Mortalidade infantil em município da região Centro-Oeste Paulista, Brasil, 1990 a 1992

INTRODUÇÃO: A mortalidade infantil em Presidente Prudente, SP (Brasil), foi estudada no período de 1990 a 1992, a partir de aplicação de métodos para obtenção de diagnóstico coletivo que orientassem a identificação e escolha de estratégias de controle de problemas locais. MATERIAL E MÉTODO: Foram utilizadas declarações de óbito colhidas no cartório, cujos dados originais foram corrigidos por meio de pesquisa documental nos serviços de saúde e entrevistas domiciliares. Para estudar variáveis como idade materna e peso ao nascer foram utilizados os dados do Sistema de Informações sobre Nascidos Vivos (SINASC). A qualidade dos dados originais das declarações de óbitos foi inicialmente analisada pela quantidade de informações, sensibilidade, especificidade e valor de Kappa. RESULTADO: A sensibilidade global para a causa básica de óbito foi 78,84% e Kappa igual a 71,32 para o total de causas. Ocorreram 189 óbitos, sendo 66,15% no período neonatal (41,28% durante o primeiro dia de vida) e 33,85% no infantil tardio. O peso ao nascer de 58,28% dos óbitos foi menor que 2.500g. As causas básicas de óbito foram estudadas segundo a possibilidade de serem prevenidas (método desenvolvido por Erica Taucher) por grupos de causas reduzidas utilizadas no International Collaborative Effort (ICE), causas múltiplas e distribuição geográfica. Observou-se que nos óbitos ocorridos até 27 dias, 22,23% poderiam ser evitados por adequada atenção ao parto, 20,64% seriam redutíveis por diagnóstico e tratamento precoce, 13,75% por bom controle da gravidez e apenas 7,94% não evitáveis. Das mortes ocorridas no período infantil tardio, 12,17% foram classificadas como outras preveníveis e 4,23% foram consideradas não evitáveis. Segundo os grupos do ICE, 58,74% faleceram por imaturidade ou asfixias; 19,58% por infecções e, 12,17%, por anomalias congênitas. CONCLUSÃO: Os resultados sugerem prioridade para assistência obstétrica no trabalho de parto e atenção pediátrica por baixo peso ao nascer, entre outras. A análise por causas múltiplas mostra que 76,05% dos óbitos têm as causas básicas relacionadas a causas perinatais e confirma a relação entre as deficiências de peso e as complicações respiratórias do recém-nascido. As complicações maternas também relacionaram-se com o baixo peso. Identificaram-se grandes diferenças no coeficiente de mortalidade infantil entre as áreas da zona urbana não somente restritas aos valores, como também ao tipo de doenças responsáveis pela ocorrência do óbito. Conclui-se haver vantagem no uso associado das quatro técnicas que são complementares, tanto para estudo, como para planejamento de ações dirigidas à prevenção da mortalidade infantil.

Sensitivity analysis by neural networks applied to power systems transient stability

This work presents a procedure for transient stability analysis and preventive control of electric power systems, which is formulated by a multilayer feedforward neural network. The neural network training is realized by using the back-propagation algorithm with fuzzy controller and adaptation of the inclination and translation parameters of the nonlinear function. These procedures provide a faster convergence and more precise results, if compared to the traditional back-propagation algorithm. The adaptation of the training rate is effectuated by using the information of the global error and global error variation. After finishing the training, the neural network is capable of estimating the security margin and the sensitivity analysis. Considering this information, it is possible to develop a method for the realization of the security correction (preventive control) for levels considered appropriate to the system, based on generation reallocation and load shedding. An application for a multimachine power system is presented to illustrate the proposed methodology. (c) 2006 Elsevier B.V. All rights reserved.

Preliminary Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus

Objective. To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE).Methods. Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein: creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets.Results. The highest-ranked candidate criteria considered absolute changes (Delta) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 x Delta SLEDAI + 0.45 x Delta P:C ratio + 0.5 x Delta MD-global + 0.02 x Delta ESR), where values of >= 1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 x Delta BILAG + Delta 0.65 x Delta P:C ratio + 0.5 + Delta MD-global + 0.02 x Delta ESR) of >= 1.15 were diagnostic of a flare. Flare scores increased with flare severity.Conclusion. Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.

A comparison of global estimates of marine primary production from ocean color

The third primary production algorithm round robin (PPARR3) compares output from 24 models that estimate depth-integrated primary production from satellite measurements of ocean color, as well as seven general circulation models (GCMs) coupled with ecosystem or biogeochemical models. Here we compare the global primary production fields corresponding to eight months of 1998 and 1999 as estimated from common input fields of photosynthetically-available radiation (PAR), sea-surface temperature (SST), mixed-layer depth, and chlorophyll concentration. We also quantify the sensitivity of the ocean-color-based models to perturbations in their input variables. The pair-wise correlation between ocean-color models was used to cluster them into groups or related output, which reflect the regions and environmental conditions under which they respond differently. The groups do not follow model complexity with regards to wavelength or depth dependence, though they are related to the manner in which temperature is used to parameterize photosynthesis. Global average PP varies by a factor of two between models. The models diverged the most for the Southern Ocean, SST under 10 degrees C, and chlorophyll concentration exceeding 1 mg Chlm(-3). Based on the conditions under which the model results diverge most, we conclude that current ocean-color-based models are challenged by high-nutrient low-chlorophyll conditions, and extreme temperatures or chlorophyll concentrations. The GCM-based models predict comparable primary production to those based on ocean color: they estimate higher values in the Southern Ocean, at low SST, and in the equatorial band, while they estimate lower values in eutrophic regions (probably because the area of high chlorophyll concentrations is smaller in the GCMs). Further progress in primary production modeling requires improved understanding of the effect of temperature on photosynthesis and better parameterization of the maximum photosynthetic rate. (c) 2006 Elsevier Ltd. All rights reserved.

The pre-emptive effect of epidural ketamine on wound sensitivity in horses tested by using von Frey filaments

Objective To evaluate the pre-emptive analgesic effect of pre-incisional epidural ketamine.Study Design A blinded, randomized experimental study.Animals Sixteen mixed breed mares, 17.6 +/- 2.8 years old, weighing 352 +/- 32 kg.Methods In a pilot study, an incision was made on one lateral thigh using a lidocaine block and no further analgesics, and it was verified that the nociceptive threshold was lower on the incised side than nonincised side (p < 0.05), and that von Frey filaments evoked a pain response. The 16 animals were divided into group A (ketamine, n = 9) and B (saline, n = 7). An epidural catheter was inserted 24 hours before the trials, the thigh was shaved bilaterally, and the right side was blocked (incised side) using lidocaine. Twenty-five minutes later, ketamine (A) or saline (B) was administered epidurally. Five minutes later, a 10-cm. skin incision was made on the right side, and then sutured. Nociceptive threshold was determined with von Frey filaments at 1, 3, and 5 cm. around the incision at 15-minute intervals for 2 hours, then at 4, 6, and 8 hours. Behavioral alterations, heart and respiratory rates were recorded. Nociceptive thresholds from these points were averaged to obtain mean values at each time, converted to a logarithmic scale, and submitted to a nonparametric analysis (Mann-Whitney and one-way repeated measures anova test,p less than or equal to 0.05).Results After 8 hours, the global range score revealed reduced hyperalgesia (p < 0.01) around the incision in 92% (4.65-4.27) of evaluated intervals in group A (ketamine). There were no significant changes in behavior, heart and respiratory rates,Conclusions It was concluded that pre-emptive epidural ketamine reduced post-incisional pain in the horse, and that von Frey filaments were able to quantify cutaneous sensitivity after tissue damage.Clinical relevance Epidural ketamine injection can reduce post-incisional sensitivity in the horse.

O Uso da informação visual global e local no controle da postura e do timing durante a tarefa de agarrar um objeto em aproximação

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Future e(+)e(-) colliders' sensitivity to Hb(b)over-bar coupling and CP violation

A complete analysis of the sensitivity to new Hbb̄ couplings from the process e+e- → bb̄vv̄ at the next generation of linear colliders was performed. These new couplings were predicted by many extensions of the Standard Model. The results are comparable to the study performed previously where a global fit analysis for L=500 fb-1 and √s=500 GeV resulted in a relative accuracy of 2.2% in the gHbb Yukawa coupling.