Operativni sustav za prognoziranje hipoksije u sjevernom Jadranu

The northern Adriatic Sea (NA), the northernmost region of the Mediterranean Sea, is affected by strong anthropogenic pressure (e.g., tourism, fisheries, maritime traffic, discharge from agriculture and industry), superimposed to a large river runoff. The consequent pressure exerted on the NA ecosystem either triggers or worsens massive mucilage insurgence, harmful algal blooms, eutrophication and even anoxic/hypoxic events. This work focuses on the anoxic/hypoxic events. During the summer-autumn period, the NA is often exposed to these events, which can be categorised as either coastal (relatively frequent south of the Po River delta during the summer) and offshore (rare, affecting wider areas). In order to improve our knowledge about these processes and to meet the needs of local governments and decision makers, an operational system for monitoring and forecasting anoxic and hypoxic events has been set up in the framework of the EU LIFE "EMMA" project. The system is composed of a meteo-oceanographic buoy; a numerical prediction system based on the Regional Ocean Modelling System (ROMS), including a Fasham-type module for biogeochemical fluxes; and periodic oceanographic surveys. Every day since June 2007, the system provides 3-hourly forecasts of marine currents, thermohaline and biogeochemical fields for the incoming three days. The system has demonstrated its ability to produce accurate temperature forecasts and relatively good salinity and dissolved oxygen forecasts. The Root Mean Square Error of the dissolved oxygen forecast was largely due to the mean bias. The system is currently being improved to include a better representation of benthic layer biogeochemical processes and several adjustments of the model. While developing model improvements, dissolved oxygen forecasts were improved with the removal of the 10-day mean bias.Sjeverni Jadran (NA), najsjeverniji dio Sredozemnog mora, pod utjecajem je jakog antropogenog djelovanja (poput turizma, ribarenja, morskog prometa, istjecanje onečišćujućih tvari u poljoprivredi i industriji) te dodatno, velikog dotoka rijeka. Posljedično, djelovanje na NA ekosustav potiče ili pojačava uzdizanje sluzavih nakupina, štetno cvjetanje algi, eutrofikaciju pa čak i događaje anoksije/hipoksije. Ovaj se rad fokusira na anoksiju/hipoksiju. Tijekom ljetno-jesenskog razdoblja, NA je često izložen ovim doga|ajima, koji se mogu kategorizirati kao obalni (relativno učestali južno od delte rijeke Po ljeti) ili udaljeni od obale (rijetki, zahvaćajući šira područja). Kako bi poboljšali poznavanje tih procesa te zbog potreba lokalne uprave, uspostavljen je operativni sustav za praćenje i prognoziranje anoksije i hipoksije u okviru EU LIFE "EMMA" projekta. Sustav se sastoji od meteorološko-oceanografske plutače; sustava za numeričku prognozu, koji se temelji na regionalnom oceanografskom modelu (ROMS), uključujući modul Fasham-tipa za biogeokemijske tokove; i periodičnim oceanografskim istraživanjima. Svakog dana, počev od lipnja 2007, sustav omogućava 3-satne prognoze morskih struja te termohalina i biogeokemijska polja za sljedeća tri dana. Sustav se pokazao sposobnim za davanje točnih prognoza temperature i relativno dobrih prognoza saliniteta i otopljenog kisika. Korijen srednje kvadratne pogreške prognoziranog otopljenog kisika postojao je uglavnom zbog srednje pristranosti (biasa). Sustav je trenutno poboljšan tako da uključuje bolji prikaz biogeokemijskih procesa u području sloja bentosa i nekoliko prilagodba modela. Tijekom poboljšavanja modela, uklanjanjem 10-dnevne srednje pristranosti (biasa) poboljšane su prognoze otopljenog kisika

Real Time Marine Data Acquisition: The Coastal Oceanographic Observatory Network in the Adriatic sea.

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Situação epidemiológica das meningites por haemophilus influenzae b na Direção Regional de Piracicaba - São Paulo

O presente estudo objetivou caracterizar a população acometida por meningites por Hib em relação às variáveis demográficas e relativas ao processo saúde-doença, no período de 1992 a 2001, na DIR de Piracicaba, SP, Brasil. Os dados foram coletados a partir de fichas de notificação compulsória, sendo sistematizados através do Programa SINAN. Observou-se que ocorreu um pico de incidência da doença em 1994, e um pico de óbitos em 1999, anteriores à introdução da vacina. Os mais acometidos foram crianças menores de 5 anos, do sexo masculino, confirmando dados de literatura. A maioria dos pacientes foi atendida em unidades hospitalares públicas de Piracicaba e Limeira, referências para as comunidades desses municípios, concretizando um dos princípios do Sistema Único de Saúde (SUS): a regionalização. A introdução da vacina promoveu redução dos casos em cerca de 73%, o que corrobora a sua importância e impele à necessidade de estimular a adesão à vacinação.El presente estudio objetivó caracterizar la población afectada por meningitis causada por Hib en relación a las variables demográficas y relativas al proceso salud-enfermedad, en el período de 1992 a 2001 en la DIR de Piracicaba, SP, Brasil. Los datos fueron recolectados a partir de fichas de notificación obligatorias, las cuales fueron sistematizadas a través del programa SINAN. Se observó que ocurrió un pico de incidencia de la enfermedad en 1994 y un pico de fallecimientos en 1999, con antelación a la introducción de la vacuna. Los más afectados fueron niños menores de 5 años, de sexo masculino, confirmando datos de la bibliografía. La mayoría de los pacientes fue atendida en unidades hospitalarias públicas de Piracicaba y Limeira, referenciales para las comunidades de tales municipios, concretando uno de los principios del Sistema Único de Salud (SUS): su regionalización. La introducción de la vacuna promovió la reducción de casos en cerca del 73%, lo que corrobora su importancia e impulsa la necesidad de estimular la adhesión a la vacunación.The objective of the present study was to characterize the population affected by Hib meningitis from 1992 to 2001, in the Regional Health Board of Piracicaba (São Paulo-Brazil) in terms of variables regarding demographics and the health-disease process. Data were collected from disease notification reports, and arranged using the SINAN Data Program . It was observed there was a peak in the incidence of meningitis in 1994 and a peak of deaths in 1999, before the vaccine had been introduced. The most affected group were male children under the age of 5 years, which is in agreement with literature. Most patients received care at public hospitals in the municipalities of Piracicaba and Limeira, which are references for the community of the entire region, which puts into effect one of the axes of the Health System of Brazil (SUS): regionalization. The introduction of the vaccine reduced incidence in about 73%, which corroborates its importance and shows that is necessary to encourage adherence to vaccination

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis.

Background Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. Methods and Results Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions Six-month mortality after IE is 25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in I

Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil

<p>Abstract</p> <p>Background</p> <p>Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil.</p> <p>Methods</p> <p>Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004–2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method.</p> <p>Results</p> <p>A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%–0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%–0.14%). Black women had a 4.9-fold (95% CI 1.42–16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928.</p> <p>Conclusion</p> <p>The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.</p