre os grupos foi concentrada em dois aglomerados distintos, de modo que alta interação se correlacionou com poder político, enquanto aqueles mais dependentes dos recursos foram caracterizados por influência decisória limitada e baixa interação com outros grupos. Esses resultados oferecem insights para a governança equitativa e sustentável de recursos hídricos e a avaliação da participação e interação entre grupos de interessados. sustentabilidade 21 stakeholders Brasil distintos político 2

ABSTRACT Introduction: Understanding the intricate dynamics between different waves of the COVID-19 pandemic and the corresponding variations in clinical outcomes is essential for informed public health decision-making. Comprehensive insights into these fluctuations can guide resource allocation, healthcare policies, and the development of effective interventions. This study aimed to compare the characteristics and clinical outcomes of COVID-19 at peak transmission points by including all patients attended during the first four pandemic waves in a referral center in Colombia. Material and methods: In a prospective observational study of 2733 patients, clinical and demographic data were extracted from the Fundacion Valle de Lili's COVID-19 Registry, focusing on ICU admission, Invasive Mechanical Ventilation (IMV), length of hospital stay, and mortality. Results: Our analysis unveiled substantial shifts in patient care patterns. Notably, the proportion of patients receiving glucocorticoid therapy and experiencing secondary infections exhibited a pronounced decrease across waves (p < 0.001). Remarkably, there was a significant reduction in ICU admissions (62.83% vs. 51.23% vs. 58.23% vs. 46.70 %, p < 0.001), Invasive Mechanical Ventilation (IMV) usage (39.25% vs. 32.22% vs. 31.22% vs. 21.55 %, p < 0.001), and Length of Hospital Stay (LOS) (9 vs. 8 vs. 8 vs. 8 days, p < 0.001) over the successive waves. Surprisingly, hospital mortality remained stable at approximately 18-20 % (p > 0.05). Notably, vaccination coverage with one or more doses surged from 0 % during the initial waves to 66.71 % in the fourth wave. Conclusions: Our findings emphasize the critical importance of adapting healthcare strategies to the evolving dynamics of the pandemic. The reduction in ICU admissions, IMV utilization, and LOS, coupled with the rise in vaccination rates, underscores the adaptability of healthcare systems. Hospital mortality's persistence may warrant further exploration of treatment strategies. These insights can inform public health responses, helping policymakers allocate resources effectively and tailor interventions to specific phases of the pandemic. Introduction COVID19 COVID 19 COVID-1 decisionmaking. decisionmaking decision making. making decision-making allocation policies Colombia methods 273 Lilis Lili s Registry admission IMV, , stay Results patterns Notably 0.001. 0001 0.001 . 001 Remarkably 62.83% 6283 62 83 (62.83 vs 5123 51 23 51.23 5823 58 58.23 4670 46 70 46.7 0.001, (IMV 39.25% 3925 39 25 (39.25 3222 32 22 32.22 3122 31 31.22 2155 21 55 21.5 LOS (LOS 9 ( days Surprisingly 1820 18 20 18-2 0.05. 005 0.05 05 0.05) 6671 66 71 66.7 wave Conclusions utilization rates systems mortalitys responses COVID1 1 COVID- 27 000 0.00 00 62.83 628 6 (62.8 512 5 2 51.2 582 58.2 467 4 7 46. 39.25 392 3 (39.2 322 32.2 312 31.2 215 21. 182 18- 0.0 667 66. 62.8 (62. 51. 58. 39.2 (39. 32. 31. 0. 62. (62 39. (39 (6 (3

Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8–8.1), and the total cost of the teaching activity would be $684 (IQR:672–696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved. trialbased trial based theoreticalpractical theoretical practical IuSTC01 IuSTC (IuSTC01 plan considered adopted dollars 8 calculated uncertainties 793 7 93 $7.9 interquartile IQR (IQR) $7.8–8.1, 7881 $7.8–8.1 , 1 $7.8–8.1) 684 $68 IQR672–696. IQR672696 672–696 . 672 696 (IQR:672–696) 50 spent 72%. 72 72% (72%) 40 involved IuSTC0 (IuSTC0 79 9 $7. (IQR 788 $7.8–8. 68 $6 IQR672 IQR672–696 IQR67269 672696 672–69 67 69 (IQR:672–696 5 (72% 4 (IuSTC $7 78 $7.8–8 6 $ IQR67 IQR672–69 IQR6726 67269 672–6 (IQR:672–69 (72 $7.8– IQR6 IQR672–6 6726 672– (IQR:672–6 (7 $7.8 IQR672– (IQR:672– ( (IQR:672 (IQR:67 (IQR:6 (IQR:

ABSTRACT Vulnerable regions to drought require resource allocation to develop projects to combat low rainfall negative impacts. In this perspective, this study proposes a multicriteria sorting model to categorize municipalities affected by drought in order to allocate resources according to criticality. The proposed model is based on the FlowSort method for sorting municipalities into highly critical, moderately critical, and slightly critical levels to cope with drought. The model was applied in the Apodi-Mossoró river basin in Rio Grande do Norte, Brazil, for sorting 14 municipalities. The findings revealed that the public administration could effectively focus its resources on municipalities experiencing more severe drought conditions. Thus, the public administration can develop strategies, public policies, and actions in coping with extreme difficulty. impacts perspective criticality ApodiMossoró Apodi Mossoró Norte Brazil 1 conditions Thus strategies policies difficulty

ABSTRACT Objective: Tuberculosis (TB) is the second most deadly infectious disease globally, posing a significant burden in Brazil and its Amazonian region. This study focused on the “riverine municipalities” and hypothesizes the presence of TB clusters in the area. We also aimed to train a machine learning model to differentiate municipalities classified as hot spots vs. non-hot spots using disease surveillance variables as predictors. Methods: Data regarding the incidence of TB from 2019 to 2022 in the riverine town was collected from the Brazilian Health Ministry Informatics Department. Moran’s I was used to assess global spatial autocorrelation, while the Getis-Ord GI* method was employed to detect high and low-incidence clusters. A Random Forest machine-learning model was trained using surveillance variables related to TB cases to predict hot spots among non-hot spot municipalities. Results: Our analysis revealed distinct geographical clusters with high and low TB incidence following a west-to-east distribution pattern. The Random Forest Classification model utilizes six surveillance variables to predict hot vs. non-hot spots. The machine learning model achieved an Area Under the Receiver Operator Curve (AUC-ROC) of 0.81. Conclusion: Municipalities with higher percentages of recurrent cases, deaths due to TB, antibiotic regimen changes, percentage of new cases, and cases with smoking history were the best predictors of hot spots. This prediction method can be leveraged to identify the municipalities at the highest risk of being hot spots for the disease, aiding policymakers with an evidenced-based tool to direct resource allocation for disease control in the riverine municipalities. Objective (TB globally region area vs nonhot non Methods 201 202 Department Morans Moran s autocorrelation GetisOrd Getis Ord GI lowincidence machinelearning Results westtoeast west east pattern AUCROC AUC ROC (AUC-ROC 081 0 81 0.81 Conclusion changes evidencedbased evidenced based 20 08 8 0.8 2 0.

RESUMO Objetivo: A tuberculose (TB) é a segunda doença infecciosa que mais mata no mundo, representando um problema de saúde pública no Brasil, especialmente na região amazônica. Este estudo analisa a TB nos municípios ribeirinhos” com o objetivo de identificar aglomerados de alta incidência, também conhecidos como “hot spots”. Posteriormente, utilizando aprendizagem de máquina, visamos prever estes aglomerados por meio de variáveis de vigilância epidemiológica. Assim buscamos auxiliar o ente público no combate à TB nesta região. Métodos: Dados da incidência de TB nos “municípios ribeirinhos” foram coletados entre os anos de 2019 e 2022 do Departamento de Informática do Ministério da Saúde. O índice de Moran foi utilizado para a determinação de autocorrelação espacial global, enquanto o método Getis-Ord GI* foi empregado para a autocorrelação espacial local. Variáveis referentes ao diagnóstico, tratamento e características socioeconômicas associadas aos casos foram utilizadas para a predição de aglomerados de alta incidência por meio de um modelo Random Forest. Resultados: Foram identificados aglomerados com alta incidência de TB a oeste e baixa incidência a leste. O total de seis variáveis de vigilância epidemiológica foi identificado como relevante para a predição. Nosso modelo Random Forest alcança uma área sob a curva da característica operacional do receptor (AUC-ROC) de 0,81. Conclusão: Municípios com altas porcentagens de casos recorrentes, mortes por TB, mudança do esquema de tratamento, casos novos e casos com história de tabagismo estão associados a aglomerados de alta incidência. Esperamos que este método de identificação de possíveis aglomerados de TB seja útil para o ente público no combate à doença na região. Objetivo (TB mundo Brasil amazônica ribeirinhos hot spots. spots . spots” Posteriormente máquina Métodos 201 202 Saúde global GetisOrd Getis Ord GI local diagnóstico Resultados leste AUCROC AUC ROC (AUC-ROC 081 0 81 0,81 Conclusão recorrentes 20 08 8 0,8 2 0,