Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts.

Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.

Population-level changes to promote cardiovascular health.

BACKGROUND: Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD. DESIGN AND METHODS: Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol). RESULTS: Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life. CONCLUSION: Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.

Secondary Accident Data Fusion for Assessing Long-Term Performance of Transportation Systems, 2007

Secondary accident statistics can be useful for studying the impact of traffic incident management strategies. An easy-to-implement methodology is presented for classifying secondary accidents using data fusion of a police accident database with intranet incident reports. A current method for classifying secondary accidents uses a static threshold that represents the spatial and temporal region of influence of the primary accident, such as two miles and one hour. An accident is considered secondary if it occurs upstream from the primary accident and is within the duration and queue of the primary accident. However, using the static threshold may result in both false positives and negatives because accident queues are constantly varying. The methodology presented in this report seeks to improve upon this existing method by making the threshold dynamic. An incident progression curve is used to mark the end of the queue throughout the entire incident. Four steps in the development of incident progression curves are described. Step one is the processing of intranet incident reports. Step two is the filling in of incomplete incident reports. Step three is the nonlinear regression of incident progression curves. Step four is the merging of individual incident progression curves into one master curve. To illustrate this methodology, 5,514 accidents from Missouri freeways were analyzed. The results show that secondary accidents identified by dynamic versus static thresholds can differ by more than 30%.

Controlo Interno como factor de melhoria empresarial - estudo de caso prático Centro de Emprego e Formação Profissonal Santa Cruz

A problemática do controlo interno como factor de melhoria empresarial, foi a que orientou esta pesquisa realizada no CEFPSC (Centro de Emprego e Formação Profissional de Santa Cruz). É que, segundo Morais & Martins (2007, pág. 27) existe controlo adequado quando a gestão planeou e organizou, isto é, concebeu, de tal modo que foi assegurado uma garantia razoável que os riscos da organização foram adequadamente geridos e de que os objectivos e metas da organização serão alcançados de forma eficiente e económica. Sendo assim, é de notar a importância desta ferramenta em traçar estratégias de gestão no processo decisório, servindo assim de uma mais-valia à entidade com vista a permitir responder à questão: Em que medida o controlo interno tem sido utilizado como método de apoio à gestão do Centro de Emprego e Formação Profissional de Santa Cruz? Este trabalho tem como objectivo compreender a actuação e a contribuição do Controlo Interno na gestão eficiente do CEFPSC. As informações foram recolhidas mediante a aplicação de um questionário de controlo interno e entrevistas ao Responsável do CEFPSC, bem como ao Presidente do IEFP, enquanto órgão central. O tratamento dos dados foi realizado com auxílio informático, utilizando, para tal, o programa Excel.

Pertenças identitárias de jovens do Casal da Boba

Resumo - O trabalho que aqui se apresenta centra-se numa reflexão sobre as pertenças identitárias de jovens descendentes de imigrantes cabo-verdianos. O objectivo principal do estudo é o de contribuir para compreender como é que estes jovens definem e afirmam as suas pertenças identitárias. Os jovens em estudo estabelecem relações com dois códigos culturais, um transmitido no seio familiar e outro pelo contacto com a sociedade portuguesa e nessa medida a sua gestão identitária é complexa. Os descendentes de imigrantes cabo-verdianos ou novos portugueses têm múltiplas referências e pertenças identitárias e representam parte da juventude portuguesa de hoje.

Spatial variability of soil chemical properties after coffee tree removal

Assessing the spatial variability of soil chemical properties has become an important aspect of soil management strategies with a view to higher crop yields with minimal environmental degradation. This study was carried out at the Centro Experimental of the Instituto Agronomico, in Campinas, São Paulo, Brazil. The aim was to characterize the spatial variability of chemical properties of a Rhodic Hapludox on a recently bulldozer-cleaned area after over 30 years of coffee cultivation. Soil samples were collected in a 20 x 20 m grid with 36 sampling points across a 1 ha area in the layers 0.0-0.2 and 0.2-0.4 m to measure the following chemical properties: pH, organic matter, K+, P, Ca2+, Mg2+, potential acidity, NH4-N, and NO3-N. Descriptive statistics were applied to assess the central tendency and dispersion moments. Geostatistical methods were applied to evaluate and to model the spatial variability of variables by calculating semivariograms and kriging interpolation. Spatial dependence patterns defined by spherical model adjusted semivariograms were made for all cited soil properties. Moderate to strong degrees of spatial dependence were found between 31 and 60 m. It was still possible to map soil spatial variability properties in the layers 0-20 cm and 20-40 cm after plant removal with bulldozers.

Mitigation of methane and nitrous oxide emissions from flood-irrigated rice by no incorporation of winter crop residues into the soil

Winter cover crops are sources of C and N in flooded rice production systems, but very little is known about the effect of crop residue management and quality on soil methane (CH4) and nitrous oxide (N2O) emissions. This study was conducted in pots in a greenhouse to evaluate the influence of crop residue management (incorporated into the soil or left on the soil surface) and the type of cover-crop residues (ryegrass and serradella) on CH4 and N2O emissions from a flooded Albaqualf soil cultivated with rice (Oryza sativa L.). The closed chamber technique was used for air sampling and the CH4 and N2O concentrations were analyzed by gas chromatography. Soil solution was sampled at two soil depths (2 and 20 cm), simultaneously to air sampling, and the contents of dissolved organic C (DOC), NO3-, NH4+, Mn2+, and Fe2+ were analyzed. Methane and N2O emissions from the soil where crop residues had been left on the surface were lower than from soil with incorporated residues. The type of crop residue had no effect on the CH4 emissions, while higher N2O emissions were observed from serradella (leguminous) than from ryegrass, but only when the residues were left on the soil surface. The more intense soil reduction verified in the deeper soil layer (20 cm), as evidenced by higher contents of reduced metal species (Mn2+ and Fe2+), and the close relationship between CH4 emission and the DOC contents in the deeper layer indicated that the sub-surface layer was the main CH4 source of the flooded soil with incorporated crop residues. The adoption of management strategies in which crop residues are left on the soil surface is crucial to minimize soil CH4 and N2O emissions from irrigated rice fields. In these production systems, CH4 accounts for more than 90 % of the partial global warming potential (CH4+N2O) and, thus, should be the main focus of research.

Heavy metals in soils and plants in mango orchards in Petrolina, Pernambuco, Brazil

The monitoring of heavy metal concentrations in areas under intensive agriculture is essential for the agricultural sustainability and food safety. This paper evaluates the total contents of heavy metals in soils and mango trees in orchards of different ages (6, 7, 8, 9, 10, 11, 14, 16, 17, 19, and 26 years) in Petrolina, Pernambuco, Brazil. Soil samples were taken from the layers 0-20 cm and 20-40 cm, and mango leaves were collected in the growth stage. Areas of native vegetation (Caatinga) adjacent to the cultivated areas were used for comparison. The total concentrations of heavy metals (Cu, Cr, Fe, Zn, Mn, Ni, and Pb) were determined in soils and leaves. In general, mango cultivation led to Cu and Zn accumulation in the soil surface and to a reduction in the contents of Ni, Pb, Mn, and Fe in surface and subsurface. Since contamination by Cu, Zn, and Cr was detected, these areas must be monitored to prevent negative environmental impacts. For instance, the presence of Cr in mango tree leaves indicates the need to investigate the source of the element in these orchards. The management strategies of the different companies led to deficiency or excess of some metals in the evaluated areas. However, the Fe and Mn levels were adequate for the mineral nutrition of mango in all areas.

Report to the Board of Corrections, Sex Offenders, 2006

This report begins with the prevalence and projected growth of offenders convicted of sex crimes within Iowa’s community-based corrections and prison populations, then describes how the Iowa Department of Corrections is addressing sex offenders’ issues through the provision of treatment and management strategies. Except where noted, information was obtained from the Iowa Corrections Offender Network (ICON) with many of the reports obtained via the Iowa Justice Data Warehouse.

Genome sequencing of the plant pathogen Taphrina deformans, the causal agent of peach leaf curl.

Taphrina deformans is a fungus responsible for peach leaf curl, an important plant disease. It is phylogenetically assigned to the Taphrinomycotina subphylum, which includes the fission yeast and the mammalian pathogens of the genus Pneumocystis. We describe here the genome of T. deformans in the light of its dual plant-saprophytic/plant-parasitic lifestyle. The 13.3-Mb genome contains few identifiable repeated elements (ca. 1.5%) and a relatively high GC content (49.5%). A total of 5,735 protein-coding genes were identified, among which 83% share similarities with other fungi. Adaptation to the plant host seems reflected in the genome, since the genome carries genes involved in plant cell wall degradation (e.g., cellulases and cutinases), secondary metabolism, the hallmark glyoxylate cycle, detoxification, and sterol biosynthesis, as well as genes involved in the biosynthesis of plant hormones. Genes involved in lipid metabolism may play a role in its virulence. Several locus candidates for putative MAT cassettes and sex-related genes akin to those of Schizosaccharomyces pombe were identified. A mating-type-switching mechanism similar to that found in ascomycetous yeasts could be in effect. Taken together, the findings are consistent with the alternate saprophytic and parasitic-pathogenic lifestyles of T. deformans. IMPORTANCE: Peach leaf curl is an important plant disease which causes significant losses of fruit production. We report here the genome sequence of the causative agent of the disease, the fungus Taphrina deformans. The genome carries characteristic genes that are important for the plant infection process. These include (i) proteases that allow degradation of the plant tissues; (ii) secondary metabolites which are products favoring interaction of the fungus with the environment, including the host; (iii) hormones that are responsible for the symptom of severely distorted leaves on the host; and (iv) drug detoxification enzymes that confer resistance to fungicides. The availability of the genome allows the design of new drug targets as well as the elaboration of specific management strategies to fight the disease.

A Three-Dimensional Framework to Analyse the Governance of Population Registers

In June 2006, the Swiss Parliament made two important decisions with regards to public registers' governance and individuals' identification. It adopted a new law on the harmonisation of population registers in order to simplify statistical data collection and data exchange from around 4'000 decentralized registers, and it also approved the introduction of a Unique Person Identifier (UPI). The law is rather vague about the implementation of this harmonisation and even though many projects are currently being undertaken in this domain, most of them are quite technical. We believe there is a need for analysis tools and therefore we propose a conceptual framework based on three pillars (Privacy, Identity and Governance) to analyse the requirements in terms of data management for population registers.

Low molecular weight carboxylic acids in oxidizing porphyry copper tailings

The distribution of low molecular weight carboxylic acids (LMWCA) was investigated in pore water profiles from two porphyry copper tailings impoundments in Chile (Piuquenes at La Andina and Cauquenes at El Teniente mine). The objectives of this study were (1) to determine the distribution of LMWCA, which are interpreted to be the metabolic byproducts of the autotroph microbial community in this low organic carbon system, and (2) to infer the potential role of these acids in cycling of Fe and other elements in the tailings impoundments. The speciation and mobility of iron, and potential for the release of H+ via hydrolysis of the ferric iron, are key factors in the formation of acid mine drainage in sulfidic mine wastes. In the low-pH oxidation zone of the Piuquenes tailings, Fe(III) is the dominant iron species and shows high mobility. LMWCA, which occur mainly between the oxidation front down to 300 cm below the tailings surface at both locations (e.g., max concentrations of 0.12 mmol/L formate, 0.17 mmol/L acetate, and 0.01 mmol/L pyruvate at Piuquenes and 0.14 mmol/L formate, 0.14 mmol/L acetate, and 0.006 mmol/L pyruvate at Cauquenes), are observed at the same location as high Fe concentrations (up to 71.2 mmol/L Fe(II) and 16.1 mmol/L Fe(III), respectively). In this zone, secondary Fe(111) hydroxides are depleted. Our data suggest that LMWCA may influence the mobility of iron in two ways. First, complexation of Fe(III), through formation of bidentate Fe(III)-LMWCA complexes (e.g., pyruvate, oxalate), may enhance the dissolution of Fe(III) (oxy)hydroxides or may prevent precipitation of Fe(III) (oxy)hydroxides. Soluble Fe(III) chelate complexes which may be mobilized downward and convert to Fe(II) by Fe(III) reducing bacteria. Second, monodentate LMWCA (e.g., acetate and formate) can be used by iron-reducing bacteria as electron donors (e.g., Acidophilum spp.), with ferric iron as the electron acceptor. These processes may, in part, explain the low abundances of secondary Fe(III) hydroxide precipitates below the oxidation front and the high concentrations of Fe(II) observed in the pore waters of some low-sulfide systems. The reduction of Fe(III) and the subsequent increase of iron mobility and potential acidity transfer (Fe(II) oxidation can result in the release of H+ in an oxic environment) should be taken in account in mine waste management strategies.

Manipulating sex ratio to increase population growth: the example of the Lesser Kestrel

Small or decreasing populations call for emergency actions like, for example, captive breeding programs. Such programs aim at rapidly increasing population sizes in order to reduce the loss of genetic variability and to avoid possible Allee effects. The Lesser Kestrel Falco naumanni is one of the species that is currently supported in several captive breeding programs at various locations. Here, we model the demographic and genetic consequences of potential management strategies that are based on offspring sex ratio manipulation. Increased population growth could be achieved by manipulating female conditions and/or male attractiveness in the captive breeders and consequently shifting the offspring sex ratio towards more female offspring, which are then used for reintroduction. Fragmenting populations into wild-breeding and captive-breeding demes and manipulating population sex ratio both immediately increase the inbreeding coefficient in the next generation (i.e. decrease N-e) but may, in the long term, reduce the loss of genetic variability if population growth is restricted by the number of females. We use the Lesser Kestrel and the wealth of information that is available on this species to predict the long-term consequences of various kinds of sex-ratio manipulation. We find that, in our example and possibly in many other cases, a sex-ratio manipulation that seems realistic could have a beneficial effect on the captive breeding program. However, the possible long-term costs and benefits of such measures need to be carefully optimized.

Case complexity and clinical outcome in diabetes mellitus. A prospective study using the INTERMED.

The aim of this study was to assess a population of patients with diabetes mellitus by means of the INTERMED, a classification system for case complexity integrating biological, psychosocial and health care related aspects of disease. The main hypothesis was that the INTERMED would identify distinct clusters of patients with different degrees of case complexity and different clinical outcomes. Patients (n=61) referred to a tertiary reference care centre were evaluated with the INTERMED and followed 9 months for HbA1c values and 6 months for health care utilisation. Cluster analysis revealed two clusters: cluster 1 (62%) consisting of complex patients with high INTERMED scores and cluster 2 (38%) consisting of less complex patients with lower INTERMED. Cluster 1 patients showed significantly higher HbA1c values and a tendency for increased health care utilisation. Total INTERMED scores were significantly related to HbA1c and explained 21% of its variance. In conclusion, different clusters of patients with different degrees of case complexity were identified by the INTERMED, allowing the detection of highly complex patients at risk for poor diabetes control. The INTERMED therefore provides an objective basis for clinical and scientific progress in diabetes mellitus. Ongoing intervention studies will have to confirm these preliminary data and to evaluate if management strategies based on the INTERMED profiles will improve outcomes.

Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary international expert panel (EPACT II)

Introduction: The development of novel therapies and the increasing number of trials testing management strategies for luminal Crohn's disease (CD) have not filled all the gaps in our knowledge. Thus, in clinical practice, many decisions for CD patients need to be taken without high quality evidence. For this reason, a multidisciplinary European expert panel followed the RAND method to develop explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD. Methods: Twelve international experts convened in Geneva, Switzerland in December 2007, to rate explicit clinical scenarios, corresponding to real daily practice, on a 9-point scale according to the literature evidence and their own expertise. Median ratings were stratified into three categories: appropriate (7-9), uncertain (4-6) and inappropriate (1-3). Results: Overall, panelists rated 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD. In anti-TNF naïve patients, budesonide and prednisone were found appropriate for mildmoderate CD, and infliximab (IFX) when those had previously failed or had not been tolerated. In patients with prior success with IFX, this drug with or without co-administration of a thiopurine analog was favored. Other anti-TNFs were appropriate in case of intolerance or resistance to IFX. High doses steroids, IFX or adalimumab were appropriate in severe active CD. Among 105 indications for ST-D or ST-R disease, the panel considered appropriate the thiopurine analogs, methotrexate, IFX, adalimumab and surgery for limited resection, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R. Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain first-line therapies in active luminal CD. Anti-TNFs, in particular IFX with respect to the amount of available evidence, remain second-line for most indications. Thiopurine analogs are preferred to anti-TNFs when steroids are not appropriate, except when anti-TNFs were previously successful. These recommendations are available online (www.epact.ch). A prospective evaluation of these criteria in a large database in Switzerland in underway to validate these criteria.