Espiritualidad femenina y modernización reflexiva en círculos de mujeres

RE S U M E N Este artículo es el resultado de una investigación cuyos objetivos fueron identificar y analizar los usos y sentidos del concepto de "espiritualidad" en tres círculos de mujeres de la ciudad de Medellín, Colombia. Para ello se empleó una metodología cualitativa basada principalmente en observaciones etnográficas de los encuentros mensuales que realizan estos círculos, así como en entrevistas semi-estructuradas a dieciséis mujeres que participan de ellos. Los resultados muestran que los usos y significados que estas personas otorgan a la espiritualidad se relacionan con la búsqueda de referentes distintos a los del patriarcado o del judeocristianismo, así como a un proceso de autoconocimiento, al contacto con un "yo sagrado" y a la revisión continua de las actitudes y los pensamientos. Se concluye entonces que la "espiritualidad femenina" es un concepto complejo a través del cual se pretende orientar de una manera novedosa las subjetividades de las participantes. Sin embargo, al hacer énfasis en la autonomía y la sacralización de la mujer dicho concepto es una manifestación de los procesos de individualización y reflexividad propios de la modernidad tardía.

This article is the result of an investigation whose main objectives are to identify and analyze the uses and meanings of the concept of "spirituality" in three women's circles in the city of Medellín. In order to achieve this, a qualitative methodology was used, based mainly on ethnographic observations of the monthly meetings held by these circles, as well as semi-structured interviews with sixteen women who participate in them. The results show that the uses and meanings that these persons give to spirituality are related to the search for referents other than those of patriarchy or Judeo-Christianity as well as a quest of self-knowledge, contact with a "sacred self" and the review of attitudes and thoughts. It is concluded that "feminine spirituality" is a complex concept intended to guide the subjectivities of the participants in a new way However; by emphasizing the autonomy and sacralization of women, this concept is a manifestation of the processes of individualization and reflexivity typical of late modernity

Este artigo é o resultado de uma investigação cujos objetivos foram identificar e analisar os usos e significados do conceito de "espiritualidade" em três círculos de mulheres na cidade de Medellín, Colômbia. Para isso, foi utilizada uma metodologia qualitativa, baseada principalmente em observações etnográficas das reuniões mensais realizadas por esses círculos, bem como entrevistas semiestruturadas com dezesseis mulheres que deles participam. Os resultados mostram que os usos e significados que essas pessoas atribuem à espiritualidade estão relacionados à busca de outros referentes que não sejam os do patriarcado ou judaico-cristianismo, bem como um processo de autoconhecimento, contato com um "eu sagrado" e a revisão de atitudes e pensamentos. Conclui-se então que a "espiritualidade feminina" é um conceito complexo por meio do qual se pretende orientar as subjetividades das participantes de uma nova forma. No entanto, ao enfatizar a autonomia e a sacralização da mulher, esse conceito é uma manifestação dos processos de individualização e reflexividade típicos da modernidade tardia.

Construction of pharmacogenomics-guided individualized medication list for elderly patients / 中国药房

OBJECTIVE To develop an individualized medication list for elderly patients by evidence-based pharmacy method， and to support clinical decisions on rational use of METHODS　Firstly， drugs with risk genetic information were screened out by systematically reviewing evidence-based pharmacy information. Secondly， researchers investigated the included drugs in lists from different data E- sources. Drugs included in three or more data sources and drugs proposed by the expert committee were then included in the medication list. Thirdly， for the drugs included in two data sources， researchers designed questionnaires to investigate the necessity of drug-related gene testing. According to the scoring results of the expert questionnaire， drugs with higher scores were included in the list. Data sources included real-world data （list of high frequency medication in hospitals， high frequency medication for elderly outpatients and inpatients in National Health Care Claims Data， drugs related to frequent medication errors and so on） and evidence-based pharmacy evidence （the websites of Clinical Pharmacogenomics Implementation Consortium， Dutch Pharmacogenetics Working Group， Food and Drug Administration and so on）. RESULTS　The study obtain 68 drugs with risk genetic information which were included in three data sources. Combined with 23 drugs proposed by the expert committee， a list containing 74 drugs was preliminarily formed after de-duplication. A total of 37 drugs included in two databases with risk genetic information were scored through the questionnaire survey to form a supplementary list of 26 drugs. This is the final composition of the list of 100 drugs developed in this study. Among them， there are 43 drugs for the central nervous system， 15 drugs for the cardiovascular system， 12 anti-tumor drugs and so on. Twelve drugs were included in six or more data sources， which mainly consisted of drugs for digestive system， all proton pump inhibitors. CONCLUSION　In this study， a list of 100 commonly used drugs which require individualized medication for the elderly was developed by evidence-based pharmacy method. The drug list will be updated in time as available evidence changes， and can provide guidance for rational use of medicines for elderly patients.

Research Progress of 3D Printing Technology for Perioperative Treatment of Osteosarcoma / 肿瘤防治研究

The anatomical site of osteosarcoma is generally complex. Hence, it is difficult to accurately remove osteosarcoma and retain important nerves and blood vessels around the tumor, as well as repair and reconstruct bone defects after osteosarcoma resection. 3D printing technology can "tailor" the "bone defect" after removing the irregular osteosarcoma to achieve a good therapeutic effect of limb reconstruction. This study reviews the application of 3D printing technology in the preoperative, intraoperative, and postoperative reconstruction of osteosarcoma and bone tissue engineering scaffolds. Thus, this study systematically analyzes the advantages and suggestions of 3D printing technology based on the characteristics of 3D printing to put forward references for the accurate treatments of osteosarcoma in the future.

Cortical thickness is related to working memory performance after non-invasive brain stimulation

Non-invasive brain stimulation (NIBS) probing the dorsolateral prefrontal cortex (DLPFC) has been shown to have little effect on working memory. The variability of NIBS responses might be explained by inter-subject brain anatomical variability. We investigated whether baseline cortical brain thickness of regions of interest was associated with working memory performance after NIBS by performing a secondary analysis of previously published research. Structural magnetic resonance imaging data were analyzed from healthy subjects who received transcranial direct current stimulation (tDCS), intermittent theta-burst stimulation (iTBS), and placebo. Twenty-two participants were randomly assigned to receive all the interventions in a random order. The working memory task was conducted after the end of each NIBS session. Regions of interest were the bilateral DLPFC, medial prefrontal cortex, and posterior cingulate cortex. Overall, 66 NIBS sessions were performed. Findings revealed a negative significant association between cortical thickness of the bilateral dorsolateral prefrontal cortex and reaction time for both tDCS (left: P=0.045, right: P=0.037) and iTBS (left: P=0.007, right: P=0.007) compared to placebo. A significant positive association was found for iTBS and posterior cingulate cortex (P=0.03). No association was found for accuracy. Our findings provide the first evidence that individual cortical thickness of healthy subjects might be associated with working memory performance following different NIBS interventions. Therefore, cortical thickness could explain - to some extent - the heterogeneous effects of NIBS probing the DLPFC.

Othering discourse and stigma amidst the identity formation process among gays, bisexuals and other men who have sex with men on HIV pre-exposure prophylaxis (PrEP) / Discurso do Outro e estigma no processo de formação de identidade entre gays, bissexuais e outros homens que fazem sexo com homens que utilizam a profilaxia pré-exposição ao HIV (PrEP)

Abstract With the global emergence of the HIV pre-exposure prophylaxis (PrEP), questions have emerged on which ways the social identity formation process among gays, bisexuals and other men who have sex with men on PrEP arise and constitute beyond exclusive sexual orientation expressions. We conducted a content analysis with thematic categories in a PrEP online group guided by group-web affiliation and individualization approaches. Individuals identify themselves as PrEPsters as part of a PrEP club, while dealing with conflicts on serosorting sexual partners and stigmatizing reactions towards people living with HIV/AIDS (PLWH). Self-worth and othering discourses towards PLWH emerged as complex themes in men's production of identity processes across four overlapping domains: (1) self-worth as a strategy to challenge individual HIV-acquisition-related anxiety and fear, (2) group-worth and group empowerment, (3) body control and reclaiming power on sexual health, and (4) othering discourses, HIV/AIDS stigma and criminalization of PLWH. Paradoxically, internal and external discourses to the group constitute and challenge identity differentiation; individuals on PrEP claim to fight against the HIV/AIDS stigma, while this reverberates alongst HIV-related discriminatory expressions in their discourses.

Resumo Com o avanço global da Profilaxia Pré-exposição ao HIV (PrEP) questões sobre a formação do processo (bio)identitário de gays, bissexuais e outros homens que fazem sexo com homens usuários de PrEP complexificam-se para além de expressões de orientação sexual. Realizamos uma análise de conteúdo com categorias temáticas em um grupo online de usuários de PrEP orientada por abordagens de redes sociais e individualização social. Os indivíduos veem-se como PrEPsters como parte de um clube de PrEP, enquanto lidam com conflitos nas relações sexuais soro-discordantes. Discursos de autovalorização e de estigma contra pessoas que vivem com HIV/Aids (PVHA) surgiram como temas complexos na produção dos processos de identidade em quatro domínios interconectados: (1) autovalorização como uma estratégia para minorar ansiedade e o medo relacionados à aquisição de HIV, (2) valorização de grupo e expressões de empoderamento individual, (3) controle do corpo e poder de decisão sobre saúde sexual, e (4) discursos de diferenciação, estigma e criminalização das PVHA. Paradoxalmente, discursos internos e externos ao grupo constituem e desafiam a diferenciação de identidade; indivíduos em PrEP afirmaram lutar contra o estigma do HIV/Aids, enquanto reproduzem expressões discriminatórias relacionadas a HIV/Aids em seus discursos.

A fresh look at the concept of Genus Epidemicus: findings from the Clificol Project

The Clificol® COVID-19 Support Project is an innovative international data collection project aimed at tackling some of the core questions in homeopathy, including the notion of Genus Epidemicus. Aims:To shed some light on the notion of Genus Epidemicus in the context of this infection. Going beyond that, the project aims to use these data to tackle more fundamental questions, such as the role of symptoms and rubrics in treatment individualisation. Methodology:This online multi-national data-collection project is supported by the ECH, ECCH, ICH, HRI, LMHI, and other professional associations. The collected data includes demographic information, severity, conventional diagnosis and treatment, presenting symptoms as well as the remedies prescribed. The outcome of treatment was tracked using the ORIDL scale. The concept of Genus Epidemicus, including the role of treatment individualisation, was investigated by analysing whether presenting symptoms cluster into distinct groups (K-Means clustering approach). The symptom data originating from China was obtained using a questionnaire. Results and discussion: 20 Chinese practioners collected 359 cases, primarily in the first half of 2020 (766 consultations, 363 prescriptions). The cluster analysis found two to be the optimum number of clusters. These two symptomatic clusters had a high overlap with the two most commonly prescribed remedies in that population: In cluster 1 there were 297 prescriptions, 95.6% of which were Gelsemium sempervirens, incluster 2, there were 61 prescriptions, 95.1% of which were Bryonia alba. Under the assumption of a single genus epidemicuswe would expect to see a single cluster of symptoms. The data from the Chinese population were not compatible with this assumption. Conclusion:This was the first study that investigated the notion of Genus Epidemicus by using modern statistical techniques. These analyses identified at least two distinct symptom pictures. The notion of a single COVID-19 Genus Epidemicus did not apply to this population.

Application of "homogenization + individualization" teaching in nursing refresher training of pediatric surgery / 中华医学教育探索杂志

Objective:To explore the application effect of the "homogenization + individualization" teaching training model on the nursing refresher training of pediatric surgery.Methods:A total of 38 nursing students who took refresher training of pediatric surgery in West China Hospital of Sichuan University for 3 months from March 2017 to February 2020 were selected as the research objects. Before and after training, the differences in basic nursing operation assessment scores, overall nursing program application scores, and post competency scores were investigated. At the same time, after the training, the theoretical knowledge level of the trainees was assessed and the trainees' satisfaction with the training process was investigated. SPSS 26.0 was performed for paired t test. Results:The basic nursing operation scores, the overall nursing quality of the responsibility system and the post competency assessment scores of the trainees after the training were significantly better than those before the training [(92.99±2.46) vs. (94.96±2.71), t=-6.18, P<0.001; (94.82±2.12) vs. (96.16±1.82), t=-3.92, P<0.001; (79.89±5.10) vs. (88.16±4.29), t=-11.58, P<0.001]. Among the 18 teaching satisfaction items, the 3 items with the lowest scores were, in turn, giving certain affirmation to the trainee's work, the department teachers having training consciousness, and guiding students to solve difficulties. Conclusion:The "homogenization + individualization" training mode can effectively improve the basic operating skills, the overall nursing quality of the responsibility system and the post competency of the advanced nursing students of pediatric surgery, and achieve better teaching satisfaction.

Individualização e trabalho no contexto da pandemia de Covid-19 no Brasil / Individualization and work in the context of COVID-19 pandemic in Brazil

RESUMO A pandemia de Covid-19 promoveu um salto produtivo em dimensões globais e, por consequência, no Brasil, consolidando profundas alterações sociais. O processo de flexibilização das relações do trabalho encontrou, no contexto pandêmico, condições objetivas para sua expansão, em especial, o crescente uso de meios técnico-informacionais e de telecomunicações. Pressupondo este cenário, discute-se neste ensaio as formas e as relações de trabalho individualizadas e individualizadoras decorrentes desse processo, bem como a intensificação da dinâmica de individualização social.

ABSTRACT The COVID-19 pandemic promoted a productive leap in global dimensions and, consequently, in Brazil, consolidating profound social changes. The process of flexibilization of work relations found, in the pandemic context, objective conditions for its expansion, in particular the increasing use of technical-informational and telecommunications solutions. Assuming this scenario, this essay discusses the individualized and individualizing forms and labor relations resulting from this process, as well as the intensification of the dynamics of social individualization.

Development of software for individualizing dosage regimens of vancomycin based on population pharmacokinetics models / 中国临床药理学与治疗学

AIM: To develop software for individualizing dosage regimens of vancomycin (VCM) according to the established population pharmacokinetics (PPK) models. METHODS: VCM dosing software was developed using MyEclipse, SQL Server, and JRE. The software developing schemes included requirement analysis, general design, detailed design, software coding, software test, software maintenance and software redevelopment. RESULTS: The developed software achieved the functions such as input and management of patient information, prediction of trough concentrations under various dosing regimens which could help initial dosage design, and prediction of trough concentrations more accurately based on therapeutic drug monitoring results and Bayesian method which could help dosage adjustment. The software was utilized in the interpretation of VCM serum concentration, pharmacists proposed the suggestions for adjusting dosage regimens. The rechecked serum concentrations all reached the expected target blood concentration range in the group of adopting advice. CONCLUSION: The new developed software based on our established PPK models can provide a useful tool in the clinical setting to facilitate the individualized therapy for the adult and elderly infected patients.

Research on Individualized Phantom Based on 3D Printing for Radiotherapy Dose Verification / 中国医疗器械杂志

Dose verification is carried out on the individualized three-dimensional phantom based on 3D printing technology, which simulates the anatomical structure of human body, contour shape, tumor anatomical structure and other dangerous organs to the greatest extent, and produces a reasonable and effective dose validation phantom. According to the need to obtain effective patient data, import Mimics software to reconstruct the parts of the body and its surrounding tissues and organs that need to be measured, and make them into three-dimensional shell components. The 3D printing is used to assemble and fill the equivalent tissue, and then the body phantom is made. The phantom was scanned by CT and the data was transmitted to TPS system. The previously completed treatment plan was transplanted to the phantom. The phantom was placed according to the patient's location information, irradiated and measured data. The three-dimensional shell assembly is completely reconstructed according to the patient's data, and the contour difference is not significant. The shell is filled with tissue radiation equivalent material whose CT value is the same as the average CT value of the shell volume. The CT image data show that the radiation equivalence of the phantom is similar to the actual tissue of the patient, and the equivalent dose distribution conforms to the conventional treatment range. It can provide a reliable means of dose verification for the accurate design of intensity modulated radiation therapy.

Bienestar psicológico y sentimiento de individuación laboral en trabajadores chilenos / Psychological wellbeing and sense of labor individuation in chilean workers / Bem-estar psicológico e sentimentos de individualização do trabalho em trabalhadores chilenos

La presente investigación estableció la relación entre Bienestar Psicológico y Sentimiento de Individuación Laboral. Además, verificó un modelo predictivo entre ambos constructos. Metodológicamente, ocupó una muestra de tipo no probabilística intencional conformada por 314 trabajadores del sector salud, educación y minería.Bienestar Psicológico fue medido mediante la adaptación española de la Escala de Bienestar Psicológico de Ryff (Diaz et al, 2006), por su parte, el Sentimiento de Individuación Laboral se describió a través del Cuestionario de Evaluación del Sentimiento de Individuación Laboral (Jorquera, 2016; Jorquera & González, 2018a). El análisis evidencia una estrecha relación entre bienestar psicológico y sentimiento de individuación laboral. El modelo propuesto del Bienestar Psicológico y el Sentimiento de Individuación Laboral mostró una adecuada bondad de ajuste (χ2 = 72,316, gl=30, p<,01; χ2/gl=2,411; CFI=,961; TLI=,942; GFI=,957; SRMR=,053; RMSEA=,067). Se discute respecto a la contribución de los resultados para comprender algunos procesos psicosociales, en el plano laboral, propios de un contexto cultural influido por procesos individualizadores.

The present investigation established the relationship between Psychological Wellbeing and Sense of Labor Individuation. In addition, he verified a predictive model between both constructs. Methodologically, it occupied an intentional non-probabilistic sample made up of 314 workers in the health, education and mining sector. Psychological Wellbeing was measured by the spanish adaptation of the Ryff Psychological Wellbeing Scale (Diaz et al, 2006), meanwhile, the Sense of Labor Individuation was described through the Questionnaire for the Evaluation of Sense of Labor Individuation (Jorquera, 2016; Jorquera & González, 2018a). The analysis shows a close relationship between the Sense of Labor Individuation and Psychological Wellbeing. The proposed model of Psychological Wellbeing and the Sense of Labor Individuation showed an adequate goodness of fit (χ2 = 72,316, gl = 30, p <,01; χ2/gl = 2,411; CFI =,961; TLI =,942; GFI = ,957; SRMR =,053; RMSEA =,067). We discuss the contribution of results to understand some psychosocial processes, in the workplace, typical of a cultural context influenced by individualizing processes.

A presente investigação estabeleceu a relação entre Bem-estar Psicológico e Sentimentos de Individualização do Trabalho. Além disso, verificou um modelo preditivo entre os dois construtos. Metodologicamente, ocupou uma amostra não probabilística intencional composta por 314 trabalhadores dos setores de saúde, educação e mineração. O Bem-estar Psicológico foi medido por meio da adaptação espanhola da Escala de Bem-Estar Psicológico Ryff (Diaz et al, 2006), por sua vez, o Sentimento de Individuação do Trabalho foi descrito por meio do Questionário para Avaliação do Sentimento de Individuação do Trabalho (Jorquera, 2016; Jorquera & González, 2018a). A análise mostra uma relação estreita entre o bem-estar psicológico e o sentimento de individuação no trabalho. O modelo proposto de Bem-estar Psicológico e Sentimento de Individuação do Trabalho mostrou um ajuste adequado (χ2 =72,316, gl = 30, p <0,01; χ2 / gl = 2,411; CFI = 0,961; TLI = 0,942; GFI =,957; SRMR = 0,053; RMSEA = 0,067). Discute-se a respeito da contribuição dos resultados para a compreensão de alguns processos psicossociais, no ambiente de trabalho, típicos de um contexto cultural influenciado por processos individualizantes.

La gestión de recursos humanos en contextos de individualización / Human Resources Management in Contexts of Individualization

Resumen La sociedad actual y el mundo del trabajo han sufrido procesos de transformación caracterizados por una tendencia hacia la individualización en las relaciones y la fragilización de los vínculos humanos. Este contexto demanda para las organizaciones retos importantes para la gestión de recursos humanos, debido a que se deben replantear las estrategias y políticas dirigidas a la gestión de personas basada en los colectivos, para remplazarlas por prácticas de gestión individualizadas que respondan a las características actuales de las relaciones de trabajo. En este artículo se proponen un conjunto de reflexiones sobre las implicaciones en la gestión de recursos humanos derivadas de los procesos de individualización y se sugieren algunas alternativas como los contratos idiosincrásicos, el liderazgo individualizado y la gestión de los contratos psicológicos como formas más efectivas de gestionar los recursos humanos en las organizaciones en contextos de individualización.

Abstract Current society and the world of labor have undergone processes of transformation characterized by a tendency towards individualization in relationships and the weakening of human bonds. This context poses important challenges to organizations' human resources management, in the sense that strategies and policies aimed at the management of people based on collectives must be rethought, so as to replace them with individualized management practices that respond to the characteristics of current work relations. This article proposes a set of reflections on the implications for the management of human resources derived from the processes of individualization and suggests some alternatives such as idiosyncratic contracts, individualized leadership and the management of psychological contracts as more effective ways of managing human resources in organizations in individualization contexts.

Individualização em gêmeos: uma revisão integrativa / Individualization in twins: an integrative literature review

O processo de individualização em gêmeos se mostra mais complexo se comparado com filhos singulares, envolvendo maiores questões em relação à separação entre o bebê e a mãe, também entre os próprios cogêmeos. Devido ao aumento de nascimentos de gêmeos, o assunto é atual, porém ainda são poucos os estudos na área. O trabalho teve por objetivo investigar a produção científica brasileira sobre o processo de individualização em gêmeos na atualidade. Para isso, realizou-se uma revisão bibliográfica integrativa em bases de dados online, de artigos e teses referentes à temática. Foram selecionados e analisados 14 trabalhos científicos que atenderam aos critérios de inclusão. Verificou-se dificuldade em estudar o processo de individualização em gêmeos devido a algumas de suas particularidades, como a genética e ambiente de criação compartilhados, intensificando, consequentemente, as ideações e práticas culturais sobre o desenvolvimento gemelar. Assim, entende-se a necessidade de estudos mais aprofundados.

The process of individualization of twins appears to be more complex when compared with individual children, involving major issues regarding the separation between the baby and the mother and also among the twins themselves. Because of the increase in births of twins, this is a current subject, although there are still few studies in the area. This study aimed to investigate the Brazilian scientific production about the individualization process in twins today. For this, an integrative literature review of online databases was conducted, including papers and theses concerning the subject. A total of 14 scientific studies that met the inclusion criteria were selected and analyzed. While studying the process of individualization of twins, some challenges appeared, mainly due to particularities like shared genetics and raising environment, which consequently intensify the ideation and cultural practices related to the growth of twins. Thus, further studies are considered necessary.

Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension / 中国康复理论与实践

Objective:To analyze the cardiopulmonary function of stable patients with pulmonary arterial hypertension (PAH), and to explore effects of the cardiopulmonary exercise testing (CPET)-based individualized moderate-intensity exercise prescription on cardiopulmonary functional reserve and exercise capacity in patients with PAH. Methods:From April, 2018 to July, 2019, 31 stable patients with PAH (PAH group) and 32 healthy counterparts (normal group) were enrolled. All subjects underwent CPET. PAH group was assessed with 6-Minute Walking Test (6MWT), and then was divided into exercise group (n = 16) and control group (n = 15). Both groups were treated with ordinary targeted drugs, while the exercise group was additionally provided with an individualized moderate-intensity exercise prescription of △50% power treadmill training, five days a week for eight weeks. CPET and 6MWT were conducted again after intervention. Results:Before intervention, body mass, body mass index (BMI), force vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum voluntary ventilation (MVV), anaerobic threshold (AT), peak heart rate (HRpeak), peak systolic blood pressure (SBPpeak), peak load power (WRpeak), peak oxygen uptake (VO2peak), peak oxygen pulse (VO2/HRpeak), peak cardiac output (COpeak), peak minute ventilation (VEpeak), peak end-tidal carbon dioxide (PETCO2peak), peak pulse oxygen saturation (SpO2peak) and oxygen uptake efficiency plateau (OUEP) were significantly lower (t > 2.419, P < 0.05), and the rest heart rate (HRrest), peak dead space to tidal volume ratio (VD/VTpeak), minimum ventilatory equivalent for carbon dioxide (Lowest VE/VCO2) and slope of ventilatory equivalent for carbon dioxide (VE/VCO2 slope) were higher (|t| > 2.615, P < 0.05) in PAH group than in the normal group. After intervention, FEV1, MVV, VO2peak (ml/min/kg) and VO2/HRpeak decreased in the control group (t > 2.272, P < 0.05); FVC, FEV1, MVV, AT, SBPpeak, WRpeak, VO2peak, VO2/HRpeak, COpeak, VEpeak, PETCO2peak, SpO2peak and 6-Minute Walking Distance (6MWD) increased (|t| > 2.167, P < 0.05), while the average Lowest VE/VCO2 and VE/VCO2 slope decreased (t > 2.264, P < 0.05) in the exercise group. Compared with the control group, the FEV1/FVC, AT, WRpeak, VO2peak, VO2/HRpeak, COpeak and 6MWD increased in the exercise group (|t| > 2.168, P < 0.05). Conclusion:The holistic cardiopulmonary function of stable patients with PAH decreases. CPET-based individualized moderate-intensity exercise could enhance the cardiopulmonary functional reserve and exercise capacity of patients with PAH.

Judicialização e subpolítica médica / Judicialization and Medical Sub-Politics

Resumo O objetivo deste artigo é discutir o fenômeno da judicialização e a subpolítica médica na contemporaneidade. A judicialização é identificada como o envolvimento do Poder Judiciário na esfera política na tutela de interesses individuais, como uma interferência no planejamento das políticas públicas. As decisões judiciais acabariam definindo políticas, à margem do modelo democrático da modernidade industrial. Diversas pesquisas defendem que o Judiciário tende a atender estas demandas, evocadas sob o fundamento da garantia da saúde e vida, abalizadas pelas normas de direito constitucional à saúde e profissionais médicos. Mas a judicialização pode ser também caracterizada como eco de um processo reflexivo da modernidade, no qual direitos fundamentais estabelecidos potencializam uma nova cultura política. Os cidadãos utilizam meios não tradicionais de intervenção e controle público e judicial, buscando defender seus interesses e direitos. O próprio fundamento fático das demandas é construído reflexivamente pelo saber médico, impermeável a formas tradicionais de controle externo. Isto gera uma judicialização pautada pela medicina e favorece a expansão do campo de atuação médica, e do mercado e pesquisa para a indústria médico-hospitalar e farmacêutica. Tanto sociedade como Estado acabam sendo obrigados a recorrer a normas e conhecimentos medicinalmente constituídos e monopolizados, em uma estratégia reflexiva de mercado.

Abstract The phenomenon of judicialization and the growing litigation in health demands have gained increasing importance - not only academic but also practical. In Brazil, this is usually seen by the academic criticism as the involvement of the Judiciary in the political sphere and its activity, as an interference in the planning of public policies. The judicial decisions would end up by defining policies, thus diverging from the democratic model of industrial modernity based upon the separation of Powers. Various research projects have argued that the Judiciary tends to attend to these demands, which invoke as their legal foundation the right to health, as defined by the constitutional norms, and based upon medical reports. This article discusses judicialization and medical sub-politics in the contemporary scene. In the light of contemporary social changes, judicialization can also be characterized as an echo of a reflexive process of modernity, in which established fundamental rights point to a new political culture. Citizens use non-traditional means of intervention and public and judicial control to defend their interests and rights. The very factual foundation of the demands is constructed reflectively by medical knowledge, impermeable to the traditional forms of external control. This generates a judicialization controlled by medicine and favors the expansion of the field of, activity, market and research for the medical, hospital and pharmaceutical industries. Thus, judicialization can attend to the more characteristically techno-scientific and economic interests than to democratic ones. Both society and the State end up by being obliged to have recourse to norms and knowledge medically constituted and monopolized, in a reflective market strategy. It is important to rethink judicialization in the light of the intensely political activity of medicine, thus opening up new prospects for the debate and critical understanding of this activity, its consequences, purposes and reflectively constructed risks.

O reaparecimento da homossexualidade masculina nas estratégias de prevenção da infecção por HIV: reflexões sobre a implementação da PrEP no Brasil / The male homosexuality reappearance in HIV infection prevention strategies: reflections on the PrEP implementation in Brazil

Resumo Este trabalho toma como ponto de partida o texto de Nestor Perlongher, intitulado "O desaparecimento da homossexualidade", que descreve um esvaziamento da identidade homossexual masculina com o surgimento da aids e propõe uma nova leitura a partir da implementação da profilaxia pré-exposição ao HIV (PrEP) pelo sistema público de saúde no Brasil. Distribuída a partir do início de 2018 e considerada como uma das mais novas medidas de prevenção ao HIV/aids, a PrEP se configura como um esquema antirretroviral de uso contínuo direcionado aos sujeitos que não foram infectados pelo vírus. Tomando como referência empírica o Protocolo Clínico de Diretrizes Terapêuticas para PrEP, identificamos como, a partir da noção de risco, a profilaxia possibilita o retorno da homossexualidade aos consultórios médicos e, mais do que isso, opera como objeto discursivo de problematizações de caráter sanitário e social. Diante disso, a PrEP produz uma nova categoria de homossexual, atrelada a tecnologias disciplinares e biopolíticas, que se apoiam na individualização e responsabilização dos indivíduos pelo cuidado de si.

Abstract This paper takes its starting point the text by Nestor Perlongher, entitled O desaparecimento da homossexualidade [The disappearance of homosexuality], depicting an emptying of male homosexual identity with the emergence of aids, and proposes a new reading about the pre-exposure prophylaxis (PrEP) implementation by the public health system in Brazil. Distributed from early 2018 and considered as one of the newest HIV/aids prevention measures, PrEP is a continuous antiretroviral therapy aimed for subjects who have not been infected with the virus. Taking as an empirical reference the Clinical Protocol of PrEP Therapeutic Guidelines, we identified how, from the notion of risk, prophylaxis enables the return of homosexuality to doctors' offices and, furthermore, operates as a discursive object of sanitary and social problematizations. Thus PrEP produces a new homosexual category, linked to disciplinary and biopolitical technologies, which rely on the individualization and accountability of individuals for self-care.

Reforma trabalhista: uma análise psicossocial / Labor reform: a psychosocial analysis

O trabalhar segue sendo atividade central na vida das pessoas na contemporaneidade e o Estado cumpre importante papel na regulação e estruturação do mundo do trabalho como promotor de segurança e proteção social. O governo brasileiro aprovou uma reforma trabalhista buscando flexibilizar para aumentar produtividade, competitividade e formalização do trabalho. Críticos à reforma apontam que a flexibilização irá aumentar a precarização do trabalho. Através do método de análise documental do texto da Reforma Trabalhista, o presente artigo visou discutir possibilidades, problemas e contradições desta reforma a partir de uma análise psicossocial. As principais conclusões indicaram que a Reforma Trabalhista, ao ser pautada na individualização, flexibilização e livre negociação no trabalho, traz uma dupla consequência. De um lado, irá beneficiar empresários/as e trabalhadores/as de alta renda e qualificação, sendo a flexibilização benéfica para as relações de trabalho. E, por outro lado, irá dificultar o suporte social demandado pela maioria de trabalhadores/as ao enfraquecer os sindicatos e relativizar os suportes e proteções sociais via Estado com a possível consequência de maior vulnerabilidade de grande parte dos/as trabalhadores/as, sendo uma flexibilização do trabalho geradora de precarização

Working continues to be a core activity in people's lives in contemporary and the State fulfills an important role in regulating and structuring working world as the promoter of security and social protection. Brazilian government has approved a labor reform which aims to make existing systems more flexible to enhance productivity, competitiveness and formalization of employment relationships. Reform critics indicate that flexibilization will increase precariousness of work. Through a documentary analysis, this paper aimed to discuss the possibilities, problems and contradictions of the reform from a psychosocial analysis. The main contribution this paper offers is the twofold consequence of a Labor Reform based on individualization, flexibilization and free negotiation of employment relationships. On the one hand, it will chiefly benefit entrepreneurs and highly skilled and high-income workers, what turns working flexibilization into a beneficial outcome. And, on the other hand, it will hamper the social supports required by most of the workers when weakening trade unions and relativizing social protections provided by State actions. One possible consequence is more vulnerability of most of workers, what turns working flexibilization into working precariousness.

Application of Individualized Dosage Auxiliary System JPKD and SmartDose in Individualization Administration of Vancomy- cin / 中国药房

OBJECTIVE： To evaluate the application of individualization dosage auxiliary system JPKD and SmartDose in individualization administration of vancomycin. METHODS： A retrospective study was conducted among adult inpatients in Hainan Provincial People’s Hospital from Apr. 2018 to Mar. 2019 with intravenous use of vancomycin. SmartDose was used to predict the steady blood trough concentration of vancomycin in the initial dosage regimen， and the absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The effects of body mass index （BMI） and acute kidney injury （AKI） on absolute weight deviation were analyzed by χ2 test or continuously corrected χ2 test. Vancomycin drug delivery scheme was adjusted for patients with ungualified steady blood drug trough concentration. JPKD and SmartDose system were used to predict the blood concentration of vancomycin after adjusting the dosage regimen. The absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The prediction ability of the two systems was evaluated and 3 examples was analyzed. RESULTS： Predicted steady blood trough blood concentration of 85 included patients in SmartDose predicted initial dosage regimen were （11.36±5.96） μg/mL （2.34-29.33   μg/mL）； the measured concentration was （11.44±6.57） μg/mL （3.10-29.50 μg/mL）； absolute weight deviation was 22.95％， and the relative prediction error was 2.72％. Whether BMI was normal or not had significant effects on the absolute weight deviation   （χ2＝4.75， P＝0.029）， and whether AKI occurred or not had no significant effects on the absolute weight deviation （χ2＝0.236， P＝0.627）. JPKD and SmartDose predicted that predicted steady blood trough concentrations of vancomycin in 22 included patients were （11.06±3.58） and （12.15±4.35） μg/mL， and the measured concentration was （12.57±4.50） μg/mL； absolute weight deviations were 18.30％ and 18.68％； relative prediction errors were －8.65％ and －0.44％， respectively. The absolute weight deviations of the predicted values of the two systems were less than 30％. The absolute weight deviations of prediction results were also less than 30％ in 3 patients. CONCLUSIONS： JPKD and SmartDose system have good predictive ability for blood concentration of vancomycin in clinical application， and can be used to optimize the individualized administration of vancomycin.

The application of 3D printing in ophthalmology / 中华实验眼科杂志

3D printing refers to the approach in manufacturing the three-dimensional physical objects by adding materials layer by layer.It features the advantages of quick styling, high flexibility and cost saving.The medical industry is extensively regarded as one of the most important application sectors for 3D printing.In recent years, due to the development of technical and the enhanced support from the nation in the 3D related research, the application of 3D printing technology in the ophthalmology has been increasing.This review made the overview analysis on the 3D printing technology application and possible prospects in the aspects of medical education, foundation research, surgical assistance and individualized treatment of ophthalmology, made a brief introduction on the 3D bioprinting technology attracting extensive attention recently.

Pay attention to the clinical value of individualized combination of drugs in the treatment of hypertension / 中国实用内科杂志

Individualized combination medication is an important measure to improve the rate of hypertension control, individualized combination medication is also an important method to protect organs, individualized combination medication is an important measure to reduce drug side effects and improve medication compliance, individualized combination medication is an important way to increase the rate of hypertension control and reduce the mortality and disability of cardiovascular disease. Therefore, it is considered that the emphasis on individualized combination medication for hypertension is an important strategy for prevention and treatment of hypertension.