Year in review 2007: Critical Care – intensive care unit management

With the development of new technologies and drugs, health care is becoming increasisngly complex and expensive. Governments and health care providers around the world devote a large proportion of their budgets to maintaining quality of care. During 2007, Critical Care published several papers that highlight important aspects of critical care management, which can be subdivided into structure, processes and outcomes, including costs. Great emphasis was given to quality of life after intensive care unit stay, especially the impact of post-traumatic stress disorder. Significant attention was also given to staffing level, optimization of intensive care unit capacity, and drug cost-effectiveness, particularly that of recombinant human activated protein C. Managing costs and providing high-quality care simultaneously are emerging challenges that we must understand and meet

A visão de professores de Educação Física acerca dacapoeira na escola: uma análise de escolas de balneário Camboriú-SC

O presente estudo trata-se de uma pesquisa que buscou investigar as visões de professores de Educação Física acerca do conteúdo Capoeira em algunscentros educacionais do município de Balneário Camboriú, Santa Catarina. Sua efetivação se deu através de um estudo qualitativo de cunho descritivo –argumentativo, utilizando como técnica de coleta de dados, entrevistas semi estruturadas dirigida a uma amostra composta por três professores de Educação Física,atuantes cada qual, em seu ambiente escolar específico. Para fomentar essa abordagem procurou-se fazer uma análise documental, na tentativa de evidenciaralguns dos processos históricos e socioculturais das lutas. Conclui-se, que os docentes pesquisados não corroboram com a ideia de que a capoeira possapotencializar a violência se forem abordadas didático pedagogicamente. No entanto, ficou claro que este conhecimento ainda não é disponibilizado por todospesquisados por apresentarem alguns argumentos restritivos. Também se argumenta durante todo o trabalho a importância do desenvolvimento dos aspectoscognitivos, motor, afetivo e social dos educandos a respeito da aplicação do conteúdo no ambiente escolar

Probing the neutrino mass hierarchy and the 13-mixing with supernovae

We consider in details the effects of the 13-mixing (sin^2 theta_{13}) and of the type of mass hierarchy/ordering (sign[ Delta m^2_{13}]) on neutrino signals from the gravitational collapses of stars. The observables (characteristics of the energy spectra of nu_e and antinu_e events) sensitive to sin^2 theta_{13} and sign[Delta m^2_{13}] have been calculated. They include the ratio of average energies of the spectra, r_E = /, the ratio of widths of the energy distributions, r_Gamma, the ratios of total numbers of nu_e and antinu_e events at low energies, S, and in the high energy tails, R_{tail}. We construct and analyze scatter plots which show the predictions for the observables for different intervals of sin^2 theta_{13} and signs of Delta m^2_{13}, taking into account uncertainties in the original neutrino spectra, the star density profile, etc.. Regions in the space of observables r_E, r_Gamma, S, R_{tail} exist in which certain mass hierarchy and intervals of sin^2 theta_{13} can be identified or discriminated. We elaborate on the method of the high energy tails in the spectra of events. The conditions are formulated for which sin^2 theta_{13} can be (i) measured, (ii) restricted from below, (iii) restricted from above. We comment on the possibility to determine sin^2 theta_{13} using the time dependence of the signals due to the propagation of the shock wave through the resonance layers of the star. We show that the appearance of the delayed Earth matter effect in one of the channels (nu_e or antinu_e) in combination with the undelayed effect in the other channel will allow to identify the shock wave appeareance and determine the mass hierarchy.Comment: LaTeX, 56 pages, 12 figures; a few clarifications added; typos corrected. Version to appear in JCA

A hierarchical Bayesian approach to multiple testing in disease mapping

We propose a Bayesian approach to multiple testing in disease mapping. This study was motivated by a real example regarding the mortality rate for lung cancer, males, in the Tuscan region (Italy). The data are relative to the period 1995–1999 for 287 municipalities. We develop a tri-level hierarchical Bayesian model to estimate for each area the posterior classification probability that is the posterior probability that the municipality belongs to the set of non-divergent areas. We show also the connections of our model with the false discovery rate approach. Posterior classification probabilities are used to explore areas at divergent risk from the reference while controlling for multiple testing. We consider both the Poisson-Gamma and the Besag, York and Mollié model to account for extra Poisson variability in our Bayesian formulation. Posterior inference on classification probabilities is highly dependent on the choice of the prior. We perform a sensitivity analysis and suggest how to rely on subject-specific information to derive informative a priori distributions. Hierarchical Bayesian models provide a sensible way to model classification probabilities in the context of disease mapping

Dynamic Assessment of Baroreflex Control of Heart Rate During Induction of Propofol Anesthesia Using a Point Process Method

In this article, we present a point process method to assess dynamic baroreflex sensitivity (BRS) by estimating the baroreflex gain as focal component of a simplified closed-loop model of the cardiovascular system. Specifically, an inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by linear and bilinear bivariate regressions on both the previous R−R intervals (RR) and blood pressure (BP) beat-to-beat measures. The instantaneous baroreflex gain is estimated as the feedback branch of the loop with a point-process filter, while the RRBP feedforward transfer function representing heart contractility and vasculature effects is simultaneously estimated by a recursive least-squares filter. These two closed-loop gains provide a direct assessment of baroreflex control of heart rate (HR). In addition, the dynamic coherence, cross bispectrum, and their power ratio can also be estimated. All statistical indices provide a valuable quantitative assessment of the interaction between heartbeat dynamics and hemodynamics. To illustrate the application, we have applied the proposed point process model to experimental recordings from 11 healthy subjects in order to monitor cardiovascular regulation under propofol anesthesia. We present quantitative results during transient periods, as well as statistical analyses on steady-state epochs before and after propofol administration. Our findings validate the ability of the algorithm to provide a reliable and fast-tracking assessment of BRS, and show a clear overall reduction in baroreflex gain from the baseline period to the start of propofol anesthesia, confirming that instantaneous evaluation of arterial baroreflex control of HR may yield important implications in clinical practice, particularly during anesthesia and in postoperative care.National Institutes of Health (U.S.) (Grant R01-HL084502)National Institutes of Health (U.S.) (Grant K25-NS05758)National Institutes of Health (U.S.) (Grant DP2- OD006454)National Institutes of Health (U.S.) (Grant T32NS048005)National Institutes of Health (U.S.) (Grant T32NS048005)National Institutes of Health (U.S.) (Grant R01-DA015644)Massachusetts General Hospital (Clinical Research Center, UL1 Grant RR025758

Local perceptions of the relative contributions of enclave tourism and agritourism to community well-being: The case of Mauritius

To date, limited attention has been paid to the contribution of tourism to the well-being of island residents in general and to whether such well-being varies according to the nature of tourism development in particular. Specifically, island tourism is frequently manifested in resort-based enclave development, a form of tourism that is often criticised for its assumed limited benefits to the wider community. As a consequence, alternative approaches such as agritourism, are increasingly proposed as a means of enhancing community development and well-being yet the relative merits of enclave and agritourism have not been explored within an island tourism context. This paper addresses this notable gap in the literature. Drawing on a questionnaire-based survey in Mauritius, it considers and compares the perceptions of local people of the extent to which enclave tourism and agritourism contribute to their well-being. The results reveal that both types of tourism development contribute both positively and negatively to community well-being although enclave tourism is perceived to have fewer positive outcomes. On the one hand, enclave tourism provides valuable cultural opportunities but damages the environment, restricts entrepreneurship and favours local elites; on the other hand, agritourism, although not yet well-established in Mauritius, is perceived to positively enhance the cultural and social spheres of community life whilst supporting entrepreneurship

The Genome Sequence of Leishmania (Leishmania) amazonensis: Functional Annotation and Extended Analysis of Gene Models

We present the sequencing and annotation of the Leishmania (Leishmania) amazonensis genome, an etiological agent of human cutaneous leishmaniasis in the Amazon region of Brazil. L. (L.) amazonensis shares features with Leishmania (L.) mexicana but also exhibits unique characteristics regarding geographical distribution and clinical manifestations of cutaneous lesions (e.g. borderline disseminated cutaneous leishmaniasis). Predicted genes were scored for orthologous gene families and conserved domains in comparison with other human pathogenic Leishmania spp. Carboxypeptidase, aminotransferase, and 3'-nucleotidase genes and ATPase, thioredoxin, and chaperone-related domains were represented more abundantly in L. (L.) amazonensis and L. (L.) mexicana species. Phylogenetic analysis revealed that these two species share groups of amastin surface proteins unique to the genus that could be related to specific features of disease outcomes and host cell interactions. Additionally, we describe a hypothetical hybrid interactome of potentially secreted L. (L.) amazonensis proteins and host proteins under the assumption that parasite factors mimic their mammalian counterparts. the model predicts an interaction between an L. (L.) amazonensis heat-shock protein and mammalian Toll-like receptor 9, which is implicated in important immune responses such as cytokine and nitric oxide production. the analysis presented here represents valuable information for future studies of leishmaniasis pathogenicity and treatment.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, EPM UNIFESP, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 São Paulo, BrazilLNBio CNPEM, Lab Nacl Biociencias, Campinas, SP, BrazilLGE UNICAMP, Lab Genom & Expressao, Campinas, SP, BrazilInst Agron Campinas, Ctr Pesquisa & Desenvolvimento Recursos Geneti Ve, Campinas, SP, BrazilUniv Calif San Diego, Sch Med, Dept Pediat, San Diego, CA 92103 USAUniversidade Federal de São Paulo, UNIFESP, Dept Ciencia & Tecnol, Sao Jose Dos Campos, BrazilUniv N Carolina, Sch Med, Dept Genet, Chapel Hill, NC USAUniv Fed Minas Gerais, ICB UFMG, Inst Ciencias Biol, Dept Biol Geral, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, EPM UNIFESP, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Ciencia & Tecnol, Sao Jose Dos Campos, BrazilFAPESP: 07/50551-2FAPESP: 10/19335-4Web of Scienc

Expression QTLs Mapping and Analysis: A Bayesian Perspective.

The aim of expression Quantitative Trait Locus (eQTL) mapping is the identification of DNA sequence variants that explain variation in gene expression. Given the recent yield of trait-associated genetic variants identified by large-scale genome-wide association analyses (GWAS), eQTL mapping has become a useful tool to understand the functional context where these variants operate and eventually narrow down functional gene targets for disease. Despite its extensive application to complex (polygenic) traits and disease, the majority of eQTL studies still rely on univariate data modeling strategies, i.e., testing for association of all transcript-marker pairs. However these "one at-a-time" strategies are (1) unable to control the number of false-positives when an intricate Linkage Disequilibrium structure is present and (2) are often underpowered to detect the full spectrum of trans-acting regulatory effects. Here we present our viewpoint on the most recent advances on eQTL mapping approaches, with a focus on Bayesian methodology. We review the advantages of the Bayesian approach over frequentist methods and provide an empirical example of polygenic eQTL mapping to illustrate the different properties of frequentist and Bayesian methods. Finally, we discuss how multivariate eQTL mapping approaches have distinctive features with respect to detection of polygenic effects, accuracy, and interpretability of the results

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Self-Reported Wisdom and Happiness: An Empirical Investigation

Possible tensions between wisdom and happiness have been extensively debated in philosophy. Some regard wisdom as the 'supreme part of happiness', whereas other think that a more accurate and wiser view on reality might reduce happiness. Analyzing a Dutch internet survey of 7037 respondents, we discovered that wisdom and happiness were modestly positively related. Wisdom, measured with the Three-Dimensional Wisdom Scale (3D-WS), explained 9.2% of the variation in hedonic happiness. The correlation with the reflective dimension of wisdom was the strongest. In addition, wisdom was more important for happiness among adults with only an elementary education. Our results suggest that happiness and wisdom do not conflict