An agenda for research and action toward diverse and just futures for life on Earth.

Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.

Una Agenda para la Investigación y la Acción hacia un Futuro Diverso y Justo para la Vida sobre la Tierra Resumen Las décadas de investigación e intervenciones políticas sobre la biodiversidad han tratado significativamente los temas de la degradación de la biodiversidad y la justicia social. Debido a esto, se requieren nuevas estrategias. Diseñamos una agenda de investigación y acción que llama a la labor colectiva de revisar la biodiversidad hacia el objetivo de sustentar un futuro diverso y justo para la vida sobre la Tierra. Cuando se revisa la biodiversidad, se requiere de una reflexión crítica sobre las investigaciones, políticas y prácticas presentes y pasadas sobre la biodiversidad para inspirar un pensamiento creativo acerca del futuro. Desarrollamos la agenda por medio de un proceso de diálogo de dos años que involucró a casi 300 expertos de diversas disciplinas y localidades. Este proceso estuvo orientado por el conocimiento de las ciencias sociales que muestra cómo la investigación y la acción para la biodiversidad están sostenidas por las opciones de cómo están conceptualizados los problemas. Reconocimos al conocimiento, la acción y la ética como inseparables y sintetizamos un conjunto de principios que ayuda a navegar la labor de revisar la biodiversidad. La agenda articula cuatro áreas temáticas para la investigación en el futuro. Primero, los investigadores necesitan revisar las narrativas de la biodiversidad mediante el cuestionamiento de las conceptualizaciones que excluyen a la diversidad y consolidan la separación entre humanos, culturas, economías y sociedades y la naturaleza. Segundo, los investigadores deberían enfocarse en las relaciones entre el antropoceno, la biodiversidad y la cultura al considerar a la humanidad y la biodiversidad como interconectadas en contextos específicos. Tercero, los investigadores deberían enfocarse en la naturaleza y las economías al tener en mejor cuenta la interacción de las estructuras de los sistemas económico y financiero como conductores nucleares de la pérdida de la biodiversidad. Finalmente, los investigadores deberían permitir la investigación y acción transformadoras de la biodiversidad al reconfigurar las relaciones entre las comunidades humanas y no humanas dentro y a través de la ciencia, la política y la práctica. La revisión de la biodiversidad necesita de un enfoque renovado sobre el diálogo entre las comunidades de la biodiversidad y más allá, que reflexione críticamente sobre el pasado para canalizar a la investigación y acción hacia el fomento del futuro justo y diverso para la vida humana y no humana sobre la Tierra.

Detection of fetal cardiac anomalies: cost-effectiveness of increased number of cardiac views.

OBJECTIVE: To compare the recommended three-view fetal heart screening method to detect major congenital heart disease (CHD) with more elaborate screening strategies to determine the cost-effective strategy in unselected (low-risk) pregnancies. METHODS: A decision-analytic model was designed to compare four screening strategies to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. The four strategies were: (1) three views: four-chamber view (4CV) and views of the left (LVOT) and right (RVOT) ventricular outflow tracts; (2) five views: 4CV, LVOT, RVOT and longitudinal views of the ductal arch and aortic arch; (3) five axial views: 4CV, LVOT, RVOT, three-vessel (3V) view and three-vessels-and-trachea view; and (4) six views: 4CV, LVOT, RVOT and 3V views and longitudinal views of the ductal arch and aortic arch. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. The analysis was performed from a healthcare-system perspective, with a cost-effectiveness willingness-to-pay threshold set at $100 000 per quality-adjusted life year (QALY). Baseline analysis, one-way sensitivity analysis and Monte-Carlo simulation were performed. RESULTS: In our baseline model, screening with five axial views was the optimal strategy, detecting 3520 more CHDs, and resulting in 259 fewer children with neurodevelopmental disability, 40 fewer neonatal deaths and only slightly higher costs, compared with screening with the currently recommended three views. Screening with six views was more effective, but also cost considerably more, compared with screening with five axial views, and had an incremental cost of $490 023/QALY, which was over the willingness-to-pay threshold. The five-view strategy was dominated by the other three strategies, i.e. it was more costly and less effective in comparison. The data were robust when tested with Monte-Carlo and one-way sensitivity analysis. CONCLUSION: Although current guidelines recommend a minimum of three views for detecting CHD during the mid-trimester anatomy scan, screening with five axial views is a cost-effective strategy that may lead to improved outcome compared with three-view screening. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective?

OBJECTIVE: To perform a cost-effectiveness analysis of different follow-up strategies for non-obese and obese women who had incomplete fetal cardiac screening for major congenital heart disease (CHD). METHODS: Three decision-analytic models, one each for non-obese, obese and Class-III-obese women, were developed to compare five follow-up strategies for initial suboptimal fetal cardiac screening. The five strategies were: (1) no follow-up ultrasound (US) examination but direct referral to fetal echocardiography (FE); (2) one follow-up US, then FE if fetal cardiac views were still suboptimal; (3) up to two follow-up US, then FE if fetal cardiac views were still suboptimal; (4) one follow-up US and no FE; and (5) up to two follow-up US and no FE. The models were designed to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. A cost-effectiveness willingness-to-pay threshold was set at US$100 000 per quality-adjusted life year (QALY). Base-case and sensitivity analysis and Monte-Carlo simulation were performed. RESULTS: In our base-case models for all body mass index (BMI) groups, no follow-up US, but direct referral to FE led to the best outcomes, detecting 7%, 25% and 82% more fetuses with CHD in non-obese, obese and Class-III-obese women, respectively, compared with the baseline strategy of one follow-up US and no FE. However, no follow-up US, but direct referral to FE was above the US$100 000/QALY threshold and therefore not cost-effective. The cost-effective strategy for all BMI groups was one follow-up US and no FE. Both up to two follow-up US with no FE and up to two follow-up US with FE were dominated (being more costly and less effective), while one follow-up US with FE was over the cost-effectiveness threshold. One follow-up US and no FE was the optimal strategy in 97%, 93% and 86% of trials in Monte-Carlo simulation for non-obese, obese and Class-III-obese models, respectively. CONCLUSION: For both non-obese and obese women with incomplete fetal cardiac screening, the optimal CHD follow-up screening strategy is no further US and immediate referral to FE; however, this strategy is not cost-effective. Considering costs, one follow-up US and no FE is the preferred strategy. For both obese and non-obese women, Monte-Carlo simulations showed clearly that one follow-up US and no FE was the optimal strategy. Both non-obese and obese women with initial incomplete cardiac screening examination should therefore be offered one follow-up US. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Aspectos econômicos do uso da parte aérea in natura de mandioca (Manihot esculenta Crantz) para nutrição de cordeiros confinados e semiconfinados / Economic aspects of the aerial part of in natura cassava (Manihot esculenta Crantz) for the nutrition of confined and semi-confined lambs

O objetivo deste trabalho foi avaliar a influência da inclusão da rama de mandioca na dieta de cordeiros confinados e semiconfinados, em substituição parcial de alimentos concentrados, como forma de redução de custos de produção. O experimento foi conduzido no Centro de Tecnologia de Ovinos (CTO), município de Campo Grande, MS. Foram utilizados 56 cordeiros do grupo genético Pantaneiro, sendo 28 machos e 28 fêmeas, com pesos médios de 18,84kg±2,02kg. As dietas recebidas foram: tratamento controle com ração comercial e tratamentos contendo a parte aérea de mandioca (PAM) em substituição de 10% dessa ração. Os machos confinados obtiveram ganho de peso médio diário de 210g e os semiconfinados, de 178g. No semiconfinamento, as fêmeas controle tiveram GMD de 120g e menor desempenho entre os grupos experimentais. A inclusão PAM acarretou uma redução de 31,29% para a mesma categoria animal. Entre os sistemas de produção, o semiconfinamento apresentou maior lucratividade média, 6,4%, e uma rentabilidade de 7,99% em relação ao sistema de confinamento, que obteve 0,04% de lucratividade e 0,87% de rentabilidade. Conclui-se que a inclusão da parte aérea da mandioca aumenta a eficiência econômica dos sistemas produtivos sem afetar o desenvolvimento dos animais em terminação.(AU)

The scope of this study was to evaluate the inclusion of raw cassava aerial parts in the diet of lambs in partial substitution of rations, in order to reduce production costs. The experiment was conducted at Sheep Technology Centre (CTO) in Campo Grande City, MS. A sample of 56 lambs from Pantaneiro genetic group was used, 28 males and 28 females, average weight of 18.84kg±2.02kg. The inclusion of PAM decreased the costs by 31.29% for the same category of animal. Among the production systems the semi-feedlot, showed the highest average profitability of 6.4% and a return of 7.99%, compared to the feedlot system, which obtained 0.04% 0.87% profitability and return. In conclusion, the inclusion of the aerial part of cassava increases the economic efficiency of production systems without affecting the development of finishing animals.(AU)

Iterative reconstruction of SiPM light response functions in a square-shaped compact gamma camera.

Compact gamma cameras with a square-shaped monolithic scintillator crystal and an array of silicon photomultipliers (SiPMs) are actively being developed for applications in areas such as small animal imaging, cancer diagnostics and radiotracer guided surgery. Statistical methods of position reconstruction, which are potentially superior to the traditional centroid method, require accurate knowledge of the spatial response of each photomultiplier. Using both Monte Carlo simulations and experimental data obtained with a camera prototype, we show that the spatial response of all photomultipliers (light response functions) can be parameterized with axially symmetric functions obtained iteratively from flood field irradiation data. The study was performed with a camera prototype equipped with a 30 × 30 × 2 mm3 LYSO crystal and an 8 × 8 array of SiPMs for 140 keV gamma rays. The simulations demonstrate that the images, reconstructed with the maximum likelihood method using the response obtained with the iterative approach, exhibit only minor distortions: the average difference between the reconstructed and the true positions in X and Y directions does not exceed 0.2 mm in the central area of 22 × 22 mm2 and 0.4 mm at the periphery of the camera. A similar level of image distortions is shown experimentally with the camera prototype.

Technical note: Assessment of the oxygen pulse and heart rate method using respiration chambers and comparative slaughter for measuring heat production of cattle.

The objective of this study was to assess the oxygen pulse and heart rate (O2P-HR) technique using the respiration chamber (RC) and comparative slaughter (CS) methods for measuring the heat production (HP) of crossbred (Holstein × Gyr) yearling bulls. Twenty-four bulls were used. Six bulls were slaughtered at the beginning of the experiment as a reference group to estimate the initial empty body weight (BW) and energy content of the remaining animals. The remaining bulls were assigned to a completely randomized design with 3 levels of dry matter intake, with 6 replicates. The levels of dry matter intake were 1.2% of BW, 1.8% of BW and ad libitum, with target orts of 5%. The bulls were fed a diet consisting of 59.6% corn silage and 40.4% concentrate on a dry matter basis. The HP (kcal/BW0.75) was measured using 3 techniques, first using O2P-HR, followed by the RC and CS methods. The HP did not differ among assessed techniques, averaging 162.7kcal/BW0.75. The intercepts of the linear regressions (mean ± SE) were 64.82±25.515 (H0: intercept=0; P=0.024), 33.77±13.418 (H0: intercept=0), and 50.02±27.495 (H0: intercept=0) for O2P-HR versus RC, CS versus RC, and O2P-HR versus CS, respectively. The slopes of the linear regressions were 0.59±0.153 (H0: slope=1), 0.88±0.081 (H0: slope=1), and 0.62±0.155 (H0: slope=1) for O2P-HR versus RC, CS versus RC, and O2P-HR versus CS, respectively. The coefficients of determination were 0.52, 0.90, and 0.52 for O2P-HR versus RC, CS versus RC, and O2P-HR versus CS, respectively. The concordance correlation coefficients, 0.70 and 0.68, were moderate for O2P-HR versus RC and O2P-HR versus CS, respectively, but high, 0.90, for CS versus RC. The between-animal coefficient of variation was greater for the O2P-HR method (16.6%) compared with RC (7.7%) or CS (6.7%). We conclude that there was an agreement among the HP measurements detected using the assessed methods and that O2P-HR is able to predict HP in cattle with great accuracy but only moderate precision. Therefore, the O2P-HR method may have limitations in terms of assessing HP in low numbers of replications due to greater between-animal coefficient of variation than either the RC or CS methods.

Increasing the donor pool reduces the severity of liver disease: lessons learned from São Paulo, Brazil.

INTRODUCTION: A new liver allocation system driven by the model for end-stage liver disease (MELD) score was implemented in Brazil in 2006. In association with the new allocation policy, there was a concomitant expansion of the number of donors. We designed this study to assess whether a potential expansion of the donor pool with these educational campaigns had reduced the severity of liver disease at transplantation. METHODS: We retrospectively reviewed the state of São Paulo liver transplant database from July 2003 through July 2009. Patients were divided into groups: those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. The number of transplantations and the severity of liver disease were the endpoints of the study. RESULTS: There has been a significant shift towards an older donor population, mainly those who are dying of cerebrovascular accidents. The average MELD score has changed over time. Approximately one quarter of the patients have been transplanted with a MELD score of more than 30 in the post-MELD era. However, this number has decreased over the past 3 years (P = .012). Currently, it has been possible to transplant patients with a MELD score from 25 to 30. The number of transplantations due to hepatocarcinoma (HCC) has increased 8-fold. CONCLUSION: An aggressive educational campaign has successfully expanded the donor pool with a concomitant yearly reduction of the average MELD score at the time of transplantation. Patients with HCC have been benefited tremendously with the new allocation system.

SU-E-T-388: Verification of Monitor Units and Dose Distributions in IMRT Plans Using Monte Carlo Algorithms on the E-IMRT Web Platform.

PURPOSE: Currently, quality control (QC) for each IMRT treatment is performed by dose distribution measurements. These techniques are very time-consuming and require long accelerator downtime. QC could be only based in verification of monitor units and dose distributions, if precise control of MLC is carried out. In such a manner, the e-IMRT platform (http://eimrt.cesga.es/) is a remote distributed computing tool, which allows comparison between the dose distributions calculated by a TPS and those calculated by Monte Carlo (MC). METHODS: Previously, our linear accelerator (Oncor Impression, Siemens) was commissioned. For this purpose, comparison of experimental and MC simulated data was carried out. Several IMRT treatments plans were calculated in superposition algorithm (TPS Xio®CMS 4.60.00) and used as input data for the e-IMRT platform. These treatment plans were previously verified employing a 2D array MapCheckTM, Sun Nuclear. The gamma index (3%, 3mm) was used for validating results. RESULTS: The platform displays calculated doses using MC, also gamma map (in the CT images, not only statistical data) and histogram shown in Figures 1a), b) and d). The gamma map illustrates the differences between the input and calculated doses. According to the legend in Figure 1 d), these differences correspond to less than 1%. Results show good agreement between the doses calculated by TPS and those computed by e-IMRT platform. CONCLUSIONS: If a rigorous quality control is established for MLC and optimisation criteria (number of gantry angles, minimum segment size, levels of intensity for fluency map) are used. Then, QC for IMRT standard treatment plans would be only based on the verification of monitor units and dose distributions using e-IMRT II.This work has been funded by the Xunta de Galicia, Project R&D Grant 09SIN007CT. We would like to thank Centro de SupercomputaciÃ3 n de Galicia for the computational resources and support.

Avaliação da adequação legal de receitas e notificações de receita de medicamentos sujeitos a controle especial dos setores públicos e privados / Evaluation of the legal prescription and notifications adequacy for special control medicinesin the public and private sectors

Os objetivos desta pesquisa foram avaliar a adequação legal de receitas de controle especial e notificações de receitas dispensadas em uma Drogaria de Varginha ? MG, estabelecer uma comparação entre as prescrições provenientes da rede pública e privada e detectar as classes de medicamentos mais prescritas. Analisaram-se 960 prescrições através de um formulário com itens obrigatórios de acordo com a legislação vigente. Os dados obtidos foram analisados pelo Teste Qui-quadrado, utilizando a origem das notificações e receitas como desfecho. Considerando as receitas; a única variável que apresentou diferença entre os setores público e privado foi a descrição por extenso da quantidade de medicamento, que foi mais adequadamente cumprida pelo setor privado. Em relação às notificações, a legibilidade foi significativamente mais freqüente em notificações provenientes de centros públicos, enquanto a designação da Unidade Federativa e a descrição por extenso da quantidade de medicamento foram mais presentes no setor privado. Por outro lado, a descrição completa da posologia, da data da notificação, a presença de carimbo e descrição da forma farmacêutica foram mais adequadas no setor público. Nenhuma das prescrições foi considerada totalmente adequada aos dados exigidos pela Portaria 344/98. As classes medicamentosas mais prescritas foram os benzodiazepínicos em notificações de receita e os antidepressivos em receituário de controle especial. Concluiu-se que a prescrição de medicamentos sujeitos a controle especial apresenta falhas de acordo com a legislação vigente.

The objectives of the present study were to evaluate the legal prescription adequacy in one drugstore located in the south of Minas Gerais state, in order to establish comparisons between the prescriptions of public and private services and to detect the most commonly classes of medicines prescribed. It was analyzed 960 prescriptions in accordance with the current law. The data were analyzed by descriptive statistics and compared using frequency distribution test(Chi-square test) considering private and public sources of prescription as the dependent variable. Considering special control prescriptions, the extensive description of the amount of medicine was fulfilled more frequently by the private sector. However, for the notifications; legibility, dosage, pharmaceutical form, date of issue and presence of stamp were more frequently present in the public service, while assignment of the Federative Union, the extensive description of the amount of medicine and the dosage was more present in the private sector. None of the evaluated prescriptions was considered totally adjusted with law 344/98. The prescribed medicines more commonly found were benzodiazepines for prescription notifications and antidepressants in special control prescriptions. It was concluded that the medicine prescriptions subjected to special control are frequently not adequate to the current law.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women.

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Allocation of deceased donor kidneys in São Paulo, Brazil: effect of human leukocyte antigen compatibility on graft survival.

In Brazil, organ transplantation has been regulated by a federal law since 1997. This law was created to guarantee equal access to treatment on a national scale. Deceased donor organ procurement and sharing are centralized and controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor kidneys up to January 1, 2002. After that, HLA mismatches (MM) were the main criterion. The aim of this study was to investigate the impact of HLA compatibility on graft survival among 3312 consecutive kidney recipients. The 2-year kidney graft survival rates were compared among recipients transplanted based on the waiting time policy and based on HLA MM. Better results were observed in the HLA MM group (78.1% vs 64.9%; P < .0001). Regarding kidney allocation based on HLA MM, recipients transplanted with 0 HLA-A, -B, or -DR MM showed significantly better 5-year survival rates than those with 1-2 or 3-4 or 5-6 HLA-A, -B, or -DR MM (70.36% vs 64.71% vs 58.07% vs 55.64%; P < .050). We concluded that HLA compatibility is a feasible criterion to allocate deceased donor kidneys in Brazil.

Model for end-stage liver disease: impact of the new deceased donor liver allocation policy in São Paulo, Brazil.

Since 1997, organ transplantation in Brazil has been regulated by a federal law, which was created to guarantee equal access to treatment on a national scale. Centralized deceased donor organ procurement and sharing are controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor livers up to July 15, 2006. After that, model for end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) scores were the main criteria. The aim of this study was to investigate the impact of the new criteria on patient survival rates using 895 consecutive liver recipients. The 1-year patient survival rates were compared between recipients transplanted based on the waiting time policy and based on MELD/PELD scores showing similar results (69.79% vs 66.69%; P = NS). Regarding liver allocation based on MELD/PELD scores, worse survival outcomes were observed among recipients transplanted with higher MELD scores. Also, under the new criteria, a high frequency of hepatocellular carcinoma and pediatric recipients underwent transplantation.

Technical note: A new and cost-effective method for detection of the bovine acyl-CoA:diacylglycerol acyltransferase 1 K232A polymorphism in cattle.

A new, quick, and inexpensive method for detecting the bovine acyl-CoA:diacylglycerol acyltransferase1 (DGAT1) polymorphism (K232A) through tetra-primer amplification refractory mutation system by PCR (ARMS-PCR) was developed in the present investigation. The DGAT1 gene was recently identified as underlying variation in milk production traits. To date, PCR techniques such as PCR-RFLP have been used for detecting the DGAT1 K232A polymorphism, despite being expensive and laborious. The method proposed here, a tetra-primer ARMS-PCR, showed 100% sensitivity and specificity when compared with PCR-RFLP results obtained in a sample of 80 animals tested in a double-blind system. Our results suggest that the use of tetra-primer ARMS-PCR for DGAT1 K232A polymorphism genotyping could greatly reduce costs providing information for both research purposes and for dairy cattle breeders who perform DGAT1 genotyping for gene-assisted selection.

PCR screening for 22q11.2 microdeletion: development of a new cost-effective diagnostic tool.

BACKGROUND: Del22q11.2 syndrome is the most frequent known chromosomal microdeletion syndrome. Previous studies suggest that a substantial number of patients with congenital heart disease have a 22q11 deletion. The molecular diagnosis of Del22q11.2 is usually made by fluorescence in situ hybridization, an expensive and not widely available technique. We developed an efficient and cost-effective PCR SNP assay designed for the screening of 22q11.2 deletion through consecutive homozygosity. METHODS: Through the screening of dbSNP we have selected SNP markers located in the 22q11.2 microdeleted region. Population heterozygosities were determined in 213 normal individuals. Designed assays consisted of PCR amplification followed by restriction enzyme digestion. Fragments generated were visualized on agarose gel and genotyped. RESULTS: Selected markers were: rs5748411, rs2238778, rs4819523 and rs4680. All selected markers were localized in the 22q11.2 deleted region. Allele and genotype frequencies of all selected markers were under Hardy-Weinberg equilibrium. Selected SNPs were not in linkage disequilibrium. Predicted assay specificity was estimated to be 92.86% in the Brazilian population. CONCLUSIONS: The use of consecutive homozygosity in this SNP-based diagnostic test may be used as a cost-effective tool in reference molecular genetics laboratories.

Assessment of risk for type 2 diabetes mellitus in a Caribbean population with high diabetes-related morbidity

Diabetes mellitus is a major cause of morbidity in Trinidad and Tobago. Screening programmes are not incorporated in the health sector and the population at risk remains unaware of the benefits of screening. We investigated the risk of developing Type 2 diabetes mellitus in office workers with one risk factor. Participants were randomly selected from the urban corporate sector in Port of Spain. Fasting capillary blood glucose and the American Diabetes Association (ADA) questionnaire for major diabetes risk factors were used to assess risk. Student pharmacists approached 482 persons, of whom 317 consented to participate (66 response rate). There were 101 (32) men and 216 (68) women, 37 (39) were of African ancestry and 28 each were of East Indian and mixed ancestry. Family history was positive in 54. Thirty per cent (95) of the volunteers were at risk of developing Type 2 diabetes mellitus (41 men; 54 women). Based on the ADA questionnaire, 82 (78) of volunteers were at high risk for developing Type 2 diabetes mellitus. The ADA risk test and Impaired Fasting Glucose were both positive in 13 (14) volunteers. In subjects at risk, Body Mass Index (BMI) was > 25 kg/m2 in 74 (78) and the waist/hip ratio was 0.85. Approximately 30 of office staff was at risk of developing diabetes mellitus. The ADA questionnaire is a useful non-invasive measure which pharmacists can use to assess risk for Type 2 diabetes mellitus. The glucometer can be used for risk assessment providing that it is associated with a quality assurance programme and that diagnosis is confirmed with laboratory testing

Assessment of risk for type 2 diabetes mellitus in a Caribbean population with high diabetes-related morbidity.

Diabetes mellitus is a major cause of morbidity in Trinidad and Tobago. Screening programmes are not incorporated in the health sector and the population at risk remains unaware of the benefits of screening. We investigated the risk of developing Type 2 diabetes mellitus in office workers with one risk factor. Participants were randomly selected from the urban corporate sector in Port of Spain. Fasting capillary blood glucose and the American Diabetes Association (ADA) questionnaire for major diabetes risk factors were used to assess risk. Student pharmacists approached 482 persons, of whom 317 consented to participate (66% response rate). There were 101 (32%) men and 216 (68%) women, 37 (39%) were of African ancestry and 28% each were of East Indian and mixed ancestry. Family history was positive in 54%. Thirty per cent (95) of the volunteers were at risk of developing Type 2 diabetes mellitus (41 men; 54 women). Based on the ADA questionnaire, 82% (78) of volunteers were at high risk for developing Type 2 diabetes mellitus. The ADA risk test and Impaired Fasting Glucose were both positive in 13 (14%) volunteers. In subjects at risk, Body Mass Index (BMI) was > 25 kg/m2 in 74% (78) and the waist/hip ratio was 0.85. Approximately 30% of office staff was at risk of developing diabetes mellitus. The ADA questionnaire is a useful non-invasive measure which pharmacists can use to assess risk for Type 2 diabetes mellitus. The glucometer can be used for risk assessment providing that it is associated with a quality assurance programme and that diagnosis is confirmed with laboratory testing.

[Vaginally assisted laparoscopic hysterectomy vs. abdominal hysterectomy. Initial experience]. / Histerectomía laparoscópica asistida vaginalmente (HLAV) contra histerectomía abdominal (HTA). Experiencia inicial.

A longitudinal prospective study was performed including 22 patients that were submitted to hysterectomy, for diverse being uterine pathologies, between March 1st. 1995 and until August 31st. 1996, in private practice at México City. The patients were divided into two groups: I) Patients submitted to total abdominal hysterectomy (TAH), 10 patients, and II) Patients submitted to vaginally assisted laparoscopical hysterectomy (VALH), 12 patients. The inclusion criteria for each group depended on the patient's weight: those with an overweight of more than 20% were included in group I, and those with an overweight of less than 20% were included in group II. All the patients were comparable in age, gestational history and surgical abdominal history. In our experience those submitted to TAH (4.2 weeks) or those submitted to VALH converted into laparotomy (3.5 weeks). In group I three patients presented minor complications (postoperative hemoglobin of less than 10 g/dl--two cases--and febrile morbidity secondary to minor lung athelectasis--one case--) that were solved with conventional measures. The mean surgical time was similar between groups I and II (159 and 152 minutes respectively) and longer in the VALH converted into laparotomy (240 minutes). The mean hospital cost was similar for groups I and II (18.6 thousand pesos). The hospital stay was similar in all cases (3.6, 3 and 3.5 days for groups I, II and the VALH converted cases, respectively). Those patients submitted to VALH electively stayed in the hospital for three day, even though their postsurgical progress was evident, so they could have been discharged of the hospital 24 hours after the surgery.

[Measurement and assessment of postoperative pain: a short review]. / Mensuração e avaliação da dor pós-operatória: uma breve revisão.

How to measure pain is a great challenge to those who desire to control adequately such a complex experience. Standardized instruments that take into consideration the patient's own account, have been developed in order to make such a task easier. In this article we carry out a revision of the instruments used mostly for measuring postoperative pain, and we point out some of the advantages and disadvantages. We emphasize the need for specific research focusing on the measurement of surgical pain, taking into consideration the multiple dimensions of a painful experience.

Diálise peritoneal ambulatorial contínua (CAPD): experiência de 5 anos / Continuous ambulatory peritoneal dialysis (CAPD): experience of 5 years

A diálise peritoneal ambulatorial contínua (CAPD), introduzida no Brasil em 1980, contituiu uma alternativa dialítica principalmente para os pacientes inadaptados à hemodiálise ou para aqueles que residiam longe de um centro dialítico. Neste período foram admitidos 56 pacientes ao programa, 25 homens e 31 mulheres com idade média de 44,9 + ou - 17,1 anos. A média de permanência no programa foi de 14,6 + ou - 12,5 meses. Após 5 anos, 28 pacientes permaneciam no programa. A sobrevida atuarial dos pacientes foi de 90% no primeiro ano, 74% no segundo e 64% do terceiro ao quinto ano. A sobrevida da técnica, excetuando-se as saídas por transplante, foi de 77% no primeiro ano, 62% no segundo e 39% do terceiro ao quinto ano. A saída do programa se deu em 9 pacientes por óbito e 19 pacientes mudaram de programa; 15 foram transferidos para hemodiálise (alta incidência de peritonite e/ou aderências peritoneais), 3 foram submetidos a transplante renal e um recuperou a funçäo renal. Foram observados 148 episódios de peritonite, o que reflete uma incidência de um episódio para cada 5,5 meses/paciente. Entretanto, a retirada de 41 episódios de peritonite recidivante altera a incidência de peritonite para um episódio para cada 7,6 meses/paciente. A maioria (70,7%) dos episódios de peritonite foi causada por germes gram-positivos, sendo 49,4% Staphylococcus aureus e 21,3% Staphylococcus epidermidis. Em 42% dos casos, a possível fonte da peritonite foi periluminal. Conclui-se que a sobrevida dos pacientes é satisfatória, mas a sobrevida da técnica pode ser melhorada, particularmente se reduzirmos as infecçöes do exit site e conseqüentemente as peritonites