Cardiometabolic risk reduction through lifestyle intervention programs in the Brazilian public health system

Public health strategies to reduce cardiovascular morbidity and mortality should focus on global cardiometabolic risk reduction. The efficacy of lifestyle changes to prevent type 2 diabetes have been demonstrated, but low-cost interventions to reduce cardiometabolic risk in Latin-America have been rarely reported. Our group developed 2 programs to promote health of high-risk individuals attending a primary care center in Brazil. This study compared the effects of two 9-month lifestyle interventions, one based on medical consultations (traditional) and another with 13 multi-professional group sessions in addition to the medical consultations (intensive) on cardiometabolic parameters. Adults were eligible if they had pre-diabetes (according to the American Diabetes Association) and/or metabolic syndrome (International Diabetes Federation criteria for Latin-America). Data were expressed as means and standard deviations or percentages and compared between groups or testing visits. A p-value < 0.05 was considered significant. Results: 180 individuals agreed to participate (35.0% men, mean age 54.7 ± 12.3 years, 86.1% overweight or obese). 83 were allocated to the traditional and 97 to the intensive program. Both interventions reduced body mass index, waist circumference and tumor necrosis factor-α. Only intensive program reduced 2-hour plasma glucose and blood pressure and increased adiponectin values, but HDL-cholesterol increased only in the traditional. Also, responses to programs were better in intensive compared to traditional program in terms of blood pressure and adiponectin improvements. No new case of diabetes in intensive but 3 cases and one myocardial infarction in traditional program were detected. Both programs induced metabolic improvement in the short-term, but if better results in the intensive are due to higher awareness about risk and self-motivation deserves further investigation. In conclusion, these low-cost interventions are able to minimize cardiometabolic risk factors involved in the progression to type 2 diabetes and/or cardiovascular disease.

Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys

Background: In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys. Methods: A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces). Conclusion: The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.

Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report

Abstract Introduction Pelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography. Case presentation We report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum. The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain. A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted. The nephrographic phase did not add any new information. The excretory phase (10-minute delay) demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space. Conclusion In this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

An integrated approach to remanufacturing: model of a remanufacturing system

Remanufacturing is the process of rebuilding used products that ensures that the quality of remanufactured products is equivalent to that of new ones. Although the theme is gaining ground, it is still little explored due to lack of knowledge, the difficulty of visualizing it systemically, and implementing it effectively. Few models treat remanufacturing as a system. Most of the studies still treated remanufacturing as an isolated process, preventing it from being seen in an integrated manner. Therefore, the aim of this work is to organize the knowledge about remanufacturing, offering a vision of remanufacturing system and contributing to an integrated view about the theme. The methodology employed was a literature review, adopting the General Theory of Systems to characterize the remanufacturing system. This work consolidates and organizes the elements of this system, enabling a better understanding of remanufacturing and assisting companies in adopting the concept.

Distribution of human immunodeficiency virus type 1 subtypes in the state of Amazonas, Brazil, and subtype C identification

Few studies have reported the molecular epidemiological characterization of HIV-1 in the Northern region of Brazil. The present study reports the molecular and epidemiological characterization of 31 HIV-1 isolates from blood donors from the State of Amazonas who donated blood between April 2006 and March 2007. Serum/plasma samples from all donors were screened for HIV antibodies by ELISA and the results confirmed by Western blot analysis. Genomic DNA was extracted from the buffy coat using the Super Quik-Gene-DNA Isolation kit. Nested PCR was performed on the env, gag, and pol regions of HIV-1 using the Gene Amp PCR System 9700. Sequencing reactions were performed using the inner PCR primers and the DYEnamic™ ET Dye Terminator Kit, and phylogenetic analysis was performed using the gag, pol, and env gene sequences. We collected samples from 31 blood donors who tested positive for HIV-1 in confirmatory experiments. The male:female ratio of blood donors was 3.4:1, and the mean age was 32.4 years (range: 19 to 61 years). Phylogenetic analysis showed that subtype B is the most prevalent among Northern Brazilian HIV-1-seropositive blood donors. One HIV-1 subtype C and one circulating recombinant form (CRF_BF) of HIV-1 were identified in the State of Amazonas. This is the first study showing the occurrence of a possible "homogenous" subtype C in this region of Brazil. This finding could contribute to a better characterization of the HIV-1 strains that circulate in the country.

Performance and radial distribution profiles of a variable flow rate sprinkler developed for precision irrigation

Variable rate sprinklers (VRS) have been developed to promote localized water application of irrigated areas. In Precision Irrigation, VRS permits better control of flow adjustment and, at the same time, provides satisfactory radial distribution profiles for various pressures and flow rates are really necessary. The objective of this work was to evaluate the performance and radial distribution profiles of a developed VRS which varies the nozzle cross sectional area by moving a pin in or out using a stepper motor. Field tests were performed under different conditions of service pressure, rotation angles imposed on the pin and flow rate which resulted in maximal water throw radiuses ranging from 7.30 to 10.38 m. In the experiments in which the service pressure remained constant, the maximal throw radius varied from 7.96 to 8.91 m. Averages were used of repetitions performed under conditions without wind or with winds less than 1.3 m s-1. The VRS with the four stream deflector resulted in greater water application throw radius compared to the six stream deflector. However, the six stream deflector had greater precipitation intensities, as well as better distribution. Thus, selection of the deflector to be utilized should be based on project requirements, respecting the difference in the obtained results. With a small opening of the nozzle, the VRS produced small water droplets that visually presented applicability for foliar chemigation. Regarding the comparison between the estimated and observed flow rates, the stepper motor produced excellent results.

Currents controlling sedimentation, deposits recording palaeo-hydrodynamics – lessons from the continental shelf-slope system off SE South America

The continental margin off SE South America hosts one of the world’s most energetic hydrodynamic regimes but also the second largest drainage system of the continent. Both, the ocean current system as well as the fluvial runoff are strongly controlled by the atmospheric circulation modes over the region. The distribution pattern of particular types of sediments on shelf and slope and the long-term built-up of depositional elements within the overall margin architecture are, thus, the product of both, seasonal to millennial variability as well as long-term environmental trends. This talk presents how the combination of different methodological approaches can be used to obtain a comprehensive picture of the variability of a shelf and upper-slope hydrodynamic system during Holocene times. The particular methods applied are: (a) Margin-wide stratigraphic information to elucidate the role of sea level for the oceanographic and sedimentary systems since the last glacial maximum; (b) Palaeoceanographic sediment proxies combined with palaeo-temperature indicating isotopes of bivalve shells to trace lateral shifts in the coastal oceanography (particularly of the shelf front) during the Holocene; (c) Neodymium isotopes to identify the shelf sediment transport routes resulting from the current regime; (d) Sedimentological/geochemical data to show the efficient mechanism of sand export from the shelf to the open ocean; (e) Diatom assemblages and sediment element distributions indicating palaeo-salinity and the changing marine influence to illustrate the Plata runoff history. Sea level has not only controlled the overall configuration of the shelf but also the position of the main sediment routes from the continent towards the ocean. The shelf front has shifted frequently since the last glacial times probably resulting from both, changes in the Westerly Winds intensity and in the shelf width itself. Remarkable is a southward shift of this front during the past two centuries possibly related to anthropogenic influences on the atmosphere. The oceanographic regime with its prominent hydrographic boundaries led to a clear separation of sedimentary provinces since shelf drowning. It is especially the shelf front which enhances shelf sediment export through a continuous high sand supply to the uppermost slope. Finally, the Plata River does not continuously provide sediment to the shelf but shows significant climate-related changes in discharge during the past centuries. Starting from these findings, three major fields of research should, in general, be further developed in future: (i) The immediate interaction of the hydrodynamic and sedimentary systems to close the gaps between deposit information and modern oceanographic dynamics; (ii) Material budget calculations for the marginal ocean system in terms of material fluxes, storage/retention capacities, and critical thresholds; (iii) The role of human activity on the atmospheric, oceanographic and solid material systems to unravel natural vs. anthropogenic effects and feedback mechanisms

Oxygen and Chlorophyll Distribution in the Eastern Atlantic Ocean from 0º to 35ºS.

Programa de doctorado en Oceanografía. Trabajo presentado para la obtención del Diploma de Estudios Avanzados.

Metabolism and biomass vertical distribution of zooplankton in the Bransfield Strait during the austral summer of 2000

[EN] The vertical distribution (0?550 m) of zooplankton biomass, and indices of respiration (electron transfer system [ETS]) and structural growth (aminoacyltRNA synthetases activity [AARS]), were studied in waters off the Antarctic Peninsula during the austral summer of 2000. The dominant species were the copepod Metridia gerlachei and the euphausiid Euphausia superba. We observed a vertical krill/copepod substitution in the water column. The zooplankton biomass in the layer at a depth of 200?500 m was of the same magnitude as the biomass in the layer at a depth of 0?200 m, indicating that biomass in the mesopelagic zone is an important fraction of the total zooplankton in Antarctic waters. The metabolic rates of the zooplankton community were sustained by less than 0.5% of the primary production in the area, suggesting that microplankton or small copepods are the main food source. Neither food availability nor predation seemed to control mesozooplankton biomass. The wide time lag between the abundance peak of the dominant copepod (M. gerlachei) and the phytoplankton bloom is suggested to be the main explanation for the low summer zooplankton biomass observed in these waters.

Multitemporal analysis of satellite imagery: implementation of a land evolution model in ALCS (ATSR LAND CLASSIFICATION SYSTEM)

In this report it was designed an innovative satellite-based monitoring approach applied on the Iraqi Marshlands to survey the extent and distribution of marshland re-flooding and assess the development of wetland vegetation cover. The study, conducted in collaboration with MEEO Srl , makes use of images collected from the sensor (A)ATSR onboard ESA ENVISAT Satellite to collect data at multi-temporal scales and an analysis was adopted to observe the evolution of marshland re-flooding. The methodology uses a multi-temporal pixel-based approach based on classification maps produced by the classification tool SOIL MAPPER ®. The catalogue of the classification maps is available as web service through the Service Support Environment Portal (SSE, supported by ESA). The inundation of the Iraqi marshlands, which has been continuous since April 2003, is characterized by a high degree of variability, ad-hoc interventions and uncertainty. Given the security constraints and vastness of the Iraqi marshlands, as well as cost-effectiveness considerations, satellite remote sensing was the only viable tool to observe the changes taking place on a continuous basis. The proposed system (ALCS – AATSR LAND CLASSIFICATION SYSTEM) avoids the direct use of the (A)ATSR images and foresees the application of LULCC evolution models directly to „stock‟ of classified maps. This approach is made possible by the availability of a 13 year classified image database, conceived and implemented in the CARD project (http://earth.esa.int/rtd/Projects/#CARD).The approach here presented evolves toward an innovative, efficient and fast method to exploit the potentiality of multi-temporal LULCC analysis of (A)ATSR images. The two main objectives of this work are both linked to a sort of assessment: the first is to assessing the ability of modeling with the web-application ALCS using image-based AATSR classified with SOIL MAPPER ® and the second is to evaluate the magnitude, the character and the extension of wetland rehabilitation.

Partial discharge in power distribution electrical systems: pulse propagation models and detection optimization

Investigation on impulsive signals, originated from Partial Discharge (PD) phenomena, represents an effective tool for preventing electric failures in High Voltage (HV) and Medium Voltage (MV) systems. The determination of both sensors and instruments bandwidths is the key to achieve meaningful measurements, that is to say, obtaining the maximum Signal-To-Noise Ratio (SNR). The optimum bandwidth depends on the characteristics of the system under test, which can be often represented as a transmission line characterized by signal attenuation and dispersion phenomena. It is therefore necessary to develop both models and techniques which can characterize accurately the PD propagation mechanisms in each system and work out the frequency characteristics of the PD pulses at detection point, in order to design proper sensors able to carry out PD measurement on-line with maximum SNR. Analytical models will be devised in order to predict PD propagation in MV apparatuses. Furthermore, simulation tools will be used where complex geometries make analytical models to be unfeasible. In particular, PD propagation in MV cables, transformers and switchgears will be investigated, taking into account both irradiated and conducted signals associated to PD events, in order to design proper sensors.

Development of human visual system analysis for the implementation of a new instrument for flicker measurement

Flicker is a power quality phenomenon that applies to cycle instability of light intensity resulting from supply voltage fluctuation, which, in turn can be caused by disturbances introduced during power generation, transmission or distribution. The standard EN 61000-4-15 which has been recently adopted also by the IEEE as IEEE Standard 1453 relies on the analysis of the supply voltage which is processed according to a suitable model of the lamp – human eye – brain chain. As for the lamp, an incandescent 60 W, 230 V, 50 Hz source is assumed. As far as the human eye – brain model is concerned, it is represented by the so-called flicker curve. Such a curve was determined several years ago by statistically analyzing the results of tests where people were subjected to flicker with different combinations of magnitude and frequency. The limitations of this standard approach to flicker evaluation are essentially two. First, the provided index of annoyance Pst can be related to an actual tiredness of the human visual system only if such an incandescent lamp is used. Moreover, the implemented response to flicker is “subjective” given that it relies on the people answers about their feelings. In the last 15 years, many scientific contributions have tackled these issues by investigating the possibility to develop a novel model of the eye-brain response to flicker and overcome the strict dependence of the standard on the kind of the light source. In this light of fact, this thesis is aimed at presenting an important contribution for a new Flickermeter. An improved visual system model using a physiological parameter that is the mean value of the pupil diameter, has been presented, thus allowing to get a more “objective” representation of the response to flicker. The system used to both generate flicker and measure the pupil diameter has been illustrated along with all the results of several experiments performed on the volunteers. The intent has been to demonstrate that the measurement of that geometrical parameter can give reliable information about the feeling of the human visual system to light flicker.