A retrospective evaluation of a score system adopted by the Ministry of Health, Brazil in the diagnosis of pulmonary tuberculosis in childhood: a case control study

Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministério da Saúde - MS), to diagnose pulmonary tuberculosis (PTB) in childhood. This system is independent of bacteriological or histopathological data to define a very likely (> or = 40 points), possible (30-35 points) or unlikely (< or = 25 points) diagnosis of tuberculosis. Records of hospitalized non-infected HIV children at the Instituto de Puericultura e Pediatria Martagão Gesteira of Federal University of Rio de Janeiro (IPPMG-UFRJ), were reviewed. Patients were adjusted for age and divided in two different groups: 45 subjects in the case group (culture-positive) [mean of age = 10.64 mo; SD 9.66]; and 96 in the control group (culture-negative and clinic criteria that dismissed the disease) [mean of age = 11.79 mo.; SD 11.31]. Among the variables analyzed, the radiological status had the greater impact into the diagnosis (OR = 25.39), followed by exposure to adult with tuberculosis (OR = 10.67), tuberculin skin test >10mm (OR = 8.23). The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9% and specificity of 86.5%.

Genetic Control of Mosquitoes: population suppression strategies

Over the last two decades, morbidity and mortality from malaria and dengue fever among other pathogens are an increasing Public Health problem. The increase in the geographic distribution of vectors is accompanied by the emergence of viruses and diseases in new areas. There are insufficient specific therapeutic drugs available and there are no reliable vaccines for malaria or dengue, although some progress has been achieved, there is still a long way between its development and actual field use. Most mosquito control measures have failed to achieve their goals, mostly because of the mosquito's great reproductive capacity and genomic flexibility. Chemical control is increasingly restricted due to potential human toxicity, mortality in no target organisms, insecticide resistance, and other environmental impacts. Other strategies for mosquito control are desperately needed. The Sterile Insect Technique (SIT) is a species-specific and environmentally benign method for insect population suppression, it is based on mass rearing, radiation mediated sterilization, and release of a large number of male insects. Releasing of Insects carrying a dominant lethal gene (RIDL) offers a solution to many of the drawbacks of traditional SIT that have limited its application in mosquitoes while maintaining its environmentally friendly and species-specific utility. The self-limiting nature of sterile mosquitoes tends to make the issues related to field use of these somewhat less challenging than for self-spreading systems characteristic of population replacement strategies. They also are closer to field use, so might be appropriate to consider first. The prospect of genetic control methods against mosquito vectored human diseases is rapidly becoming a reality, many decisions will need to be made on a national, regional and international level regarding the biosafety, social, cultural and ethical aspects of the use and deployment of these vector control methods.

Towards effective control of P2P traffic aggregates in network infrastructures

Nowadays, many P2P applications proliferate in the Internet. The attractiveness of many of these systems relies on the collaborative approach used to exchange large resources without the dependence and associated constraints of centralized approaches where a single server is responsible to handle all the requests from the clients. As consequence, some P2P systems are also interesting and cost-effective approaches to be adopted by content-providers and other Internet players. However, there are several coexistence problems between P2P applications and In- ternet Service Providers (ISPs) due to the unforeseeable behavior of P2P traffic aggregates in ISP infrastructures. In this context, this work proposes a collaborative P2P/ISP system able to underpin the development of novel Traffic Engi- neering (TE) mechanisms contributing for a better coexistence between P2P applications and ISPs. Using the devised system, two TE methods are described being able to estimate and control the impact of P2P traffic aggregates on the ISP network links. One of the TE methods allows that ISP administrators are able to foresee the expected impact that a given P2P swarm will have in the underlying network infrastructure. The other TE method enables the definition of ISP friendly P2P topologies, where specific network links are protected from P2P traffic. As result, the proposed system and associated mechanisms will contribute for improved ISP resource management tasks and to foster the deployment of innovative ISP-friendly systems.

An automated framework for the management of P2P traffic in ISP infrastructures

Peer-to-Peer (P2P) is nowadays a widely used paradigm underpinning the deployment of several Internet services and applications. However, the management of P2P traffic aggregates is not an easy task for Internet Service Providers (ISPs). In this perspective, and considering an expectable proliferation in the use of such ap- plications, future networks require the development of smart mechanisms fostering an easier coexistence between P2P applications and ISP infrastructures. This paper aims to contribute for such research efforts presenting a framework incorporating useful mechanisms to be activated by network administrators, being also able to operate as an automated management tool dealing with P2P traffic aggregates.

Mejoramiento del comportamiento térmico de sistemas de calentamiento de agua solares termosifónicos hechos con materiales no convencionales y con tanques de almacenamiento verticales y horizontales Performance improvement of solar thermosyphonic systems for water heating made of non conventional materials and using horizontal and vertical storage tanks

El objeto de estudio de este proyecto son los sistemas de calentamiento de agua mediante energía solar que funcionan termosifónicamente. En particular se tratará con dos diseños particulares generados por fabricantes de la Provincia de Córdoba y que han solicitado el asesoramiento del Grupo de Energía Solar (GES) para el mejoramiento de la performance térmica de dichos equipos. Se trata de dos sistemas que tienen materiales no tradicionales y se diferencian además por tener una distinta disposición del tanque de almacenamiento: uno es en forma vertical y el otro en forma horizontal. Basados en los resultados de un ensayo bajo norma internacional, donde se detectaron algunas puntos factibles de mejora, se propone en este proyecto el análisis en detalle de los equipos, para lo cual se les debe desarmar completos, para realizar un estudio analítico y experimental de los mismos con el objeto de hacer un planteo teórico-analítico del comportamiento de los mismos, con la implementación de propuestas de mejora y chequeo de los resultados. Se propone entonces como objetivo lograr un mejoramiento de la performance térmica de los citados equipos a partir de un estudio experimental y analítico. Asumiendo esta posibilidad de mejora, se plantea la hipótesis de que es posible representar el funcionamiento de estos equipos mediante modelos físico-matemáticos desarrollados a partir de ecuaciones y correlaciones conocidas y procesos a interpretar mediante resoluciones numéricas y softwares específicos de simulación. De esta manera, se plantea el despieze completo de los equipos para estudiar en detalle su estructura y conexiones internas y a partir de la geometría, dimensiones y propiedades termofísicas de materiales constructivos y fluidos de trabajo, realizar modelos físico-matemáticos que permitan realizar variaciones de propiedades y geometría y así buscar las mejores combinaciones que produzcan equipos más eficientes térmicamente. Los modelos físico-matemáticos serán codificados en lenguajes de alto nivel para poder luego de una validación de los modelos, correr simulaciones en un software de reconocimiento internacional que permite sumar dichos modelos mediante un protocolo de comunicación, haciendo que las poderosas prestaciones del software se puedan aplicar a nuestros modelos. Se complementará el estudio con un análisis exergético para identificar los puntos críticos en que se producen las pérdidas de oportunidad de aprovechar la energía disponible, para así analizar cómo solucionar los problemas en dichos puntos. Los materiales a utilizar serán los propios equipos provistos por los fabricantes, que serán modificados convenientemente para operarlos como prototipos Se espera obtener un conocimiento acabado de los procesos y principios de funcionamiento de los equipos, que permita plantear las mejoras, las cuales se implementarán en los prototipos, realizándose una medición mediante norma igual a la inicial para ver en que magnitud se logran las mejoras esperadas. Se pretende además que las mejoras a implementar, en la etapa de transferencia a las empresas involucradas, redunden no sólo en un beneficio técnico, sino que también los sea desde el punto de vista económico. Para ello se trabajará también sobre los procesos y métodos de fabricación para que los equipos mejorados no sean mas caros que los originales y de ser posible sean aún más económicos, todo esto apuntando a la difusión de la energía solar térmica y poner al alcance de todos estos equipos tan convenientes para la propagación de las energías limpias. El proyecto redundará también en un importante beneficio para el conocimiento de la comunidad científica en general, con el aporte de nuevos resultados en diseños novedosos y con nuevos materiales. Además, la institución se beneficiará con la formación que obtendrán los integrantes del proyecto, muchos de ellos en etapa de realización de sus estudios de posgrado y en una etapa importante de su vida como investigadores. The main goal of this project is the improvement of two thermosyphonic solar water heating systems, made of non conventional materials and with different arrangement of their storage tanks: one is vertical and the other one horizontal. The thermosyphonic systems are provided by manufacturers of the Córdoba Province, who came to the Solar Energy Group (GES) of the National University of Río Cuarto looking for help for the design of their products. In an agreement with these manufacturers, it was proposed this project in order to work analytically and experimentally in order to obtain physical-mathematical models of these two systems, which allow for changes to look by means of simulations the best changes to implement on the equipments for the improvement of their thermal performance. Then, the materials to be used are the proper systems provided by the manufacturers, which will be disarmed to be studied in detail. After the analytical study the proposals of improvement will be implemented in a high level language of programming to perform simulations in the environment of a well-known software for energy simulations (TRNSYS). After the simulations, the best modifications will be physically implemented in the prototypes to perform finally the same normalized test of the beginning and check the magnitude of the implemented improvements. The importance of this project is based on the offer of better systems the companies would make, which would benefit the deployment of the thermal solar energy. Another relevant point is to make the new equipments at the same cost of the previous ones or cheaper, in order to achieve a good deployment of the solar water heating systems; then, the manufacture processes and methods must be studied to obtain not only good technical solutions, but also economical equipments. In addition, this project will contribute to the increasing of the knowledge in the area of thermosyphonic solar systems and the training of postgraduate students.

Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

Background:Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs.Objectives:To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years.Methods:All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05.Results:The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05).Conclusion:In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.

The Politics of Intergovernmental Fiscal Relations in Argentina

The search for political determinants of intergovernmental fiscal relations has shaped much of the recent literature on the economic viability of federalism. This study assesses the explanatory power of two competing views about intergovernmental transfers; one emphasizing the traditional neoclassical approach to federal-subnational fiscal relations and the other suggesting that transfers are contingent on the political fortunes and current political vulnerability of each level of government. The author tests these models using data from Argentina, a federation exhibiting one of the most decentralised fiscal systems in the world and severe imbalances in the territorial distribution of legislative and economic resources. It is shown that overrespresented provinces ruled by governors who belong to opposition parties can bring into play their political overrepresentation to attract shares of federal transfers beyond social welfare criteria and to shield themselves from unwanted reforms to increase fiscal co-responsibilty. This finding suggests that decision makers in federal countries must pay close heed to the need to synchronize institutional reforms and fiscal adjustment.

System analysis of a Peer-to-Peer Video-on-Demand architecture: Kangaroo

Architectural design and deployment of Peer-to-Peer Video-on-Demand (P2PVoD) systems which support VCR functionalities is attracting the interest of an increasing number of research groups within the scientific community; especially due to the intrinsic characteristics of such systems and the benefits that peers could provide at reducing the server load. This work focuses on the performance analysis of a P2P-VoD system considering user behaviors obtained from real traces together with other synthetic user patterns. The experiments performed show that it is feasible to achieve a performance close to the best possible. Future work will consider monitoring the physical characteristics of the network in order to improve the design of different aspects of a VoD system.

Creation of a carrier-grade telco based on a voice over IP backbone

En aquesta memòria l'autor, fent servir un enfoc modern, redissenya i implementa la plataforma que una empresa de telecomunicacions del segle 21 necessita per poder donar serveis de telefonia i comunicacions als seus usuaris i clients. Al llarg d'aquesta exposició es condueix al lector des d'una fase inicial de disseny fins a la implementació i posada en producció del sistema final desenvolupat, centrant-nos en solucionar les necessitats actuals que això implica. Aquesta memòria cubreix el software, hardware i els processos de negoci associats al repte de fer realitat aquest objectiu, i presenta al lector les múltiples tecnologies emprades per aconseguir-ho, fent emfàsi en la convergència actual de xarxes cap al concepte de xarxes IP i basant-se en aquesta tendència i utilitzant aquesta tecnologia de veu sobre IP per donar forma a la plataforma que finalment, de forma pràctica, es posa en producció.

The London School of Hygiene and Tropical Medicine: a new century of malaria research

The global malaria situation has scarcely improved in the last 100 years, despite major advances in our knowledge of the basic biology, epidemiology and clinical basis of the disease. Effective malaria control, leading to a significant decrease in the morbidity and mortality attributable to malaria, will require a multidisciplinary approach. New tools - drugs, vaccine and insecticides - are needed but there is also much to be gained by better use of existing tools: using drugs in combination in order to slow the development of drug resistance; targeting resources to areas of greatest need; using geographic information systems to map the populations at risk and more sophisticated marketing techniques to distribute bed nets and insecticides. Sustainable malaria control may require the deployment of a highly effective vaccine, but there is much that can be done in the meantime to reduce the burden of disease.

Impact of a computerized physician order entry system on compliance with prescription accuracy requirements.

OBJECTIVE: To assess the change in non-compliant items in prescription orders following the implementation of a computerized physician order entry (CPOE) system named PreDiMed. SETTING: The department of internal medicine (39 and 38 beds) in two regional hospitals in Canton Vaud, Switzerland. METHOD: The prescription lines in 100 pre- and 100 post-implementation patients' files were classified according to three modes of administration (medicines for oral or other non-parenteral uses; medicines administered parenterally or via nasogastric tube; pro re nata (PRN), as needed) and analyzed for a number of relevant variables constitutive of medical prescriptions. MAIN OUTCOME MEASURE: The monitored variables depended on the pharmaceutical category and included mainly name of medicine, pharmaceutical form, posology and route of administration, diluting solution, flow rate and identification of prescriber. RESULTS: In 2,099 prescription lines, the total number of non-compliant items was 2,265 before CPOE implementation, or 1.079 non-compliant items per line. Two-thirds of these were due to missing information, and the remaining third to incomplete information. In 2,074 prescription lines post-CPOE implementation, the number of non-compliant items had decreased to 221, or 0.107 non-compliant item per line, a dramatic 10-fold decrease (chi(2) = 4615; P < 10(-6)). Limitations of the computerized system were the risk for erroneous items in some non-prefilled fields and ambiguity due to a field with doses shown on commercial products. CONCLUSION: The deployment of PreDiMed in two departments of internal medicine has led to a major improvement in formal aspects of physicians' prescriptions. Some limitations of the first version of PreDiMed were unveiled and are being corrected.

MAPI: towards the integrated exploitation of bioinformatics Web Services.

BACKGROUND. Bioinformatics is commonly featured as a well assorted list of available web resources. Although diversity of services is positive in general, the proliferation of tools, their dispersion and heterogeneity complicate the integrated exploitation of such data processing capacity. RESULTS. To facilitate the construction of software clients and make integrated use of this variety of tools, we present a modular programmatic application interface (MAPI) that provides the necessary functionality for uniform representation of Web Services metadata descriptors including their management and invocation protocols of the services which they represent. This document describes the main functionality of the framework and how it can be used to facilitate the deployment of new software under a unified structure of bioinformatics Web Services. A notable feature of MAPI is the modular organization of the functionality into different modules associated with specific tasks. This means that only the modules needed for the client have to be installed, and that the module functionality can be extended without the need for re-writing the software client. CONCLUSIONS. The potential utility and versatility of the software library has been demonstrated by the implementation of several currently available clients that cover different aspects of integrated data processing, ranging from service discovery to service invocation with advanced features such as workflows composition and asynchronous services calls to multiple types of Web Services including those registered in repositories (e.g. GRID-based, SOAP, BioMOBY, R-bioconductor, and others).

Endoscopic off-pump aortic valve replacement: does the pericardial cuff improve the sutureless closure of left ventricular access?

OBJECTIVE: Off-pump trans left ventricular approach provides more precise deployment of stented aortic valve of any size with respect to the endovascular replacement. One of the key steps of this procedure is the ventricle repair after catheter withdrawing. We designed an animal study to compare the consistency of a sutureless repair of the left ventricle access using nitinol occluder with and without pericardial cuff on the ventricular side. METHODS: Material description: The Amplatz-nitinol occluder consists of two square heads squeezing ventricle wall in between them, sealing the defect. To improve its sealing property, a pericardial patch was sutured to the ventricular head of the occluder. Animal study setup: In adult pigs, a 30F sheath was inserted into the epigastric area through the cardiac apex, up to the left ventricle, simulating the approach for off-pump aortic valve replacement. The sheath was then removed and the ventricle closed with standard occluder in half of the animals, and cuffed occluder in the other half. Animals were followed-up for 3h, collecting haemodynamics data and pericardial bleeding. RESULTS: Device was successfully deployed in 12 animals in less than 1min. In the group where the standard occluder was used, bleeding during the deployment was 80+/-20ml and after the deployment was 800+/-20ml over 3h. In the group where the cuffed occluder was used, bleeding during the deployment was 85+/-20ml and after the deployment was 100+/-5ml over 3h. In the cuffed group, bleeding was significantly lower than the standard group, p-value being <0.001. CONCLUSIONS: The occluder is easy to use and the pericardial cuff dramatically increases its efficacy as demonstrated by a significant reduction of blood loss. The cuffed occluder opens the way for endoscopic, off-pump, transventricular aortic valve replacement.

Federalism and Welfare to Work in Switzerland: The Development of Active Social Policies in a Fragmented Welfare State

This article is concerned with the impact that federal structures have on the development of welfare to work or activation policies. More precisely, it argues that the incentives and the risks associated with a division of responsibilities among different jurisdictions may constitute an obstacle to broad reforms that promote labor market participation of nonworking benefit recipients. This argument is illustrated with a case study discussing policy responses to a massive rise in caseloads among social assistance recipients in Switzerland. We conclude that the lack of a fundamental reform was the consequence of the incentives provided by the federal structure of the program. These incentives have both encouraged cost shifting among jurisdictions and discouraged involvement of federal level policy makers in a bigger reform.

State of Iowa Single Audit Report, June 30, 2003

State Agency Audit Report Independent Auditor's Reports Iowa Comprehensive Annual Financial Report - Financial Section Schedule of expenditures of Federal Awards Schedule of findings and questioned costs