GeoHealth: A Georeferenced System for Health Data Analysis in Primary Care

The Primary Care Information System (SIAB) concentrates basic healthcare information from all different regions of Brazil. The information is collected by primary care teams on a paper-based procedure that degrades the quality of information provided to the healthcare authorities and slows down the process of decision making. To overcome these problems we propose a new data gathering application that uses a mobile device connected to a 3G network and a GPS to be used by the primary care teams for collecting the families' data. A prototype was developed in which a digital version of one SIAB form is made available at the mobile device. The prototype was tested in a basic healthcare unit located in a suburb of Sao Paulo. The results obtained so far have shown that the proposed process is a better alternative for data collecting at primary care, both in terms of data quality and lower deployment time to health care authorities.

Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

Background: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short- term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes-Moleca (R)-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca (R) is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention to treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (alpha = 5%). Discussion: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca (R) shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.

Late remote ischemic preconditioning in children undergoing cardiopulmonary bypass: A randomized controlled trial

Objective: Cardiopulmonary bypass is associated with ischemia-reperfusion injury to multiple organs. We aimed to evaluate whether remote ischemic preconditioning performed the day before surgery for congenital heart disease with cardiopulmonary bypass attenuates the postoperative inflammatory response and myocardial dysfunction. Methods: This was a prospective, randomized, single-blind, controlled trial. Children allocated to remote ischemic preconditioning underwent 4 periods of 5 minutes of lower limb ischemia by a blood pressure cuff intercalated with 5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48 hours after cardiopulmonary bypass to evaluate nuclear factor kappa B activation in leukocytes by quantification of mRNA of I kappa B alpha by real-time quantitative polymerase chain reaction and for interleukin-8 and 10 plasma concentration measurements by enzyme-linked immunosorbent assay. Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic peptide and cardiac troponin I plasma concentrations, measured by chemiluminescence, and clinical parameters of low cardiac output syndrome. Results: Twelve children were allocated to remote ischemic preconditioning, and 10 children were allocated to the control group. Demographic data and Risk Adjustment for Congenital Heart Surgery 1 classification were comparable in both groups. Remote ischemic preconditioning group had lower postoperative values of N-terminal pro-B-type natriuretic peptide, but cardiac troponin I levels were not significantly different between groups. Interleukin-8 and 10 concentrations and I kappa B alpha gene expression were similar in both groups. Postoperative morbidity was similar in both groups; there were no postoperative deaths in either group. Conclusions: Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass. (J Thorac Cardiovasc Surg 2012;144:178-83)

Air quality simulations for Londrina region, Brazil

The objective of this work were apply and provide a preliminary evaluation of the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) performance, for Londrina region. We performed comparison with measurements obtained in meteorological stations. The model was configured to run with three domains with 27,9 and 3 km of grid resolution, using the ndown program and also was realized a simulation with the model configured to run with a single domain using a land use file based in a classified image for region of MODIS sensor. The emission files to supply the chemistry run were generated based in the work of Martins et al., 2012. RADM2 chemical mechanism and MADE/SORGAM modal aerosol models were used in the simulations. The results demonstrated that model was able to represent coherently the formation and dispersion of the pollution in Metropolitan Region of Londrina and also the importance of using the appropriate land use file for the region.

I-Found

[ES] El presente proyecto final de carrera surge con la idea de cubrir una necesidad social a un servicio no existente en muchos contextos. "I-Found" es un concepto de oficina virtual de objetos perdidos, con el añadido de que no solo gestiona objetos, sino también personas y animales (lo que en este proyecto se denomina un "OPA"). Además ofrece la posibilidad de poner en contacto directo y sin intermediarios a personas que han perdido o les ha sido robado un "OPA", con personas que los haya encontrado y viceversa, dentro de cualquier ámbito posible. Los objetivos principales del proyecto son : el aprendizaje de la plataforma Android para dispositivos móviles y el desarrollo de una aplicación, basada en el concepto "I-Found", totalmente funcional, experimental, libre y gratuita, restringida al ámbito geográfico e institucional de la Universidad de Las Palmas de Gran Canaria. Por este motivo, la app desarrollada se denomina "I-Found@ULPGC", leído en inglés como "I-Found at ULPGC". Esta app demuestra la capacidad de personalización del concepto "I-Found" a múltiples contextos institucionales o geográficos.

Wireless systems for the fourth generation

Today, third generation networks are consolidated realities, and user expectations on new applications and services are becoming higher and higher. Therefore, new systems and technologies are necessary to move towards the market needs and the user requirements. This has driven the development of fourth generation networks. ”Wireless network for the fourth generation” is the expression used to describe the next step in wireless communications. There is no formal definition for what these fourth generation networks are; however, we can say that the next generation networks will be based on the coexistence of heterogeneous networks, on the integration with the existing radio access network (e.g. GPRS, UMTS, WIFI, ...) and, in particular, on new emerging architectures that are obtaining more and more relevance, as Wireless Ad Hoc and Sensor Networks (WASN). Thanks to their characteristics, fourth generation wireless systems will be able to offer custom-made solutions and applications personalized according to the user requirements; they will offer all types of services at an affordable cost, and solutions characterized by flexibility, scalability and reconfigurability. This PhD’s work has been focused on WASNs, autoconfiguring networks which are not based on a fixed infrastructure, but are characterized by being infrastructure less, where devices have to automatically generate the network in the initial phase, and maintain it through reconfiguration procedures (if nodes’ mobility, or energy drain, etc..., cause disconnections). The main part of the PhD activity has been focused on an analytical study on connectivity models for wireless ad hoc and sensor networks, nevertheless a small part of my work was experimental. Anyway, both the theoretical and experimental activities have had a common aim, related to the performance evaluation of WASNs. Concerning the theoretical analysis, the objective of the connectivity studies has been the evaluation of models for the interference estimation. This is due to the fact that interference is the most important performance degradation cause in WASNs. As a consequence, is very important to find an accurate model that allows its investigation, and I’ve tried to obtain a model the most realistic and general as possible, in particular for the evaluation of the interference coming from bounded interfering areas (i.e. a WiFi hot spot, a wireless covered research laboratory, ...). On the other hand, the experimental activity has led to Throughput and Packet Error Rare measurements on a real IEEE802.15.4 Wireless Sensor Network.

Ansatz zur Generierung einer konditionalen, reversiblen Wt1 k.o.-Maus

Ansatz zur Generierung einer konditionalen, reversiblen Wt1 k.o.-Maus Der Wilms-Tumor (WT, Nephroblastom) ist ein embryonaler Nierentumor, der durch die maligne Transformation von undifferenziertem Nierengewebe, sog. nephrogenen Resten, entsteht. WT treten mit einer Inzidenz von 1 in 10.000 Lebendgeburten auf. Das Hauptmanifestationsalter, der normalerweise einseitig und sporadisch auftretenden Tumore, liegt zwischen dem 3. und 4. Lebensjahr. Etwa 10 % der Patienten entwickeln jedoch bilaterale Tumore. In diesen Fällen ist eine Assoziation mit komplexen genetischen Krankheitsbildern (u. a. WAGR-, Denys-Drash-, Frasier- und Beckwith-Wiedemann-Syndrom) festzustellen. In 15 % der sporadischen WT sind Mutationen im WT1 (Wilms-Tumor 1)-Gen beschrieben. WT1 besteht aus zehn Exons und weist typische Merkmale von Transkriptionsfaktoren (z. B. vier Zinkfinger) auf. Zwei alternative Spleißereignisse betreffen Exon 5 (+/−Exon 5) und Exon 9 (Transkripte mit bzw. ohne die codierenden Sequenzen für die AS Lysin-Threonin-Serin; +/−KTS). Die Lage der drei alternativ vorhandenen AS zwischen den Zinkfingern 3 und 4 bestimmt die verschiedenen Funktionen der WT1-Proteine (4 Isoformen) als Transkriptionsfaktor (−KTS) bzw. als RNA-bindendes Protein (+KTS). Das zunächst im Zusammenhang mit WT als Tumorsuppressorgen identifizierte WT1 ist ein Entwicklungsgen mit einem sehr komplexen Expressionsmuster in der Embryonalentwicklung. Dabei ist v. a. die Bedeutung in der Urogenitalentwicklung entscheidend. Konstitutive, homozygote Wt1−/− k.o.-Mäuse sind embryonal (~ E12,5 dpc) letal und bilden u. a. keine Gonaden und keine Nieren. Aus diesem Grund existiert bisher kein Wilms-Tumormodell. Die Herstellung eines konditionalen murinen Tiermodells auf Basis des Tet on/off-Systems zur Untersuchung der Nierenentwicklung bzw. zur Analyse der Wilms-Tumorpathogenese war Ziel dieser Arbeit. Hierfür wurden drei Mauslinien generiert: Zwei transgene sog. Responder-Linien, die eine chimäre spleißbare Wt1-cDNA der Variante musWt1+Exon 5;+/−KTS unter der Kontrolle eines Tet-responsiven Promotors im Genom tragen. Dieses tTA/Dox-abhängig regulierbare Wt1-Transgen (tgWt1) sollte (exogen regulierbar) die Expression des endogenen Wt1-Lokus ausreichend nachahmen, um die kritischen Phasen der Embryogenese zu überwinden und lebensfähige Tiere zu erhalten. Parallel dazu wurde die Wt1-Effektor-Mauslinie (WE2) generiert. Diese trägt einen tetrazyklinabhängigen Transaktivator (tTA) zur Steuerung Tet-regulierbarer Transgene unter der Kontrolle des endogenen Wt1-Promotors. Die durch homologe Rekombination in ES-Zellen erreichte Integration des tTA direkt am Translationsstartpunkt des Wt1-Lokus hat in den Tieren einen heterozygoten Wt1 knock out/tTA knock in zur Folge. Die bisher vorgenommenen Verpaarungen doppelt transgener Wt1-tTA+/−/Resp-Mäuse ergaben keinen Rescue des letalen Wt1 k.o. und es konnten bislang keine Wilms-Tumore induziert werden. Alle im Verlauf der Arbeit generierten Mauslinien wurden umfassend charakterisiert. So konnte für die Tiere der Responder-Linien Wt1-Resp1 (mit zusätzlichen Isolator-Sequenzen zum Schutz des Transgens vor Positionseffekten) und Wt1-Resp2 (ohne Isolatoren) konnte die Tet-induzierbare Expression und die Spleißbarkeit des tgWt1 in MEF-Assays und mittels Effektor-Mäusen auf RNA-Ebene nachgewiesen werden. Die genomische Charakterisierung der WE2-Linie ergab eine ungeklärte etwa 120 kb große Inversion am Wt1-Lokus, die alle 5'-regulatorischen Sequenzen mitsamt des tTA vom Rest von Wt1 trennt. Tiere dieser Linie weisen aber dennoch einen funktionalen Wt1 k.o. auf: Unter den Nachkommen aus Intercross-Verpaarungen von Wt1-tTA+/−-Mäusen lassen sich auf Grund der Letalität keine Wt1−/−-Genotypen nachweisen. Die Charakterisierung der Effektor-Linie auf RNA-Ebene und mittels Reporter-Mäusen liefert ein Wt1-analoges tTA-Expressionsmuster: So findet man eine deutliche tTA-Expression u. a. in Niere (Glomeruli), Uterus, Ovar und Testis. Die hier vorgestellten Experimente ergeben darüber hinaus eindeutige Hinweise einer Beteiligung von Wt1 in der Entstehung der glatten Muskulatur bzw. in der Vaskulogenese.

Functional thin films fabricated by plasma polymerization and their biological applications

Plasma polymerization technique is widely accepted as an effective and simple method for the preparation of functional thin films. By careful choice of precursors and deposition parameters, plasma polymers bearing various functional groups could be easily obtained. In this work, I explored the deposition of four kinds of plasma polymerised functional thin films, including the protein-resistant coatings, the thermosensitive coatings, as well as, the coatings bearing amine or epoxide groups. The deposited plasma polymers were characterized by various techniques, such as X-ray photoelectron spectroscopy, atom force microscopy, Fourier transform infrared spectroscopy, surface plasmon resonance spectroscopy, optical waveguide spectroscopy, and so on. As expected, high retention of various functional groups could be achieved either at low plasma input power or at low duty cycle (duty cycle = Ton/(Ton+Toff)). The deposited functional thin films were found to contain some soluble materials, which could be removed simply by extraction treatment. Besides the thermosentive plasma polymer (see Chapter 9), other plasma polymers were used for developing DNA sensors. DNA sensing in this study was achieved using surface plasmon enhanced fluorescence spectroscopy. The nonfouling thin films (i.e., ppEO2, plasma polymerization of di(ethylene glycol) monovinyl ether) were used to make a multilayer protein-resistant DNA sensor (see Chapter 5). The resulted DNA sensors show good anti-fouling properties towards either BSA or fibrinogen. This sensor was successfully employed to discriminate different DNA sequences from protein-containing sample solutions. In Chapter 6, I investigated the immobilization of DNA probes onto the plasma polymerized epoxide surfaces (i.e., ppGMA, plasma polymerization of glycidyl methacrylate). The ppGMA prepared at a low duty cycle showed good reactivity with amine-modified DNA probes in a mild basic environment. A DNA sensor based on the ppGMA was successfully used to distinguish different DNA sequences. While most DNA detection systems rely on the immobilization of DNA probes onto sensor surfaces, a new homogeneous DNA detection method was demonstrated in Chapter 8. The labeled PNA serves not only as the DNA catcher recognizing a particular target DNA, but also as a fluorescent indicator. Plasma polymerized allylamine (ppAA) films were used here to provide a positively charged surface.

Advanced schemes for surface plasmon resonance and plasmon-enhanced fluorescence biosensors

Advanced optical biosensor platforms exploiting long range surface plasmons (LRSPs) and responsive N-isopropylacrylamide (NIPAAm) hydrogel binding matrix for the detection of protein and bacterial pathogen analytes were carried out. LRSPs are optical waves that originate from coupling of surface plasmons on the opposite sites of a thin metallic film embedded between two dielectrics with similar refractive indices. LRSPs exhibit orders of magnitude lower damping and more extended profile of field compared to regular surface plasmons (SPs). Their excitation is accompanied with narrow resonance and provides stronger enhancement of electromagnetic field intensity that can advance the sensitivity of surface plasmon resonance (SPR) and surface plasmon-enhanced fluorescence spectroscopy (SPFS) biosensors. Firstly, we investigated thin gold layers deposited on fluoropolymer surface for the excitation of LRSPs. The study indicates that the morphological, optical and electrical properties of gold film can be changed by the surface energy of fluoropolymer and affect the performance of a SPFS biosensor. A photo-crosslinkable NIPAAm hydrogel was grafted to the sensor surface in order to serve as a binding matrix. It was modified with bio-recognition elements (BREs) via amine coupling chemistry and offered the advantage of large binding capacity, stimuli responsive properties and good biocompatibility. Through experimental observations supported by numerical simulations describing diffusion mass transfer and affinity binding of target molecules in the hydrogel, the hydrogel binding matrix thickness, concentration of BREs and the profile of the probing evanescent field was optimized. Hydrogel with a up to micrometer thickness was shown to support additional hydrogel optical waveguide (HOW) mode which was employed for probing affinity binding events in the gel by means of refractometric and fluorescence measurements. These schemes allow to reach limits of detection (LODs) at picomolar and femtomolar levels, respectively. Besides hydrogel based experiments for detection of molecular analytes, long range surface plasmon-enhanced fluorescence spectroscopy (LRSP-FS) was employed for detection of bacterial pathogens. The influence of capture efficiency of bacteria on surfaces and the profile of the probing field on sensor response were investigated. The potential of LRSP-FS with extended evanescent field is demonstrated for detection of pathogenic E. coli O157:H7 on sandwich immunoassays . LOD as low as 6 cfu mL-1 with a detection time of 40 minutes was achieved.rn

Comparison of randomized treatments for late whiplash

BACKGROUND: To compare 4 different treatment strategies in patients with late whiplash syndrome. METHODS: Patients were randomly assigned to one of the following treatment groups: infiltration, physiotherapy, or medication. Group allocation was stratified according to gender, age, and education. Additionally, patients of each group were randomized 1:1 to cognitive-behavioral therapy (CBT) or no CBT. Patients were assessed at baseline, after an 8-week treatment period, and 3 and 6 months later. Main outcome measures were subjective outcome rating, pain intensity, and working ability. RESULTS: Of 91 enrolled patients, 73 completed the study; 62% were women. After treatment, 47 patients (64%) were subjectively improved (48%), or free of symptoms (16%), with a preponderance of women (73% vs 50%, p = 0.047). There was no difference regarding outcomes among the 3 treatment groups in men and women. The most robust difference was achieved with CBT, associated with a higher rate of recovery (23% vs 9%), and improvement (53% vs 42%) (p = 0.024), and with a gender difference (p = 0.01). All treatments significantly improved pain intensity and working ability. CONCLUSION: Intensive therapy in late whiplash syndrome can achieve improvement of different outcome measures including working ability in two-thirds of patients, more effective in women, persisting beyond 6 months in half. Additional cognitive-behavioral therapy was the most effective treatment modality. Classification of evidence: This interventional study provides Class III evidence that CBT used as an adjunct to infiltration, medication, or physiotherapy increases improvement rates in persons with late whiplash syndrome.

Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.

Morphological alterations of exogenous surfactant inhibited by meconium can be prevented by dextran

BACKGROUND: Surfactant dysfunction due to inhibition is involved in the pathophysiology of meconium aspiration syndrome. Dextran addition has been shown to reverse exogenous surfactant inactivation by meconium, but the precise mechanisms and the morphological correlate of this effect are yet unknown. Morphological surfactant analysis by transmission electron microscopy (TEM) and stereology allows the differentiation of active (large aggregates = LA) and inactive (small aggregates = SA) subtypes. METHODS: To determine the in vitro effects of meconium and dextran addition on the morphology of a modified porcine natural surfactant (Curosurf), Curosurf samples were either incubated alone or together with meconium or with meconium and dextran, fixed and processed for TEM. Volume fractions of surfactant subtypes [lamellar body-like forms (LBL), multilamellar vesicles (MV), unilamellar vesicles (UV)] were determined stereologically. RESULTS: All preparations contained LBL and MV (corresponding to LA) as well as UV (corresponding to SA). The volume fraction of UV increased with addition of meconium and decreased with further addition of dextran. Correspondingly, the UV/(LBL+MV) ratio (resembling the SA/LA ratio) increased when meconium was added and decreased when dextran was added to the surfactant-meconium mixture. CONCLUSION: Meconium causes alterations in the ultrastructural composition of Curosurf that can be visualized and analyzed by TEM and stereology. These alterations resemble an increase in the SA/LA ratio and are paralleled by an increase in minimum surface tension. Dextran prevents these effects and may therefore be a useful additive to exogenous surfactant preparations to preserve their structural and functional integrity, thereby improving their resistance to inactivation.

Prospectively assessed incidence, severity, and determinants of respiratory symptoms in the first year of life

Respiratory symptoms are common in infancy. Nevertheless, few prospective birth cohort studies have studied the epidemiology of respiratory symptoms in normal infants. The aim of this study was to prospectively obtain reliable data on incidence, severity, and determinants of common respiratory symptoms (including cough and wheeze) in normal infants and to determine factors associated with these symptoms. In a prospective population-based birth cohort, we assessed respiratory symptoms during the first year of life by weekly phone calls to the mothers. Poisson regression was used to examine the association between symptoms and various risk factors. In the first year of life, respiratory symptoms occurred in 181/195 infants (93%), more severe symptoms in 89 (46%). The average infant had respiratory symptoms for 4 weeks and 90% had symptoms for less than 12 weeks (range 0 to 23). Male sex, higher birth weight, maternal asthma, having older siblings and nursery care were associated with more, maternal hay fever with fewer respiratory symptoms. The association with prenatal maternal smoking decreased with time since birth. This study provides reliable data on the frequency of cough and wheeze during the first year of life in healthy infants; this may help in the interpretation of published hospital and community-based studies. The apparently reduced risk in children of mothers with hayfever but no asthma, and the decreasing effect of prenatal smoke exposure over time illustrate the complexity of respiratory pathology in the first year of life.

Floppy Baby mit makrozytärer Anämie und veganischer Mutter

We report the case of a 7 month-old girl that presented with acute anemia, generalized muscular hypotonia and failure to thrive. Laboratory evaluation revealed cobalamin deficiency, due to a vegan diet of the mother. The clinical triad of an acquired floppy baby syndrome with megaloblastic anemia and failure to thrive is pathognomic for infantile cobalamin deficiency. Neurological abnormalities are often irreversible and may be associated with delayed myelinization in the MRI. A normal cobalamin level in maternal serum and absence of anemia do not exclude subclinical deficiency. If cobalamin deficiency is suspected, e.g. in pregnant women on vegan diet, urinary methylmalonic acid excretion and plasma homocysteine levels should be determined and cobalamin substitution should be started at an early stage to avoid potentially irreversible damage of the fetus.