Practical rules for summing the series of the Tweedie probability density function with high-precision arithmetic.

For some ranges of its parameters and arguments, the series for Tweedie probability density functions are sometimes exceedingly difficult to sum numerically. Existing numerical implementations utilizing inversion techniques and properties of stable distributions can cope with these problems, but no single one is successful in all cases. In this work we investigate heuristically the nature of the problem, and show that it is not related to the order of summation of the terms. Using a variable involved in the analytical proof of convergence of the series, the critical parameter for numerical non-convergence ("alpha") is identified, and an heuristic criterion is developed to avoid numerical non-convergence for a reasonably large sub-interval of the latter. With these practical rules, simple summation algorithms provide sufficiently robust results for the calculation of the density function and its definite integrals. These implementations need to utilize high-precision arithmetic, and are programmed in the Python programming language. A thorough comparison with existing R functions allows the identification of cases when the latter fail, and provide further guidance to their use.

A spatial approach for the epidemiology of antibiotic use and resistance in community-based studies: the emergence of urban clusters of Escherichia coli quinolone resistance in Sao Paulo, Brasil.

BACKGROUND: Population antimicrobial use may influence resistance emergence. Resistance is an ecological phenomenon due to potential transmissibility. We investigated spatial and temporal patterns of ciprofloxacin (CIP) population consumption related to E. coli resistance emergence and dissemination in a major Brazilian city. A total of 4,372 urinary tract infection E. coli cases, with 723 CIP resistant, were identified in 2002 from two outpatient centres. Cases were address geocoded in a digital map. Raw CIP consumption data was transformed into usage density in DDDs by CIP selling points influence zones determination. A stochastic model coupled with a Geographical Information System was applied for relating resistance and usage density and for detecting city areas of high/low resistance risk. RESULTS: E. coli CIP resistant cluster emergence was detected and significantly related to usage density at a level of 5 to 9 CIP DDDs. There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density. CONCLUSIONS: There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density. The usage density of 5-9 CIP DDDs per 1,000 inhabitants within the same influence zone was the resistance triggering level. This level led to E. coli resistance clustering, proving that individual resistance emergence and dissemination was affected by antimicrobial population consumption.

An entomological surveillance system based on open spatial information for participative dengue control.

Aedes aegypti is a very efficient disseminator of human pathogens. This condition is the result of evolutionary adaptations to frequent haematophagy, as well as to the colonization of countless types of habitats associated with environmental and cultural factors that favor the proliferation of this mosquito in urban ecosystems. Studies using sensitive methods of monitoring demonstrate that the methods of surveillance used in the Brazilian program do not show the high degrees of the infestation of cities by this vector. To increase the capacity of the health sector, new tools are needed to the practice of surveillance, which incorporate aspects of the vector, place and human population. We describe here the SMCP-Aedes - Monitoring System and Population Control of Aedes aegypti, aiming to provide an entomological surveillance framework as a basis for epidemiological surveillance of dengue. The SMCP-Aedes is uphold in the space technology information, supported by the intensive use of the web and free software to collect, store, analyze and disseminate information on the spatial-temporal distribution of the estimated density for the population of Aedes, based on data systematically collected with the use of ovitraps. Planned control interventions, intensified where and when indicated by the entomological surveillance, are agreed with the communities, relying on the permanent social mobilization.

Irradiation effect on fatty acid composition and conjugated linoleic acid isomers in frozen lamb meat.

The effect of gamma radiation processing on the lipid content, fatty acid composition and conjugated linoleic acid (CLA) profile in frozen lamb meat was investigated. Samples of longissimus thoracis muscle from lambs fed lucerne basal diets either unsupplemented or supplemented with polyunsaturated vegetable oils were irradiated (7kGy) and analysed. CLA contents in lamb meat did not affect (P>0.05) the levels of lipid oxidation induced by the irradiation. No significant differences (P>0.05) were observed for fatty acid composition, related nutritional indexes (n-6/n-3 and PUFA/SFA), as well as for total lipid and CLA contents, between non-irradiated (control) and irradiated meat samples. In contrast, meat irradiation affected the relative proportions of total trans,trans and cis/trans CLA isomers (P<0.001), in addition to the percentage of some minor individual CLA isomers (t11,t13 and t9,t11, with P<0.05 and P<0.001, respectively). The percentage of total cis/trans CLA isomers slightly decreased in irradiated samples, while the relative proportion of total trans,trans isomers slightly increased. This observation may be explained by the higher susceptibility to autoxidation of the cis double bond relative to the trans configuration.

Dorsal minithoracotomy for ductus arteriosus clip closure in premature neonates.

We present a new surgical technique for patent ductus arteriosus (PDA) occlusion in premature neonates (PN). Through a dorsal minithoracotomy the PDA is dissected extrapleurally with q-tips and clipped. The short surgical time, avoidance of pleural drainage, and prevention of late breast deformity are the operation highlights.

Coronary sinus iatrogenic lesion during repeated mitral valve replacement: case report of an immediate transmitral annulus repair

Apresenta-se a história e a evoluçäo de uma paciente no qual o seio coronariano foi lesado e, imediatamente, reconstruído através do anel valvar mitral. O acidente cirúrgico aconteceu durante a instrumentaçäo para remoçäo de uma prótese biológica degenerada. Uma quase completa lesäo da artéria coronária circunflexa foi a primeira impressäo. Um calibrador coronariano foi distalmente detectado dentro do átrio direito, mostrando tratar-se de uma lesäo do seio coronariano. A correçäo cirúrgica foi realizada por sutura contínua com fio de polipropileno 7-0 através do anel valvar. Uma angiografia, realizada após 14 meses, mostrou apenas discreto estreitamento do seio coronariano no local da sutura, observando-se a fase venosa de uma arteriografia seletiva da artéria coronária descendente anterior. Os autores acreditam que a simples ligadura ou a reconstruçäo do seio coronariano, na condiçäo iatrogênica apresentada, é motivo para especulações.

Leiomiossarcoma atrial esquerdo / Leiomyosarcoma of the left atrium

Homem de 48 anos, submetido à excisäo completa de leiomiossarcoma do átrio esquerdo. Portador de um nódulo próximo à glândula supra-renal direita, o tumor cardíaco foi achado casualmente durante exame ecocardiográfico, como parte da investigaçäo cardiológica pré-operatória da cirurgia abdominal, uma vez que apresentava dispnéia aos esforços. Os leiomiossarcomas cardíacos säo muito raros e, na maioria dos casos, constituem-se em achados necroscópicos casuais. Neste relato säo relatados os aspectos diagnósticos, com especial ênfase ao exame ecocardiográfico, bem como os aspectos terapêuticos e prognósticos com base em extensa revisäo da literatura

Coarctação da aorta associada a grande aneurisma / Coaretation of the Aorta associated With a Huge Aneurysm

Paciente de 16 anos, sintomática, encaminhada com suspeita de coartctaçäo da aorta clássica. O estudom hemodinâmico revelou grave coarctaçäo da aorta logo após a artéria subclávia esquerda e grande aneurisma da regiäo pós-estenótica. Correçäo cirúrgica com retirada "em bloco" do aneurisma foi realizada com sucesso e dois meses após a cirurgia a pressäo arterial da paciente estava normal e o aspecto ecodopplercardiográfico era bom, com gradiente de 10/mmHg no local da anastomose

The case of a symptomatic 16-year-old girl, referred with the diagnosis of coarctation of the aorta is presented. Aortography showed a severe coarctation and a huge aneurysm distal to the coarctation. Successful operation was performed with resection of the coarctation and aneurysm and interposition of a tube of bovine pericardium for the anastomosis. Two months after the operation the blood pressure was normal and a 10mm/Hg gradient was detected by dopplerechocardiography

Fístula artério-venosa congênita entre a artéria e veia subclávia: correçäo cirúrgica favorável em um lactente / Congenital Subclavian Artery-to-vein Fistula. Successful Surgical Correction in an Infant

Criança de 6 meses de idade, assintomática, atendida, inicialmente, devido a edema localizado do membro superior direito. Um sopro contínuo, audível na região infra-clavicular direita, cardiomegalia e hiperfluxo pulmonar estavam associados com uma fístula única entre a artéria e a veia subclávia direita diagnosticada pela angiografia. Ligadura cirúrgica da fístula foi realizada com sucesso, havendo normalização do diâmetro do membro e da área cardíaca do tórax 4 anos após cirurgia

The case of an asymptomatic 6 month-old-boy, first seen due to a right arm edema is described. A continuous murmur heard at the right infraclavicular area, cardiomegaly plus increased flow to the lungs on the chest X-ray were associated with an isolated right subclavian artery-to-vein fistula diagnosed at angiography. Successful ligation of the fistula was done at operation with normalization of the arm circunference and heart size on the chest X-rav at 4 years follow up