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At the beginning of the pandemic, the Brazilian Public Health System (SUS) did not to test all suspects cases of COVID-19, thus, hospitalized individuals, health professionals, and symptomatic contacts were prioritized. Contrary to the criteria adopted by the government, the municipality of Botucatu chose to test all people who manifested flu-like syndrome. We aimed to investigate whether positive cases for COVID-19 were more frequent in patients seeking diagnosis via SUS or in the group of people seeking diagnosis via Municipal Health Center and whether the viral load was expressed differently in hospitalized patients (HP) compared to mild symptoms (MHC). Results showed that there were no differences in the percentage between the groups. Regarding the viral load, significant differences were found between the samples from HP and MHC (3-10 days of symptoms), with HP presenting a lower viral load. The results provide significant information about the viral load at different time-lapses.

Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5-11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children.To estimate the potential impact of vaccinating children aged 5-11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario.We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5-11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only.Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children.This manuscript was funded by the Brazilian Council for Scientific and Technology Development (CNPq - Process # 402834/2020-8).

IntroductionModeling is important for guiding policy during epidemics. The objective of this work was to describe the experience of structuring a multidisciplinary collaborative network in Brazil for modeling coronavirus disease 2019 (COVID-19) to support decision-making throughout the pandemic.MethodsResponding to a national call in June 2020 for proposals on COVID-19 mitigation projects, we established a team of investigators from public universities located in various regions throughout Brazil. The team’s main objective was to model severe acute respiratory syndrome coronavirus 2 transmission dynamics in various demographic and epidemiologic settings in Brazil using different types of models and mitigation interventions. The modeling results aimed to provide information to support policy making. This descriptive study outlines the processes, products, challenges, and lessons learned from this innovative experience.ResultsThe network included 18 researchers (epidemiologists, infectious diseases experts, statisticians, and modelers) from various backgrounds, including ecology, geography, physics, and mathematics. The criteria for joining the network were having a communication channel with public health decision-makers and being involved in generating evidence for public policy. During a 24-month period, the following sub-projects were established: (i) development of a susceptible-exposed-infected-recovered-like, individual-based meta-population and Markov chain model; (ii) projection of COVID-19 transmission and impact over time with respect to cases, hospitalizations, and deaths; (iii) assessment of the impact of non-pharmacological interventions for COVID-19; (iv) evaluation of the impact of reopening schools; and (v) determining optimal strategies for COVID-19 vaccination. In addition, we mapped existing COVID-19 modeling groups nationwide and conducted a systematic review of relevant published research literature from Brazil.ConclusionsInfectious disease modeling for guiding public health policy requires interaction between epidemiologists, public health specialists, and modelers. Communicating modeling results in a non-academic format is an additional challenge, so close interaction with policy makers is essential to ensure that the information is useful. Establishing a network of modeling groups will be useful for future disease outbreaks.

Brazil experienced moments of collapse in its health system throughout 2021, driven by the emergence of variants of concern (VOC) combined with an inefficient initial vaccination strategy against Covid-19.To support decision-makers in formulating COVID-19 immunization policy in the context of limited vaccine availability and evolving variants over time, we evaluate optimal strategies for Covid-19 vaccination in Brazil in 2021, when vaccination was rolled out during Gamma variant predominance.Using a discrete-time epidemic model we estimate Covid-19 deaths averted, considering the currently Covid-19 vaccine products and doses available in Brazil; vaccine coverage by target population; and vaccine effectiveness estimates. We evaluated a 5-month time horizon, from early August to the end of December 2021. Optimal vaccination strategies compared the outcomes in terms of averted deaths when varying dose intervals from 8 to 12 weeks, and choosing the minimum coverage levels per age group required prior to expanding vaccination to younger target populations. We also estimated dose availability required over time to allow the implementation of optimal strategies.To maximize the number of averted deaths, vaccine coverage of at least 80 % should be reached in older age groups before starting vaccination into subsequent younger age groups. When evaluating varying dose intervals for AZD1222, reducing the dose interval from 12 to 8 weeks for the primary schedule would result in fewer COVID-19 deaths, but this can only be implemented if accompanied by an increase in vaccine supply of at least 50 % over the coming six-months in Brazil.Covid-19 immunization strategies should be tailored to local vaccine product availability and supply over time, circulating variants of concern, and vaccine coverage in target population groups. Modelling can provide valuable and timely evidence to support the implementation of vaccination strategies considering the local context, yet following international and regional technical evidence-based guidance.

Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx.In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods.Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p 0.001).There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.

Introdução: O ambiente hospitalar é um cenário de risco para transmissão da covid19, com possibilidade de surtos e comprometimento de pacientes mais suscetíveis a evolução para doença grave. Por isso, medidas como check list de sintomas respiratórios, rastreio com testes laboratoriais, precaução respiratória e de contato para casos suspeitos e confirmados são empregadas para evitar esta transmissão. Objetivo: Este estudo buscou avaliar a transmissão da covid19 no ambiente hospitalar onde tais medidas de controle de infecção são utilizadas. Métodos: Entre março e agosto de 2021, foi avaliada uma coorte de indivíduos que foram expostos a paciente confirmado com COVID19 durante sua internação. Após contato, os indivíduos expostos foram submetidos à precaução respiratória e contato, e acompanhados por 14 dias. O rastreamento da transmissão envolveu a avaliação diária dos sintomas e, ou, achados típicos em tomografia de tórax. Aqueles identificados com tais alterações foram submetidos a swab nasofaríngeo para RT-PCR. Resultados: Foram identificados 73 pacientes confirmados para covid19 durante sua hospitalização, previamente sem este diagnóstico, sendo a maioria em enfermarias (56,2%), seguido do pronto socorro (35,6%) e UTI (8,2%). Foram 197 pacientes expostos a estes casos, dos quais 61 (31%) desenvolveram sintomas sugestivos de síndrome gripal nos 14 dias consecutivos à exposição e 18 (9,1%) confirmaram covid19. Entre estes últimos, 15 (12,2%) foram expostos a caso fonte sintomático respiratório enquanto que 3 (4,0%) decorreu de contato com assintomáticos positivos (p = 0,07). Não foi observada transmissão da covid19 em UTI. Pacientes expostos a casos positivos sintomáticos respiratórios no pronto socorro tiveram maior risco de aquisição de covid19 do que aqueles cujo contato ocorreu em ambiente de enfermaria [OR = 3,78 (1,15 - 12,39), p = 0,02]. Conclusão: Embora o hospital adote medidas para evitar a transmissão da covid19 intra hospitalar, tais como check list de sintomas respiratórios e pesquisa por RT-PCR em saliva para todas as admissões, ocorre um escape de casos que podem transmitir a doença para os demais hospitalizados. Esta transmissão foi maior em paciente sintomáticos respiratórios e aqueles acamados no pronto socorro, onde o distanciamento entre leitos é menor.

Introdução: O êxodo rural no Brasil se intensificou na década de 80 e atualmente, no Nordeste, 73,12% da população vive em cidades. O crescimento desordenado destas e a supressão de áreas verdes, muitas vezes de forma desordenada e/ou ilegal, está associado a diminuição de saúde e de qualidade de vida, com aumento em casos de depressão e ansiedade, relacionados, em parte, à perda de contato e de senso de pertencimento com a natureza. Objetivos: Avaliar o potencial para promoção de saúde mental em propriedade rural no município de Murici do Portelas-PI. Material e métodos: Fez-se estudo bibliográfico e 4 visitas de campo, de junho a setembro de 2021, localização 3°15’46.96’’S 41°57’04.25’’O, onde se pretende criar Reserva Particular do Patrimônio Natural na maior parte da área. Resultados: A propriedade rural, de 52 hectares, possui vegetação nativa, classificada como Floresta Estacional, de transição entre Cerrado e Caatinga, e sob influência pré-Amazônica e litorânea. O local apresenta potencial para o desenvolvimento das seguintes atividades: passeios guiados, educação ambiental, eventos culturais, observação de fauna e flora, hospedagem, retiros religiosos, retiros intelectuais, bioconstrução, práticas agroflorestais, esportes ao ar livre e trilhas para pedestres e ciclistas. A pandemia do Covid-19 acentuou a importância de espaços verdes para a manutenção de saúde mental, e o local sob estudo tem potencial para promoção de saúde aliada ao desenvolvimento de atividades econômicas rentáveis para os proprietários e para o município, que possui muito baixo IDH e é um dos municípios mais pobres do Piauí. Conclusão: Recomenda-se a criação de centro de visitantes no local, a fim de oferecer conforto, acessibilidade, e rentabilidade com cobrança de entrada e venda de produtos alimentícios locais, além das atividades previamente citadas. A promoção de saúde mental deve ser vista como mais um serviço ecossistêmico essencial produzido pela natureza e que, por isso, deve ser remunerada e estimulada. Assim, faz-se necessário o poder público, estadual ou municipal, reconhecer a importância dos serviços ecossistêmicos prestados e regulamentar a lei Lei 14.119/21, que prevê o pagamento por serviços ambientais.

Introdução: Monsenhor Gil encontra-se em área limítrofe de Cerrado e Caatinga, com paisagens interrelacionadas com as condições ambientais, como umidade e solo, onde se observam desde buritizais em baixios com água perene até matas decíduas em topos de morros. Apesar da beleza cênica e da importância ecológica, o município sofre com o avanço do desmatamento sobre sua vegetação nativa. Muitos remanescentes de Cerrado e Caatinga no Brasil encontram-se em propriedade privadas, fora de Unidades de Conservação. Estas poderiam contribuir com a conservação ambiental, mas enfrentam problemas de segurança e gestão. Objetivo: Identificar desafios à conservação ambiental presentes em propriedade privada no município de Monsenhor Gil-PI. Material e Métodos: O trabalho foi feito por análise de imagens de satélite obtidas pelo software Google Earth e 4 visitas à propriedade, localização 5°37'8.04"S e 42°37'23.24"O, de abril a agosto de 2021. Percorreram-se áreas abertas e trilhas já existentes, registraram-se imagens do ambiente, da fauna e da flora, bem como realizaram-se coletas botânicas. Resultados: Identificaram-se as fisionomias de Campo Sujo, Cerrado stricto sensu, Babaçual, Mata Semidecídua, Mata Decídua, Lajedo, Vegetação Rupestre, Mata de Galeria associada a córrego temporário (Riacho Curral de Pedra), e espécimes de madeira comercial. Os principais desafios identificados foram invasão por terceiros, entrada de herbívoros exóticos, herbivoria e pisoteio de plântulas, compactação do solo por veículos e gado, balneário sem controle de visitantes, acúmulo de lixo, poluição do córrego e da laje por sabão derivado da lavagem de roupas, depredação da laje, vestígios de caça, pichações, corte de madeira sem autorização e problemas quanto à delimitação da propriedade. Conclusão: Diante do exposto, propõe-se cercamento e georreferenciamento da propriedade, construção de sede com respectiva contratação de cuidador(a), realização de levantamento florístico e denúncia da retirada ilegal de madeira aos órgãos competentes, para evitar o corte seletivo de espécies madeireiras, potencial fator precipitante de extinção local ou diminuição do banco genético. Também seria benéfico conscientizar a população do entorno da importância de se preservar os remanescentes de Cerrado. Essas medidas poderiam solucionar parte dos desafios enfrentados na propriedade rural e contribuir para a preservação das diferentes fitofisionomias e suas respectivas espécies.

Made available in DSpace on 2022-04-29T08:32:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks. Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu Universidade Estadual Paulista. Departamento de Bioestatística. Instituto de Biociências da Botucatu. Botucatu Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu Universidade Estadual Paulista. Departamento de Bioestatística. Instituto de Biociências da Botucatu. Botucatu

An agent-based model is proposed to access the impact of vaccination strategies to halt the COVID-19 spread. The model is parameterized using data from São Paulo State, Brazil. It was considered the two vaccines that are already approved for emergency use in Brazil, the CoronaVac vaccine developed by the Chinese bio-pharmaceutical company Sinovac and the Oxford-AstraZeneca vaccine (ChadOx1) developed by Oxford University and the British laboratory AstraZeneca. Both of them are two-dose schemes, but the efficacy and the interval between doses are different. We found that even in the worst scenario, in which the vaccine does not prevent infection either severe symptoms, the number of deaths decreases from 122 to 99 for CoronaVac application and to 80 for ChadOx1 administration. The same patterns have been seen in hospitalizations. Nevertheless, we show that when a low risk perception occurs, the reduction values decrease between 2% to 4%. Moreover, the increase of disease prevalence also jeopardizes immunization, showing the importance of the mitigation measures maintenance. On the other hand, doubling the vaccination rate would be able to significantly decrease the disease outcomes, reducing deaths by up to 74.4%. In conclusion, vaccination, along with non-pharmaceutical measures, is key to the control of COVID-19 in Brazil.

Made available in DSpace on 2021-06-25T11:10:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy. Department of Infectious Diseases Botucatu Medical School São Paulo State University (UNESP) Department of Geography Faculty of Science and Technology São Paulo State University (UNESP) Department of Geography Federal University of Espírito Santo Institute of Biosciences São Paulo State University (UNESP) Institute of Mathematics Statistics and Scientific Computation University of Campinas (UNICAMP) Department of Infectious Diseases Botucatu Medical School São Paulo State University (UNESP) Department of Geography Faculty of Science and Technology São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP)

Interrupted time series analyses (ITSA) were performed to measure the impact of social distancing policies (instituted 22/03/2020) and subsequent mandatory masking in the community (instituted 04/05/2020) on the incidence and effective reproductive number (Rt) of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.

Made available in DSpace on 2020-12-12T02:49:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-18 Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo. School of Agriculture São Paulo State University (Unesp) Botucatu Medical School São Paulo State University (Unesp) Clinical Hospital of Botucatu Medical School (HCFMB) Institute of Biosciences São Paulo State University (Unesp) School of Technology and Sciences São Paulo State University (Unesp) Federal University of Espirito Santo (UFES) School of Agriculture São Paulo State University (Unesp) Botucatu Medical School São Paulo State University (Unesp) Clinical Hospital of Botucatu Medical School (HCFMB) Institute of Biosciences São Paulo State University (Unesp) School of Technology and Sciences São Paulo State University (Unesp)

Early 2020 and the world experiences its very first pandemic of globalized era. A novel coronavirus, SARS-Cov-2, is the causative agent of severe pneumonia and rapidly spread through many nations, crashing health systems. In Brazil, the emergence of local epidemics in major metropolitan areas is a concern. In a huge and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for an inner Brazil and what can we do to control infection transmission in each one of these locations? In this paper, a mathematical model was developed to simulate disease transmission among individuals in several scenarios, differing by the intensity and type of control measures. Mitigation strategies rely on social distancing of all individuals, and detection and isolation of infected ones. The model shows that control effort varies among cities. The social distancing is the most efficient method to control disease transmission but improving detection and isolation of infected individuals can help loosening this mitigation strategy.

Objectives: The impact of COVID-19 in metropolitan areas has been extensively studied. The geographic spread to smaller cities is of great concern and may follow hierarchical influence of urban centers. With that in mind, we investigated factors that affect vulnerability of inner municipalities in São Paulo State, Brazil, an area with 24 million inhabitants. Methods: Surveillance data for confirmed COVID-19 cases and admissions for severe acute respiratory disease (SARD) up to April 18th were recorded for each of 604 municipalities that lay outside São Paulo metropolitan area. Vulnerability was assessed in Multivariable models, including sociodemographic indexes, road distance to the State Capital and the municipalities classification proposed by the Brazilian Institute of Geography and Statistics. Municipalities of great regional relevance were used as reference category for that classification. The outcome of interest for Cox regression was having COVID-cases, with time counting from the first report in São Paulo State. For binomial negative regression models, the outcomes of interest were rates of confirmed COVID-19 cases and admissions for SARD.Results: A total of 198 (32.8%) municipalities had autochthonous COVID-19 cases. In Cox models, affected municipalities were likely to have greater population density (Hazard Ratio[HR] for each 100 inhabitants per square kilometer, 1.07; 95% Confidence Interval [CI], (1.05-1.10)), proportion of inhabitants in urban area (HR, 1.02; 95%CI, 1.00-1.04), higher human development index (HDI, HR for 1%, 1.06; 95%CI, 1.00-1.13) and Gini Index for Inequality of income (HR for 1%, 1.04, 95% CI, 1.00-1.07). On the other hand, distance from the Capital was protective (HR for each 100Km, 0.82; 95%CI, 0.74-0.90). The HR95%[95%CI] also varied negatively according to the categories of influence of major centers (0.41 [0.22-0.77], 0.16 [0.09-0.32], 0.07 [0.03-0.15]). The binomial negative regression models for COVID-19 incidence also detected positive association with population density (Incidence Rate Ratio[IRR], 1.13; 95%CI, 1.07-1.18) and proportion of urban population (IRR, 1.04; 95%CI, 1.01-1.05), protection for cities distant to the Capital (IRR=0.73; 95%CI, 0.68-0.81) and increasing negative association for categories of influence (0.19 [0.09-0.42], 0.07 [0.03-0.15] and 0.03 [0.02-0.08]). Similar findings were detected when we used SARD incidence as outcome.Conclusion: Municipalities with greater population, density and regional influence were more likely to be affected earlier and more intensely by COVID-19. Non-pharmacological measures should be strengthened in those areas of greater risk.

Made available in DSpace on 2021-06-25T11:09:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analyzed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing, and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission. Clinical Hospital of Botucatu Medical School (HCFMB) São Paulo State University (UNESP) Botucatu Medical School Department of Infectious Diseases São Paulo State University (UNESP) School of Agriculture São Paulo State University (UNESP) School of Technology and Sciences University of Campinas (UNICAMP) Institute of Mathematics Statistics and Scientific Computation Federal University of Abc (UFABC) Center for Mathematics Computation and Cognition Federal University of Espírito Santo (UFES) São Paulo State University (UNESP) Institute of Biosciences Clinical Hospital of Botucatu Medical School (HCFMB) São Paulo State University (UNESP) Botucatu Medical School Department of Infectious Diseases São Paulo State University (UNESP) School of Agriculture São Paulo State University (UNESP) School of Technology and Sciences São Paulo State University (UNESP) Institute of Biosciences

Submitted by GABRIEL BERG DE ALMEIDA (gabrielberg@rocketmail.com) on 2019-08-23T19:29:48Z No. of bitstreams: 1 Dissertação Gabriel Repositório.pdf: 1412382 bytes, checksum: 3c01092d512bf87b68ff78b977c7b4da (MD5) Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2019-08-26T11:51:46Z (GMT) No. of bitstreams: 1 almeida_gb_me_bot_par.pdf: 290897 bytes, checksum: 012f6d78e15a16257c0310f643a2ad7a (MD5) Made available in DSpace on 2019-08-26T11:51:46Z (GMT). No. of bitstreams: 1 almeida_gb_me_bot_par.pdf: 290897 bytes, checksum: 012f6d78e15a16257c0310f643a2ad7a (MD5) Previous issue date: 2019-07-30 Introdução: A literatura científica é escassa quanto à prevalência e ao manejo da sífilis em candidatos ao transplante renal (TxR). O presente estudo objetivou ampliar os conhecimentos sobre o assunto. Métodos: Série de casos que incluiu todos os inscritos em lista de espera para o TxR de centro único brasileiro entre 2013 e 2017, com diagnóstico sorológico de sífilis. Foi indicada avaliação oftalmológica e exame liquórico para todos os indivíduos. Os pacientes foram classificados de acordo com a forma clínica da sífilis e tratados segundo protocolos vigentes. Os dados demográficos, epidemiológicos, clínicos, laboratoriais e terapêuticos foram revisados por meio de prontuário eletrônico. Foi realizada análise estatística descritiva. Resultados: A prevalência da sífilis na população estudada foi de 3,3% (27/807). Dos 27 pacientes incluídos no estudo, 77,8% foram diagnosticados com a forma latente da doença e 22,2% com neurossífilis. A única alteração liquórica presente nos pacientes com neurossíflis foi a hiperproteinorraquia. A avaliação oftalmológica detectou comprometimento ocular da sífilis em um paciente assintomático. Onze pacientes foram transplantados, sendo que cinco destes não receberam profilaxia específica após o TxR. Não foi identificada reativação da doença dentro do período de acompanhamento mediano de 46 meses. Discussão: A soroprevalência da sífilis mostrou-se elevada na população estudada. A proporção da forma neurológica foi significativa, porém, não se podem descartar diagnósticos falso-positivos. A triagem oftalmológica foi eficaz em identificar a forma ocular da sífilis em paciente assintomático. A profilaxia específica pós-TxR para pacientes com tratamento prévio adequado parece desnecessária. Introduction: Scientific literature is scarce regarding the prevalence and the adequate management of syphilis in patients who are candidates for kidney transplantation (KTx). The aim of this study was to increase knowledge about the subject. Methods: Case series that included all patients placed on a Brazilian single center KTx waiting list between 2013 and 2017, with serological diagnosis of syphilis. Ophthalmologic evaluation and cerebrospinal fluid examination were indicated for all subjects. Patients were classified according to the clinical form of syphilis and treated according to current protocols. Demographic, epidemiological, clinical, laboratory and therapeutic data were reviewed using electronic medical records. Descriptive statistical analysis was performed. Results: The prevalence of syphilis in the population studied was 3.3% (27/807). Of the 27 patients included in the study, 77.8% were diagnosed with the latent form of the disease and 22.2% with neurosyphilis. Increased protein level was the only cerebrospinal fluid alteration present in patients with neurosyphilis. Ophthalmologic evaluation detected ocular involvement of syphilis in an asymptomatic patient. Eleven patients were transplanted, five of whom did not receive specific prophylaxis after KTx. No disease reactivation was identified within the median follow-up period of 46 months. Discussion: Seroprevalence of syphilis was high in the studied population. The proportion of neuroshyphilis was significant; however, false-positive diagnoses cannot be ruled out. Ophthalmologic screening was effective in identifying the ocular form of syphilis in an asymptomatic patient. Specific post-KTx prophylaxis for patients with adequate prior treatment seems unnecessary.

Cytogenetic and molecular genetic data are of paramount importance in the diagnosis, prognosis, and risk stratification of patients with malignant diseases. Sometimes they even directly guide the choice of therapy.1 Disease-specific abnormalities, particularly translocations, can provide essential information to assist the Pathologist and/or Oncologist in assigning a diagnosis. In several diseases, tumour genetics correlate strongly with clinical risk; thus, cytogenetic information may help the Oncologist counsel the patient, choose a specific treatment, and/or modulate treatment intensity. Clinical trials may involve cytogenetic classification of patients to the appropriate treatment regimens. Currently, the provision of specific assays for acquired neoplasiaspecific genomic changes varies among and within countries as a range of laboratories offer diagnostic solid tumour genetics; these may include Cytogenetic, Pathology, Haematology, and Molecular Genetics laboratories. Technical standards and general guidelines for the analysis and the report of results on most solid tumours are lacking. To address these deficits, a tumour best practice meeting with invited tumour experts without conflict of interest was held on 23rd April 2013 in Oxford, United Kingdom. The aim was to produce professional guidelines for tumour genetic laboratories and to incorporate the standards imposed by generic European guidelines,2 regulatory bodies (ISO15189, 2012 Medical laboratories – requirements for quality and competence),3 reporting guidelines,4 ISCN,5 and acquired best practice guidelines, while taking into account the current practice in Europe. The guidelines are aimed principally at giving guidance on the minimum, standard cytogenetic analyses, which are applicable to different types of laboratories operating under different regulatory arrangements and are relevant if more specific recommendations are not available. It was universally acknowledged that information on ancillary techniques in use in most cytogenetic laboratories (eg, RTPCR) or advanced techniques not always extensively performed in all laboratories (eg, next-generation sequencing (NGS)) were considered. The process for developing these evidence-based consensus guidelines included agreement on the need of general uniform rules on solid tumour analysis and reporting, discussion on the architecture of the guidelines, working group formation with different tasks (collection, analysis and comparison of any existing guidelines on this subject, type of tumours to be included according to published data and database consultation, method of analysis to be included, report formulation), circulation of the working group activities, formulation and circulation of the initial recommendations, draft and discussion, final consensus, and approval. It is noted that some elements of the tumour diagnostic service not subject to statute may be varied according to local constraints and agreements. Therefore, these guidelines are minimum requirements and additional professional judgment may be of paramount importance under many circumstances. In addition, as new techniques, particularly NGS, as well as clinical evidence, are becoming available all the time, these should be kept under constant review. Notes: The use of ‘must’ in this document indicates a requirement and the use of ‘should’ indicates a recommendation. Where there appears to be contradiction between available guidelines, the most recently published ones should be taken to apply to all. All diagnostic laboratories should be accredited to national or internationally accepted standards (ISO15189).3,6 Laboratories should participate in an External Quality Assessment Scheme7 in all aspects of their service for which a scheme is available.

We study the following problem: preprocess a set \(\mathcal {O}\) of objects into a data structure that allows us to efficiently report all pairs of objects from \(\mathcal {O}\) that intersect inside an axis-aligned query range \(Q\). We present data structures of size \(O(n\,\mathrm {polylog}\,n)\) and with query time \(O((k+1)\,\mathrm {polylog}\, n)\) time, where k is the number of reported pairs, for two classes of objects in the plane: axis-aligned rectangles and objects with small union complexity. For the 3-dimensional case where the objects and the query range are axis-aligned boxes in \(\mathbb {R}^3\), we present a data structure of size \(O(n\sqrt{n}\, \mathrm {polylog}\, n)\) and query time \(O((\sqrt{n}+k)\,\mathrm {polylog}\,n)\). When the objects and query are fat, we obtain \(O((k+1)\,\mathrm {polylog}\,n)\) query time using \(O(n\,\mathrm {polylog}\,n)\) storage.

A sliding camera in an orthogonal polygon \(P\) is a point guard \(g\) that travels back and forth along an orthogonal line segment \(s\) inside \(P\). A point \(p\) in \(P\) is guarded by \(g\) if and only if there exists a point \(q\) on \(s\) such that line segment \(pq\) is normal to \(s\) and contained in \(P\). In the minimum sliding cameras (MSC) problem, the objective is to guard \(P\) with the minimum number of sliding cameras. We give a linear-time dynamic programming algorithm for the MSC problem on \(x\)-monotone orthogonal polygons, improving the 2-approximation algorithm of Katz and Morgenstern (2011). More generally, our algorithm can be used to solve the MSC problem in linear time on simple orthogonal polygons \(P\) for which the dual graph induced by the vertical decomposition of \(P\) is a path. Our results provide the first polynomial-time exact algorithms for the MSC problem on a non-trivial subclass of orthogonal polygons.

Introduction: Stroke individuals have sensorimotor repercussions on their ipsilesional upper limb. Therefore, it is important to use tests that allow an adequate assessment and follow-up of such deficits. Physical and occupational therapists commonly use maximal grip strength tests to assess the functional condition of stroke individuals. However, one could ask whether a single test is able to characterize the hand function in this population. Objective: The aim of this study was to investigate the relationship among outcomes of different tests frequently used to describe the function of the hand in the ipsilesional upper limb of stroke individuals. Methods: Twenty-two stroke individuals performed four hand function tests: maximal handgrip strength (HGSMax), maximal pinch grip strength (PGSMax), Jebsen-Taylor Hand Function Test (JTHFT) and Nine Hole Peg Test (9-HPT). All tests were performed with the ipsilesional hand. Pearson's correlation analyses were performed. Results: the results indicated a moderate and positive relationship between HGSMax and JTHFT (r = 0.50) and between JTHFT and 9-HPT (r = 0.55). Conclusion: We conclude that the existence of only moderate relationships between test outcomes demonstrates the need to use at least two instruments to better describe the ipsilesional hand function of stroke individuals. Resumo Introdução: Indivíduos que sofreram um acidente vascular encefálico (AVE) apresentam repercussões sensoriomotoras em membro superior ipsilesional, se tornando importante a utilização de testes que possibilitem a avaliação e o acompanhamento adequado de tais déficits. Profissionais da reabilitação, como fisioterapeutas e terapeutas ocupacionais, comumente utilizam testes de força de preensão máxima para avaliar as condições funcionais de indivíduos após um AVE. Porém, será que apenas um teste é capaz de caracterizar a funcionalidade das mãos? Objetivo: O objetivo desse estudo foi examinar a relação do desempenho entre testes comumente utilizados para descrever a função manual do membro ipsilesional de indivíduos que sofreram um AVE. Métodos: Vinte e dois indivíduos pós AVE realizaram quatro testes: força de preensão palmar máxima (FPPMax), força de preensão digital máxima (FPDMax), teste de função manual Jebsen-Taylor (TFMJT) e teste dos nove pinos nos buracos (9-PnB). Todos os testes foram realizados com a mão ipsilesional. Foram realizados testes de correlação de Pearson entre os resultados obtidos em cada teste. Resultados: Os resultados indicaram uma relação positiva e moderada apenas entre TFMJT e FPPMax (r = 0,50) e entre o desempenho no TFMJT e no teste dos 9-PnB (r = 0,55). Conclusão: Conclui-se que a existência de relações de fraca a moderada demonstra a necessidade de utilização de pelo menos dois instrumentos, para que se possa descrever melhor a funcionalidade das mãos de indivíduos pós AVE.

Inspired by video analysis of team sports, we study the following problem. Let P be a polygonal path in the plane with n vertices. We want to preprocess P into a data structure that can quickly count the number of inclusion-minimal subpaths of P whose Frechet Distance to a given query segment Q is at most some threshold value e. We present a data structure that solves an approximate version of this problem: it counts all subpaths whose Frechet Distance is at most e, but this count may also include subpaths whose Frechet Distance is up to $(2+3\sqrt{2})\varepsilon $ . For any parameter n≤s≤n2, our data structure can be tuned such that it uses O(s polylog n) storage and has $O((n/\sqrt{s}){\rm polylog} n)$ query time. For the special case where we wish to count all subpaths whose Frechet Distance to Q is at most e·length(Q), we present a structure with O(n polylog n) storage and O(polylog n) query time.

We present a linear-time algorithm that, given a planar graph with m edges and maximum degree 3, finds an induced matching of size at least m/9. This is best possible.

We prove that any planar graph on n vertices has less than O(5.2852^n) spanning trees. Under the restriction that the planar graph is 3-connected and contains no triangle and no quadrilateral the number of its spanning trees is less than O(2.7156^n). As a consequence of the latter the grid size needed to realize a 3d polytope with integer coordinates can be bounded by O(147.7 n^). Our observations imply improved upper bounds for related quantities: the number of cycle-free graphs in a planar graph is bounded by O(6.4884^n), the number of plane spanning trees on a set of n points in the plane is bounded by O(158.6^n), and the number of plane cycle-free graphs on a set of n points in the plane is bounded by O(194.7^n).

Let A and B be two sets of n resp. m disjoint unit disks in the plane, with m ≥ n. We consider the problem of finding a translation or rigid motion of A that maximizes the total area of overlap with B. The function describing the area of overlap is quite complex, even for combinatorially equivalent translations and, hence, we turn our attention to approximation algorithms. We give deterministic (1 - ∊)-approximation algorithms for translations and for rigid motions, which run in O((nm/∊2) log (m/∊)) and O((n2m2/∊3) log m)) time, respectively. For rigid motions, we can also compute a (1 - ∊)-approximation in O((m2n4/3Δ1/3/∊3) log n log m) time, where Δ is the diameter of set A. Under the condition that the maximum area of overlap is at least a constant fraction of the area of A, we give a probabilistic (1 - ∊)-approximation algorithm for rigid motions that runs in O((m2/∊4) log 2(m/∊) log m) time and succeeds with high probability. Our results generalize to the case where A and B consist of possibly intersecting disks of different radii, provided that (i) the ratio of the radii of any two disks in A ∪ B is bounded, and (ii) within each set, the maximum number of disks with a non-empty intersection is bounded.

We introduce a new type of bounding-volume hierarchy, the c-oriented rotated-box tree, or c-rb-tree for short. A c-rb-tree uses boxes as bounding volumes, whose orientations come from a fixed set of predefined box orientations. We theoretically and experimentally compare our new c-rb-tree to two existing bounding-volumes hierarchies, namely c-dop-tree and box-trees. Both authors were supported by the Netherlands’ Organisation for Scientific Research (NWO) under project no. 639.023.301. P.H. was also supported in part by a NABIIT grant from the Danish Strategic Research Council and by the Danish National Research Foundation.

We prove tight bounds on the complexity of bisectors and Voronoi diagrams on so-called realistic terrains, under the geodesic distance. In particular, if ndenotes the number of triangles in the terrain, we show the following two results. (i) If the triangles of the terrain have bounded slope and the projection of the set of triangles onto the xy-plane has low density, then the worst-case complexity of a bisector is i¾?(n). (ii) If, in addition, the triangles have similar sizes and the domain of the terrain is a rectangle of bounded aspect ratio, then the worst-case complexity of the Voronoi diagram of mpoint sites is $\Theta(n+m\sqrt{n})$.

Inspired by sports analysis, we study data structures for storing a trajectory representing the movement of a player during a game, such that the following queries can be answered: Given two positions s and t, report all sub-trajectories in which the player moved in a more or less straight line from s to t. We consider two measures of straightness, namely dilation and direction deviation, and present efficient construction algorithms for our data structures, and analyze their performance. We also present an O(n^{1.5¿+¿e}) algorithm that, given a trajectory P and a threshold t, finds a simplification of P with a minimum number of vertices such that each edge in the simplification replaces a sub-trajectory of length at most t times the length of the edge. This significantly improves the fastest known algorithm for the problem.

Purpose To assess whether the scores of an Internet-administered adolescent health questionnaire (using two different interfaces) are equivalent to those obtained via paper and pencil (P&P). Furthermore, it compares adolescents' evaluations of modes of administration. Methods We randomly assigned 591 adolescents (aged 13–17 years) from five secondary schools within their classes to one of the two Internet interfaces (multiple items vs. one item per screen) or P&P. Adolescents completed questionnaires on psychosocial well-being (KIVPA), self-reported problems, health care utilization, and health-related behavior and supplementary evaluation surveys (on the given health questionnaire mode) in the computer classrooms. Differences in questionnaire scores among administration modes were analyzed by the Student's t -test and Wald test. Results Response rate was 96% (n = 565). Adolescents in the Internet one-item mode more frequently reported satisfaction with appearance compared with the Internet multiple-items mode ( p ≤ .01). The Internet group had more adolescents reporting that they have a sufficient number of friends than those in the paper mode ( p ≤ .01). The Internet mode received more favorable evaluations than P&P. The multiple items per screen format was favored over the one item per screen format on perceived speed of the administration mode. Conclusions Health questionnaires via Internet were positively evaluated and generally resulted in equal scores of health status/health behavior compared with the P&P mode. We recommend further research with other questionnaires, and in other settings as well with regard to score equivalence between web-based and P&P-administered questionnaires.

This article presents paraeducators' perceptions of the role they play in connecting the school to its community. Forty-nine paraeducators employed in various educational settings participated in focus-group interviews. Paraeducators reported close relationships with students and their parents that provided the basis for the paraprofessionals to act as connectors between parents and teachers, parents and community services, students and teachers, students and their parents, and students and their peers. The participants shared how they provided connections between the student and curriculum by using specific strategies aimed at helping students learn. The study uncovered the barriers that hamper the paraprofessional role as a connector.

In traditional colored range-searching problems, one wants to store a set of n objects with m distinct colors for the following queries: report all colors such that there is at least one object of that color intersecting the query range. Such an object, however, could be an ‘outlier’ in its color class. Therefore we consider a variant of this problem where one has to report only those colors such that at least a fraction t of the objects of that color intersects the query range, for some parameter t. Our main results are on an approximate version of this problem, where we are also allowed to report those colors for which a fraction (1 - e)t intersects the query range, for some fixed e> 0. We present efficient data structures for such queries with orthogonal query ranges in sets of colored points, and for point stabbing queries in sets of colored rectangles.

Addressing the theme of the cost management in agribusiness poultry industry, this study aims to analyze from the perspective of variable costing indicators the possibility of a poultry producer who works under the scheme of integration migrate to a system of independent production. Through an applied, quantitative case of study, the cost were raised, the contribution margin, break-even point and margin of safety and income statement were calculated in both production systems to enable a comparative analysis between the independent and integrated system of production. Finally, a sensitivity analysis of the contribution margin in relation to the variable cost in the independent system was performed, so a more accurate comparative analysis was possible. Based on the results obtained it was possible to address the pre-established problem of the research and discuss the results found.

Let S be a planar polygonal subdivision with n edges contained in the unit square. We present a data structure for point location in S where queries with points far away from any region boundary are answered faster. More precisely, we show that point location queries can be answered in time O(1 + min(log \frac{1}{\Delta_p} , log n)), where {\Delta_p} is the Euclidean distance of the query point p to the boundary of the region containing p. Our solution consists of a depth-bounded quadtree and a general point location structure, both of which can be constructed in O(n log n)time. We also show how to extend the result to convex polyhedral subdivisions in three dimensions.