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Saturday, November 11, 2023

3.162 - AMICOR (26)

 3.162 - AMICOR (26) 

#com Valderês A. Robinson Achutti (*13/06/1931+15/06/2021)

Nas Cataratas do Iguaçu em 2005, durante Congresso Mundial de Cardiologia Preventiva

#Re-Publicando artigos antigos meus

TRANSAÇÃO ECONÔMICA (21/08/2015)

    Não sei se estou ficando maluco, maníaco, ou sucumbindo à infestação de um vírus cultural, mas desde que aprendi sobre o circuito da recompensa, sou levado a ver tudo sob a influência da economia, transações comerciais, ou negócios de várias outras naturezas.

    Parece que tudo está relacionado com a evolução e a preservação das espécies, e que seres mais complexos chegam a dispor de dispositivos fisiológicos complicados, com a memória, para facilitar o caminho de ida e volta. Em nós humanos, a sofisticação chegou a um grau mais avançado, misturando inteligência e emoção, dando-nos até a ilusão de autonomia, liberdade de escolha, e auto-determinação, quando não expliccável pela "vontade divina", intervenção externa, ou síndrome da conspiração...
    Parece ser aplicável para relacionamento tanto entre espécies distintas como entre indivíduos da mesma espécie.
    Se um vírus encontra uma célula de outro organismo, negocia sua sobrevivência, tirando proveito do que a célula pode lhe favorecer, cujo limite está na possibilidade de ambos sobreviverem, ou se adaptarem, pois se o hospedeiro morre o jogo acaba, a não ser que haja outro para o substituir, dando origem a uma cadeia epidêmica, que tentamos cortar, ensinando truques (vacinas) para nosso sistema imunitário, antecipando-nos à negociação.
    A transa amorosa, a disputa de poder político, o mercado, quase tudo pode ser traduzido pela mesma linguagem comercial.
    Nossa tendência romântica nos induz a interpretar como atração. Os arquétipos tribais, e o instinto classificatório, também com utilidade defensiva, estão misturados nisso tudo.
    Sempre foi assim, o toma-lá-da-cá, a serpente que vendeu a maçã para Eva, que a compartilhou com Adão, que resultou em terem que ficar depois se escondendo...O segredo é a alma do negócio, até surgir delação premiada (prêmio=recompensa=troca de valores=negócio). O que é que tinha o "criador" que permitir tudo - chamando atenção - ao valorizar o fruto da árvore proibida, aguçando a curiosidade, e a cobiça pela sabedoria, e pela separação do bem e do mal?
    O próprio exercício do mecanismo do "reward" já dá prazer em si mesmo - independentemente do resultado - o que nos faz muitas vezes acioná-lo mesmo sem objetivo, só pelo gozo virtual, ou artificial, quando se descobrem os mediadores ou suas imagens, podendo terminar até em dependência...
    Desculpem o delírio, mas vejo que às vezes tenho algum prazer em dar um troco, seja ele qual for, para não ficar fora do negócio, e não me sentir ameaçado pela falência de todos os valores, ou seus equivalentes, que serviram de pretexto para nos mover até aqui...

#Maestro dos fundos...



Assim chamo nosso neto Percussionista Antônio Achutti Olivé que brilhou, e repercutiu, mais uma vez no fim de semana, durante mais um concerto da Orquestra Filarmônica da UFRGS. Parabéns...

#IHME

IHME Updates texts with IHME logo to the right
IHME will be closed Friday, November 10, in observance of Veterans Day. We will pause our weekly newsletter next week and will resume on Tuesday, November 21.
US gun violence still rising, new data shows  


The recent headlines from Maine are a painful reminder of how frequently gun violence occurs in the US, re-igniting conversations on how this violence should galvanize policymakers to act. Updated Global Burden of Disease (GBD) data for 2021 depicts a grave view of the US compared to other countries around the world. 
  • The US ranks first for rates of firearm homicides among high-income countries with populations over 10 million. 
  • Since 2000, the share of all childhood deaths caused by gun violence in the US has increased by about 33%.
  •  US states have high age-adjusted firearm homicide rates similar to other countries: Washington, DC’s rate is similar to those of Brazil and Jamaica, which rank ninth and tenth globally. New Hampshire’s rate is similar to that of Chile.
  •  Age-adjusted firearm homicide rates in the US are 33 times greater than in Australia and 77 times greater than in Germany.
We published an update to our blog on gun violence with updated GBD data. The blog piece includes compelling visuals on gun violence in the US and other countries from 2000 to 2021, as well as instances where other countries have implemented gun violence policies that have significantly reduced deaths and improved the lives of their populations.

#Primeiros jasmins do ano 2023 em nosso jardim

Não consigo repassar o perfume!...
#Our World in data

Child mortality has declined, but millions of children still die every year, many from preventable causes


Explore a major overhaul of our work on child and infant mortality.

Child mortality is one of the world’s largest problems. Around 6 million children under 15 die per year. That’s around 16,000 deaths every day, or 11 every minute.

This devastating statistic reveals the vast number of children whose lives end before they can discover their talents, passions, and dreams as they grow older – and represents the impact of child mortality on so many people’s lives: parents, siblings, families, and communities.

What’s tragic is how many of these deaths are preventable. Most are caused by malnutrition, birth disorders such as preterm birth, sepsis and trauma, and infectious diseases such as pneumonia, malaria, and HIV/AIDS.

These have all declined substantially in many, but not all, parts of the world – child deaths were a grim constant in the past. For most of human history, around 1 in 2 newborns died before reaching the age of 15. By 1950, that figure had declined to around one-quarter globally. By 2020, it had fallen to 4%.

But while humanity has made much progress, there’s still a lot of work to do. To make more progress, it’s essential to have data on child mortality and its causes, and research on how to prevent it.

On this page, you will find data and research on child mortality across the world, how it has changed, its causes, and what we can do about it.

Recent articles, updates, and announcements

#Centro Histórico e Cultural da Santa Casa

#HISTORY: Queda do Muro de Berlim 09/11/1989

No dia 9 de novembro de 1989, após semanas de distúrbios civis e em meio a uma onda
revolucionária no Leste Europeu, o governo da Alemanha Oriental anunciou que todos os
seus habitantes poderiam visitar a Alemanha Ocidental e Berlim Ocidental. Com a decisão,
 milhares de alemães orientais atravessaram o muro que dividia a capital alemã, juntando-se
 aos alemães ocidentais do outro lado. Nos dias seguintes, partes do muro foram destruídas
e, mais tarde, máquinas removeram quase toda estrutura. A queda do muro de Berlim deu
o passo inicial para a reunificação alemã, formalmente assinada em 3 de outubro de 1990.
O muro de Berlim foi construído em agosto de 1961 pela República Democrática Alemã
(Alemanha Oriental), durante a Guerra Fria, e circundava toda a Berlim Ocidental,
separando-a da Alemanha Oriental, incluindo Berlim Oriental. O muro, além de impedir
a emigração, também servia como divisor político. De um lado, estava a capitalista
República Federal da Alemanha (RFA) e, do outro, os soviéticos da República Democrática
Alemã (RDA). O muro tinha 66,5 quilômetro de gradeamento metálico, 302 torres de
observação, 127 redes metálicas electrificadas com alarme e 255 pistas de corrida para
cães. O número exato de pessoas que morreram na tentativa de passar o muro nunca foi
confirmado.  (Imagem: via Wikimedia Commons)


#Nature Briefing


 #The Heart. org

What Not to Prescribe to Older Adults.What to Use Instead

Neil Skolnik, MD

I'm Dr Neil Skolnik. Today we are going to talk about the American Geriatrics Society 2023 updated Beers Criteria guidance for medication use in older adults. These criteria have been updated and revised approximately every 5 years since 1991 and serve to alert us to medications for which the risk-benefit ratio is not as good in older adults as in the rest of the population.

These are important criteria because medications are metabolized differently in older adults and have different effects compared with younger patients. For the sake of these criteria, older adults are 65 years of age or older. That said, we know that everyone from 65 to 100 is not the same. As people age, they develop more comorbidities, they become more frail, and they are more sensitive to the effects and side effects of drugs.

The guidance covers potentially inappropriate medications for older adults. The word "potentially" is important because this is guidance. As clinicians, we make decisions involving individuals. This guidance should be used with judgment, integrating the clinical context of the individual patient.

There is a lot in this guidance. I am going to try to cover what I feel are the most important points.

Aspirin. Since the risk for major bleeding increases with age, for primary prevention of atherosclerotic cardiovascular disease, the harm can be greater than the benefit in older adults, so aspirin should not be used for primary prevention. Aspirin remains indicated for secondary prevention in individuals with established cardiovascular disease.

WarfarinFor treatment of atrial fibrillation or venous thromboembolism (deep vein thrombosis or pulmonary embolism), warfarin should be avoided if possible. Warfarin has a higher risk for major bleeding, particularly intracranial bleeding, than direct oral anticoagulants (DOACs); therefore the latter are preferred. Rivaroxaban should be avoided, as it has a higher risk for major bleeding in older adults than the other DOACs. Apixaban is preferred over dabigatran. If a patient is well controlled on warfarin, you can consider continuing that treatment.

Antipsychotics. These include first- and second-generation antipsychotics such as aripiprazolehaloperidololanzapinequetiapinerisperidone, and others. The guidance says to avoid these agents except for FDA-approved indications such as schizophreniabipolar disorder, and adjuvant treatment of depression. Use of these antipsychotics can increase risk for stroke, heart attack, and mortality. Essentially, the guidance says do not use these medications lightly for the treatment of agitated dementia. For those of us with older patients, this can get tricky because agitated dementia is a difficult issue for which there are no good effective medications. The Beers guidance recognizes this in saying that these medications should be avoided unless behavioral interventions have failed. So, there are times where you may need to use these medicines, but use them judiciously.

For patients with dementia, anticholinergics, antipsychotics, and benzodiazepines should be avoided if possible.

Benzodiazepines. Benzodiazepines should also be avoided because older adults have increased sensitivity to the effects of benzodiazepines due to slower metabolism and clearance of these medications, which can lead to a much longer half-life and higher serum level. In older adults, benzodiazepines increase the risk for cognitive impairment, delirium, falls, fractures, and even motor accidents. The same concerns affect the group of non-benzodiazepine sleeping medicines known as "Z-drugs."

Nonsteroidal anti-inflammatory drugs (NSAIDs). Used frequently in our practices, NSAIDs are nevertheless on the list. As we think through the risk-benefit ratio of using NSAIDs in older adults, we often underappreciate the risks of these agents. Upper gastrointestinal ulcers with bleeding occur in approximately 1% of patients treated for 3-6 months with an NSAID and in 2%-4% of patients treated for a year. NSAIDs also increase the risk for renal impairment and cardiovascular disease.

Other medications to avoid (if possible). These include:

  • Sulfonylureas, due to a high risk for hypoglycemia. A short-acting sulfonylurea, such as glipizide, should be used if one is needed.

  • Proton pump inhibitors should not be used long-term if it can be avoided.

  • Digoxin should not be first-line treatment for atrial fibrillation or heart failure. Decreased renal clearance in older adults can lead to toxic levels of digoxin, particularly during acute illnesses. Avoid doses > 0.125 mg/day.

  • Nitrofurantoin should be avoided when the patient's creatinine clearance is < 30 or for long-term suppressive therapy.

  • Avoid combining medications that have high anticholinergic side effects, such as scopolaminediphenhydramineoxybutynincyclobenzaprine, and others.

It is always important to understand the benefits and the risks of the drugs we prescribe. It is also important to remember that older adults are a particularly vulnerable population. The Beers criteria provide important guidance which we can then use to make decisions about medicines for individual patients.

GEOMETRY | ALL TOPICS

 

In the ‘Wild West’ of Geometry, Mathematicians Redefine the Sphere

By LEILA SLOMAN

High-dimensional spheres can have a much wider variety of structures than mathematicians thought possible.

Read the article

NEUROSCIENCE

 

Why the Human Brain Perceives Small Numbers Better

By YASEMIN SAPLAKOGLU

The discovery that the brain has different systems for representing small and large numbers provokes new questions about memory, attention and mathematics.

Read the article


Related: 
Hidden Computational Power
Found in the Arms of Neurons

By Jordana Cepelewicz (2020)

COMPUTER SECURITY

 

Cryptographers Solve Decades-Old Privacy Problem

By MADISON GOLDBERG

Three researchers have found a long-sought way to pull information from large databases secretly, moving us closer to fully private internet searches.

Read the blog


Related: 
In Neural Networks, Unbreakable
Locks Can Hide Invisible Doors

By Ben Brubaker

GEOPHYSICS

 

The Scientist Who Decodes the Songs of Undersea Volcanoes

By ROBIN GEORGE ANDREWS

In the rumbles and groans of underwater volcanoes, Jackie Caplan-Auerbach finds her favorite harmonies — and clues to the Earth’s interior.

Read the interview


Related: 
Scientists Unravel How the Tonga Volcano
Caused Worldwide Tsunamis

By Robin George Andrews (2022)

QUANTA SCIENCE PODCAST

 

Underground Cells Make ‘Dark Oxygen’ Without Light

By SAUGAT BOLAKHE;
Podcast hosted by SUSAN VALOT

In some deep subterranean aquifers, cells have a chemical trick for making oxygen that could sustain whole ecosystems of underground life.


Listen to the podcast

Read the article

Around the Web

A Cosmos of Wonder
Since it first came online in 2021, JWST has snapped breathtaking photos of the deep cosmos and made stunning discoveries about our universe, writes Kate LaRue in an interactive story for The New York Times. One of the many new discoveries was the abundance of massive black holes in the early universe. In August, Charlie Wood wrote for Quanta about how the black holes could change our picture of how the universe evolved.

Dust Killed the Dinos
A new study suggests that the mass extinction event that wiped out the dinosaurs was due in part to a cloud of dust kicked up by the asteroid impact, reports Katharine Sanderson for Nature. The dust blocked sunlight for several years, devastating ecosystems. The asteroid impact is now generally accepted as the primary cause of the extinction that killed the dinosaurs, but that wasn’t always so. Writing for Quanta in 2020, Joshua Sokol interviewed the paleontologist Pincelli Hull about the key evidence she gathered that helped settle the debate.

#Zero Hora - Santa Maria - Medianeira


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