IDENTIFYING POTENTIAL REGIONS FOR A PRECIPITATION INDEX INSURANCE PRODUCT IN PARANÁ – BRAZIL: A HIERARCHICAL CLUSTERING APPROACH

In this article the availability and quality of public databases for soybean yields and daily rainfall in the state of Paraná in Brazil is assessed in order to verify the feasibility of an index insurance product. The multiple imputation by chained equations (MICE) method is utilized to fill missing values in the rainfall dataset and study the existence of spatial and temporal patterns in the data by means of hierarchical clustering. The results indicate that Paraná fulfills data requirements for a scalable weather index insurance with MICE and hierarchical clustering being effective tools in the pre-processing of precipitation data

Prevention of HIV/AIDS on the Home Front: Lessons Learned from our Global Neighbors

The Human Immunodeficiency Virus, or HIV, epidemic represents one of the greatest public health challenges of the late 20th and now, early 21st century. According to the World Health Organization (2013), approximately 70 million people have been infected with HIV worldwide since the beginning of the epidemic and approximately 35 million people have perished. To date, great strides have been made therapeutically in the creation and distribution of HIV antiretrovirals (ARVs) that can keep viral levels low in the infected individual thus prolonging his/her life expectancy; however, in the absence of an effective vaccine, prevention still is the most viable method of combating the pandemic. As the greatest burden of the epidemic lies outside the United States, there have been a plethora of prevention programs that have been launched internationally to combat HIV infection. Programs offering voluntary counseling and testing, condom distribution, needle/syringe exchange, and antiretroviral distribution have shown success in reducing HIV incidence in a wide range of geographic locations, including developing countries, where they have been launched. While many of the concepts of the programs are not new to the United States; to date, most prevention efforts have been sporadic and focused at the state or local level as opposed to federally-funded, evidence-based prevention programs on a national scale. Utilizing information gleaned from other countries, and especially developing countries, a series of recommendations are presented for how to improve HIV prevention efforts in the United States. Barriers to implementation of these ideas are also discussed and methods to overcome these barriers are presented, including social marketing, a field of study and practice that can be potentially utilized to launch prevention efforts in the communities of individuals that are most at risk.Master of Public Healt

International Technology Transfer of a GCLP-Compliant HIV-1 Neutralizing Antibody Assay for Human Clinical Trials

The Collaboration for AIDS Vaccine Discovery/Comprehensive Antibody – Vaccine Immune Monitoring Consortium (CAVD/CA-VIMC) assisted an international network of laboratories in transferring a validated assay used to judge HIV-1 vaccine immunogenicity in compliance with Good Clinical Laboratory Practice (GCLP) with the goal of adding quality to the conduct of endpoint assays for Human Immunodeficiency Virus I (HIV-1) vaccine human clinical trials. Eight Regional Laboratories in the international setting (Regional Laboratories), many located in regions where the HIV-1 epidemic is most prominent, were selected to implement the standardized, GCLP-compliant Neutralizing Antibody Assay for HIV-1 in TZM-bl Cells (TZM-bl NAb Assay). Each laboratory was required to undergo initial training and implementation of the immunologic assay on-site and then perform partial assay re-validation, competency testing, and undergo formal external audits for GCLP compliance. Furthermore, using a newly established external proficiency testing program for the TZM-bl NAb Assay has allowed the Regional Laboratories to assess the comparability of assay results at their site with the results of neutralizing antibody assays performed around the world. As a result, several of the CAVD/CA-VIMC Regional Laboratories are now in the process of conducting or planning to conduct the GCLP-compliant TZM-bl NAb Assay as an indicator of vaccine immunogenicity for ongoing human clinical trials

APLICAÇÃO DO MODELO STARIMA PARA DADOS DE TEMPERATURAS MINÍMAS MENSAIS

O clima tem grande influência nas culturas agrícolas e a temperatura é uma das principais variáveis que afetam seu desenvolvimento e sua produtividade final. A modelagem de dados de temperatura tem se tornado frequente, e este trabalho utiliza a classe de modelos autorregressivos integrados e de médias móveis espaço-temporais (STARIMA), para um conjunto de dados de temperaturas mínimas diárias coletadas na mesorregião Oeste do estado do Paraná, por ser um dos maiores produtores de grãos do país. Utilizando-se as etapas iterativas do método de Box e Jenkins (1970) para análise de séries temporais, concluiu-se que o modelo espaço-temporal STARIMA(1_1,0,1)x(1,1,1)_12 sazonal foi o mais adequado. É importante ressaltar que, o método para determinar a dependência espacial que trouxe melhores resultados foi o inverso da distância euclidiana, a matriz de variâncias e covariâncias dos resíduos, G, não apresentou esfericidade, e o programa computacional utilizado é o R Core Team (2017)

Macrophage Notch Ligand Delta-Like 4 Promotes Vein Graft Lesion Development, Implications for the Treatment of Vein Graft Failure

Objective—Despite its large clinical impact, the underlying mechanisms for vein graft failure remain obscure and no effective therapeutic solutions are available. We tested the hypothesis that Notch signaling promotes vein graft disease. Approach and Results—We used 2 biotherapeutics for Delta-like ligand 4 (Dll4), a Notch ligand: (1) blocking antibody and (2) macrophage- or endothelial cell (EC)–targeted small-interfering RNA. Dll4 antibody administration for 28 days inhibited vein graft lesion development in low-density lipoprotein (LDL) receptor-deficient (Ldlr−/−) mice, and suppressed macrophage accumulation and macrophage expression of proinflammatory M1 genes. Dll4 antibody treatment for 7 days after grafting also reduced macrophage burden at day 28. Dll4 silencing via macrophage-targeted lipid nanoparticles reduced lesion development and macrophage accumulation, whereas EC-targeted Dll4 small-interfering RNA produced no effects. Gain-of-function and loss-of-function studies suggested in vitro that Dll4 induces proinflammatory molecules in macrophages. Macrophage Dll4 also stimulated smooth muscle cell proliferation and migration and suppressed their differentiation. Conclusions—These results suggest that macrophage Dll4 promotes lesion development in vein grafts via macrophage activation and crosstalk between macrophages and smooth muscle cells, supporting the Dll4–Notch axis as a novel therapeutic target.United States. National Institutes of Health (R01HL107550)American Heart Association (0655878T)American Heart Association (12GRNT9510001)American Heart Association (12GRNT1207025)Good Samaritan FoundationShapiro Family Foundatio

The Magnetoelastic Distortion of Multiferroic BiFeO3_3 in the Canted Antiferromagnetic State

Using THz spectroscopy, we show that the spin-wave spectrum of multiferroic BiFeO$_3$ in its high-field canted antiferromagnetic state is well described by a spin model that violates rhombohedral symmetry. We demonstrate that the monoclinic distortion of the canted antiferromagnetic state is induced by the single-ion magnetoelastic coupling between the lattice and the two nearly anti-parallel spins. The revised spin model for BiFeO$_3$ contains two new single-ion anisotropy terms that violate rhombohedral symmetry and depend on the direction of the magnetic field.Comment: 28 pages (main & supplementary), 2 figures (main article), 15 figures (supplementary material

500.05 Comparison Between Fractional Flow Reserve (FFR) vs. Computational Fractional Flow Reserve Derived from Three-dimensional Intravascular Ultrasound (IVUSFR) and Quantitative Flow Ratio (QFR)

BACKGROUND The determination of the ischemic status of a coronary artery by wireless physiologic assessment derived from angiography has been validated and approved in the US. However, the use ofplain angiography quantitative variables does not add much to thephysiology data since it has low correlation with fractional flowreserve (FFR) and predicts clinical outcomes poorly. Recently, a grayscale intravascular ultrasound (IVUS) derived physiology method(IVUSFR) was developed and showed a good correlation with invasiveFFR by combining the geometric advantages of IVUS with physiology.The aim of this study is to assess the coefficient of correlation (R) ofinvasive FFR compared to IVUSFR and quantitative flow ratio (QFR).METHODS Stable coronary artery disease (CAD) patients with intermediate lesions (i.e. 40?80% of diameter stenosis) were assessed by angiography and IVUS. QFR was derived from the angiography images, andIVUSFR was derived from quantitative IVUS data using computationalfluid dynamics. Coefficient of correlation (R) was used in this report.RESULTS Twenty-four patients with 34 lesions were included in theanalysis. The IVUSFR, invasive FFR, Vessel QFR fixed flow (vQFRf),and Vessel QFR contrast flow (vQFRc) values varied from 0.52 to 1.00,0.71 to 0.99, 0.55 to 1.00, and 0.34 to 1.00, respectively. The coefficient of correlation (R) of FFR vs. IVUSFR was 0.79; FFR vs. vQFRf was0.72; FFR vs. vQFRc was 0.65 (Figure).CONCLUSION Compared to invasive FFR, IVUSFR and vQFRf showed asimilar coefficient of correlation and were better than vQFR contrast flowFil: Kajita, Alexandre. Medstart; Estados UnidosFil: Bezerra, Cristiano Guedes. Universidade Federal da Bahia; BrasilFil: Ozaki, Yuichi. Medstart; Estados UnidosFil: Dan, Kazuhiro. Medstart; Estados UnidosFil: Melaku, Gebremedhin D.. Medstart; Estados UnidosFil: Pinton, Fabio A.. Universidade de Sao Paulo; BrasilFil: Falcão, Breno A. A.. Hospital of Messejana; BrasilFil: Mariani, José. Universidade de Sao Paulo; BrasilFil: Bulant, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. National Laboratory For Scientific Computing; BrasilFil: Maso Talou, Gonzalo Daniel. National Laboratory For Scientific Computing; BrasilFil: Esteves, Antonio. Universidade de Sao Paulo; BrasilFil: Blanco, Pablo Javier. National Laboratory For Scientific Computing; BrasilFil: Waksman, Ron. Medstart; Estados UnidosFil: Garcia Garcia, Hector M.. Medstart; Estados UnidosFil: Lemons, Pedro Alves. Universidade de Sao Paulo; Brasi

Perception and comprehension of concepts of the Brazilian Food Insecurity Scale in indigenous communities in the state of Amazonas, Brazil

OBJECTIVE: The objective was to evaluate the perception and comprehension of concepts and terminology related to food security and insecurity, especially those that comprise the Brazilian Food Insecurity Scale, in the context of indigenous socio-cultural reality. METHODS: Qualitative research techniques were used in Cacau, Flexeira and Mamori indigenous communities located in the Médio Juruá watershed, in the municipalities of Envira and Eirunepé (AM). The methods were based on a methodology used previously in Brazil and adapted to the present context in a meeting of specialists familiar with these indigenous communities. Next, focus groups were organized in each one of the three communities, with a total of 18 participants. RESULTS: Hunger appeared as a phenomenon experienced frequently by the participants. Many of the concepts and terms, such as food security, hunger, and good food, were well-understood, but others, such as varied food, sufficient food strategies to avoid problems with food were not. Everyday life depends on family relations that allow exchanges, which differs from studies conducted previously in urban and rural areas, where difficulties related to access to food were due to lack of financial resources. The subject of trading, or exchanges, appeared often during the focus groups, as well as a collective aspect of the experience of food security that had not emerged previously in focus groups conducted as part of the Brazilian Food Insecurity Scale validation. CONCLUSION: More in-depth qualitative and quantitative studies are needed to develop a food security measurement instrument that reflects the reality of these indigenous communities while, at the same time, provides results that are comparable to other indigenous communities as well as to results obtained using the Brazilian Food Insecurity Scale in other populations. To apprehend the situation of food security in these grups is necessary an instrument that takes into consideration the question of trading/exchange, the collective aspect, and the importance of the environment in their experiences related to food security and insecurity. It is recommended that, if questionnaires are to be used, that they should be kept as short and simple as possible.OBJETIVO: Este estudo teve como objetivo avaliar a percepção e a compreensão de conceitos e terminologia da segurança e insegurança alimentar, especialmente os que compõem a Escala Brasileira de Insegurança Alimentar, no contexto da realidade sócio-cultural indígena. MÉTODOS: Foram utilizados recursos de pesquisa qualitativa para a abordagem das comunidades indígenas Cacau, Flexeira e Mamori, situadas na bacia hidrográfica do Médio Juruá, nos municípios de Envira e Eirunepé (AM), baseando-se em metodologia já previamente utilizada no Brasil e adaptada ao presente contexto, em uma reunião com especialistas da área. Em seguida foram organizados grupos focais, com 18 participantes das três comunidades indígenas. RESULTADOS: A fome apareceu como situação vivenciada por muitos dos participantes dos grupos focais das três comunidades estudadas. Os conceitos e as terminologias como segurança alimentar, fome e comida boa foram bem compreendidos, no entanto, comida variada, comida suficiente e estratégia para evitar problemas com comida foram conceitos não compreendidos por eles. A rotina de vida desses povos baseia-se nas relações familiares que permitem trocas, diferindo de outros grupos focais da área urbana e rural, conduzidos como parte da validação da Escala Brasileira de Insegurança Alimentar, nos quais a dificuldade de acesso aos alimentos era conseqüência da falta de recursos financeiros. CONCLUSÃO: São necessários novos e aprofundados estudos, qualitativos e quantitativos, para o desenvolvimento de um instrumento de mensuração de insegurança alimentar que reflita a realidade desses povos, ao mesmo tempo em que busquem fornecer resultados comparáveis com aqueles de outros povos indígenas e mesmo os obtidos pela Escala Brasileira de Insegurança Alimentar em outras populações. Será necessário um instrumento que contemple a questão da troca, o aspecto coletivo, a importância e o uso do ambiente nas experiências de segurança ou insegurança alimentar. Sugere-se ainda que, para estudos quantitativos, o questionário deva ser mais resumido e simples.53s63

Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

<p>Abstract</p> <p>Background</p> <p>Sternal instability with mediastinitis is a very serious complication after median sternotomy. Biomechanical studies have suggested superiority of rigid plate fixation over wire cerclage for sternal fixation. This study tests the hypothesis that sternal closure stability can be improved by adding plate fixation in a human cadaver model.</p> <p>Methods</p> <p>Midline sternotomy was performed in 18 human cadavers. Four sternal closure techniques were tested: (1) approximation with six interrupted steel wires; (2) approximation with six interrupted cables; (3) closure 1 (wires) or 2 (cables) reinforced with a transverse sternal plate at the sixth rib; (4) Closure using 4 sternal plates alone. Intrathoracic pressure was increased in all techniques while sternal separation was measured by three pairs of sonomicrometry crystals fixed at the upper, middle and lower parts of the sternum until 2.0 mm separation was detected. Differences in displacement pressures were analyzed using repeated measures ANOVA and Regression Coefficients.</p> <p>Results</p> <p>Intrathoracic pressure required to cause 2.0 mm separation increased significantly from 183.3 ± 123.9 to 301.4 ± 204.5 in wires/cables alone vs. wires/cables plus one plate respectively, and to 355.0 ± 210.4 in the 4 plates group (p < 0.05). Regression Coefficients (95% CI) were 120 (47–194) and 142 (66–219) respectively for the plate groups.</p> <p>Conclusion</p> <p>Transverse sternal plating with 1 or 4 plates significantly improves sternal stability closure in human cadaver model. Adding a single sternal plate to primary closure improves the strength of sternal closure with traditional wiring potentially reducing the risk of sternal dehiscence and could be considered in high risk patients.</p