Certificação de produtos orgânicos: obstáculos à implantação de um sistema participativo de garantia na Andaluzia, Espanha.

O trabalho analisa o processo de organização de produtores orgânicos da Andaluzia que estiveram envolvidos em uma tentativa de implantação de um sistema participativo de garantia. Esta iniciativa foi liderada pela administração dessa comunidade autônoma espanhola entre 2006 e 2008. O estudo baseia-se em entrevistas realizadas com atores sociais que estiveram implicados nesse processo, identificando os obstáculos políticos e organizativos que impediram que essa proposta pudesse avançar

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Multi-actor networks and innovation niches: university training for local Agroecological Dynamization

Unidad de excelencia María de Maeztu MdM-2015-0552The global environmental and social-economic crises of industrialized agriculture have led to the emergence of agroecology as an alternative approach aiming to increase the ecological, social and economic sustainability of agri-food systems. The 'multi-level perspective' is now a widely used framework to understand and promote the upscaling of local innovation niches, such as agroecology, to broader scales (e.g., regional, national, international), thus reconfiguring the dominant socio-technical regimes. Additionally, emergent 'hybrid forums' can provide a space between niche and regime where niche innovators can become important actors in scaling up and out emergent innovations. In this paper, we examine a university training program (Postgraduate Diploma in Local Agroecological Dynamization at the Universitat Autònoma de Barcelona), to better understand its role as a 'hybrid forum'. Our analysis focuses especially on how the program, as an example of a hybrid forum, worked to reconfigure practices, concepts, and tools of local development practitioners. We also assess to what extent the program contributed to transitioning local development institutions toward agroecology. An online survey (n = 46) and in-depth interviews (n = 16) were carried out to determine how the training program has impacted the student's opinions and their respective institutions. The results show that most of the students consider that they have acquired new theoretical frameworks and useful methods to re-framing their local development projects, that new alliances with multi-actor networks have been perceived, and that some internal changes of the local development practices have taken place. We conclude that the training program, as a hybrid forum, is capable of outscaling niche innovations through linkages with different kind of actors both from the niche and the regime. Political changes in the socio-technical landscape level offer an opportunity to amplify the impact of the innovations which are being generated by those multi-actor networks, but with a limited multi-level impact as far as institutional regime-actors not aligned with agroecological transition keep the most of the competencies on agri-food systems

Chagasic patients are able to respond against a viral antigen from influenza virus

<p>Abstract</p> <p>Background</p> <p><it>Trypanosoma cruzi,</it> the etiological agent of Chagas’ disease<it>,</it> is an obligate intracellular parasite which induces a CD8⁺ T cell immune response with secretion of cytokines and release of cytotoxic granules. Although an immune-suppressive effect of <it>T. cruzi</it> on the acute phase of the disease has been described, little is known about the capacity of CD8⁺ T cell from chronic chagasic patients to respond to a non-<it>T. cruzi</it> microbial antigen.</p> <p>Methods</p> <p>In the present paper, the frequency, phenotype and the functional activity of the CD8⁺ T cells specific from Flu-MP*, an influenza virus epitope, were determined in 13 chagasic patients and 5 healthy donors.</p> <p>Results</p> <p>The results show that Flu-MP* peptide specific CD8⁺ T cells were found with similar frequencies in both groups. In addition, Flu-MP* specific CD8⁺ T cells were distributed in the early or intermediate/late differentiation stages without showing enrichment of a specific sub-population. The mentioned Flu-MP* specific CD8⁺ T cells from chagasic patients were predominately T_EM (CCR7- CD62L-), producing IL-2, IFNγ, CD107a/b and perforin, and did not present significant differences when compared with those from healthy donors.</p> <p>Conclusions</p> <p>Our results support the hypothesis that there is no CD8⁺ T cell nonspecific immune-suppression during chronic Chagas disease infection. Nonetheless, other viral antigens must be studied in order to confirm our findings.</p

Participatory system of guarantees – PSG of the Red de Mercados Agroecológicos de Bogotá Región RMABR. A contribution to the sustainability of agroecological producers and markets

Following the development of a framework of sustainability indicators for the Red de Mercados Agroecológicos de Bogotá Región – RMABR, in 2016, it was identified, that only 56% of its producers were agroecological, while the remaining were mostly in the process of agroecological transition. To address this problem, this Participatory Action Research – PAR was carried out in 2016, which included the design, implementation, and evaluation of a PSG. The methodology was subdivided into five phases: participatory diagnosis, agreement on the same language, design of the Participatory System of Guarantees – PSG, pilot implementation, evaluation, and adjustment. The developed PSG encompasses a structure with a PSG committee and certification visiting teams; a justification, definition, and principles of agroecology; formats for participatory certification, agroecological transition plans, seal, and sanctions. PSG is operating, it is cheaper than the Third Party Certification – TPC, it allows certifying producers giving coherence to markets and confidence to consumers, promotes agroecology in producers and allows them to sell in local markets, and has generated cohesion in the RMABR

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams &amp; Wilkins