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Minha intenção, no presente artigo, é a de fornecer certos elementos permitindo-nos compreender como a ciência moderna ( a que se constituiu a partir do século XVII ) já nasceu como instituição marcadamente "patriarcal" e ”machista“.

Conta a História do Brasil que Pedro Álvares Cabral desembarcou em Porto Seguro, lugar de calmaria, de tranquilidade e de segurança. Lugar onde as caravelas portuguesas abrigaram-se, ficaram protegidas contra as intempéries do tempo e as borrascas do mar. Verdadeira ou não essa estória, gostaria de utilizar a metáfora do ’'Porto Seguro” para postular a instauração de uma pedagogia da incerteza, da insegurança e da provisoriedade, incapaz de parâmetros dogmáticos e absolutos ou de verdades definitivas.

Objectives: Prolonged emergency department (ED) length of stay (LOS) is linked to adverse outcomes, decreased patient satisfaction, and ED crowding. This multicenter study identified factors associated with increased LOS.Methods: This retrospective study included 9 EDs from across the United States. Emergency department daily operational metrics were collected from calendar year 2009. A multivariable linear population average model was used with log-transformed LOS as the dependent variable to identify which ED operational variables are predictors of LOS for ED discharged, admitted, and overall ED patient categories.Results: Annual ED census ranged from 43,000 to 101,000 patients. The number of ED treatment beds ranged from 27 to 95. Median overall LOS for all sites was 5.4 hours. Daily percentage of admitted patients was found to be a significant predictor of discharged and admitted patient LOS. Higher daily percentage of discharged and eloped patients, more hours on ambulance diversion, and weekday (vs weekend) of patient presentation were significantly associated with prolonged LOS for discharged and admitted patients (P < .05). For each percentage of increase in discharged patients, there was a 1% associated decrease in overall LOS, whereas each percentage of increase in eloped patients was associated with a 1.2% increase in LOS.Conclusions: Length of stay was increased on days with higher percentage daily admissions, higher elopements, higher periods of ambulance diversion, and during weekdays, whereas LOS was decreased on days with higher numbers of discharges and weekends. This is the first study to demonstrate this association across a broad group of hospitals. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. METHODS: We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. RESULTS: Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. CONCLUSION: Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. [ABSTRACT FROM AUTHOR]

*O presente trabalho foi encomendado no ano de 2014, por ocasião de conferência ministrada pelo Prof.Hilton Japiassú na UFT. Após a conferência, a então gestão da Universidade Federal do Tocantins instituiu o Prêmio Hilton Japiassú de Excelência em Pesquisa, através de sua Pró-Reitoria de Pesquisa e Pós-graduação. Em homenagem ao referido professor, a comissão editorial de Desafios decidiu manter o texto original, tal como foi enviado em sua primeira versão. O Prof.Hilton Japiassu faleceu, no Rio de Janeiro, no ano de 2015.

*O presente trabalho foi encomendado no ano de 2014, por ocasião de conferência ministrada pelo Prof.Hilton Japiassú na UFT. Após a conferência, a então gestão da Universidade Federal do Tocantins instituiu o Prêmio Hilton Japiassú de Excelência em Pesquisa, através de sua Pró-Reitoria de Pesquisa e Pós-graduação. Em homenagem ao referido professor, a comissão editorial de Desafios decidiu manter o texto original, tal como foi enviado em sua primeira versão. O Prof.Hilton Japiassu faleceu, no Rio de Janeiro, no ano de 2015.

Abstract Background There is recent interest in the role of carotid bifurcation anatomy, geometry and hemodynamic factors in the pathogenesis of carotid artery atherosclerosis. Certain anatomical and geometric configurations at the carotid bifurcation have been linked to disturbed flow. It has been proposed that vascular dimensions are selected to minimize energy required to maintain blood flow, and that this occurs when an exponent of 3 relates the radii of parent and daughter arteries. We evaluate whether the dimensions of bifurcation of the extracranial carotid artery follow this principle of minimum work. Methods This study involved subjects who had computed tomographic angiography (CTA) at our institution between 2006 and 2007. Radii of the common, internal and external carotid arteries were determined. The exponent was determined for individual bifurcations using numerical methods and for the sample using nonlinear regression. Results Mean age for 45 participants was 56.9 ± 16.5 years with 26 males. Prevalence of vascular risk factors was: hypertension-48%, smoking-23%, diabetes-16.7%, hyperlipidemia-51%, ischemic heart disease-18.7%. The value of the exponent ranged from 1.3 to 1.6, depending on estimation methodology. Conclusions The principle of minimum work (defined by an exponent of 3) may not apply at the carotid bifurcation. Additional factors may play a role in the relationship between the radii of the parent and daughter vessels.

A significação aparente da ciência encontra-se nas intenções subjetivas dos próprios cientistas, cuja preocupação fundamental seria a busca do conhecimento,e nas intenções dos que elaboram a política científica, tendo em vista o aumento da produção de bens como decorrência da produção de conhecimentos.O cientista, no mundo atual, saiu da ficção neutralista e com ele a ciência. Por isso estamos diante de dois mitos da ciência: o mito da ciência-que-conduz-necessariamente-ao-progresso e o da ciência-pura-e-imaculada. Segundo o primeiro a ciência se expõe a ser julgada pelo valor social de seus resultados e de acordo com o segundo a ciência é seu próprio fim,não tendo que prestar contas a nenhuma instância exterior. Se há crise na ciência é porque os cientistas se interrogam sobre a significação e função reais, na sociedade, de seus trabalhos (H.B.) Abstract One can find the apparent meaning of science in the subjective intentions of the scientists themselves, in which the fundamental preocupation would be the search of knowledge, and in the intentions of those who are responsible for science policy, having in mind the growth of the produce of wealth as a resultof the produce of knowledge.Nowadays the neutrality was left out by the scientist and so was science. That's why we're facing the twomyths of science: the science that leads to progressand the pure and immaculate one. According to the first one science exposes itself to be judged by the social value of its results, whereas to the secondone science is not affected by any exterior instance. Whether there's a crisis in science it is because the scientists ask themselves about the real meaning and function of their works in society.(M.P.)