Privatization and Oligopolies of the Renal Replacement Therapy Sector on Contemporary Capitalism: A Systematic Review and the Brazilian Scenario.

Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.

Estimating the Lambda measure in multiple-merger coalescents.

Multiple-merger coalescents, also known as Λ-coalescents, have been used to describe the genealogy of populations that have a skewed offspring distribution or that undergo strong selection. Inferring the characteristic measure Λ, which describes the rates of the multiple-merger events, is key to understand these processes. So far, most inference methods only work for some particular families of Λ-coalescents that are described by only one parameter, but not for more general models. This article is devoted to the construction of a non-parametric estimator of the density of Λ that is based on the observation at a single time of the so-called Site Frequency Spectrum (SFS), which describes the allelic frequencies in a present population sample. First, we produce estimates of the multiple-merger rates by solving a linear system, whose coefficients are obtained by appropriately subsampling the SFS. Then, we use a technique that aggregates the information extracted from the previous step through a kernel type of re-construction to give a non-parametric estimation of the measure Λ. We give a consistency result of this estimator under mild conditions on the behavior of Λ around 0. We also show some numerical examples of how our method performs.

Merger and expansion of equivalence classes via meaningful stimuli.

The present experiments evaluated the effect of meaningful stimuli on the inclusion of a set of extra-experimental meaningful pictures into equivalence classes using within- and between-subjects designs. There were 35 adult participants in total (NEXP1 = 22; NEXP2 = 13). In both experiments, participants were first trained on six baseline relations with abstract stimuli (A, B, and C) and assessed on the emergence of three 3-member equivalence classes. Next, they were trained on DA relations and assessed on the inclusion of the D stimuli and a set of meaningful pictures in the equivalence classes. In Experiment 1, D1 and D2 were meaningful written words and D3 was a written pseudoword. In Experiment 2, for 2 groups, D1, D2, and D3 were meaningful words; for another group, D1, D2, and D3 were pseudowords. In both experiments, participants formed the ABC classes and included the D stimuli in the classes. When D was a meaningful word, participants also included a set of pictures potentially related to the word in the ABC class established experimentally. The results have implications for the definition of meaningfulness and contribute to discussions on the impact of test arrangements on emergent responding.

Measuring the "transfer of meaning" through members of equivalence classes merged via a class-specific reinforcement procedure.

Seven participants received conditional discrimination training that established the 12 conditional relations A1B1, A2B2, A3B3, A1C1, A2C2, A3C3, D1E1, D2E2, D3E3, D1F1, D2F2, and D3F3. The A stimuli were pictures of faces portraying emotional expressions; the others were arbitrary forms. Correct responses resulted in presentations of class-specific reinforcers, Sr1, Sr2, and Sr3. After training, tests confirmed the formation of ABC and DEF equivalence classes. Further tests then documented the merger of the classes and the emergence of SrB, SrC, SrE, and SrF relations, showing that the class-specific reinforcers were equivalence class members. Finally, participants did Semantic Differential ratings that tested whether the emotional valence of the A stimuli transferred to the arbitrary forms, B and E. The results show that participants' evaluations of the B and E stimuli were similar to evaluations of the A stimuli made by participants of a control group. This finding is considered as a demonstration that class-specific outcomes can mediate class merger phenomena and the transfer of functions through members of merged classes.

Merger Syndrome: impacts on people in a strategic alliance / Síndrome da fusão: impactos nas pessoas numa aliança estratégica

This paper is based on the author's master thesis "Social categories and merger syndrome: impacts on people in a strategic alliance" (Coimbra, 2010). For the present publication, the focus will be on two investigated aspects that are the perception of employees regarding the strategic alliance their company entered into, and the merger syndrome. The reactions to merger impact, a kind of organizational combination, have been described in literature as merger syndrome (Buono & Bowditch, 2003; Cartwright & Cooper, 1992; Marks & Mirvis, 2002, 1998) which presents consequences in individuals, groups and organizations. The present study aims i) to evaluate how the strategic alliance is perceived by the workers, in this way, to verify its impact on individuals, according to merger syndrome variable, and ii) creating a valid scale of measure for merger syndrome construct. The study is empirical and quantitative, with a mainly exploratory objective. The sample was composed of 486 employees from a Brazilian company, which entered into in a strategic alliance with a multinational of the same industry. Results revealed that the perception of the combination is mainly positive and the present set of data is not organized in a way to make the latent structure of merger syndrome emerge.

O presente artigo tem por base a dissertação de mestrado da autora, "Categorias sociais e síndrome da fusão: impactos nas pessoas numa aliança estratégica" (Coimbra, 2010). Para esta publicação, o enfoque será sobre dois aspectos investigados, quais sejam, a percepção dos trabalhadores acerca da aliança estratégia que estavam vivenciando e a síndrome da fusão. Esta última tem sido descrita na literatura como o conjunto de reações aos impactos da fusão, que é um tipo de combinação organizacional, que se expressa em diversos níveis (pessoais, organizacionais e culturais). O presente estudo visa: i) avaliar como a aliança estratégica é percebida e neste sentido verificar seus impactos nos trabalhadores, considerando-se a variável síndrome da fusão e; ii) criar uma escala de medida válida para o construto "síndrome da fusão". Trata-se de estudo empírico, quantitativo e com objetivos exploratórios. A amostra foi composta de 486 trabalhadores de uma empresa brasileira que entrou numa aliança estratégica com uma empresa multinacional no mesmo setor de atuação. Os principais resultados indicaram que a percepção dos trabalhadores acerca da combinação organizacional é majoritariamente positiva, porém o conjunto de dados não evidenciou a emergência do construto da síndrome da fusão.

Conocimiento Actitudes y Prácticas Sobre el Aborto Voluntario y Terapéutico en Especialistas en Ginecología y Obstetricia que Laboran en Hospitales Públicos del Cantón Cuenca / Knowledge Attitudes and Practices About Voluntary and Therapeutic Abortion in Specialists in Gynecology and Obstetrics who Work in Public Hospitals of the Cuenca Canton

ANTECEDENTES: El código integral penal señala que el aborto provocado no será punible cuando se realice para evitar un peligro en la salud de la mujer y cuando el embarazo es consecuencia de una violación en una mujer que padezca de discapacidad mental. OBJETIVOS: Identificar los conocimientos actitudes y prácticas de los ginecólogos de los hospitales públicos de Cuenca, sobre el aborto voluntario y terapéutico; identificar si existe relación entre la edad, el género, los años de ejercicio profesional y las concepciones religiosas de los ginecólogos, sobre el conocimiento de la legislación sobre el aborto y su apertura hacia el aborto voluntario y terapéutico. METODOLOGÍA: Un total de 27 ginecólogos, que traba-jan en hospitales públicos del cantón Cuenca fueron encuestados; se seleccionaron los profesionales que la-boran en centros con internación por la mayor posibilidad de que ellos puedan tener contacto con paciente que requieren abortos terapéuticos, o hayan atendido pacientes con abortos provocados. RESULTADOS: La muestra fue constituida por 27 especia-listas en ginecología y obstetricia, con una edad media de 37 años, el 77.8% de los encuestados de sexo mascu-lino y el 22.2% femenino; el tiempo medio de ejercicio profesional fue 7.36; el 91.7% de los profesionales profe-sa una religión, el 88.9% considera importante la religión en su vida. El 81.5% sabe que el aborto terapéutico es legal en el Ecuador, sin embargo, el 29.6% puede citar correctamente las causales en las cuales el aborto no es punible. El 63% considera que se debe despenalizar el aborto en el Ecuador en todas las causales. El 22.2% ha realizado un aborto terapéutico; 81%, ha visto una paciente con un aborto provocado durante el último año. En la presente investigación no se pudo demostrar asociación entre la edad, el género, años de ejercicio profesional y las concepciones religiosas de los ginecólogos, sobre el conocimiento de la legislación acerca del aborto y su apertura sobre el aborto voluntario y terapéutico. CONCLUSIONES: El conocimiento sobre las causales en las cuales el aborto no es punible, es bajo entre los ginecólogos de los servicios públicos de salud; un pequeño porcentaje de ellos, tiene experiencia en la ejecución de un aborto terapéutico, sin embargo, el 63% tiene una actitud positiva hacia la despenalización del aborto en todas sus causales.

BACKGROUND: The penal integral code says that indu-ced abortion is not punishable when it is performed to avoid a hazard on the women health and when the pregnancy is a consequence of a rape to a woman who suffers mental disabilities. OBJECTIVE: This research objective is to identify the knowledge, attitudes and practices of gynecologists from public hospitals in Cuenca on voluntary and the-rapeutic abortion; also it aims to identify the correlation between: age, gender, and years of practice and reli-gious conceptions of gynecologists about the knowle-dge of the legislation on abortion and openness to the voluntary and therapeutic abortion. METHODOLOGY: A total of 27 gynecologists who work in public hospitals in Cuenca were surveyed; professionals who are working in centers with internship were selec-ted because they may have a higher contact with pa-tients that require therapeutic abortions, or have seen patients with induced abortions.RESULTS: The sample was composed of 27 specialists in gynecology and obstetrics, with an average age of 37 years, the 77.8% male and 22.2% female; the average time of professional practice was 7.36; the 91.7% of pro-fessionals profess a religion, the 88.9% consider the reli-gion how something important in their life. The 81.5% of respondents know that therapeutic abortion is legal in Ecuador; however, the 29.6% can quote correctly the grounds on which abortion is not punishable. The 63% of participants believe that abortion should be decrimina-lized in Ecuador in all grounds. The 22.2% (n = 6) of the professionals surveyed have made a therapeutic abor-tion; the 81% of respondents, has seen a patient with an induced abortion during the last year. In this research the association between age, gender, years of practice and religious conceptions of gynecologists, knowledge of legislation about abortion and its opening on volun-tary and therapeutic abortion could not be proven. CONCLUSIONS: The knowledge about the grounds on which abortion is not punishable, it is low among gyne-cologists of public health services; a small percentage of them have experience in performing a therapeu-tic abortion, however, the 63% have a positive attitu-de towards the decriminalization of abortion in all its grounds.

A relação entre a habilidade de leitura e a consciência fonológica: estudo longitudinal em crianças pré- escolares / The relationship between reading skills and phonological awareness: a Longitudinal study in preschool children

O trabalho apresenta os resultados de uma pesquisa longitudinal em criançasfalantes de língua portuguesa, investigando a relação entre consciênciafonológica e a aprendizagem da leitura. A consciência fonológica foi medida pormeio de tarefas que envolviam a fusão e a segmentação silábica e fonêmica queforam aplicadas na pré-escola e no final do primeiro ano de alfabetização.Análises de regressão linear múltipla controlando a idade e a inteligência (verbal e não verbal) foram realizadas e apenas os escores na tarefa de fusão silábica aplicada no final do primeiro ano de alfabetização predisseram os escores em um teste de leitura aplicado no mesmo período. Porém análises nãoparamétricas indicaram que ambas as tarefas de fusão (fonêmica e silábica)aplicadas na pré-escola predisseram a leitura um ano depois. Esses resultadosforam discutidos considerando-se a natureza das tarefas de consciênciafonológica empregadas e o seu papel em relação ao aprendizado da leitura...

This paper presents the results of a longitudinal research on portuguese-speaking children, investigating the relationship between phonologicalawareness and reading acquisition. Phonological awareness was accessed on two periods of time: on the pre-school and on the end of the first year of reading education. Phonological awareness was indexed by tasks involving fusion (phonemic and syllabic) and segmentation (phonemic and syllabic). Multiple regression analyses controlling for age and intelligence (verbal and non-verbal) indicated that only the syllabic fusion task accessed on the first year of education predicted reading. However non-parametric analyses revealedthat both phonemic and syllabic fusion tasks accessed on pre-school predictedreading one year later. The nature of phonological awareness tasks and itsrelations with reading acquisition were discussed...

A relação entre a habilidade de leitura e a consciência fonológica: estudo longitudinal em crianças pré- escolares / The relationship between reading skills and phonological awareness: a Longitudinal study in preschool children

O trabalho apresenta os resultados de uma pesquisa longitudinal em crianças falantes de língua portuguesa, investigando a relação entre consciência fonológica e a aprendizagem da leitura. A consciência fonológica foi medida por meio de tarefas que envolviam a fusão e a segmentação silábica e fonêmica que foram aplicadas na pré-escola e no final do primeiro ano de alfabetização. Análises de regressão linear múltipla controlando a idade e a inteligência (verbal e não verbal) foram realizadas e apenas os escores na tarefa de fusão silábica aplicada no final do primeiro ano de alfabetização predisseram os escores em um teste de leitura aplicado no mesmo período. Porém análises não paramétricas indicaram que ambas as tarefas de fusão (fonêmica e silábica) aplicadas na pré-escola predisseram a leitura um ano depois. Esses resultados foram discutidos considerando-se a natureza das tarefas de consciência fonológica empregadas e o seu papel em relação ao aprendizado da leitura. (AU)

This paper presents the results of a longitudinal research on portuguese-speaking children, investigating the relationship between phonological awareness and reading acquisition. Phonological awareness was accessed on two periods of time: on the pre-school and on the end of the first year of reading education. Phonological awareness was indexed by tasks involving fusion (phonemic and syllabic) and segmentation (phonemic and syllabic). Multiple regression analyses controlling for age and intelligence (verbal and non-verbal) indicated that only the syllabic fusion task accessed on the first year of education predicted reading. However non-parametric analyses revealed that both phonemic and syllabic fusion tasks accessed on pre-school predicted reading one year later. The nature of phonological awareness tasks and its relations with reading acquisition were discussed. (AU)