Análise da concordância da codificação de causa básica de óbito por acidentes de trânsito

OBJECTIVE: An evaluation of information researched as to basic underlying cause of death by traffic accidents and a comparison with codings attributed on the basis of death certificates. MATERIAL AND METHOD: The official coding of underlying cause of death on Death Certificates was compared with coding based on primary data obtained from five hospitals and accident reports. Kappa statistics with 95% CI were used to assess the agreement between the two coding systems. RESULTS: The research covered 1,719 patients, 57 of whom died. Of these 57 deaths, the official coding for 50 was obtained. Data showed an underreporting of deaths by traffic accidents, since 32% of the 50 deaths were coded as non-specific accidents (E 928.9). There were also 38% of deaths coded as non-specific traffic accidents (E 819.9). Using primary data, non-specific traffic accidents dropped to 4%, accidents to pedestrians (E 814.7) being responsible for 48% of deaths. The Kappa coefficient (0.124), with 95% confidence interval (-0.1533 - 0.4022) was calculated to assess the inter-rater reliability between the two codings, which was considered poor. CONCLUSION: It is concluded that coroners, who perform autopsies on casualties of traffic accidents, should dedicabe greater effort to filling out Death Certificates correctly.OBJETIVO: Avaliar a concordância de informações pesquisadas sobre causa básica de óbito por acidente de trânsito e compará-las com as codificações feitas a partir das Declarações de Óbitos. MATERIAL E MÉTODO: Foram estudados 50 óbitos por acidentes de trânsito ocorridos em 5 hospitais de Belo Horizonte, MG.Com base nas informações obtidas através de questionário procedeu-se à codificação da causa básica dos óbitos. A seguir foi feita análise de concordância entre esta classificação e a registrada na Declaração do Óbito. RESULTADOS: Foi calculado o Kappa (0,124) com intervalo de confiança 95% (-0,1533 - 0,4022), sendo considerada uma baixa concordância. Os dados mostraram também uma subclassificação de óbitos por acidentes de trânsito, uma vez que 32% dos 50 óbitos estudados foram codificados como acidentes não especificados (E928.9). CONCLUSÃO: Concluiu-se pela necessidade de haver maior esforço na melhoria do preenchimento da Declaração de Óbito pelos médicos legistas que realizam as necrópsias em mortes por acidentes de trânsito

Interrupção do acompanhamento clínico ambulatorial de pacientes infectados pelo HIV

OBJECTIVE: To determine factors associated with the interruption of outpatient care of HIV-positive patients. METHODS: Non-concurrent prospective study carried out in a public AIDS referral center in Belo Horizonte, Brazil. Medical records were reviewed in order to assess factors associated with the interruption of clinical care of HIV patients admitted between 1993 and 1995. Patients should have attended at least one follow-up visit within a period of 7 months. Statistical analysis was carried out using Chi-square and relative hazard (RH) with 95% confidence interval (CI) estimated by Cox Regression Model. RESULTS: Cumulative incidence of interruption was 54% among 517 patients included in the study (mean follow-up=24.6 months; 26.5/100 person-years). Multivariate analysis indicated that those individuals who had fewer (OBJETIVO: Determinar os fatores associados à interrupção do acompanhamento clínico ambulatorial de pacientes com infecção pelo HIV. MÉTODOS: Foi realizado um estudo do tipo prospectivo não-concorrente (coorte histórica) no município de Belo Horizonte, MG, em um ambulatório público de referência para atendimento de pacientes com infecção pelo HIV/Aids. Foram revisados registros médicos para se avaliar os fatores associados à interrupção do acompanhamento clínico por pacientes soropositivos para o HIV admitidos no serviço entre 1993 e 1995. Os pacientes deveriam ter comparecido a pelo menos uma consulta de retorno no prazo de sete meses. A análise estatística incluiu chi2 e Relative Hazard - RH com intervalo de 95% de confiança (IC) estimado pelo Modelo de Regressão de Cox. RESULTADOS: A incidência acumulada da interrupção do acompanhamento clínico foi de 54,3% entre os 517 pacientes incluídos no estudo (tempo médio de acompanhamento =24,6 meses; incidência pessoa tempo =26,5/100 pessoas-ano). A análise multivariada mostrou que realizar menos que duas contagens de linfócitos T CD4+ (RH =1.94; IC 95% =1.32-2.84) não realizar medida de carga viral (RH =14.94; IC 95% =5.44-41.04), comparecer a seis retornos ou menos (RH =2.80; IC 95% =1.89-4.14), não mudar de categoria clínica (RH =1.40; IC 95% =1.00-1.93) e não usar anti-retroviral, (RH =1.43; IC 95% =1.06-1.93) estava associado a um maior risco de interromper o acompanhamento clínico no serviço estudado. CONCLUSÕES: Foi alta a taxa de interrupção do acompanhamento clínico aos pacientes estudados, sugerindo que a interrupção do acompanhamento pode ser uma função que vise a priorizar os pacientes com pior situação clínica, podendo ser um marcador de futura aderência ao uso de anti-retroviral

Pydna: a simulation and documentation tool for DNA assembly strategies using python

Background: Recent advances in synthetic biology have provided tools to efficiently construct complex DNA molecules which are an important part of many molecular biology and biotechnology projects. The planning of such constructs has traditionally been done manually using a DNA sequence editor which becomes error-prone as scale and complexity of the construction increase. A human-readable formal description of cloning and assembly strategies, which also allows for automatic computer simulation and verification, would therefore be a valuable tool.Results: We have developed pydna, an extensible, free and open source Python library for simulating basic molecular biology DNA unit operations such as restriction digestion, ligation, PCR, primer design, Gibson assembly and homologous recombination. A cloning strategy expressed as a pydna script provides a description that is complete, unambiguous and stable. Execution of the script automatically yields the sequence of the final molecule(s) and that of any intermediate constructs. Pydna has been designed to be understandable for biologists with limited programming skills by providing interfaces that are semantically similar to the description of molecular biology unit operations found in literature.Conclusions: Pydna simplifies both the planning and sharing of cloning strategies and is especially useful for complex or combinatorial DNA molecule construction. An important difference compared to existing tools with similar goals is the use of Python instead of a specifically constructed language, providing a simulation environment that is more flexible and extensible by the user.Thanks to Dr. Aric Hagberg Los Alamos National Laboratory, U.S.A and Sergio Simoes, Universidade de Sao Paulo, Brasil for help with NetworkX and graph theory in general. Thanks to Henrik Bengtsson, Dept of Epidemiology & Biostatistics, University of California San Francisco, U.S.A. for critical reading of the manuscript. Thanks to the 2013 Bioinformatics 6605 N4 students A. Coelho, A. Faria, A. Neves D. Yelshyna and E. Costa for testing. This work was supported by the Fundacao para a Ciencia e Tecnologia (FCT) [PTDC/AAC-AMB/120940/2010, EXPL/BBB-BIO/1772/2013]; and the FEDER POFC-COMPETE [PEst-C/BIA/UI4050/2011]. FA and GR were supported by FCT fellowships [SFRH/BD/80934/2011 and SFRH/BD/42565/2007, respectively].info:eu-repo/semantics/publishedVersio

Cause-specific mortality for 249 causes in Brazil and states during 1990–2015 : a systematic analysis for the global burden of disease study 2015

Background: Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. Methods: We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. Results: There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. Conclusions: A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly

Merging Resource Availability with Isotope Mixing Models: The Role of Neutral Interaction Assumptions

Background: Bayesian mixing models have allowed for the inclusion of uncertainty and prior information in the analysis of trophic interactions using stable isotopes. Formulating prior distributions is relatively straightforward when incorporating dietary data. However, the use of data that are related, but not directly proportional, to diet (such as prey availability data) is often problematic because such information is not necessarily predictive of diet, and the information required to build a reliable prior distribution for all prey species is often unavailable. Omitting prey availability data impacts the estimation of a predator's diet and introduces the strong assumption of consumer ultrageneralism (where all prey are consumed in equal proportions), particularly when multiple prey have similar isotope values. Methodology: We develop a procedure to incorporate prey availability data into Bayesian mixing models conditional on the similarity of isotope values between two prey. If a pair of prey have similar isotope values (resulting in highly uncertain mixing model results), our model increases the weight of availability data in estimating the contribution of prey to a predator's diet. We test the utility of this method in an intertidal community against independently measured feeding rates. Conclusions: Our results indicate that our weighting procedure increases the accuracy by which consumer diets can be inferred in situations where multiple prey have similar isotope values. This suggests that the exchange of formalism for predictive power is merited, particularly when the relationship between prey availability and a predator's diet cannot be assumed for all species in a system.National Science Foundation (NSF) [DEB-0608178]U.S. Environmental Protection AgencyDepartment of EducationSigma XiUniversity of ChicagoFundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)(CAPES) Coordenacao de Aperfeicoamento de Pessoal de Nivel Superiori

Enhanced Astrocytic Nitric Oxide Production and Neuronal Modifications in the Neocortex of a NOS2 Mutant Mouse

BACKGROUND: It has been well accepted that glial cells in the central nervous system (CNS) produce nitric oxide (NO) through the induction of a nitric oxide synthase isoform (NOS2) only in response to various insults. Recently we described rapid astroglial, NOS2-dependent, NO production in the neocortex of healthy mice on a time scale relevant to neuronal activity. To explore a possible role for astroglial NOS2 in normal brain function we investigated a NOS2 knockout mouse (B6;129P2-Nos2(tm1Lau)/J, Jackson Laboratory). Previous studies of this mouse strain revealed mainly altered immune responses, but no compensatory pathways and no CNS abnormalities have been reported. METHODOLOGY/PRINCIPAL FINDINGS: To our surprise, using NO imaging in brain slices in combination with biochemical methods we uncovered robust NO production by neocortical astrocytes of the NOS2 mutant. These findings indicate the existence of an alternative pathway that increases basal NOS activity. In addition, the astroglial mutation instigated modifications of neuronal attributes, shown by changes in the membrane properties of pyramidal neurons, and revealed in distinct behavioral abnormalities characterized by an increase in stress-related parameters. CONCLUSIONS/SIGNIFICANCE: The results strongly indicate the involvement of astrocytic-derived NO in modifying the activity of neuronal networks. In addition, the findings corroborate data linking NO signaling with stress-related behavior, and highlight the potential use of this genetic model for studies of stress-susceptibility. Lastly, our results beg re-examination of previous studies that used this mouse strain to examine the pathophysiology of brain insults, assuming lack of astrocytic nitrosative reaction

Remediation of radioiodine using polyamine anion exchange resins

Two weak base anion exchange resins, Lewatit A365 and Purolite MTS9850, have been tested for the removal of aqueous iodide from conditions simulating nuclear waste reprocessing streams. pH variation and relevant co-contaminant addition (nitrate, molybdate and iodine) allowed for assessment of iodide extraction behaviour of each resin. Isotherm experiments were performed and maximum uptake capacities obtained exceed current industrial adsorbents, such as silver-impregnated zeolites. Maximum loading capacities, determined by Dubinin–Radushkevich isotherm, were 761 ± 14 mg g−1 for MTS9850 and 589 ± 15 mg g−1 for A365. Uptake for both resins was significantly suppressed by nitrate and molybdate ions. The presence of dissolved iodine in the raffinate however, was found to increase iodide uptake. This was explained by characterisation of the spent resin surface by infrared and Raman spectroscopy, which determined the presence of triiodide, indicating charge-transfer complex formation on the surface. Dynamic studies assessed the effect of co-contaminants on iodide uptake in a column environment. Data was fitted to three dynamic models, with the Dose-Response model providing the best description of breakthrough. In all cases iodide breakthrough was accelerated, indicating suppression of uptake, but capacity was still significant