Qualitative study on nurses′demand for nursing robot application scenarios in level3 general hospitals / 中国实用护理杂志

Objective:To analyze the needs and recommendation of nurses in level3 general hospital for the application scenarios of nursing robots, so as to provide a basis for the design of intelligent machine systems to reduce the workload of nurses in the hospitals.Methods:Using phenomenological research methods, a total of 17 clinical nurses from Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongda Hospital Southeast University and the First People′s Hospital of Lianyungang from November 2021 to March 2022 were selected for semi-structured interviews. Colaizzi content analysis method was used to sort out the data.Results:Clinical nurses′requirements for application scenarios of nursing robots could be summarized into four themes: feasibility of clinical application of robot recognized by nurses; expected alternative care scenarios; summary of nursing robot design features; multiple factors limit the application of nursing robots.Conclusions:Clinical nurses have diverse requirements for the application scenarios of nursing robots, and only part of non-clinical tasks will be authorized to robots in a short period of time. In the face of future opportunities and challenges, with the help of policies, legal supervision should be strengthened, so as to improve the reliability and safety of clinical application of nursing robots.

Trajetórias socioeconômicas compartilhadas no Brasil: cenários para a dinâmica populacional e os desafios à adaptação e mitigação / Shared socioeconomic pathways in Brazil: Scenarios for population dynamics and the challenges to adaptation and mitigation / Trayectorias socioeconómicas compartidas en Brasil: escenarios de dinámica poblacional y desafíos para la adaptación y mitigación

Resumo Dentre os múltiplos avanços científicos na compreensão das relações entre mudanças climáticas e dinâmica populacional, uma das principais inovações ocorreu na atual geração de modelagem climática, com a inclusão de um conjunto de cenários em que as questões populacionais são centrais. Baseados em narrativas de trajetórias socioeconômicas, estes cenários traçam alternativas para os desenvolvimentos sociais futuros, que, por sua vez, consideram projeções populacionais multidimensionais, construídas a partir das variáveis sexo, idade e escolaridade. Tais projeções incorporam heterogeneidades populacionais relevantes para a adaptação, sendo, potencialmente, mais sensíveis às mudanças na dinâmica demográfica e à compreensão da relação população e ambiente. No Brasil, contudo, tanto os pressupostos como as implicações desta abordagem são quase inexistentes. O presente artigo aborda esta discussão para o país, considerando seus aspectos teóricos e metodológicos. Destacam-se algumas das inferências da abordagem das shared socioeconomic pathways (SSPs) - trajetórias socioeconômicas compartilhadas - para construir projeções populacionais no nível subnacional, enfatizando os ganhos potenciais desta agenda no campo de população e ambiente.

Abstract During the past decades, there were scientific advances to better comprehend climate change and population dynamics. One of the main ones was the inclusion of a set of scenarios in current generation of climate modelling, with population as its human core. These are the shared socioeconomic pathways that result in population projections constructed by multi-dimensional demography, with population disaggregated by, sex, age and educational attainment. Such projections incorporate relevant population heterogeneities to adaptation and are potentially more sensitive to capture changes in demographic dynamics. This paper addresses this discussion for Brazil, considering both theoretical and methodological aspects. We highlight some of the implications of SSPs approach to construct population projections at the subnational level, emphasizing the benefits this agenda could bring to the population and environment fields.

Resumen Los avances en la ciencia para una mejor comprensión de las relaciones entre el cambio climático y la dinámica de la población se han producido en varios campos durante las últimas tres décadas. Una de las principales innovaciones se observa en la generación actual de modelos climáticos, con la inclusión de un conjunto de escenarios en los que los temas de población son centrales. Estos escenarios, denominados trayectorias socioeconómicas compartidas, esbozan alternativas para futuros desarrollos sociales que, a su vez, consideran proyecciones poblacionales multidimensionales, construidas a partir de las variables sexo, edad y educación. Estas proyecciones incorporan heterogeneidades de población relevantes para la adaptación y son potencialmente más sensibles a los cambios en la dinámica demográfica. Este artículo aborda esta discusión para Brasil, considerando sus aspectos teóricos y metodológicos. Se destacan algunas de las implicaciones del enfoque para construir proyecciones de población en el ámbito subnacional, con énfasis los logros que esta agenda puede traer al campo de población y medio ambiente.

Evolución de los estudios académicos sobre gestión del conocimiento y su efecto en organizaciones cubanas

Se realizó un análisis de las investigaciones académicas sobre Gestión del Conocimiento desarrolladas por la Facultad de Comunicación de la Universidad de La Habana en los niveles de diploma, maestría y doctorado entre el 2000 y el 2020 con el objetivo de valorar la situación de este campo de estudios. Para ello se definieron determinadas variables como: temas y subtemas tratados, tutores que guiaron las investigaciones y etapas de los estudios. Se utilizaron las versiones digitales de las tesis, debido a que no se tuvo acceso a los originales por la situación de la pandemia de la COVID-19. Los métodos empleados fueron el análisis documental y el cuestionario, aplicado a un grupo de instituciones cubanas que introdujeron este proceso en su gestión con la finalidad de valorar su efecto en el quehacer de los centros. Dentro de los resultados se precisaron los temas más productivos en cada nivel y se identificaron los principales tutores que asumieron las investigaciones. Estas tesis han tenido como objeto de estudio a organismos centrales y sus dependencias, institutos de investigación, empresas productivas de subordinación nacional y centros especializados en servicios de información. Los aspectos analizados en este estudio reflejan el esfuerzo desarrollado durante más de 20 años para conocer a cabalidad los enfoques de la Gestión del Conocimiento y obtener mejores resultados en la toma de decisiones, la innovación y el desarrollo profesional.

An analysis of the academic research on Knowledge Management developed by the Faculty of Communication of the University of Havana was carried out, at the diploma, master's and doctoral levels, from 2000 to 2020 with the objective of assessing the situation of this field of studies. To this end, certain variables were defined, such as: topics and subtopics covered, tutors who guided the investigations, and stages of the studies. The digital versions of the theses were used, since there was no access to the originals due to the COVID-19 pandemic situation. Documentary analysis and the questionnaire were the methods used. The questionnaire was applied to a group of Cuban institutions that introduced this process in their management in order to assess the effect on their work. From the results, the most productive topics at each level were specified and the main tutors who assumed the investigations were identified. These theses have had, as their object of study, central organizations and their dependencies, research institutes, productive companies of national subordination and specialized centers in information services. The aspects analyzed in this study reflect the effort developed over more than 20 years to fully understand Knowledge Management approaches and to obtain better results in decision-making, innovation and professional development.

El cuidado prenatal y los determinantes sociales: estudio ecológico en Argentina / Prenatal care and social determinants: ecological study in Argentina

Resumen Introducción: el cuidado prenatal es un aspecto clave de salud pública, con gran impacto en la salud materna y perinatal, así como en otras etapas del ciclo vital. Sus características pueden ser variables entre y al interior de los países, y vincularse a ciertos determinantes sociales. El objetivo de este estudio fue identificar escenarios sociosanitarios del cuidado prenatal y analizar asociaciones entre determinantes sociales e indicadores sintéticos seleccionados del cuidado prenatal en Argentina (2010-2018). Metodología: se desarrolló un estudio ecológico de grupos múltiples (n = 24 jurisdicciones). Los datos se obtuvieron a partir de fuentes secundarias: última información disponible del Sistema Informático Perinatal (2018) y censo nacional (2010). Se realizó un análisis de conglomerados de tipo jerárquico y aglomerativo (método de Ward). Se ilustró la distribución espacial de los escenarios identificados y se valoraron las diferencias entre ellos mediante la prueba ANOVA. Para estimar asociaciones entre indicadores sociales e indicadores del cuidado prenatal se propusieron modelos de regresión lineal. Resultados: se identificaron cinco escenarios sociosanitarios del cuidado prenatal, que revelan heterogeneidades en la distribución de indicadores de cuidado prenatal y sociales a nivel provincial. Además, el porcentaje de hogares en situación de pobreza presentó una asociación directa, en tanto el índice de desarrollo humano y la esperanza de vida al nacer una inversa con el control prenatal insuficiente. Conclusiones: existen diferentes escenarios sociosanitarios del cuidado prenatal en Argentina y ciertas características sociales de los contextos en que residen las personas podrían subyacer a su configuración.

Abstract Introduction: the prenatal care is a key aspect in public health, with great impact in maternal and perinatal health, as well as in other stages of the life cycle. The features of the prenatal care could be variable between and within countries, and be related to social determinants. The aim of this study was to identify socio-sanitary scenarios of prenatal care, and to analyze associations between social determinants and selected synthetic indicators of prenatal care in Argentina (2010-2018). Methodology: A multi-group ecological study (n=24 jurisdictions) was developed. The data were obtained from secondary sources: the latest available data of the Perinatal Informatics' System (2018) and national census (2010). A hierarchical and agglomerative cluster analysis was carried out (Wards method). The spatial distribution of the scenarios was illustrated by a map. ANOVA test was applied to assess the differences between the identified scenarios. To estimate associations between social indicators and indicators of prenatal care, linear regression models were applied. Results: five socio-sanitary scenarios of prenatal care were identified, which reveal heterogeneities in the distribution of prenatal and social care indicators. In addition, the percentage of households living in poverty presented a direct association, and the human development index and life expectancy at birth an inverse association with insufficient prenatal care. Conclusions: different socio-sanitary scenarios exist in Argentina, and some social characteristics of the contexts in which people live might underlie its configuration.

Different profiles and epidemiological scenarios: past, present and future

The multiplicity of epidemiological scenarios shown by Chagas Disease, derived from multiple transmission routes of the aetiological agent, occurring on multiple geo-ecobiosocial settings determines the complexity of the disease and reveal the difficulties for its control. From the first description of the link between the parasite, the vector and its domestic habitat and the disease that Carlos Chagas made in 1909, the epidemiological scenarios of the American Trypanosomiasis has shown a dynamic increasing complexity. These scenarios changed with time and geography because of new understandings of the disease from multiple studies, because of policies change at the national and international levels and because human movements brought the parasite and vectors to new geographies. Paradigms that seemed solid at a time were broken down, and we learnt about the global dispersion of Trypanosoma cruzi infection, the multiplicity of transmission routes, that the infection can be cured, and that triatomines are not only a health threat in Latin America. We consider the multiple epidemiological scenarios through the different T. cruzi transmission routes, with or without the participation of a Triatominae vector. We then consider the scenario of regions with vectors without the parasite, to finish with the consideration of future prospects.

Aplicabilidad en Suramérica de escenarios de progresión de la infección por SRAS-CoV-2 / Applicability in South America of SARS-CoV-2 infection progression scenarios

Resumen El brote epidémico por SRAS-CoV-2 y la enfermedad ocasionada, COVID-19, en poco tiempo se transformó en una emergencia de salud pública inter- nacional que progresó rápidamente a pandemia con severo impacto sobre la salud y la economía de los países afectados. El objetivo del presente escrito es describir los escenarios epidemiológicos de progresión de la infección definidos y aplicables como marcos iniciales de la dinámica de transmisión de la enfermedad a Suramérica, salvando sus particularidades poblacionales, en la lucha por controlar la pandemia. Se trata de un estudio documental de revisión de la literatura especializada. Del análisis de esta información resultan dos secciones a saber: modelos epidemiológicos en infecciones y, escenarios de progresión de la pandemia de SRAS-CoV-2. Se concluye que los escenarios epidemiológicos de progresión de la infección de unas regiones pueden transpolarse a otras como marco para el control de la pandemia, salvando las particularidades de cada población en cuanto a características individuales, culturales, económicas y sanitarias.

Abstract The SARS-CoV-2 epidemic outbreak soon developed into an international public health emergency that rapidly progressed to a pandemic with severe impact on the health and economies of affected countries. The objective of this paper is to describe the epidemiological scenarios of the progression of the infection defined and applicable as initial frameworks of the dynamics of transmission of the disease to South America, saving its population particularities, in the fight to control the pandemic. This is a review of the specialized literature. The analysis of the information results in two sections: epidemiological models in infections and, scenarios of progression of the SARS-CoV-2 pandemic. It is concluded that the epidemiological scenarios of progression of the infection in some regions can be transposed to others as a framework for the control of the pandemic, saving the particularities of each population in terms of individual, cultural, economic and health characteristics.

Escenarios ocultos de la muerte materna: desde la mirada de mujeres sobrevivientes / Hidden scenarios of maternal death: from the gaze of surviving women

El propósito: develar los escenarios ocultos de la muerte materna ocurrida en los micromundos poco abordados en el estado Aragua durante el quinquenio 2011 ­2015.La muerte materna constituye un complejo problema de salud pública, un importante indicador de desarrollo humano, que muestra las más grandes inequidades entre países de diferentes niveles de desarrollo. El enfoque integrador transcomplejo, constituye un camino epistemológico para develar lo que poco se dice y se evidencia, partiendo de referentes multidimensionales que se explican en una dialógica de saberes que no se aplanan unos a los otros sino que se interceptan para hacer tangible las determinaciones socioculturales poco abordadas en las explicaciones de la muerte materna. Desde esta perspectiva epistemológica se hace posible evidenciar las tramas ocultas del discurso de la vida de las mujeres sobrevivientes a la muerte materna, debido a la posibilidad que esta visión de pensamiento brinda para identificar distintos tipos de discurso y las hipertrofias de los mismos, develadas desde interpretaciones que no solo son parte de los micromundos estudiados de las mujeres sino desde la maya de saberes que se imbrican para la comprensión de los testimonios de las informantes. Mediante la hermenéutica como metódica y la historia de vida, se desarrolló un proceso de interpretación y comprensión de los significados de la muerte materna, fundamentadas en sus puntos de encuentro, permitiendo visibilizar lo invisible, desde una postura intersubjetiva. Con técnica de observación, entrevistas enfocadas a: dos mujeres que sobrevivieron a la muerte materna, se obtuvieron las vivencias, lo percibido y recordado, logrando la retención de esa experiencia vivida, que fueron procesadas, encontrando algunos hallazgos como: inadecuada praxis en salud; violencia obstétrica, violencia de género, violencia institucional; creencias socioculturales y representaciones sociales en relación con el embarazo; cargas sociales, emocionales y de trabajo durante el embarazo.

The purpose: to reveal the hidden scenarios of maternal death that occurred in the little-addressed micro-worlds in the state of Aragua during the five-years period 2011 -2015. Maternal death constitutes a complex public health problem, an important indicator of human development, which shows the most great inequities between countries of different levels of development. The integrative cross-complex approach constitutes an epistemological path to reveal what little is said and evidenced, starting from multidimensional references that are explained in a dialogic of knowledge that do not flatten each other but are intercepted to make sociocultural determinations tangible. little addressed in the explanations of maternal death. From this epistemological perspective, it is possible to reveal the hidden plots of the discourse of the lives of women survivors of maternal death, due to the possibility that this vision of thought offers to identify different types of discourse and their hypertrophy, revealed from interpretations that are not only part of the studied microworlds of the women but also from the Mayan knowledge that overlap for the understanding of the informants' testimonies. Through hermeneutics as a method and life history, a process of interpretation and understanding of the meanings of maternal death was developed, based on their meeting points, allowing the invisible to be made visible, from an intersubjective position. With observation technique, interviews focused on: two women who survived maternal death, the experiences were obtained, what was perceived and remembered, achieving the retention of that lived experience, which were processed, finding some findings such as: inadequate health praxis; obstetric violence, gender violence, institutional violence; sociocultural beliefs and social representations in relation to pregnancy; social, emotional and work burdens during pregnancy.

La mediación pedagógica en el sistema familiar frente a los contenidos en televisión, internet y redes sociales online / Pedagogical Mediation in the Family System Regarding Contents on Television, the Internet and Online Social Networks

Resumen Este artículo es producto de una investigación de mixta donde predominó el énfasis en la descripción de los resultados, con características cuantitativas de la información obtenida a través del cuestionario aplicado. El diseño descriptivo permitió observar y reflexionar sobre las mediaciones pedagógicas que se dan en los contextos familiares frente a la recepción y consumo de productos y servicios ofertados por la televisión, internet y las redes sociales on line. Los participantes fueron estudiantes universitarios (16 y 24 años de edad) a los que se les aplicó un cuestionario y un diario de observación. Se realizó una triangulación de los resultados de la observación participante y de los cuestionarios aplicados. Se encontró que existía un tipo de mediación familiar frente a los contenidos televisivos. Sin embargo, no se encontró un indicador que aclare si las familias están mediando los contenidos que circulan en internet. Esto permite una oportunidad para plantear estrategias de comunicación familiar, que posibiliten una injerencia de los padres / cuidadores o acompañantes sobre estos contenidos, teniendo en cuenta el ciclo vital individual y familiar.

Abstract This article was based on a mixed methods research where the predominant emphasis was placed on the description of the results, with quantitative characteristics obtained through the applied questionnaire. The descriptive design made it possible to observe and reflect on the pedagogical mediations that occur in family contexts with regard to the reception and consumption of products and services offered by television, the internet, and online social networks. The participants were university students (16 and 24-year-old) who responded the questionnaire and kept an observational diary. A triangulation of the results of both the participants' observations and the questionnaires was used. We found that there is a type of family mediation with regard to television contents. However, no indicator was found to clarify if the families are mediating the contents and information circulating on the internet. This opens up an opportunity to propose family communication strategies that allow for a more direct influence of the parents/caregivers or companions on these contents, taking into account the individual and family life cycles.

Establishment of Application Database for Electrocardiograph in Different Scenes / 中国医疗器械杂志

It is significant to establish scene ECG database which improves the automatic diagnostic function of electrocardiograph under different application scenarios. We built the ECG database in different scene according to the hospital level (grade 3, grade 2, grade 1) and clinical environment (intensive care and acute wards, outpatient clinics and general wards). Sample size was obtained according to the incidence of various ECG diagnoses. The database covers ECG signal, ECG waveform, ECG characteristic values, ECG diagnostic results by experts and clinical information of patients etc. It not only provides important reference for electrocardiograph manufacturers to evaluate and test the parameters of automatic diagnosis under different clinical scene, but also provides valuable scientific research and teaching resources for medical workers.

Algunas reflexiones sobre dilemas éticos del cuidado en un entorno de pandemia / Algumas reflexões sobre dilemas do cuidado ético em um ambiente pandémico / Some reflections on ethical care dilemmas in a pandemic environment

Resumen En este texto se propone un esquema para analizar dilemas éticos en el contexto de la pandemia del Covid 19, los cuales se presentan ante un conflicto moral al que se enfrenta una persona (por criterios normativos en tensión) o, cuando varias personas o instancias normativas tienen distintas estrategias ante un evento específico y, además, cada quien asume que su postura es la más aceptable. La ética no decide cuál es la referencia moral correcta, sino que analiza los supuestos de distintas normatividades y acompaña a tomar conciencia de los mismos. El texto no propone soluciones, sino que presenta un esquema de análisis ético, que considera como insumo clave la identificación de actores relacionados con el contexto de la pandemia y la forma en que son tomados en cuenta. Se recupera la categoría de cuidado, como recomendación central para lidiar con la pandemia y como supuesto de todo análisis ético.

Resumo Este texto propõe um esquema para analisar dilemas éticos, no contexto da pandemia Covid 19, que se apresentam diante de um conflito moral enfrentado por uma pessoa (por critérios normativos em tensão) ou quando várias pessoas ou órgãos políticos têm estratégias diferentes diante de um evento específico e, além disso, cada um assume que sua posição é a mais aceitável. A ética não decide qual é a referência moral correta, mas analisa os pressupostos de diferentes normatividades e auxilia a a tomar conhecimento deles. O texto não propõe soluções, mas apresenta um esquema de análise ética, que considera como insumo fundamental a identificação de atores relacionados ao contexto da pandemia e como são levados em conta. A categoria de cuidado é recuperada como recomendação central para lidar com a pandemia e como pressuposto de toda a análise ética.

Abstract This text proposes a scheme to analyze ethical dilemmas in the context of the Covid 19 pandemic, which present the sembling of a moral conflict faced by a person (by tensed normative criteria) or when several people or policy-bodies have different strategies in the face of a specific event and, in addition, each one assumes that their position is the most acceptable one. Ethics does not decide what the correct moral reference is, it analyses different normativity assumptions and helps to become aware of them. The text does not propose solutions, but presents an ethical analysis scheme that considers as a key input the identification of actors related to the context of the pandemic and how they are taken into account. The category of care is restored as a central recommendation to deal with the pandemic and as an assumption of all the ethical analysis.

Drivers of change in biodiversity and ecosystem services in the Cantareira System Protected Area: A prospective analysis of the implementation of public policies / Agentes de mudança na biodiversidade e serviços ecossistêmicos na APA Sistema Cantareira: Uma análise prospectiva da implementação de políticas públicas

Abstract: The lack of implementation of well-designed public policies aimed at the conservation of natural ecosystems has resulted, at a global level, in the decline of ecosystem functioning and, consequently, of the contributions they make to people. The poor enforcement of important environmental legislation in Brazil - for instance, the "Atlantic Forest Law" (Law n.11.428/2006) and the "Forest Code" (Law n.12.651/2012) - could compromise the overall maintenance of ecosystems and the services they provide. To explore the implications of different levels of federal laws' enforcement within the Cantareira System Protected Area (PA) - a PA in southeastern Brazil that provides fresh water for 47% of the Sao Paulo Metropolitan Area -, we developed a conceptual framework to identify indirect and direct drives of biodiversity and ecosystem changes. We also projected four land-use scenarios to 2050 to test the effects of deforestation control and forest restoration practices on biodiversity and ecosystem services maintenance: the "business-as-usual" scenario (BAU), which assumes that all trends in land-use cover changes observed in the past will continue in the future, and three alternative exploratory scenarios considering the Atlantic Forest Law implementation, the partial implementation of the Forest Code and the full implementation of the Forest Code. Using the land-use maps generated for each scenario, we assessed the impacts of land-use changes on biodiversity conservation and soil retention. Our results revealed all alternative scenarios could increase biodiversity conservation (by 7%; 12%; and 12%, respectively), reduce soil loss (by 24.70%; 34.70%; and 38.12%, respectively) and sediment exportation to water (by 27.47%; 55.06%; and 59.28%, respectively), when compared to the BAU scenario. Our findings highlight the importance of restoring and conserving native vegetation for the maintenance and improvement of biodiversity conservation and for the provision of ecosystem services.

Resumo: A falta de implementação de políticas públicas voltadas para a conservação ambiental, tem resultado, em nível global, em impactos sobre a biodiversidade e o funcionamento dos ecossistemas e, consequentemente, na contribuição da natureza para as pessoas. A aplicação inadequada de importantes de leis ambientais no Brasil, como por exemplo, a "Lei da Mata Atlântica" (Lei nº 11.428 / 2006) e o "Código Florestal" (Lei nº 12.651 / 2012), podem comprometer a manutenção dos ecossistemas e dos serviços que eles fornecem. Neste estudo, nós desenvolvemos um mapa conceitual que busca identificar causas diretas e indiretas de mudanças - agentes de mudança - na biodiversidade e na provisão de serviços ecossistêmicos relacionados ao solo e à água, na Área de Proteção Ambiental (APA) Sistema Cantareira. A APA Sistema Cantareira, localizada no sudeste do Brasil, fornece água potável para 47% da Região Metropolitana de São Paulo. Além da abordagem conceitual, nós projetamos quatro cenários de mudança no uso da terra para o ano de 2050, a fim de analisar o impacto de diferentes níveis de aplicação de leis federais: o cenário "business-as-usual" (BAU), que pressupõe que as tendências na mudança de uso da terra observadas no passado continuarão no futuro, e três cenários alternativos, considerando a implementação da Lei da Mata Atlântica, a implementação parcial do Código Florestal e a implementação completa do Código Florestal. A partir dos mapas de uso da terra gerados, avaliamos os impactos de cada cenário na conservação da biodiversidade, na retenção de solos e na exportação de sedimentos para os corpos d'água. Nossos resultados mostraram que os três cenários alternativos podem aumentar a conservação da biodiversidade (em 7%; 12%; e 12%, respectivamente), reduzir a perda de solo (em 24,70%; 34,70%; e 38,12%, respectivamente) e reduzir a exportação de sedimentos para a água (em 27,47 %; 55,06%; e 59,28%, respectivamente), quando comparados ao cenário BAU. Este estudo destaca a importância da restauração e conservação da vegetação nativa para a manutenção da biodiversidade e melhoria na provisão de serviços ecossistêmicos relacionados ao solo e à água, em uma região estratégica para o abastecimento de água no Brasil.

Development of a conceptual framework for the management of biodiversity and ecosystem services in the Mexican Caribbean / Desenvolvimento de um roteiro conceitual para a gestão da biodiversidade e dos serviços ecossistêmicos no Caribe mexicano

Abstract: Coral reefs and mangroves support rich biodiversity and provide ecosystem services that range from food, recreational benefits and coastal protection services, among others. They are one of the most threatened ecosystems by urbanization processes. In this context, we developed a conceptual framework for the management of biodiversity and ecosystem services for these coastal environments. We based our workflow on two sections: "Information base" and "Governance" and use the Puerto Morelos Coastal region as a case study for coastal protection. Puerto Morelos is between two of the most touristic destinations of Mexico (Playa del Carmen and Cancun) that has experienced an increase of population in the past four decades resulting in an intensification of multiple threats to its ecosystems. We characterized the two ecosystems with a "Management Units" strategy. An expert-based ecosystem services matrix was also described in order to connect mangroves and coral reef ecosystems with the multiple beneficiaries. Then an ecosystem model (conceptual model and Global Biodiversity model) was developed. The conceptual model was useful in understanding the interplay processes between systems regarding the ecosystem service of "Coastal Protection". The Global Biodiversity model evidenced the human-induced shifts in the biodiversity for mangrove and coral reefs ecosystems. Also, a projection for 2035 of "best" and "worst" scenarios was applied using GLOBIO3. A DPSIR conceptual framework was used to analyze environmental problems regarding ecosystem services maintenance. Finally, we evaluated a set of policies associated with these ecosystems that favor coastal protection integrity. This framework facilitates the identification of the most relevant processes and controls about the provision of coastal protection service. It can also be useful to better target management actions and as a tool to identify future management needs to tackle the challenges preventing more effective conservation of coastal environments.

Resumo: Recifes de coral e manguezais possuem rica biodiversidade e fornecem serviços ecossistêmicos, tais como, alimento, recreação, proteção costeira, entre outros. Esses ecossistemas encontram-se entre os mais ameaçados pelos processos de urbanização. Nesse contexto, desenvolvemos um roteiro conceitual para a gestão da biodiversidade e dos serviços ecossistêmicos desses ambientes costeiros. Organizamos nossa sequência de passos de trabalho em duas seções: "Base de informações" e "Governança" e usamos a região costeira da cidade de Puerto Morelos (México) como um estudo de caso para analisar o serviço de proteção de costa. Puerto Morelos encontra-se entre dois dos destinos mais turísticos do México (Playa del Carmen e Cancún), e portanto sua população vem aumentando nas últimas quatro décadas, resultando na intensificação de múltiplas ameaças para os ecossistemas. Primeiramente, caracterizamos os dois ecossistemas identificando-os como "Unidades de Gestão", detalhando seus principais componentes e processos. Através de uma "Matriz de serviços ecossistêmicos", construída com base na opinião de especialistas, foram sistematizados os principais serviços ecossistêmicos prestados pelos manguezais e recifes de corais aos múltiplos beneficiários. Em seguida, foi desenvolvida uma modelagem do sistema (e ecossistemas) através de sua representação na forma de um modelo conceitual e um modelo numérico de Biodiversidade Global. O modelo conceitual facilitou a compreensão dos processos de interação entre sistemas em relação ao serviço "Proteção Costeira". O modelo numérico evidenciou as mudanças induzidas pelo homem na biodiversidade dos ecossistemas de manguezal e recifes de coral. Além disso, uma projeção dos cenários "melhor" e "pior" foi desenvolvida para 2035 usando GLOBIO3. A Estrutura conceitual DPSIR foi aplicada para analisar problemas ambientais relacionados à manutenção dos serviços ecossistêmicos. Finalmente, avaliamos um conjunto de políticas públicas associadas a esses ecossistemas e que favorecem a integridade da proteção costeira. Portanto, o roteiro facilitou a identificação dos principais processos e controles para a provisão de um serviço ecossistêmico. Além disso, pode ser útil para direcionar melhor as ações de gerenciamento, bem como, uma ferramenta para identificar necessidades futuras de planejamento e gestão para enfrentar desafios que permitam uma conservação mais eficaz dos ambientes costeiros.

Increasing capacity to produce scenarios and models for biodiversity and ecosystem services / Capacitando profissionais para o desenvolvimento de cenários e modelos em biodiversidade e serviços ecossistêmicos

Abstract: Extensive anthropogenic activities driven by the demand for agriculture and forestry products have led to dramatic reductions in biodiversity worldwide and significant changes in the provisioning of ecosystem services. These trends are expected to continue in the future as the world continues to develop without much consideration of the role that nature plays in sustaining human livelihoods. Scenarios and models can be important tools to help policy- and decision-makers foresee the impact of their decisions; thus, increasing capacity in creating such models and scenarios is of utmost importance. However, postgraduate training schools that focus on this topic are still rare. Here we present and reflect on the experience of the São Paulo School of Advanced Science on Scenarios and Modelling on Biodiversity and Ecosystem Services to Support Human Well-Being (SPSAS Scenarios). In addition, we introduce the Special Issue of Biota Neotropica that resulted from the activities taking place during the SPSAS Scenarios. In total, nine case studies emerged from the activities carried out during SPSAS Scenarios. These focused on a variety of ecosystems, their current drivers of change and expected trends, as well as on the development of alternative positive scenarios applying the recently developed Nature Futures Framework. We emphasize the need to increase capacity in scenario and modelling skills in order to address some of the existing gaps in producing policy-relevant scenarios and models for biodiversity and ecosystem services.

Resumo: Atividades antropogênicas extensas, impulsionadas pela demanda por produtos da agricultura e da silvicultura, têm levado a reduções dramáticas na biodiversidade mundial e a mudanças significativas no provimento de serviços ecossistêmicos. Estas tendências devem continuar no futuro, pois o mundo continua a se desenvolver sem muita consideração pelo papel que a natureza desempenha em sustentar a subsistência humana. Cenários e modelos são ferramentas importantes para ajudar os tomadores de decisão a preverem o impacto de suas decisões, auxiliando na definição das melhores opções para políticas de conservação e uso sustentável; portanto o aumento da capacidade para o desenvolvimento de modelos e cenários é de suma importância. Entretanto, ainda são raros os cursos de pós-graduação que foquem na capacitação de profissionais para o desenvolvimento de modelos e cenários em biodiversidade e serviços ecossistêmicos. Neste trabalho apresentamos a experiência da Escola São Paulo de Ciências Avançadas de Cenários e Modelagem em Biodiversidade e Serviços Ecossistêmicos para Apoiar o Bem-Estar Humano (SPSAS Scenarios). Adicionalmente, apresentamos neste Número Especial da Biota Neotropica os resultados dos exercícios de modelagem e cenários desenvolvidos no decorrer da SPSAS Scenarios. No total, as atividades realizadas durante o SPSAS Scenarios resultaram em nove estudos de caso. Estes se concentraram em uma diversidade de ecossistemas, nos atuais drivers de mudança e as respectivas tendências, bem como nas alternativas de desenvolvimento visando cenários mais positivos propostos recentemente no contexto da Framework Futuros para Natureza da Plataforma Intergovernamental de Biodiversidade e Serviços Ecossistêmicos (IPBES). Enfatizamos aqui a necessidade de acelerar a capacitação de profissionais que trabalhem com cenários e modelagem de forma a preencher algumas lacunas existentes na produção de cenários e modelos relevantes para a tomada de decisão em biodiversidade e serviços ecossistêmicos

A conceptual model to assess the impact of anthropogenic drivers on water-related ecosystem services in the Brazilian Cerrado / Um modelo conceitual para avaliar o impacto de fatores antropogênicos nos serviços ecossistêmicos relacionados à água no Cerrado

Abstract: The development of strategies that conciliate anthropogenic activities with nature conservation is becoming increasingly urgent, particularly in regions facing rapid conversion of native vegetation to agriculture. Conceptual modelling enables assessment of how anthropogenic drivers (e.g. land use/land cover change and climate change) modify natural processes, being a useful tool to support strategic decision-making. The present work describes a conceptual model to evaluate water-related ecosystem service provision under different land use scenarios in the Matopiba region of the Brazilian Cerrado, the world's most biodiverse savanna and an agricultural frontier. Model variables were determined (direct drivers, indirect drivers, focal components and responses) and the Nature Futures Framework was consulted to incorporate socio-ecological components and feedbacks. Future scenarios were developed considering potential trajectories of drivers and governance responses that may impact land use in the region, including the possibility of full compliance with Forest Code and implementation of the Soy Moratorium in the region. The conceptual model and scenarios developed in the present study may be useful to improve understanding of the complex interactions among anthropogenic drivers, water-related ecosystem services and their potential repercussions for natural and social systems of the region. Governance decisions will be critical to maintaining the ecosystems of the region, the services it provides and the culture and tradition of the people historically embedded in the landscape. In acknowledgment of humanity's dependence on nature, the importance of inverting the way scenarios are used is highlighted. Rather than using scenarios to measure the impacts of different policy options on nature, scenarios representing the desired outcomes for biodiversity and ecosystem services can be used to inform how policies can guarantee ecosystem integrity into the future.

Resumo: O desenvolvimento de estratégias que conciliem atividades antropogênicas com a conservação da natureza tem se tornado cada vez mais urgente, principalmente em regiões que enfrentam uma rápida conversão da vegetação nativa em agricultura. Modelos conceituais permitem avaliar como fatores antropogênicos (por exemplo, mudança de uso e cobertura do solo e mudanças climáticas) modificam os processos naturais, sendo uma ferramenta útil para apoiar a tomada de decisões estratégicas. O presente trabalho descreve um modelo conceitual para avaliar a provisão de serviços ecossistêmicos relacionados à água sob diferentes cenários de uso do solo na região de Matopiba, no Cerrado, a savana com maior biodiversidade do mundo e uma fronteira agrícola. Foram determinadas as variáveis do modelo (fatores diretos, fatores indiretos, componentes focais e respostas) e o Nature Futures Framework foi consultado para incorporar componentes socioeconômicos e feedbacks. Cenários futuros foram desenvolvidos considerando possíveis trajetórias de fatores antropogênicos e respostas de governança que podem impactar o uso do solo na região, incluindo a possibilidade de cumprimento total do Código Florestal e a implementação da Moratória da Soja na região. O modelo conceitual e os cenários apresentados no presente trabalho podem ser úteis para melhorar a compreensão das complexas interações entre fatores antropogênicos, serviços ecossistêmicos relacionados à água e suas possíveis implicações para os sistemas naturais e sociais da região. Decisões de governança serão críticas para manter os ecossistemas da região, os serviços fornecidos por eles, a cultura e tradição das pessoas historicamente inseridas na paisagem. Em reconhecimento da dependência da humanidade em relação à natureza, destaca-se a importância de inverter a maneira como os cenários são usualmente usados. Em vez de mensurar os impactos de diferentes políticas na natureza, cenários representando os resultados desejados para biodiversidade e serviços ecossistêmicos podem ser usados para informar como políticas podem garantir a integridade dos ecossistemas no futuro.

Promoción de estilos de vida saludables: estrategias y escenarios / Promotion of healthy lifestyles: strategies and scenarios / Promoção de estilos de vida saudaveís: estrategias e cenarios

Resumen Objetivo: analizar las estrategias de promoción de la salud para el fomento de Estilos de Vida Saludables en escenarios de familia, trabajo, comunidad, educación y sector sanitario. Método: estudio descriptivo a partir de la revisión y análisis sistemático de estudios originales primarios sobre estrategias de promoción de la salud y estilos de vida saludables, haciendo uso de la lista de control PRISMA. Resultados: se identificaron tres estrategias de PS para el fomento de EVS, estas se basaron en información, educación, cambio de actitudes, fortalecimiento de la autoestima y toma de decisiones a través de salud móvil, técnicas de motivación, talleres prácticos y psicoeducación. Conclusiones: el desarrollo de estrategias que promueven estilos de vida saludables es incipiente en escenarios como el lugar de trabajo y la familia, lo cual genera una baja cobertura poblacional y demanda acciones interdisciplinarias desde diferentes campos como el de la Psicología de la Salud.

Abstract Objective: To analyze Health Promotion (HP) strategies for the encouragement of healthy lifestyles (EHL) in family, work, community, education and the health sector scenarios. Method: descriptive study based on the systematic review and analysis of primary original studies on health promotion strategies in healthy lifestyles, making use of the PRISMA checklist. Results: three HP strategies were identified for the promotion of EHL which were based on information, education, change of attitudes, strengthening of self-esteem and decision making through mobile health, motivation techniques, practical workshops and psychoeducation. Conclusions: the development of strategies that promote healthy lifestyles is incipient in scenarios such as the workplace and the family, which generates low population coverage and demands interdisciplinary actions from different fields such as the Psychology of health.

Resumo Objetivo: analisar as estratégias de promoção da saúde para o fomento de Estilos de Vida Saludáveis em cenários de família, trabalho, comunidade, educação e setor sanitário. Método: estudo descritivo a partir da revisão e analise sistemático de estudos originais primários sobre estratégias de promoção da saúde e estilos de vida saudáveis, fazendo uso da lista de controle PRISMA. Resultados: Identificaram-se três estratégias de PS para o fomento de EVS, estas se basearam em informação, educação, cambio de atitudes, fortalecimento da autoestima e toma de decisões a través de saúde móvel, técnicas de motivação, oficinas práticos e psico-educação. Conclusões: o desenvolvimento de estratégias que promovem estilos de vida saudáveis é incipiente em cenários como o lugar de trabalho e a família, o qual gera uma baixa cobertura populacional e demanda ações interdisciplinares desde diferentes campos como o da Psicologia da Saúde.

Outcome Of Peer-Assisted Learning With Clinical Scenarios

This educational intervention study was conducted in a municipal medical college in Maharashtra, India. 60 rst-year MBBS students aged 18 years and above, of either gender, were briefed about peer-assisted learning. A pre-test was administered after a faculty-delivered conventional lecture. Subsequently, a trained peer teacher taught the same topic and an identical test was again administered. The mean marks (out of 20) of students increased from 15.37 +/- 2.69 (pre-test) to 17.80 +/- 1.97 (post-test), exhibiting signicant difference (p<0.00001). The differences in the mean marks obtained in the pre-and post-tests by male (p=0.000079) and female (p=0.000063) students were also signicant. The gender differences in the mean marks were not statistically signicant in the pre-test (p=0.633) and the post-test (p=0.696). The results suggest that case scenarios combined with peer-assisted learning increases cognitive domain scores and have the potential to be used as a supplementary method, as an adjunct to faculty teaching.

Outcome of combination of methods of educational interventions in physiology for first-year MBBS students

Background: This comparative, before and after study (without controls) was conducted in a municipal medical college to compare the cognitive domain scores obtained by first-year MBBS students after didactic lectures with that obtained after an educational intervention that combined integrated teaching with clinical scenarios.Methods: After obtaining prior permissions, the purpose of the study was explained to first-year MBBS students and written informed consent was obtained. After attending curriculum-based didactic lectures on the alimentary system, the students (n=62, females: n=29, 46.77% and males: n=33, 53.23%) took a pre-test comprising ten questions (total 20 marks). After the pre-test, the participants attended an educational intervention that combined integrated teaching with clinical scenarios on the same topic. Subsequently, the post-test was administered using a questionnaire that was identical to that of the pre-test.Results: The mean overall marks obtained in the pre-test was 14.73±1.87 (95% CI: 14.26-15.19), while that obtained in the post-test was 17.16±1.73 (95% CI: 16.73-17.59), exhibiting highly significant (p <0.00001) difference. The gender difference in scores was significant (p=0.011) for only question no. 1 in the pre-test and there was no significant gender difference in the post-test.Conclusions: A combined method of educational intervention was found to enhance the cognitive domain scores of students. Though a larger study would be needed to generalize the findings, male students seem to need an additional educational intervention to improve their cognitive domain scores. Despite time limitations in the teaching schedule for the first-year MBBS course, integrated teaching with case scenarios can be implemented to impart early clinical exposure.

Tutor evaluation on the scoring criterion for non-technical skills in surgeons / 中华医学教育探索杂志

Objective Non-technical skills (NTS) are necessary to evaluate the comprehensive quality of surgeons.In this study,we proposed the concept of C-NTS,a scoring criterion for NTS based on real scenarios (for example,history taking) and video recording,and verified its practical application effects.Methods Study objects were divided into the tutor group and the student group.The tutor group contained four senior attending physicians in gastrointestinal surgery department of one tertiary hospital (all male with doctor degree).The student group had four rotating surgeons who were randomly selected from the same department in 2018 (two males and two females).Before and after the training,the tutor rated the same anonymous video by C-NTS.One-factor analysis of variance was used to compare the differences between and within the groups,and Kendall concordant coefficient was used to test the consistency by SPSS 22.0.Results After the tutor receiving training,Kendall concordant coefficient was increased from 0.425 to 0.853 and the latter suggested the difference had statistical significance (P=0.017),which confirmed the effectiveness of the training.Conclusion C-NTS has preliminarily solved the difficulty of homogenization of NTS assessment.Relevant C-NTS discussions and trainings for clinical tutors may be beneficial to save time and manpower in clinical teaching and evaluation.

Tutor evaluation on the scoring criterion for non-technical skills in surgeons / 中华医学教育探索杂志

Objective@#Non-technical skills (NTS) are necessary to evaluate the comprehensive quality of surgeons. In this study, we proposed the concept of C-NTS, a scoring criterion for NTS based on real scenarios (for example, history taking) and video recording, and verified its practical application effects.@*Methods@#Study objects were divided into the tutor group and the student group. The tutor group contained four senior attending physicians in gastrointestinal surgery department of one tertiary hospital (all male with doctor degree). The student group had four rotating surgeons who were randomly selected from the same department in 2018 (two males and two females). Before and after the training, the tutor rated the same anonymous video by C-NTS. One-factor analysis of variance was used to compare the differences between and within the groups, and Kendall concordant coefficient was used to test the consistency by SPSS 22.0.@*Results@#After the tutor receiving training, Kendall concordant coefficient was increased from 0.425 to 0.853 and the latter suggested the difference had statistical significance (P=0.017), which confirmed the effectiveness of the training.@*Conclusion@#C-NTS has preliminarily solved the difficulty of homogenization of NTS assessment. Relevant C-NTS discussions and trainings for clinical tutors may be beneficial to save time and manpower in clinical teaching and evaluation.

Processos de formação e cenários de ensino-aprendizagem: discussão sobre práticas em saúde e educação em serviço no curso de graduação em Terapia Ocupacional da FMUSP / Training process and teaching-learning scenarios: discussion on health practices and service education in Occupational Therapy degree course of FMUSP

Resumo Nas últimas décadas, tem-se discutido, em nível nacional, a formação dos estudantes nos cursos de graduação em saúde voltados para o Sistema Único de Saúde e, de acordo com as Diretrizes Curriculares Nacionais, valorizando uma formação em percurso, em que se estimule a integração estudante-instituição-serviços-comunidade. O Curso de Terapia Ocupacional da FMUSP tem se preocupado com essas questões, reorientando seu currículo e projeto político pedagógico a partir do preconizado nas Diretrizes Curriculares Nacionais da área. O objetivo da pesquisa foi analisar, através das ementas das práticas e estágios, se o curso tem colocado suas convergências com alguns dos paradigmas da formação prática do estudante, com ampliações e implicações de seus cenários de ensino-aprendizagem. As metodologias utilizadas foram revisão da literatura e análise documental. O estudo descreve alguns aspectos das práticas em saúde e dos espaços de ensino-aprendizagem, analisando o conjunto de propostas de práticas e estágios do curso de graduação. Os resultados e discussão apontam para a preocupação de dialogar com as Diretrizes Curriculares Nacionais e com o Sistema Único de Saúde, visando uma formação que seja ativa e contemple os princípios da humanização, integralidade, cuidado, alteridade e diversidade.

Abstract In recent decades, the training of students in health degree programs for the unified health system has been discussed at the national level and in accordance with the National curriculum guidelines, enhancing training in course, which values the student-institution-services integration-community. The course of occupational therapy of the FMUSP has been concerned with these issues, redirecting its curriculum and pedagogical political project from the proposed national curriculum guidelines. The purpose of the article was to analyze, through the menus of the practices and internships, if the course has put its convergence with some of the paradigms of the student's practical training, with extensions and implications of their teaching-learning scenarios. In this way, the study describes some aspects of health practices and teaching-learning spaces, in which the proposed set of practices and internships of undergraduate programs are analyzed. The result and discussion are concern in dialogue with national curriculum guidelines and with the Unified Health System, aimed at an active training and considering the principles of humanization, completeness, careful, otherness and diversity.