One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

INTRODUCTION: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. OBJECTIVES: We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. METHODS: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. RESULTS: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Follow-up all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term all-cause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60-0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. CONCLUSIONS: MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE

Outlying HII Regions in HI-Selected Galaxies

We present results from the first systematic search for outlying HII regions, as part of a sample of 96 emission-line point sources (referred to as ELdots - emission-line dots) derived from the NOAO Survey for Ionization in Neutral Gas Galaxies (SINGG). Our automated ELdot-finder searches SINGG narrow-band and continuum images for high equivalent width point sources outside the optical radius of the target galaxy (> 2 X r25 in the R-band). Follow-up longslit spectroscopy and deep GALEX images (exposure time > 1000 s) distinguish outlying HII regions from background galaxies whose strong emission lines ([OIII], Hbeta or [OII]) have been redshifted into the SINGG bandpass. We find that these deep GALEX images can serve as a substitute for spectroscopic follow-up because outlying HII regions separate cleanly from background galaxies in color-color space. We identify seven SINGG systems with outlying massive star formation that span a large range in Halpha luminosities corresponding to a few O stars in the most nearby cases, and unresolved dwarf satellite companion galaxies in the most distant cases. Six of these seven systems feature galaxies with nearby companions or interacting galaxies. Furthermore, our results indicate that some outlying HII regions are linked to the extended-UV disks discovered by GALEX, representing emission from the most massive O stars among a more abundant population of lower mass (or older) star clusters. The overall frequency of outlying HII regions in this sample of gas-rich galaxies is 8 - 11% when we correct for background emission-line galaxy contamination (~75% of ELdots).Comment: 20 pages, 14 Figures, Accepted by A

Primary healthcare and the construction of thematic health networks: what role can they play?

The enhancement of primary healthcare has been a core strategy for the empowerment of the Brazilian Unified Health System (SUS). Recent guidelines issued by OPAS and the Ministry of Health highlight the role it has played as a thematic communication network center, a regulating agent for the access and use of services required for comprehensive healthcare. Sponsored by PPSUS/Fapesp, this study examines the possibilities of the primary healthcare network exercising such a strategic function. Life narratives involving 15 regular users were produced in two cities of ABC Paulista, which have adopted the Family Health Strategy for the organization of their primary healthcare networks. The study presents three main findings: the primary healthcare network serves as an outpost of SUS by producing user values even for high complexity service users; the primary network is perceived is a place for simple care needs; there is shared impotence between users and teams when it comes to the network functioning as the coordinator of care, indicating that it does not possess the technological, operational and organizational material conditions or symbolic conditions (values, meanings, and representations) to be in a central position in the coordination of thematic healthcare networks.O fortalecimento da atenção básica tem sido valorizado como estratégia central para a construção do SUS. Diretrizes recentes emanadas pela OPAS e pelo MS destacam seu papel como centro de comunicação de redes temáticas, como reguladora do acesso e utilização dos serviços necessários para a integralidade do cuidado. O presente estudo, financiado com recursos PPSUS/Fapesp, problematiza as possibilidades da rede básica exercer tal função estratégica. Foram produzidas narrativas de vida de 15 usuários altamente utilizadores de serviços de saúde em dois municípios do ABC paulista, que adotaram a Estratégia de Saúde da Família para organização de suas redes básicas. O estudo apresenta três achados principais: a rede básica funciona como posto avançado do SUS, produzindo valores de uso mesmo para os pacientes utilizadores de serviços de alta complexidade; a rede básica é vista como lugar de coisas simples; há uma impotência compartilhada entre usuários e equipes quando se trata da rede básica funcionar como coordenadora do cuidado, indicando como ela não reúne condições materiais (tecnológicas, operacionais, organizacionais) e simbólicas (valores, significados e representações) de deter a posição central da coordenação das redes temáticas de saúde.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina PreventivaInstituto Superior de Ciências do Trabalho e da Empresa Instituto Universitário de Lisboa Faculdade de Ciências Médicas Departamento de Saúde ColetivaUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de Saúde ColetivaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL

Bologna process, higher education and a few considerations about the New University

O presente artigo analisa o que se convencionou chamar de Processo de Bolonha, isto é, a produção de uma “política pública de um meta-Estado para um meta-campo universitário”, constituindo-se em uma política educacional supranacional, comum aos estados-membros da União Européia, com vista à construção de um “espaço europeu de educação superior”. O processo político e de reformas institucionais, realizado por cada governo nacional, conduzirá ao estabelecimento efetivo do novo sistema europeu de educação superior até 2010, incluindo atualmente 45 países – todos os da UE e outros 18 países europeus não pertencentes a ela. Nesse sentido, por se tratar de um vastíssimo número de “subsistemas nacionais” e de instituições educativas, atribui-se um grande protagonismo às questões relativas à “garantia de qualidade”. Analisam-se, igualmente, as recentes transformações na educação superior no Brasil, em que o projeto da chamada “Universidade Nova” e o Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (REUNI) constituem-se nas manifestações mais claras do reordenamento desse nível de ensino (seguindo os parâmetros de Bolonha), que já experimentara grandes transformações nos governos de Fernando Henrique Cardoso (1995-2002) e teve prosseguimento nos governos de Luiz Inácio Lula da Silva (2003-2006; 2007), embora com distintos matizes.This article analyzes what is conventionally known as the Bologna Process, or the making of a “public policy of a meta-State for a University meta-field” that corresponds to a supranational educational policy for all the European Union membership States, with the goal of building a “European higher education space.” The political process and the institutional reforms of each national government intends to establish the new European higher education system until 2010, with 45 countries – the number reflects current developments, including the EU membership States and 18 non-EU countries. Given the high quantity and the myriads of “national subsystems” and educational institutions involved, “quality assurance” becomes a major task in this process. We analyze, in the same way, the recent higher education changes in Brazil, where the so-called “New University” project and the Program of Support for the Restructuring and Expansion of Brazilian Federal Universities (REUNI, in Portuguese) are the clearest expressions of the reshaping of the higher education system (in accordance with the Bologna standards) after the dramatic changes made by Fernando Henrique Cardoso´s government (1995-2002) and continued by Luiz Inácio Lula da Silva´s government (2003-2006; 2007), despite some differences between both administrations

High-level of viral genomic diversity in cervical cancers: a Brazilian study on human papillomavirus type 16

Invasive cervical cancer (ICC) is the third most frequent cancer among women worldwide and is associated with persistent infection by carcinogenic human papillomaviruses (HPVs). The combination of large populations of viral progeny and decades of sustained infection may allow for the generation of intra-patient diversity, in spite of the assumedly low mutation rates of PVs. While the natural history of chronic HPVs infections has been comprehensively described, within-host viral diversity remains largely unexplored. In this study we have applied next generation sequencing to the analysis of intra-host genetic diversity in ten ICC and one condyloma cases associated to single HPV16 infection. We retrieved from all cases near full-length genomic sequences. All samples analyzed contained polymorphic sites, ranging from 3 to 125 polymorphic positions per genome, and the median probability of a viral genome picked at random to be identical to the consensus sequence in the lesion was only 40%. We have also identified two independent putative duplication events in two samples, spanning the L2 and the L1 gene, respectively. Finally, we have identified with good support a chimera of human and viral DNA. We propose that viral diversity generated during HPVs chronic infection may be fueled by innate and adaptive immune pressures. Further research will be needed to understand the dynamics of viral DNA variability, differentially in benign and malignant lesions, as well as in tissues with differential intensity of immune surveillance. Finally, the impact of intralesion viral diversity on the long-term oncogenic potential may deserve closer attention.Funded by Grants # 2011/24035-2 and # 2012/23290-1, São Paulo Research Foundation (FAPESP

Identifying patterns of alumni commitment in key strategic relationship programmes

Higher education institutions (HEIs) need to understand their alumni when drawing strategic relationship programmes. This paper aims to identify clusters of alumni based on their commitment relationship and to analyse factors influencing their intention to collaborate with the HEI. The study took place at a Portuguese university, considering a dataset of 1075 of alumni asserting intention to collaborate. First, a cluster analysis was conducted to identify patterns of commitment relationship. Secondly, a logistic regression was run to identify determinants of intention to collaborate. Both techniques revealed the decisive role of HEI commitment in the process. Relationship advantages and positive feelings towards the HEI were also pointed out as important. Alumni asserted recommendations, further training, sharing experiences and giving help as ways to collaborate with HEI. Regression results suggest that sociodemographic variables such as gender, marital status and volunteering are significantly associated with a probability to collaborate. Results also show that affiliation in sororities/fraternities and participation in extracurricular activities are significantly associated with that collaborative intention. The findings provide clues to support strategic relationship programmes based on consistent marketing campaigns, while bringing value to the literature in the European context, where alumni culture requires real insights to evolve.info:eu-repo/semantics/publishedVersio

Expanding the knowledge about Leishmania species in wild mammals and dogs in the Brazilian savannah

Background: Wild, synanthropic and domestic mammals act as hosts and/or reservoirs of several Leishmania spp. Studies on possible reservoirs of Leishmania in different areas are fundamental to understand host-parasite interactions and develop strategies for the surveillance and control of leishmaniasis. In the present study, we evaluated the Leishmania spp. occurrence in mammals in two conservation units and their surroundings in Brasília, Federal District (FD), Brazil. Methods: Small mammals were captured in Brasília National Park (BNP) and Contagem Biological Reserve (CBR) and dogs were sampled in residential areas in their vicinity. Skin and blood samples were evaluated by PCR using different molecular markers (D7 24Sα rRNA and rDNA ITS1). Leishmania species were identified by sequencing of PCR products. Dog blood samples were subjected to the rapid immunochromatographic test (DPP) for detection of anti-Leishmania infantum antibodies. Results: 179 wild mammals were studied and 20.1% had Leishmania DNA successfully detected in at least one sample. Six mammal species were considered infected: Clyomys laticeps, Necromys lasiurus, Nectomys rattus, Rhipidomys macrurus, Didelphis albiventris and Gracilinanus agilis. No significant difference, comparing the proportion of individuals with Leishmania spp., was observed between the sampled areas and wild mammal species. Most of the positive samples were collected from the rodent N. lasiurus, infected by L. amazonensis or L. braziliensis. Moreover, infections by Trypanosoma spp. were detected in N. lasiurus and G. agilis. All 19 dog samples were positive by DPP; however, only three (15.8%) were confirmed by PCR assays. DNA sequences of ITS1 dog amplicons showed 100% identity with L. infantum sequence. Conclusions: The results suggest the participation of six species of wild mammals in the enzootic transmission of Leishmania spp. in FD. This is the first report of L. amazonensis in N. lasiurus

Variação do CO2 atmosférico e do efluxo de CO2 do solo em iPF na Amazônia.

O estudo teve como objetivo quantificar a concentração de dióxido de carbono (CO2) na atmosfera ([CO2]) e estimar o efluxo de CO2 do solo (Esolo) em um sistema de integração pecuária-floresta (iPF) no leste da Amazônia. Campanhas intensivas de 24 horas de medidas foram conduzidas nos períodos: (i) menos chuvoso de 2016, 2017 e 2018; (ii) chuvoso de 2017 e 2018, e, (iii) transição do chuvoso para menos chuvoso de 2017 e 2018, no município de Terra Alta, nordeste do Pará. Sistema de medição da [CO2] foram instalados em espécies florestais e na pastagem, e pontos no renque florestal e pastagem foram selecionados para a medição do Esolo. Uma torre meteorológica automática foi instalada na área para a obtenção de dados ancilares. A [CO2] apresentou variação temporal com menores valores durante o dia e maiores durante a noite. Houve maior [CO2] no período chuvoso e na transição do período chuvoso para menos chuvoso comparado ao menos chuvoso. O Esolo foi maior no interior do renque florestal e apresentou as maiores medidas no mesmo período que a [CO2]. A velocidade do vento e Esolo atuam de maneira diferente sobre a [CO2] a depender do período

Selected Schizosaccharomyces pombe Strains Have Characteristics That Are Beneficial for Winemaking

At present, wine is generally produced using Saccharomyces yeast followed by Oenococus bacteria to complete malolactic fermentation. This method has some unsolved problems, such as the management of highly acidic musts and the production of potentially toxic products including biogenic amines and ethyl carbamate. Here we explore the potential of the fission yeast Schizosaccharomyces pombe to solve these problems. We characterise an extensive worldwide collection of S. pombe strains according to classic biochemical parameters of oenological interest. We identify three genetically different S. pombe strains that appear suitable for winemaking. These strains compare favourably to standard Saccharomyces cerevisiae winemaking strains, in that they perform effective malic acid deacidification and significantly reduce levels of biogenic amines and ethyl carbamate precursors without the need for any secondary bacterial malolactic fermentation. These findings indicate that the use of certain S. pombe strains could be advantageous for winemaking in regions where malic acid is problematic, and these strains also show superior performance with respect to food safety