Text-Driven Video Acceleration: A Weakly-Supervised Reinforcement Learning Method.

The growth of videos in our digital age and the users' limited time raise the demand for processing untrimmed videos to produce shorter versions conveying the same information. Despite the remarkable progress that summarization methods have made, most of them can only select a few frames or skims, creating visual gaps and breaking the video context. This paper presents a novel weakly-supervised methodology based on a reinforcement learning formulation to accelerate instructional videos using text. A novel joint reward function guides our agent to select which frames to remove and reduce the input video to a target length without creating gaps in the final video. We also propose the Extended Visually-guided Document Attention Network (VDAN+), which can generate a highly discriminative embedding space to represent both textual and visual data. Our experiments show that our method achieves the best performance in Precision, Recall, and F1 Score against the baselines while effectively controlling the video's output length.

A systematic literature review and meta-analysis of Toxoplasma gondii seroprevalence in goats.

The aim of this study was evaluate to seroprevalence of Toxoplasma gondii in goats worldwide and the main risk factors associated from 2000 to 2020, through meta-analysis with 55,317 goats from 75 reports published in seven electronic databases of major global importance. A global seroprevalence detected was 27.49% (95% CI 24.15-30.95; I2 = 99%), with the lowest percentage in Asia (20.74%; 95% CI 16.45-25.39) and highest in Central America (62.15%; 95% CI 57.28-66.90) and Europe (31.53%; 95% CI 21.71-42.26). The seropositivity in Africa and South America were (29.41%; 95% CI 19.11-40.89) and (29.76%; 95% CI 25.84-33.83), respectively. The seroprevalence was associated with presence of cats (OR 2.22; 95% CI 1.30-3.82), goats older than one year (OR 1.77; 95% CI 1, 37-2.29), females (OR 1.43; 95% CI 1.23-1.65), rearing system (extensive vs. intensive) (OR 4.82; 95% CI 1.96-11, 84) and rearing system (semi-intensive vs. intensive) (OR 1.48; 95% CI 1.48-6.13). The heterogeneity was evidenced in most world regions and the risk factors may play roles in varying the seroprevalence.

Efficiency and sustainability of public health spending in Brazil

Objective: This paper discusses issues related to the efficiency and sustainability of public spending on health in Brazil. Despite the achievements of recent decades, the Unified Health System (SUS) faces structural challenges with consequences on the access to public health services and on the financial protection of the population. Methods: The paper provides a brief overview of the public healthcare financing in Brazil over the last ten years and presents an efficiency analysis of the SUS public health spending, using data envelopment analysis (DEA) models for the years of 2013 and 2017. Results: In terms of public spending, the paradox that Brazil spends little but poorly on health still persists. Public expenditures on health are relatively lower than those observed in countries with health systems with similar characteristics, but public expenditures per capita grow at rates higher than the growth of gross domestic product (GDP) per capita. In terms of efficiency of public health spending, the analysis shows that there is potential to increase the efficiency of the SUS. In 2017, these inefficiencies amounted R$ 35.8 billion. In general, SUS primary healthcare (APS) is more efficient (63% and 68% in 2013 and 2017) than high and medium complexity care (MAC) (29% and 34% in the same years, respectively). Conclusion: Improving the efficiency of public spending on health is particularly important in the current context of low economic growth and strong fiscal constraints in the post-pandemic environment. Efficiency gains can be achieved with: (i) scale gains in the structure and operation of hospitals, (ii) integration of care in health care networks, (iii) increased density and better distribution of the health workforce, (iv) change in mechanisms and incentives to link payments to providers and professionals to health outcomes, with the PHC as the organizer of the system, (v) innovations in the management of health service providers, with an emphasis on public partnership models and private companies (PPPs) . The consolidation of the SUS depends on public policies to improve the efficiency and quality of services provided to the population.

Eficiência e sustentabilidade do gasto público em saúde no Brasil / Efficiency and sustainability of public health spending in Brazil

Objetivo: Este artigo discute questões relativas à eficiência e à sustentabilidade do gasto público com saúde no Brasil. A despeito das conquistas das últimas décadas, o Sistema Único de Saúde (SUS) enfrenta desafios estruturais com consequências no acesso aos serviços públicos de saúde e na proteção financeira da população. Métodos: O artigo traça um breve panorama do financiamento da saúde no Brasil nos últimos 10 anos e apresenta análise da eficiência do gasto público em saúde utilizando modelos de análise envoltória de dados (data envelopment analysis ­ DEA) para os gastos com o SUS nos de 2013 e 2017. Resultados: Do ponto de vista do financiamento do sistema público de saúde, persiste o paradoxo de que o Brasil gasta pouco, mas gasta mal. Os gastos públicos com saúde são relativamente menores que os observados em países com sistemas de saúde com caraterísticas semelhantes, porém os gastos públicos per ca pita crescem a taxas maiores do que o crescimento do Produto Interno Bruto (PIB) per capita. Do ponto de vista da eficiência, a análise demonstra que há potencial de aumentar a eficiência do SUS. Apenas em 2017 essas ineficiências somavam R$ 35,8 bilhões. De forma geral, a atenção primária à saúde (APS) do SUS tem eficiência maior (63% e 68% em 2013 e 2017) do que a atenção de alta e média complexidade (MAC) (29% e 34% nos mesmos anos, respectivamente). Conclusão: Melhorar a eficiência do gasto público com saúde é particularmente importante no contexto atual de baixo crescimento econômico e fortes restrições fiscais no ambiente pós-pandemia. Ganhos de eficiência podem ser alcançados com: (i) ganhos de escala na estrutura e operação dos hospitais, (ii) integração do cuidado em redes de atenção à saúde, (iii) aumento da densidade e melhor distribuição da força de trabalho em saúde, (iv) mudança nos mecanismos e incentivos para vincular os pagamentos aos provedores e profissionais aos resultados de saúde, tendo a APS como organizadora do sistema, (v) inovações na gestão dos provedores de serviços de saúde, com ênfase em modelos de parcerias público-privadas (PPPs). A consolidação do SUS depende de políticas públicas que melhorem a eficiência e a qualidade dos serviços prestados à população.

Objective: This paper discusses issues related to the efficiency and sustainability of public spending on health in Brazil. Despite the achievements of recent decades, the Unified Health System (SUS) faces structural challenges with consequences on the access to public health services and on the financial protection of the population. Methods: The paper provides a brief overview of the public healthcare financing in Brazil over the last ten years and presents an efficiency analysis of the SUS public health spending, using data envelopment analysis (DEA) models for the years of 2013 and 2017. Results: In terms of public spending, the paradox that Brazil spends little but poorly on health still persists. Public expenditures on health are relatively lower than those observed in countries with health systems with similar characteristics, but public expenditures per capita grow at rates higher than the growth of gross domestic product (GDP) per capita. In terms of efficiency of public health spending, the analysis shows that there is potential to increase the efficiency of the SUS. In 2017, these inefficiencies amounted R$ 35.8 billion. In general, SUS primary healthcare (APS) is more efficient (63% and 68% in 2013 and 2017) than high and medium complexity care (MAC) (29% and 34% in the same years, respectively). Conclusion: Improving the efficiency of public spending on health is particularly important in the current context of low economic growth and strong fiscal constraints in the post-pandemic environment. Efficiency gains can be achieved with: (i) scale gains in the structure and operation of hospitals, (ii) integration of care in health care networks, (iii) increased density and better distribution of the health workforce, (iv) change in mechanisms and incentives to link payments to providers and professionals to health outcomes, with the PHC as the organizer of the system, (v) innovations in the management of health service providers, with an emphasis on public partnership models and private companies (PPPs) . The consolidation of the SUS depends on public policies to improve the efficiency and quality of services provided to the population.

Measuring Financial Protection in Health in Brazil: Catastrophic and Poverty Impacts of Health Care Payments Using the Latest National Household Consumption Survey.

This paper measures financial protection in health in Brazil by estimating the incidence and describes the profile of catastrophic expenditures and impoverishment due to household out-of-pocket (OOP) health spending. It uses the latest Brazilian consumption survey (POF 2017/2018) to analyze the composition of household health spending and applies two thresholds of household consumption to identify households facing catastrophic expenditures and impoverishment due to health care payments. Results show that a third of households spend more than 10% of their budget on health, and the share of households facing financial hardship is significantly higher among the Brazilian poor (37% among the bottom consumption deciles). Medicines are the main contributor to component of OOP health spending, reaching 85% of all OOP payments for the lowest consumption deciles. Households with women as household head and those with heads with more years of schooling have higher probability of incurring catastrophic health spending. Yearly, more than 10 million Brazilians are pushed into poverty due to OOP health care payments, which represents a larger percentage of individuals (4.87%) than reported globally (2.5%) or among Latin America and Caribbean countries (1.8%). Conclusions: Despite the achievements in implementing universal health coverage in Brazil, challenges remain to guarantee financial protection to its population (especially the Brazilian poor). Policies to expand access and affordability of essential medicines are key to improve financial protection in health in Brazil.

Anterior Veneer Restorations - An Evidence-based Minimal-Intervention Perspective.

PURPOSE: The goals of this review are (1) to describe the evidence behind the use of ceramics vs composite resin to restore teeth with anterior veneers using a minimally-invasive strategy; and (2) to discuss the choice of materials and techniques for anterior veneer restorations. OVERVIEW: In recent years new adhesive restorative materials and techniques have been introduced in dentistry, including nanofilled composite resins for direct restorations, new ceramic materials that combine esthetics and strength, and polymer/ceramic materials for indirect restorations that are fabricated chairside using CAD/CAM technology, allowing the dentist to design, mill, and cement the restoration in one session. In spite of the novelty and new technology behind the introduction of new materials, the available evidence that backs some of these materials does not justify their use over similar materials or techniques that have been used by dentists for some years. Notwithstanding the success of laminate veneers and the popularity of new materials and digital techniques, the classical direct composite resin veneer is still very popular among clinicians and taught in dental schools and continuing education courses. Direct composite resin veneers are usually more affordable than indirect veneers, less invasive of the tooth structure, and easier to repair. Current composite resin materials can be finished to a tooth-like appearance, but they are susceptible to alterations of the surface gloss and potential discoloration of the composite resin. On the other hand, the preparation for indirect veneers is generally more invasive and the respective restorations are more difficult to repair. In addition, the esthetic outcome of bonded ceramic restorations still depends on the clinical behavior of the dentin adhesive and resin luting cement used to bond the restoration to the tooth structure. CONCLUSIONS: The ultimate goals of any restorative treatment are to restore function and esthetics, prevent recurrent caries lesions and bacterial leakage into the pulp space, save tooth structure, and promote the well-being of our patients. The armamentarium of new dental materials for esthetic clinical procedures has increased exponentially in the last few years. The use of different materials and techniques for anterior veneer restorations must be based on sound evidence rather than on the marketing hype or testimonials.

Exploring the Catalytic Mechanism of the RNA Cap Modification by nsp16-nsp10 Complex of SARS-CoV-2 through a QM/MM Approach.

The inhibition of key enzymes that may contain the viral replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have assumed central importance in drug discovery projects. Nonstructural proteins (nsps) are essential for RNA capping and coronavirus replication since it protects the virus from host innate immune restriction. In particular, nonstructural protein 16 (nsp16) in complex with nsp10 is a Cap-0 binding enzyme. The heterodimer formed by nsp16-nsp10 methylates the 5'-end of virally encoded mRNAs to mimic cellular mRNAs and thus it is one of the enzymes that is a potential target for antiviral therapy. In this study, we have evaluated the mechanism of the 2'-O methylation of the viral mRNA cap using hybrid quantum mechanics/molecular mechanics (QM/MM) approach. It was found that the calculated free energy barriers obtained at M062X/6-31+G(d,p) is in agreement with experimental observations. Overall, we provide a detailed molecular analysis of the catalytic mechanism involving the 2'-O methylation of the viral mRNA cap and, as expected, the results demonstrate that the TS stabilization is critical for the catalysis.

Adhesive dentistry: Current concepts and clinical considerations.

OBJECTIVES: To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use. OVERVIEW: Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins. CONCLUSIONS: (a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade. CLINICAL SIGNIFICANCE: New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Investigating the Fluid-Solid Interaction of Acid Nonionic Nanoemulsion with Carbonate Porous Media.

The subject of rock-fluid interaction is important in cases where flow through porous media is occurring. One special case is when the fluid reacts with the porous matrix. In this case, the mass transfer and reaction rate control the dissolution pattern. This article aimed to study the interaction between an acid nanoemulsion system and a carbonate porous media. Nanoemulsions were developed to retard the rock's dissolution and to promote the formation of conductivity channels. Nanoemulsions were prepared using ALK100 (alkyl alcohol ethoxylate) and RNX110 (alkylphenol ethoxylate) (nonionic surfactants), sec-butanol (co-surfactant), xylene isomers (oil phase), and a solution of HCl (aqueous phase). The obtained systems were characterized in terms of surface tension, droplet diameter, and reactivity. X-ray fluorescence/diffraction (XRF/XRD) and X-ray microtomography (microCT) were performed on carbonate porous media samples treated with the acid systems in order to observe the effects of the fluid-rock interaction. The results showed that the acid nanoemulsion, presenting a low oil content formulation, showed the low surface tension and droplet size characteristic of nanoemulsions. It was experimentally verified that the reactivity in the nanoemulsion media was mass-transfer-retarded, and that the wormhole pattern was verified under the studied conditions.

Catalysis by solvation rather than the desolvation effect: exploring the catalytic efficiency of SAM-dependent chlorinase.

Chlorinase SalL halogenate S-adenosyl-l-methionine (SAM) reacts with chloride to generate 5'-chloro-5'-deoxyadenosine and l-methionine through a nucleophilic substitution mechanism. Although it is known that chlorinase enhances the rate of reaction by a factor of 1.2 × 1017 fold, it is not entirely clear how this is accomplished. The search for the origin of the catalysis of chlorinase and other enzymes has led to a desolvation hypothesis. In the present work, we have used well defined computational simulations in order to evaluate the origin of the catalytic efficiency of chlorinase. The results demonstrate that the catalytic effect of chlorinase is associated with the fact that Cl- is "solvated" by the protein more than by the reference solution reaction, which is not in accordance with proposed catalysis by desolvation. It is found that chlorinase SalL active sites provide electrostatic stabilization of the transition state which is the origin of its catalytic effect.

To Ban or Not to Ban? Regulating Dual Practice in Palestine.

Abstract-Dual practice, health professionals working simultaneously in the public and private sectors, is perceived to negatively impact quality of health care. Though a range of policy options exists to regulate dual practice, little is known about the impact of different options on quality of care. Successful policy is dependent on a country's health care system, health labor market, monitoring of private sector activity, and enforceability of regulations. This article provides evidence on the potential impact of banning dual practice in Palestine. We apply theoretical evidence and international experience, together with context-specific primary and secondary data, to assess the policy's enforceability, implications, and sustainability in the Palestinian context. In this setting, though the risk of losing health workers to the private sector is low, banning dual practice will most likely lead to the "brain drain" of rare specialists from the public sector. Moreover, though there is some evidence that dual practice is negatively impacting quality of care, poor quality in public facilities associated with shortages in supplies and equipment, poor organizational and management practices, low motivation, and absence of monitoring and accountability systems are unlikely to change by banning dual practice. Finally, the ban, as conceptualized, is fiscally unsustainable in a strained health budget and may be challenging to enforce due to a weak monitoring system. Overall, it was found that an outright ban on dual practice would not reduce the financial burden on patients and enhance their access to quality services in the public sector.

Transforming Health Workers' Education for Universal Health Coverage: Global Challenges and Recommendations.

Health workforce challenges remain a critical bottleneck in achieving universal health coverage (UHC) goals in most countries. As it stands, health professional training is primarily clinical, curricular and delinked from the needs of the health system. To achieve global health goals and maximize opportunities for employment and economic growth, all in the context of limited fiscal realities, a paradigm shift is needed with respect to the health workforce and corresponding education systems. There is a need to shift towards fair, gender friendly employment at a rate that matches the overall growth of the health economy, which acknowledges the role of the private sector in education and training. This paper emphasizes the importance and implications of such a paradigm shift. It argues the need for a 21st century framework for health professional education. This framework should represent a more satisfactory interface between supply and demand for health professional labor, in line with the need for UHC, job creation and economic growth.

Factors influencing job preferences of health workers providing obstetric care: results from discrete choice experiments in Malawi, Mozambique and Tanzania.

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas.

Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro.

BACKGROUND: Brazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses. METHODS: Analysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews. RESULTS: In the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak. CONCLUSIONS: Both cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.

Moving towards universal health coverage: lessons from 11 country studies.

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls--but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

Stability of Allopurinol, Amitriptyline Hydrochloride, Carbamazepine, Domperidone, Isoniazid, Ketoconazole, Lisinopril, Naproxen, Paracetamol (Acetaminophen), and Sertraline Hydrochloride in SyrSpend SF PH4 Oral Suspensions.

Oral liquids are safe alternatives to solid dosage forms, notably for elderly and pediatric patients that present dysphagia. The use of ready-to-use suspending vehicles such as SyrSpend SF PH4 is a suitable resource for pharmacists as they constitute a safe and timesaving option that has been studied often. The objective of this study was to evaluate the stability of 10 commonly used active pharmaceutical ingredients (allopurinol 20 mg/mL; amitriptyline hydrochloride 10 mg/mL; carbamazepine 25 mg/mL; domperidone 5 mg/mL; isoniazid 10 mg/mL; ketoconazole 20 mg/mL; lisinopril 1 mg/mL; naproxen 25 mg/mL; paracetamol [acetaminophen] 50 mg/mL; and sertraline hydrochloride 10 mg/mL) compounded in oral suspensions using SyrSpend SF PH4 as the vehicle throughout the study period and stored both at controlled refrigerated (2°C to 8°C) and room temperature (20°C to 25°C). Stability was assessed by means of measuring the percent recovery at varying time points throughout a 90-day period. The quantification of the active pharmaceutical ingredients was performed by high-performance liquid chromatography through a stability-indicating method. Methods were adequately validated. Forced-degradation studies showed that at least one parameter influenced the stability of the active pharmaceutical ingredients. All suspensions were assayed and showed active pharmaceutical ingredient contents between 90% and 110% during the 90-day study period. Although the forced-degradation experiments led to visible fluctuations in the chromatographic responses, the final preparations were stable in the storage conditions. The beyond-use dates of the preparations were found to be at least 90 days for all suspensions, both for controlled refrigerated temperature and room temperature. This confirms that SyrSpend SF PH4 is a stable suspending vehicle for compounding with a broad range of different active pharmaceutical ingredients for different medical usages.

Randomized clinical trial of four adhesion strategies in posterior restorations-18-month results.

PURPOSE: To evaluate the 18-month clinical performance of four adhesive strategies in posterior composite restorations placed in private practice. MATERIALS AND METHODS: Upon approval by an institutional review board, 144 restorations were inserted in 45 subjects (average age = 32.6) to treat caries lesions or to replace existing restorations in vital molars and premolars. The adhesives OptiBond FL (three-step etch-and-rinse), OptiBond SOLO Plus (two-step etch-and-rinse), OptiBond XTR (two-step self-etch), and OptiBond All-in One (one-step self-etch) were applied as per manufacturer's (Kerr Co.) instructions followed by a nanofilled resin composite (Filtek Z350XT, 3M ESPE) under rubber dam isolation. Restorations were evaluated at baseline and at 18 months using United States Public Health Service (USPHS)-modified criteria and high-resolution digital photographs. Statistical analyses included the McNemar and the Mann-Whitney non-parametric tests (p < 0.05). RESULTS: A total of 137 restorations were evaluated after 18 months. The number of alfa ratings did not change significantly from baseline to 18 months for any of the adhesion strategies. When the 18-month evaluation criteria were pooled by pairs of adhesives, none of the adhesives resulted in a significantly different number of alfa ratings for any of the criteria compared with the other adhesives. CONCLUSION: Bonding strategy did not influence the clinical performance of posterior composite restorations under the clinical conditions used in this study. CLINICAL SIGNIFICANCE: When used in ideal clinical conditions, the composition of current dentin adhesives may be more clinically relevant than their adhesion strategy.