Improving outcome of childhood bacterial meningitis by simplified treatment : Experience from Angola

Background Acute bacterial meningitis (BM) continues to be an important cause of childhood mortality and morbidity, especially in developing countries. Prognostic scales and the identification of risk factors for adverse outcome both aid in assessing disease severity. New antimicrobial agents or adjunctive treatments - except for oral glycerol - have essentially failed to improve BM prognosis. A retrospective observational analysis found paracetamol beneficial in adult bacteraemic patients, and some experts recommend slow β-lactam infusion. We examined these treatments in a prospective, double-blind, placebo-controlled clinical trial. Patients and methods A retrospective analysis included 555 children treated for BM in 2004 in the infectious disease ward of the Paediatric Hospital of Luanda, Angola. Our prospective study randomised 723 children into four groups, to receive a combination of cefotaxime infusion or boluses every 6 hours for the first 24 hours and oral paracetamol or placebo for 48 hours. The primary endpoints were 1) death or severe neurological sequelae (SeNeSe), and 2) deafness. Results In the retrospective study, the mortality of children with blood transfusion was 23% (30 of 128) vs. without blood transfusion 39% (109 of 282; p=0.004). In the prospective study, 272 (38%) of the children died. Of those 451 surviving, 68 (15%) showed SeNeSe, and 12% (45 of 374) were deaf. Whereas no difference between treatment groups was observable in primary endpoints, the early mortality in the infusion-paracetamol group was lower, with the difference (Fisher s exact test) from the other groups at 24, 48, and 72 hours being significant (p=0.041, 0.0005, and 0.005, respectively). Prognostic factors for adverse outcomes were impaired consciousness, dyspnoea, seizures, delayed presentation, and absence of electricity at home (Simple Luanda Scale, SLS); the Bayesian Luanda Scale (BLS) also included abnormally low or high blood glucose. Conclusions New studies concerning the possible beneficial effect of blood transfusion, and concerning longer treatment with cefotaxime infusion and oral paracetamol, and a study to validate our simple prognostic scales are warranted.

A POSSIBLE EVOLUTIONARY SCENARIO OF HIGHLY MAGNETIZED SUPER-CHANDRASEKHAR WHITE DWARFS: PROGENITORS OF PECULIAR TYPE Ia SUPERNOVAE

Several recently discovered peculiar Type Ia supernovae seem to demand an altogether new formation theory that might help explain the puzzling dissimilarities between them and the standard Type Ia supernovae. The most striking aspect of the observational analysis is the necessity of invoking super-Chandrasekhar white dwarfs having masses similar to 2.1-2.8 M-circle dot, M-circle dot being the mass of Sun, as their most probable progenitors. Strongly magnetized white dwarfs having super-Chandrasekhar masses have already been established as potential candidates for the progenitors of peculiar Type Ia supernovae. Owing to the Landau quantization of the underlying electron degenerate gas, theoretical results yielded the observationally inferred mass range. Here, we sketch a possible evolutionary scenario by which super-Chandrasekhar white dwarfs could be formed by accretion on to a commonly observed magnetized white dwarf, invoking the phenomenon of flux freezing. This opens multiple possible evolution scenarios ending in supernova explosions of super-Chandrasekhar white dwarfs having masses within the range stated above. We point out that our proposal has observational support, such as the recent discovery of a large number of magnetized white dwarfs by the Sloan Digital Sky Survey.

Doenças emergentes e condições de trabalho de enfermagem: um estudo de caso durante a pandemia de H1N1 no Rio de Janeiro

As doenças infecto-parasitárias, ainda hoje, em pleno século XXI são responsáveis por uma quantidade generosa de morbidade e mortalidade no Brasil e no mundo. Muitas delas são amplamente influenciadas pelas mudanças climáticas que estão ocorrendo em todo o planeta fazendo com que sua incidência e distribuição geográfica aumentem. A dengue é considerada a principal doença reemergente nos países tropicais e subtropicais. A malária tem forte incidência nos países ao sul do deserto do Saara na África, ocorrendo também em vários países da América do Sul que possuem parte da região Amazônica em seu território. Várias doenças voltam a assolar a população de vários locais como as leishmanioses, a Doença de Lyme, erlichioses entre outras. Em março de 2009 começam a ocorrer os primeiros casos de uma nova doença inicialmente denominada Influenza suína, a qual, levou alguns indivíduos a óbito em Oaxaca, uma cidade mexicana localizada a 400 quilômetros da capital. Rapidamente, a doença se espalhou pelo país e posteriormente, no começo do mês de abril de 2009 já, existiam relatos de casos em vários países. O objetivo geral desta pesquisa é verificar em que medida o cuidado de enfermagem realizado expressou um maior ou menor grau de controle do enfermeiro sobre seu trabalho, apontando para os potenciais riscos (biológicos) de adoecimento e impactos negativos na saúde deste trabalhador. O presente estudo foi desenvolvido por meio de uma abordagem quantitativa com desenho longitudinal e observacional, delineamento de pesquisa não experimental e caráter descritivo. Foi feita a análise observacional nas tendas quanto a sua infraestrutura e posteriormente foi passado um questionário aos enfermeiros pautado em questões sobre o risco biológico que estes estavam sendo submetidos. Faz-se necessário que a cultura do improviso acabe e comece a se pensar em uma nova realidade: as doenças transmissíveis são uma realidade, elas existem e há de ser feito um adequamento de tudo que esteja ligado à área de saúde pensando em um novo contexto. É imperioso que tanto as autoridades como os profissionais revejam e reflitam sobre o que aconteceu, para que os erros do passado possam ficar para trás e não se repitam.

Genetic Evidence for a Causal Role of Obesity in Diabetic Kidney Disease

Obesity has been posited as an independent risk factor for diabetic kidney disease (DKD), but establishing causality from observational data is problematic. We aimed to test whether obesity is causally related to DKD using Mendelian randomization, which exploits the random assortment of genes during meiosis. In 6,049 subjects with type 1 diabetes, we used a weighted genetic risk score (GRS) comprised of 32 validated BMI loci as an instrument to test the relationship of BMI with macroalbuminuria, end-stage renal disease (ESRD), or DKD defined as presence of macroalbuminuria or ESRD. We compared these results with cross-sectional and longitudinal observational associations. Longitudinal analysis demonstrated a U-shaped relationship of BMI with development of macroalbuminuria, ESRD, or DKD over time. Cross-sectional observational analysis showed no association with overall DKD, higher odds of macroalbuminuria (for every 1 kg/m(2) higher BMI, odds ratio [OR] 1.05, 95% CI 1.03-1.07, P < 0.001), and lower odds of ESRD (OR 0.95, 95% CI 0.93-0.97, P < 0.001). Mendelian randomization analysis showed a 1 kg/m(2) higher BMI conferring an increased risk in macroalbuminuria (OR 1.28, 95% CI 1.11-1.45, P = 0.001), ESRD (OR 1.43, 95% CI 1.20-1.72, P < 0.001), and DKD (OR 1.33, 95% CI 1.17-1.51, P < 0.001). Our results provide genetic evidence for a causal link between obesity and DKD in type 1 diabetes. As obesity prevalence rises, this finding predicts an increase in DKD prevalence unless intervention should occur.

Dependence of Indian monsoon rainfall on moisture fluxes across the Arabian Sea and the impact of coupled model sea surface temperature biases

The Arabian Sea is an important moisture source for Indian monsoon rainfall. The skill of climate models in simulating the monsoon and its variability varies widely, while Arabian Sea cold sea surface temperature (SST) biases are common in coupled models and may therefore influence the monsoon and its sensitivity to climate change. We examine the relationship between monsoon rainfall, moisture fluxes and Arabian Sea SST in observations and climate model simulations. Observational analysis shows strong monsoons depend on moisture fluxes across the Arabian Sea, however detecting consistent signals with contemporaneous summer SST anomalies is complicated in the observed system by air/sea coupling and large-scale induced variability such as the El Niño-Southern Oscillation feeding back onto the monsoon through development of the Somali Jet. Comparison of HadGEM3 coupled and atmosphere-only configurations suggests coupled model cold SST biases significantly reduce monsoon rainfall. Idealised atmosphere-only experiments show that the weakened monsoon can be mainly attributed to systematic Arabian Sea cold SST biases during summer and their impact on the monsoon-moisture relationship. The impact of large cold SST biases on atmospheric moisture content over the Arabian Sea, and also the subsequent reduced latent heat release over India, dominates over any enhancement in the land-sea temperature gradient and results in changes to the mean state. We hypothesize that a cold base state will result in underestimation of the impact of larger projected Arabian Sea SST changes in future climate, suggesting that Arabian Sea biases should be a clear target for model development.

A spectral view of nonlinear fluxes and stationary-transient interaction in the atmosphere

Nonlinear spectral transfers of kinetic energy and enstrophy, and stationary-transient interaction, are studied using global FGGE data for January 1979. It is found that the spectral transfers arise primarily from a combination, in roughly equal measure, of pure transient and mixed stationary-transient interactions. The pure transient interactions are associated with a transient eddy field which is approximately locally homogeneous and isotropic, and they appear to be consistently understood within the context of two-dimensional homogeneous turbulence. Theory based on spatial wale separation concepts suggests that the mixed interactions may be understood physically, to a first approximation, as a process of shear-induced spectral transfer of transient enstrophy along lines of constant zonal wavenumber. This essentially conservative enstrophy transfer generally involves highly nonlocal stationary-transient energy conversions. The observational analysis demonstrates that the shear-induced transient enstrophy transfer is mainly associated with intermediate-scale (zonal wavenumber m > 3) transients and is primarily to smaller (meridional) scales, so that the transient flow acts as a source of stationary energy. In quantitative terms, this transient-eddy rectification corresponds to a forcing timescale in the stationary energy budget which is of the same order of magnitude as most estimates of the damping timescale in simple stationary-wave models (5 to 15 days). Moreover, the nonlinear interactions involved are highly nonlocal and cover a wide range of transient scales of motion.

Eddies and variability in the Mozambique Channel

Between 1995 and 2000, on average 4 eddies per year are observed from satellite altimetry to propagate southward through the Mozambique Channel, into the upstream Agulhas region. Further south, these eddies have been found to control the timing and frequenc yof Agulhas ring shedding. Within the Mozambique Channel, anomalous SSH amplitudes rise to 30 cm ; in agreement with in situ measured velocities. Comparison of an observed velocit ysection with GCM model results shows that the Mozambique Channel eddies in these models are too surface intensified. Also, the number of eddies formed in the models is in disagreement with our observational analysis. Moored current meter measurements observing the passage of three eddies in 2000 are extended to a 5-year time series b yreferencing the anomalous surface currents estimated from altimeter data to a s ynoptic LADCP velocit y measurement. The results show intermittent edd ypassage at the mooring location. A statistical analysis of SSH observations in different parts of the Mozambique Channel shows a southward decrease of the dominant frequency of the variability, going from 7 per year in the extension of the South Equatorial Current north of Madagascar to 4 per year south of Madagascar. The observations suggest that frequency reduction is related to the Rossb ywaves coming in from the east

A case study of convective organization into precipitating lines in the Southwest Amazon during the WETAMC and TRMM-LBA

A case study of convective development in the Southwest Amazon region during the Wet Season Atmospheric Mesoscale Campaign (WETAMC) and Tropical Rainfall Measuring Mission (TRMM)/Large-Scale Biosphere-Atmosphere (LBA) Experiment in Amazonia is presented. The convective development during 7 February 1999 is shown to occur during a period of very weak large-scale forcing in the presence of topography and deforestation. The available data include dual Doppler radar analysis, radiosonde launches, and surface and boundary layer observations. The observational analysis is complemented with a series of model simulations using the RAMS with 2-km resolution over a 300 km 300 km area forced by a morning radiosonde profile. A comparison of the observed and simulated thermodynamic transformation of the boundary layer and of the formation of convective lines, and of their kinematic and microphysical properties is presented. It is shown that only a few very deep and intense convective cells are necessary to explain the overall precipitating line formation and that discrete propagation and coupling with upper atmosphere circulations may explain the appearance of several lines. The numerical simulation indicates that topography may be the cause of initial convective development, although later on the convective line is parallel to the midlevel shear. There are indications that small-scale deforestation may have an effect on increasing rainfall in the wet season when the large-scale forcing is very weak.

Efficiency and portability: Guidelines to develop websites

The use of the Internet as a means of ensuring greater visibility for products, services and information offered by companies is gaining strength in recent decades. However, it is known that to ensure satisfaction and subsequent virtual customer loyalty, it is necessary to guarantee the quality of the websites, allowing indiscriminate access regardless of the resources used, as well as rapid responses to possible requests. In order to assist this process, this paper presents a set of guidelines for the development of websites having quality characteristics, efficiency and portability as per ISO 9126 norms. An observational analysis of e-commerce websites was done which showed that they are inadequate as to the proposed guidelines, making them difficult to access available content. Therefore, the adoption of the proposed guidelines can greatly contribute to increasing the quality of websites and, consequently, enable quick and effective access regardless of the resources used.

Diretrizes para a criação de aplicações web com ênfase em portabilidade e eficiência

Pós-graduação em Ciência da Computação - IBILCE

Eventos extremos da zona de convergência intertropical sobre o Atlântico durante o período chuvoso da Amazônia oriental

Este trabalho reporta uma investigação observacional sobre as características climatológicas (período de 1985 a 2007) associadas aos eventos extremos da ZCIT observados sobre o Oceano Atlântico equatorial, procurando estabelecer as influências na variabilidade pluviométrica da Amazônia oriental, durante os meses de fevereiro, março e abril. Tais eventos foram selecionados objetivamente através da análise de Funções Ortogonais Empíricas e os padrões oceano-atmosfera associados aos eventos da ZCIT, bem como seus impactos na precipitação da Amazônia oriental, foram investigados com base em composições mensais. Os resultados evidenciaram algumas diferenças mensais, principalmente no padrão da circulação atmosférica em 200 hPa e na configuração vertical da circulação troposférica meridional associada à célula de Hadley equatorial. Quanto à estrutura dinâmica dos padrões oceano-atmosfera observada nos meses de fevereiro, março e abril, basicamente evidenciou-se que a ZCIT forma-se sobre o Oceano Atlântico equatorial numa região de confluência dos ventos alísios de sudeste e nordeste, coincidente com áreas contendo TSM anomalamente quente, movimento vertical ascendente associado à célula de Hadley, com divergência do vento em altos níveis. Os impactos de tais eventos na variabilidade espacial da precipitação sobre a Amazônia oriental mostrou que os principais estados afetados pela ZCIT são: Amapá, Pará e Maranhão. Adicionalmente, relatam-se alguns impactos sócio-ambientais (enchentes, alagamentos, queda de árvores, proliferação de doenças, entre outros) que ocorreram na Região Metropolitana de Belém, associados a ocorrência dos eventos extremos da ZCIT selecionados neste trabalho.

Avaliação das boas práticas de fabricação em linha de processamento de queijos Minas frescal e ricota

In order to assure the maintenance of foods integrity and quality, for avoiding chemical, physical or biological contamination, it is essential to follow the Good Manufacturing Practices (GMP). Among the techniques used for evaluating GMP there is the observational analysis carried out by means of a check-list form application. The present study evaluated the suitability of GMP in a dairy industry producer of Minas fresh and ricotta cheeses, located in São José do Rio Preto, SP, by applying a check-list form. A significant improvement in conformity was evidenced, increasing from 43% to 78%. Neither the blocks related to the handlers nor the existing documentation in the company showed any improvements, as poor conditions unchanged. All of the other evaluated blocks showed significant improvement after applying the GMPrelated corrective measures. Based on these findings, the observance of corrective measures by the dairy industry on dairy products, physical environment, GMP, and handlers training was crucial for assuring the improvements and to increase the product quality and consumers safety.

Importância da segregação de materiais no gerenciamento de lixo hospitalar na área de hemoterapia

In recent years the environment and its effects on human life has been the subject of research. The scientific society organized to manage the problem of large amount of waste generated, discuss the degradation of the environment and point out possible solutions. The scarcity of references in the specific hemotherapy motivated this research. This study is an observational descriptive in order to raise the issue of hospital waste specific area of hemotherapy, presenting its latest ratings on Brazilian law also highlights the proposed Waste Management Program Health Service (PGRSS) Blood Center of Botucatu (HB) highlighting the importance of segregation of noble material in the generation of other therapeutic products using the technique of cleaner production (CP). The observational analysis of the reports shows a 20-fold increase in the amount of waste generated from 1993 to 2005, while the increase of manpower was 2.5 times. The increase in generation was due RSS hemocenter deployment of automated techniques, increased demand and improved sorting of waste. The technique implanted P + L in 2001 began using units of fresh frozen plasma, previously discarded after 12 months of storage, for the composition of new therapeutics for topical use, called bio dressing. In 10 years of implementation of this new technique, therapeutic products generated 535 patients benefited from micro-Botucatu.

Visual scanning in sports actions: comparison between soccer goalkeepers and judo fighters

Visual search and oculomotor behaviour are believed to be very relevant for athlete performance, especially for sports requiring refined visuo-motor coordination skills. Modern coaches believe that a correct visuo-motor strategy may be part of advanced training programs. In this thesis two experiments are reported in which gaze behaviour of expert and novice athletes were investigated while they were doing a real sport specific task. The experiments concern two different sports: judo and soccer. In each experiment, number of fixations, fixation locations and mean fixation duration (ms) were considered. An observational analysis was done at the end of the paper to see perceptual differences between near and far space. Purpose: The aim of the judo study was to delineate differences in gaze behaviour characteristics between a population of athletes and one of non athletes. Aspects specifically investigated were: search rate, search order and viewing time across different conditions in a real-world task. The second study was aimed at identifying gaze behaviour in varsity soccer goalkeepers while facing a penalty kick executed with instep and inside foot. Then an attempt has been done to compare the gaze strategies of expert judoka and soccer goalkeepers in order to delineate possible differences related to the different conditions of reacting to events occurring in near (peripersonal) or far (extrapersonal) space. Judo Methods: A sample of 9 judoka (black belt) and 11 near judoka (white belt) were studied. Eye movements were recorded at 500Hz using a video based eye tracker (EyeLink II). Each subject participated in 40 sessions for about 40 minutes. Gaze behaviour was considered as average number of locations fixated per trial, the average number of fixations per trial, and mean fixation duration. Soccer Methods: Seven (n = 7) intermediate level male volunteered for the experiment. The kickers and goalkeepers, had at least varsity level soccer experience. The vision-in-action (VIA) system (Vickers 1996; Vickers 2007) was used to collect the coupled gaze and motor behaviours of the goalkeepers. This system integrated input from a mobile eye tracking system (Applied Sciences Laboratories) with an external video of the goalkeeper’s saving actions. The goalkeepers took 30 penalty kicks on a synthetic pitch in accordance with FIFA (2008) laws. Judo Results: Results indicate that experts group differed significantly from near expert for fixations duration, and number of fixations per trial. The expert judokas used a less exhaustive search strategy involving fewer fixations of longer duration than their novice counterparts and focused on central regions of the body. The results showed that in defence and attack situation expert group did a greater number of transitions with respect to their novice counterpart. Soccer Results: We found significant main effect for the number of locations fixated across outcome (goal/save) but not for foot contact (instep/inside). Participants spent more time fixating the areas in instep than inside kick and in goal than in save situation. Mean and standard error in search strategy as a result of foot contact and outcome indicate that the most gaze behaviour start and finish on ball interest areas. Conclusions: Expert goalkeepers tend to spend more time in inside-save than instep-save penalty, differences that was opposite in scored penalty kick. Judo results show that differences in visual behaviour related to the level of expertise appear mainly when the test presentation is continuous, last for a relatively long period of time and present a high level of uncertainty with regard to the chronology and the nature of events. Expert judoist performers “anchor” the fovea on central regions of the scene (lapel and face) while using peripheral vision to monitor opponents’ limb movements. The differences between judo and soccer gaze strategies are discussed on the light of physiological and neuropsychological differences between near and far space perception.

Congenital nasolacrimal duct obstruction:Comparison of two different treatment algorithms

Purpose: To clarify the most appropriate treatment regimen for congenital nasolacrimal duct obstruction (CNLDO). Methods: A retrospective observational analysis was performed of patients undergoing probing with or without intubation to treat CNLDO in a single institution (Royal Victoria Hospital, Belfast) from 2006 to 2011. Results: Based on exclusion criteria, 246 eyes of 177 patients (aged 0 to 9.8 years with a mean age of 2.1 years) were included in this study: 187 (76%) eyes had successful outcome at first intervention with primary probing, whereas 56 (23%) eyes underwent secondary intervention. There were no significant differences by gender, age, or obstruction complexity between the successful and unsuccessful patients with first intervention. For those patients requiring secondary intervention, 16 of 24 (67%) eyes had successful probing, whereas 22 of 24 (92%) had successful intubation. Patients with intubation as a secondary procedure were significantly more likely to have a successful outcome (P = .037). Statistical analysis was performed using the Fisher's exact test and Barnard's exact test. Conclusions: Primary probing for CNLDO has a high success rate that is not adversely affected by increasing age. This study also indicates that if initial probing is unsuccessful, nasolacrimal intubation rather than repeat probing yields a significantly higher success rate.