Screening for neurocognitive deficits in adult populations reliant on toxic cassava as the main source of food

Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was 949.5+518.3 mol/l after adjusting Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed, and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was . for age, gender, nutritional status, and history of konzo, neurocognition domain-specific deficits were independently associated with either hypertension or USCN (350mol / l incremental increase in excretion Functional impairments in daily-life activities increased as subjects poorly performed at the CSID screening (Spearman r = - .2, p < 0.01). Conclusion. Neurocognitive deficits in adults are common in Congolese adults relying on cyanogenic cassava as the main source of food. Our study findings warrant further studies to elucidate the overall lifespan brain/behavioral burden and mechanisms of cassava toxicity among adults with dietary dependency on cyanogenic cassava as the main source of food

Determinação do período de estabilidade de soluções volumétricas rotineiramente utilizadas em laboratórios de análises químicas / Determination of the stability period of volumetric solutions routinely used in chemical analysis laboratories / Determinación del período de estabilidad de las soluciones volumétricas utilizadas habitualmente en los laboratorios de análisis químicos

As soluções volumétricas são rotineiramente utilizadas nos laboratórios, principalmente nos processos de síntese de produtos e nas análises quantitativas de matéria-prima e/ou produto acabado, entretanto poucos são os estudos que abordam a estabilidade destas soluções. Considerando que a qualidade das soluções volumétricas pode afetar os procedimentos de análises químicas e consequentemente induzir a erros, e ainda que, a Farmacopeia Brasileira (2010) não cita tempo máximo de utilização dessas soluções padronizadas, a avaliação da estabilidade das mesmas é importante. Sendo assim, o objetivo do trabalho foi avaliar a estabilidadede 10 soluções volumétricas, empregadas rotineiramente em laboratórios de análises químicas, com o intuito de estabelecer o período que essas soluções permanecem estáveis, isto é, sem sofrer alteração na concentração. As metodologias de preparo e padronização das soluções volumétricas seguiram os métodos descritos na Farmacopeia Brasileira (2010), sendo as mesmas padronizadas no momento do preparo e a cada 20 dias, por um período de 180 dias. As soluções contendo ácidos e bases, bem como as soluções de iodato de potássio e nitrato de prata, permaneceram constantes durante o período de análises. As soluções de EDTA, iodo, nitrito de sódio, permanganato de potássio e tiossulfato de sódio apresentaram estabilidade inferior a 180 dias, tornando necessária a realização de padronização periódica. As soluções volumétricas utilizadas nos laboratórios apresentam diferentes estabilidades, o que ressalta a importância da determinação do período que as mesmas se mantêmcom as concentrações estáveis, evitando possíveis alterações de resultados nas análises químicas.

Volumetric solutions are routinely used in laboratories, mainly in product synthesis processes and in quantitative analyzes of raw materials and/or finished products, however there are few studies that address the stability of these solutions. Considering that the quality of volumetric solutions can affect chemical analysis procedures and consequently induce errors, and even though the Brazilian Pharmacopoeia (2010) does not mention the maximum time for using these standardized solutions, the evaluation of their stability is important. Therefore, the aim of this work was to evaluate the stability of 10 volumetric solutions, routinely used in chemical analysis laboratories, in order to establish the period that these solutions remain stable without changing their concentrations. The methodologies for preparing and standardizing the volumetric solutions followed the methods described in the Brazilian Pharmacopoeia (2010), being standardized at the time of preparation and every 20 days, for a period of 180 days. Solutions containing acids and bases, as well as potassium iodate and silver nitrate solutions, were stable during the analysis period. The solutions of EDTA, iodine, sodium nitrite, potassium permanganate and sodium thiosulfate showed stability less than 180 days, making it necessary to carry out periodic standardization of these solutions. The volumetric solutions used in the laboratories have different stabilities, which highlights the importance of determining the period in which they remain stable, avoiding possible changes in results in chemical analyzes.

Las soluciones volumétricas se utilizan de forma rutinaria en los laboratorios, principalmente en los procesos de síntesis de productos y en el análisis cuantitativo de materias primas y/o productos acabados. Sin embargo, existen pocos estudios que aborden la estabilidad de estas soluciones. Considerando que la calidad de las soluciones volumétricas puede afectar los procedimientos de análisis químico y consecuentemente inducir a errores, y también que, la Farmacopea Brasileña (2010) no menciona el tiempo máximo de uso de estas soluciones estandarizadas, la evaluación de su estabilidad es importante. Así, el objetivo del trabajo fue evaluar la estabilidad de 10 soluciones volumétricas, utilizadas rutinariamente en los laboratorios de análisis químico, con el fin de establecer el período en que estas soluciones permanecen estables, es decir, sin sufrir alteraciones en la concentración. Las metodologías de preparación y estandarización de las soluciones volumétricas siguieron los métodos descritos en la Farmacopea Brasileña (2010), siendo las mismas estandarizadas en el momento de la preparación y cada 20 días, por un período de 180 días. Las soluciones que contienen ácidos y bases, así como las soluciones de yodato de potasio y nitrato de plata, permanecieron constantes durante el periodo de análisis. Las soluciones de EDTA, yodo, nitrito de sodio, permanganato de potasio y tiosulfato de sodio fueron estables durante menos de 180 días, por lo que fue necesario realizar estandarizaciones periódicas. Las soluciones volumétricas utilizadas en los laboratorios presentan diferentes estabilidades, lo que pone de manifiesto la importancia de determinar el periodo que permanecen con concentraciones estables, evitando posibles cambios en los resultados en los análisis químicos.

Mortalidade por suicídio na cidade de São Paulo: caracterização, tendências e análise de efeito idade-período-coorte (1996-2018) / Suicide mortality in the city of São Paulo: characterization, trends, and age-period- cohort effect analysis (1996-2018)

Introdução - Globalmente, o suicídio é a causa de morte violenta mais frequente. No Brasil, a taxa de suicídio está crescendo. Para a saúde pública, é fundamental conhecer a magnitude e tendência dos suicídios para criar estratégias de prevenção, visando à diminuição desses óbitos evitáveis. Objetivo - Descrever a mortalidade por suicídio no Município de São Paulo entre 1996 e 2018, analisando tendências temporais e os efeitos independentes de idade, período e coorte de nascimento. Métodos - Foram calculadas taxas de mortalidade por suicídio brutas, específicas e padronizadas por idade. A mortalidade proporcional foi descrita segundo sexo, idade, raça/cor, escolaridade, estado civil, meios utilizados, regiões de residência e períodos. Modelos lineares generalizados foram ajustados para avaliar a tendência temporal do suicídio segundo sexo, idade e meios utilizados e estimar a Variação Percentual Anual das taxas. Análises de idade-período-coorte estratificadas por sexo foram realizadas para estimar separadamente os efeitos do tempo calendário, da idade e da coorte de nascimento sobre o suicídio. Resultados - Foram registrados 11.204 óbitos por suicídio no período. A taxa de mortalidade por suicídio foi de 5,2 óbitos (por 100 mil habitantes), e a razão de taxas entre sexos foi de 3,7. A região Centro apresentou a maior taxa, e a região Sul, a menor. Em ambos os sexos, as taxas por enforcamento, envenenamento e precipitação cresceram no período, e as por meios não especificados tiveram queda. Para os homens, o meio mais comum utilizado foi o enforcamento, independentemente de idade, estado civil, escolaridade, raça/cor ou período. O uso das armas de fogo foi o segundo mais frequente, mas as taxas por esse meio tiveram queda de -11,3% ao ano (IC 95% -15,7 : -6,6) até 2001, crescimento de 4,9% (IC 95% 0,4 : 9,6) até 2006 e queda de -5,6% (IC 95% -7,4 : -3,7) até 2018. Não foi identificada tendência nas taxas de homens de 10 a 19 anos (p = 0,74). Em homens adultos, houve tendência de queda de -5,6% ao ano (IC 95% -7,3 : -4,0) até 2002, crescimento de 2,6% (IC 95% 1,7 : 3,5) até 2012 e queda de -3,1% (IC 95% -4,7 : -1,5) até 2018. Em homens idosos, houve tendência de queda de -2,8% (IC 95% -4,1 : -1,5) até 2012, seguida de crescimento de 4,6% (IC 95% 0,8 : 8,5). Em homens adultos e idosos, foram identificados efeitos significativos de idade e período, mas não de coorte de nascimento. Para as mulheres, enforcamento, envenenamento e precipitação foram os meios mais comuns, e os suicídios por armas de fogo caíram -6,6% (IC 95% -9,0 : -4,1) em todo o período. Houve tendência de queda de -4,2% (IC 95% -6,9 : -1,4) nas mulheres da faixa de 10 a 19 anos e de - 1,1% (IC 95% -2,1 : -0,1) nas demais faixas até 2008. Idosas tiveram queda permanente nas taxas. Nas mulheres de 10 a 59 anos, as taxas cresceram 8,7% (IC 95% 5,3 : 12,3) entre 2008 e 2012. Houve queda no período final de -1,1% (IC 95% -2,1 : -0,1) nas mulheres de 10 a 39 anos e de -9,4% (IC 95% -13,2 : -5,6) nas de 40 a 59 anos. Em mulheres adultas, houve efeitos de idade, período e coorte, com crescimento linear no risco de suicídio a partir das gerações nascidas após 1970. Em mulheres idosas, houve efeitos significativos apenas de idade. Conclusões - Em geral, houve uma queda no suicídio de homens e mulheres. Homens idosos são o único grupo etário com tendência recente de crescimento. Além destes, as populações com maior risco atualmente são as mulheres entre 20 e 39 anos, bem como as nascidas após 1970. Suicídios por armas de fogo tiveram expressiva redução após mudança legislativa dos anos 2000. Recomenda-se mais pesquisas na área da epidemiologia do suicídio no Brasil, considerando a subnotificação desse tipo de óbito e o crescimento de suas taxas no país.

Introduction - Globally, suicide is the most frequent cause of violent death. The suicide rate is growing in Brazil. It is essential to know the magnitude and trends of suicide for prevention strategies, aiming to reduce these preventable deaths. Objective - To describe suicide mortality in the city of São Paulo between 1996 and 2018, analyzing temporal trends and the independent effects of age, period and birth cohort. Methods - Crude, age-specific, and agestandardized suicide mortality rates were calculated. Proportional mortality was described according to sex, age, race/color, education, marital status, suicide methods, city regions and periods. Generalized linear models were fitted to assess the temporal trend of suicide according to sex, age, and methods, and to estimate the Annual Percent Change of the rates. Sex-stratified age-period-cohort analyzes were performed to estimate the effects of calendar time, age, and birth cohort on suicide. Results - There were 11,204 deaths from suicide in the period. Suicide mortality rate was 5.2 deaths (per 100,000 inhabitants), and sex rate ratio was 3.7. The central region had the highest rate and the southern region the lowest. Suicide rates by hanging, poisoning and precipitation increased over the period, and decreased for unspecified methods, for both sexes. For men, the most common method was hanging, regardless of age, marital status, education, race/color or period. Firearms were the second most frequent method, but firearmspecific rates decreased -11.3% per year (95% CI -15.7 : - 6.6) until 2001, increased 4.9% (95% CI 0.4 : 9.6) until 2006, and decreased -5.6% (95% CI - 7.4 : -3.7) until 2018. No trend was identified in the rates for 10 to 19-year-old men (p = 0.74). Adult men rates decreased -5.6% per year (95% CI -7.3 : -4.0) until 2002, increased 2.6% (95% CI 1.7 : 3.5) until 2012, and decreased -3.1% (95% CI -4.7 : -1.5) until 2018. Elderly men rates decreased -2.8% (95% CI -4.1 : -1.5) until 2012, followed by a 4.6% increase (95% CI 0.8 : 8.5). Significant age and period effects were identified for adult and elderly men suicide, but no birth cohort effect. For women, hanging, poisoning and precipitation were the most common methods, and firearmspecific rates decreased -6.6% (95% CI -9.0 : -4.1) throughout the period. Women rates decreased -4.2% (95% CI -6.9 : -1.4) in the 1019 age range and -1.1% (95% CI -2.1 : - 0.1) in the other ranges until 2008. Elderly women had a permanent decrease in rates. The rates for 10 to 59-year-old women increased 8.7% (95% CI 5.3 : 12.3) between 2008 and 2012. In the final period, 10 to 39-year-old women rates decreased -1.1% (95% CI -2.1 : -0.1), and 40 to 59 rates decreased -9.4% (95% CI -13.2 : -5.6). There were age, period, and cohort effects for adult women, with a linear increase in suicide risk from generations born after 1970. Only age effects were detected for elderly women suicide. Conclusion - In general, suicide declined for men and women. Elderly men are the only age group with a recent increasing trend. Other populations at risk today are 20 to 39-year-old women, as well as women born after 1970. Firearm suicides had a significant reduction after legislative change in the 2000s. Further research in Brazilian suicide epidemiology is recommended, considering the typical underreporting of suicide and the increase on its national rates.

La Historiografía de la Ciencia de la Información y sus periodizaciones: una aproximación / The Historiography of Information Science and its periodization: an approach

Se examinaron determinados esquemas de periodización de la Historiografía de la Ciencia de la Información. Utilizando la revisión documental como instrumento metodológico, se revisaron las fuentes de información que contenían la producción historiográfica de los estudiosos de la Ciencia de la Información elegidos. Se discutió la interrelación existente entre Historia e Historiografía y se valoró el significado de las periodizaciones históricas. Se examinó la problemática histórica de la Ciencia de la Información, y se detallaron las propuestas de periodización de los autores seleccionados. Se fundamentó la propuesta de periodización del autor del texto(AU)

Certain patterns of periodization of the Historiography of Information Science were examined. Using the documentary review as a methodological instrument, this study reviewed the sources of information containing the historiographical production of the chosen Information Science scholars. The interrelation between History and Historiography was discussed and the meaning of historical periodization was valued. The historical problems of Information Science were examined, and the periodization proposals of the selected authors were detailed. The proposal of periodization of the author of this text was substantiated(AU)

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Quantification of multi-oocyte follicles in ovaries of bitches / [Quantificação de folículos multiócitos em ovários de cadelas]

The objective of this study was to quantify the number and frequency of monocyte (MnOF) and multi-oocyte (MtOF) follicles in ovaries of bitches subjected to ovary salpingohysterectomy (OSH). Right and left ovaries of 38 bitches were collected after OSH, prepared, and a histological analysis was carried out. The ovaries were subjected to surface and deep histological cuts; the follicles were classified, and the number of follicles and cumulus oophorus complexes (COC) per follicle were quantified for each histological cut. MnOF and MtOF were found in all ovaries, at different developmental stages; primary follicles were grouped in the ovarian cortex, and follicles at other follicular stages presented a random distribution. MtOF containing two, three, four, or more COC were found in the ovaries of bitches, with a decreasing frequency trend, according to the number of COC in the MtOF. The effect of the age, number of estrus, estrus interval, and number of progenies per delivery was not significant for the number and frequency of MtOF in the ovaries of the bitches, whereas the size, number of pregnancies, use and number of contraceptive applications had some effect on the number and frequency of MtOF in the ovaries of the bitches.(AU)

Objetivou-se, com este estudo, quantificar o número e a frequência de folículos monocitários (MOF) e polioocitários (POF) provenientes de ovários de cadelas submetidas à ovariossalpingo-histerectomia (OSH). Para tanto, coletaram-se os ovários (direito e esquerdo) de 38 cadelas após OSH, com posterior preparação e análise histológica. Cada ovário foi submetido a dois cortes histológicos (superficial e profundo) onde se quantificou o número e a classificação dos folículos, bem como o número de complexos cumulus oophorus (COCs) por folículo em cada corte histológico. Observaram-se MOF e POF em todos os ovários estudados, em diferentes estádios de desenvolvimento, sendo os folículos primários agrupados no córtex ovariano, frente a uma distribuição aleatória dos outros estádios foliculares. FOPs contendo dois, três, quatro ou mais COCs foram observados nos ovários de todas as fêmeas estudadas, e sua frequência tendeu a diminuir de acordo com o número de COC presente no POF. Não se observou influência da idade, do número e do intervalo de estros, assim como do número de filhotes por gestação sobre o número/frequência de FOP nos ovários das cadelas estudadas, enquanto o porte, o número de gestações, o uso e o número de contraceptivo apresentaram algum grau de influência sobre o número/frequência de FOP nos ovários das cadelas estudadas.(AU)

Associations of plasma lipids, lipoproteins, and cardiovascular outcomes with climatic variations in a large Brazilian population of Campinas, São Paulo state: an eight-year study

In this eight-year retrospective study, we evaluated the associations between climatic variations and the biological rhythms in plasma lipids and lipoproteins in a large population of Campinas, São Paulo state, Brazil, as well as temporal changes of outcomes of cardiovascular hospitalizations. Climatic variables were obtained at the Center for Meteorological and Climatic Research Applied to Agriculture (University of Campinas - Unicamp, Brazil). The plasma lipid databases surveyed were from 27,543 individuals who had their lipid profiles assessed at the state university referral hospital in Campinas (Unicamp). The frequency of hospitalizations was obtained from the Brazilian Public Health database (DATASUS). Temporal statistical analyses were performed using the methods Cosinor or Friedman (ARIMA) and the temporal series were compared by cross-correlation functions. In normolipidemic cases (n=11,892), significantly different rhythmicity was observed in low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol (C) both higher in winter and lower in summer. Dyslipidemia (n=15,651) increased the number and amplitude of lipid rhythms: LDL-C and HDL-C were higher in winter and lower in summer, and the opposite occurred with triglycerides. The number of hospitalizations showed maximum and minimum frequencies in winter and in summer, respectively. A coincident rhythmicity was observed of lower temperature and humidity rates with higher plasma LDL-C, and their temporal series were inversely cross-correlated. This study shows for the first time that variations of temperature, humidity, and daylight length were strongly associated with LDL-C and HDL-C seasonality, but moderately to lowly associated with rhythmicity of atherosclerotic outcomes. It also indicates unfavorable cardiovascular-related changes during wintertime.

Objectively measured physical activity according to the periods of the day in the Pelotas Cohort / Medida objetiva de atividade física de acordo com períodos do dia em uma coorte de Pelotas

This study aims to describe objectively measured physical activity (PA) in different periods of the day in young adults according to sex, socioeconomic position and during weekdays and weekends. This is a cross-sectional analysis carried out with the participants of the 1993 Pelotas Birth Cohort at 22 years. PA was assessed by triaxial accelerometer. Descriptive analyses were performed presenting the time spent on light PA (LPA) and bouted moderate to vigorous PA (MVPA) in different periods of the day (morning - 6am to 11:59 am, afternoon ­ 12pm to 7:59 pm and night ­ 8pm to 11:59pm). The present study included 2,766 individuals (48.2% male and 51.8% female). LPA was higher among women, while bouted MVPA levels were higher among men. The median of PA was higher on weekdays compared to weekends for all intensities. The bouted MVPA medians in the morning and at night were zero minutes for all days and both sexes. The richest group presented a higher percentage of individuals with zero minutes. PA may vary according to different periods of the day and intensity. The absence of PA practice was markedly influenced by sex and socioeconomic position

Este estudo teve o objetivo de mensurar atividade física (AF) objetivamente em diferentes períodos do dia em adultos jovens de acordo com sexo, posição socioeconômica e dia de semana e final de semana. Esta é uma análise transversal conduzida com participantes da Coorte de Nascimentos de 1993 de Pelotas aos 22 anos. AF foi avaliada por um acelerômetro triaxial. Foram realizadas análises descritivas apresentando o tempo em AF leve (AFL) e moderada a vigorosa (AFMV ) em diferentes períodos do dia (manhã ­ 6h às 11:59h, tarde ­ 12h às 19:59h e noite ­ 20h às 0h). O presente estudo incluiu 2.766 individuos (48.2% homens e 51.8% mulheres). AFL foi maior entre as mulheres enquanto AFMV foi maior entre os homens. A mediana de AF foi maior nos dias de semana comparado aos dias de final de semana para qualquer intensidade. As medianas de AFMV pela manhã e noite foram zero minutos para todos os dias nos dois sexos. O grupo econômico mais alto apresentou maior percentual de individuos com zero minutos de AFMV. AF pode variar de acordo com diferentes períodos do dia e intensidades. A ausência de prática de AF foi marcadamente influenciada por sexo e posição socioeconômica

Partnering ethics and chemistry in secondary and university STEM education via an innovatively designed periodic table of chemical elements / Ética y química asociadas en la educación secundaria y universitaria STEM, a través de una tabla periódica de elementos químicos de diseño innovador / Associando ética e química na educação stem secundária e universitária via uma tabela periódica de elementos químicos desenvolvida de forma innovadora

As declared by the United Nations, 2019 is the International Year of the Periodic Table of Chemical Elements. Accordingly, an innovative new Periodic Table of Chemical Elements and Ethics [PETE] has been developed as an educational tool for secondary and university STEM (Science, Technology, Engineering and Mathematics) education. The tool is designed to be used in a case-based approache that is feasible to both individual and small group learners. Specifically, with the new periodic table, STEM becomes aligned with STSE (Science and Technology on Society and Environment), laying a curricular pathway for integrating discussions of ethics into the teaching of chemistry. Presented is the table, as well as sources for pairable ethics cases, and guidance for teachers to create curriculum which facilitates connections between ethics, chemistry, and society.

Según lo declarado por las Naciones Unidas, 2019 es el Año Internacional de la Tabla Periódica de Elementos Químicos. En consecuencia, se ha desarrollado una nueva e innovadora tabla periódica de elementos químicos y ética [PETE] como una herramienta educativa para la educación secundaria y universitaria STEM (Ciencia, Tecnología, Ingeniería y Matemáticas). La herramienta está diseñada para usarse en un enfoque basado en casos que sea factible tanto para estudiantes individuales como para grupos pequeños. Específicamente, con la nueva tabla periódica, STEM se alinea con STSE (Ciencia y Tecnología en Sociedad y Medio Ambiente), estableciendo una vía curricular para integrar las discusiones de ética en la enseñanza de la química. Se presenta la tabla, así como las fuentes de casos de ética que se pueden pactar, y orientación para que los maestros creen un plan de estudios que facilite las conexiones entre la ética, la química y la sociedad.

Como declarado pelas Nações Unidas, 2019 é o Ano Internacional da Tabela Periódica de Elementos Químicos. Portanto, uma inovadora e nova Tabela Periódica de Elementos Químicos e Ética (PETE, sigla em inglês) foi desenvolvida como uma ferramenta educacional para educação STEM (sigla em inglês para Ciência, Tecnologia, Engenharia e Matemática) secundária e universitária. A ferramenta é elaborada para ser usada em uma abordagem baseada em casos, viável tanto para aprendizagem individual como de pequenos grupos. Especificamente, com a nova tabela periódica, STEM se alinha com STSE (sigla em inglês para Ciência e Tecnologia na Sociedade e Ambiente), estabelecendo uma via curricular para integrar discussões de ética no ensino de química. Apresenta-se a tabela, bem como fontes de casos éticos pareados, e orientação para professores criarem um currículo que facilite conexões entre ética, química e sociedade.

Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study / Variabilidade dos sintomas diários de pacientes com DPOC estável no Brasil: um estudo observacional de vida real

ABSTRACT Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

RESUMO Objetivo: Analisar os sintomas em diferentes momentos do dia em pacientes com DPOC. Métodos: Estudo observacional multicêntrico de corte transversal em oito centros brasileiros. Foram avaliados os sintomas matinais, diurnos e noturnos em pacientes com DPOC estável. Resultados: Foram incluídos 593 pacientes em tratamento regular, sendo 309 (52,1%) do sexo masculino e 92 (15,5%) fumantes ativos. A média de idade foi de 67,7 anos, e a média de VEF1 foi de 49,4% do valor previsto. Os pacientes com sintomas mais graves (n = 183; 30,8%), em comparação com aqueles com sintomas leves e moderados, apresentaram pior nível de atividade física (p = 0,002), maior limitação ao fluxo aéreo (p < 0,001), exacerbações ambulatoriais (p = 0,002) e hospitalares (p = 0,043) mais frequentemente e piores resultados em instrumentos específicos. Os sintomas matinais e noturnos mais frequentes foram dispneia (em 45,2% e 33,1%, respectivamente), tosse (em 37,5% e 33,3%, respectivamente) e chiado (em 24,4% e 27,0%, respectivamente). Houve forte correlação da intensidade dos sintomas diurnos com sintomas matinais (r = 0,65, p < 0,001), sintomas noturnos (r = 0,60, p < 0,001), bem como com o escore do COPD Assessment Test (r = 0,62; p < 0,001); porém, houve uma correlação fraca com VEF1 (r = −0,205; p < 0,001). Conclusões: A dispneia foi mais frequente no período matinal do que no período noturno. Ter sintomas matinais e/ou noturnos foi associado à pior gravidade dos sintomas diurnos. A intensidade dos sintomas foi fortemente associada a pior qualidade de vida e frequência de exacerbações, mas fracamente associada à limitação ao fluxo aéreo.

Comparação da carga de treinamento de atletas profissionais entre modos de treinos especificos do voleibol e de força / Comparison of the training load of professional athletes between modes of volleyball specific drills and strength conditioning

RESUMO O objetivo deste estudo foi comparar a carga de treinamento em três tipos de treinamentos de uma equipe de voleibol profissional.. Participaram do estudo 28 jogadores (26,6 ± 4,7 anos; 91,5 ± 8,5 Kg; 194,1 ± 6,0 cm). Foi realizada uma análise descritiva de 29 sessões de treino técnico, 84 tecnico-tático e 75 de musculação e isoladamente das variáveis que compõem a carga de treinamento, PSE e o tempo de duração da sessão, posteriormente sendo reunidos em média e desvio padrão de acordo com tipo de treino. Para análise dos dados foi adotado o teste de Shapiro-Wilk e em seguida aplicou-se o teste Anova Two-Way com o Post Hoc de Tamhane e também foi utilizado o tamanho do efeito para análise das comparações. Os resultados demonstraram respostas significativas e grande tamanho de efeitos quando comparados técnico e técnico-tático com a musculação na carga interna de treinamento TxM (TE=1,2: grande; p= 0,002); TTxM (TE=1,3: grande; p= 0,001) e no tempo de duração da sessão TxM (TE=1,7: grande; p= 0,001); TTxM (TE=2,0: grande; p= 0,001), já a PSE da sessão apresentou apenas uma diferença sigifcativa TTxM (TE= 0,8: moderado; p= 0,001). Os estímulos de treinamentos específicos de quadra como técnico e técnico-tático promoveram maior carga interna nos atletas do que o treino de força, através principalmente pela influencia da variável tempo de duração da sessão que refletiu a carga externa.

ABSTRACT The aim of this study was to compare the training load in three types of training of a professional volleyball team. Participants were 28 players (26.6 ± 4.7 years, 91.5 ± 8.5 kg; 194.1 ± 6.0 cm). A descriptive analysis of 29 technical training sessions, 84 technical-tactical training sessions and 75 training sessions, and of the variables that compose the training load, PSE and the duration of the session were performed, and were then collected on average and standard deviation according to with type of training. To analyze the data, the Shapiro-Wilk test was adopted, and then the Anova Two-Way test was applied with Tamhane's Post Hoc and the effect size was also used for analysis of the comparisons. The results demonstrated significant responses and a large effect size when compared to technical and tactical-to- strength training (T = 1.2: large; p = 0.002); TTxM (TE = 1.3: large, p = 0.001) and the duration of the session / external load in the TxM training (TE = 1.7: large; p = 0.001); TTxM (TE = 2.0: large, p = 0.001), whereas the PSE of the session showed only a sigifcant difference TTxM (TE = 0.8: moderate; p = 0.001). The stimuli of specific training of court as technician and technician-tactician promoted greater internal load in the athletes than the strength training, mainly through the influence of the variable time of the session that reflected to external load.

Therapeutic effect of adjuvant treatment of acupuncture in a period of day from 7:00 am to 9:00 am on non-dipper essential hypertension / 中国针灸

OBJECTIVE@#To compare the infuences on circadian rhythm of blood pressure in the patients with non-dipper essential hypertension between the combined treatment of time acupuncture and western medication and the simple western medication.@*METHODS@#A total of 70 patients with non-dipper essential hypertension were randomized into an acupuncture plus western medication group (35 cases, 2 cases dropped out) and a western medication group (35 cases). In the western medication group, levamlodipine maleate tablets were taken orally, 2.5 mg each time, once daily. In the acupuncture plus western medication group, on the base of the treatment as the western medication group, acupuncture was applied specially in the period of the day from 7:00 am to 9:00 am. The acupoints included Fengchi (GB 20), Zhongwan (CV 12), Tianshu (ST 25), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36), etc. Acupuncture was given once daily, 5 treatments a week. The duration of treatment in the two groups was 4 weeks. The clinic blood pressure before and after treatment, 24 h ambulatory blood pressure and the levels of serum melatonin (MT) and 5-serotonin (5-HT) were observed in the two groups.@*RESULTS@#The total effective rate of anti-hypertension was 75.8% (25/33) in the acupuncture plus western medication group, better than 54.3% (19/35) in the western medication group (<0.05). The 24 h average systolic blood pressure, the daytime average systolic blood pressure, the daytime average diastolic pressure, and the nighttime average systolic blood pressure were all reduced after treatment in the two groups (<0.05). The reduction effect of the aforementioned 4 indexes in the acupuncture plus western medication group was much more obvious as compared with the western medication group (<0.05). After treatment, the serum level of MT was increased and 5-HT decreased in the patients of two groups (<0.05). The serum level of MT in the acupuncture plus western medication group was higher than that in the western medication group and the level of 5-HT was lower than the western medication group (<0.05).@*CONCLUSION@#Time acupuncture therapy in the period of the day from 7:00 am to 9:00 am, combined with western medication effectively reduce blood pressure and regulate the levels of serum MT and 5-HT so as to maintain the circadian rhythm of blood pressure in patients with non-dipper essential hypertension. The therapeutic effect of this combined treatment is superior to simple western medication.

Propagation Characteristics of Fasting Duodeno-Jejunal Contractions in Healthy Controls Measured by Clustered Closely-spaced Manometric Sensors

BACKGROUND/AIMS: High-resolution methods have advanced esophageal and anorectal manometry interpretation but are incompletely established for intestinal manometry. We characterized normal fasting duodeno-jejunal manometry parameters not measurable by standard techniques using clustered closely-spaced recordings. METHODS: Ten fasting recordings were performed in 8 healthy controls using catheters with 3–4 gastrointestinal manometry clusters with 1–2 cm channel spacing. Migrating motor complex phase III characteristics were quantified. Spatial-temporal contour plots measured propagation direction and velocity of individual contractions. Coupling was defined by pressure peak continuity within clusters. RESULTS: Twenty-three phase III complexes (11 antral, 12 intestinal origin) with 157 (95% CI, 104–211) minute periodicities, 6.99 (6.25–7.74) minute durations, 10.92 (10.68–11.16) cycle/minute frequencies, 73.6 (67.7–79.5) mmHg maximal amplitudes, and 4.20 (3.18–5.22) cm/minute propagation velocities were recorded. Coupling of individual contractions was 39.1% (32.1–46.1); 63.0% (54.4–71.6) of contractions were antegrade and 32.8% (24.1–41.5) were retrograde. Individual phase III contractions propagated > 35 fold faster (2.48 cm/sec; 95% CI, 2.25–2.71) than complexes themselves. Phase III complexes beyond the proximal jejunum were longer in duration (P = 0.025) and had poorer contractile coupling (P = 0.025) than proximal complexes. Coupling was greater with 1 cm channel spacing vs 2 cm (P < 0.001). CONCLUSIONS: Intestinal manometry using clustered closely-spaced pressure ports characterizes novel antegrade and retrograde propagation and coupling properties which degrade in more distal jejunal segments. Coupling is greater with more closely-spaced recordings. Applying similar methods to dysmotility syndromes will define the relevance of these methods.

The Fourth Industrial Revolution and Its Impact on Occupational Health and Safety, Worker's Compensation and Labor Conditions

The “fourth industrial revolution” (FIR) is an age of advanced technology based on information and communication. FIR has a more powerful impact on the economy than in the past. However, the prospects for the labor environment are uncertain. The purpose of this study is to anticipate and prepare for occupational health and safety (OHS) issues.In FIR, nonstandard employment will be common. As a result, it is difficult to receive OHS services and compensation. Excessive trust in new technologies can lead to large-scale or new forms of accidents. Global business networks will cause destruction of workers' biorhythms, some cancers, overwork, and task complexity. The social disconnection because of an independent work will be a risk for worker's mental health. The union bonds will weaken, and it will be difficult to apply standardized OHS regulations to multinational enterprises.To cope with the new OHS issues, we need to establish new concepts of "decent work” and standardize regulations, which apply to enterprises in each country, develop public health as an OHS service, monitor emerging OHS events and networks among independent workers, and nurture experts who are responsible for new OHS issues.

Similarities of Aspects of Biological Rhythms between Major Depression and Bipolar II Disorder Compared to Bipolar I Disorder: A Finding from the Early-Onset Mood Disorder Cohort

OBJECTIVE: The biological rhythm is closely related to mood symptoms. The purpose of this study was to assess the differences in biological rhythms among subjects with mood disorder [bipolar I disorder (BD I), bipolar II disorder (BD II), major depressive disorder (MDD)] and healthy control subjects.METHODS: A total of 462 early-onset mood disorder subjects were recruited from nine hospitals. The controls subjects were recruited from the general population of South Korea. Subject groups and control subject were evaluated for the Korean language version of Biological Rhythms Interview of Assessment in Neuropsychiatry (K-BRIAN) at the initial evaluation.RESULTS: The mean K-BRIAN scores were 35.59 [standard deviation (SD)=13.37] for BD I, 43.05 (SD=11.85) for BD II, 43.55 (SD=12.22) for MDD, and 29.1 (SD=8.15) for the control group. In the case of mood disorders, biological rhythm disturbances were greater than that in the control group (p<0.05). A significant difference existed between BD I and BD II (BD I <BD II, p<0.001) and between BD I and MDD (BD I<MDD, p< 0.001) but no difference was observed between BD II and MDD.CONCLUSION: BD II and MDD are similar to each other but different from BD I in biological rhythm patterns in early-onset mood disorder cases. Biological rhythm disturbances are similar for early-onset major depression and BD II.

Effect of night shift work on the control of hypertension and diabetes in workers taking medication

BACKGROUND: Night shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes. METHODS: Subjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL). RESULTS: Among 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers. CONCLUSIONS: Night shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.

Evaluación de las solicitudes de hemoglobina glicosilada en un hospital público de Mar del Plata / Evaluation of glycosylated hemoglobin applications in a public hospital from Mar del Plata / Avaliação das solicitações de hemoglobina glicosilada em um hospital público em Mar del Plata

La Asociación Americana de Diabetes (ADA) establece la medición de hemoglobina glicosilada (HbA1c) en todos los pacientes con diabetes en la evaluación inicial y durante el seguimiento. La frecuencia de su solicitud depende de la situación clínica, el régimen de tratamiento y el juicio del médico. El objetivo de este trabajo fue evaluar las solicitudes de HbA1c realizadas en el Hospital Interzonal General de Agudos (HIGA) Dr. Oscar Alende de la ciudad de Mar del Plata. Para conocer la periodicidad de las solicitudes se dividió a la población según la frecuencia de pedidos de HbA1c, y el valor de la misma. Para evaluar la presencia de resultados alterados de HbA1c debidos a anemia, se constató el valor de la hemoglobina total. En las 1.956 solicitudes de HbA1c, se detectaron 720 errores según lo establecido por la ADA; el 47,4% correspondieron a pedidos realizados con una frecuencia inadecuada y el 52,6% no tenían un hemograma acompañante. Se observó un elevado porcentaje de solicitudes de HbA1c realizadas de forma incorrecta. Este trabajo demuestra la importancia del control de las solicitudes reiterativas para lograr la mejora en la calidad de los resultados de laboratorio y una correcta toma de decisiones médicas.

The American Diabetes Association (ADA) establishes the measurement of glycosylated hemoglobin (HbA1c) in all patients with diabetes at the initial assessment and during follow-up. The frequency of the request depends on the clinical situation, the treatment regimen and the doctor’s judgment. The objective was to evaluate the HbA1c requests at the HIGA Oscar Alende of the city of Mar del Plata. In order to know the periodicity of the prescription, the population was divided according to the frequency of the request for HbA1c, and their value. To assess the presence of altered HbA1c results due to anemia, the total hemoglobin value was evaluated. In the 1956 requests for HbA1c, 720 errors were detected as established by the ADA; 47.4% corresponded to requests made with an inadequate frequency and 52.6% did not have an accompanying blood count. A high percentage of HbA1c requests made incorrectly was observed. This work demonstrates the importance of the control of repetitive requests to achieve the improvement in the quality of the laboratory results and a correct medical decision making.

A Associação Americana de Diabetes (ADA) estabelece a medida da hemoglobina glicosilada (HbA1c) em todos os pacientes com diabetes na avaliação inicial e durante o seguimento. A frequência da sua solicitação depende da situação clínica, do regime de tratamento e da opinião do médico. O objetivo deste trabalho foi avaliar as solicitações HbA1c feitos no Hospital Interzonal Geral de Agudos (HIGA) Dr. Oscar Alende da cidade de Mar del Plata. Para conhecer a periodicidade das solicitações, a população foi dividida de acordo com a frequência de pedidos de HbA1c, e o valor da mesma. Para avaliar a presença de resultados alterados de HbA1c por anemia, o valor total da hemoglobina foi encontrado. Nas 1.956 solicitações de HbA1c foram detectados 720 erros conforme o estabelecido pela ADA; 47,4% corresponderam a solicitações feitas com uma frequência inadequada e 52,6% não apresentaram contagem sanguínea. Foi observada uma alta porcentagem de solicitações de HbA1c feitas de forma incorreta. Este trabalho demonstra a importância do controle de solicitações repetitivas para alcançar a melhoria da qualidade dos resultados laboratoriais e uma tomada de decisões médica correta.

Construction of a biological rhythm assessment scale for children / Construção de uma escala de avaliação do ritmo biológico para crianças

Abstract Introduction Biological rhythm is associated with the level of alertness, cognitive performance and mood of the individuals. Its regularity is essential to preserve good health and quality of life. Objective To present the steps for the construction of the scale entitled Biological Rhythm Interview of Assessment in Neuropsychiatry - Kids (BRIAN-K), designed to measure biological rhythm disruptions in Brazilian children and adolescents. Methods Items were developed following the adult version of the scale. Analysis of the psychometric characteristics of the scale was based on the responses of 373 parents/caregivers of school age children (7 and 8 years old). Results A theoretical model of 17 items with the purpose of evaluating four domains (sleep, activities, social rhythm and eating pattern) was determined using exploratory factor analysis (EFA) and via identification of a general factor. The psychometric properties of the BRIAN-K showed favorable properties. Conclusion Only two items needed to be rewritten. Further studies are needed to investigate the instrument's adequacy to different age groups and additional evidence of validity and reliability.

Resumo Introdução O ritmo biológico está associado ao nível de alerta, desempenho cognitivo e humor dos indivíduos. Sua regularidade é essencial para preservar uma boa saúde e qualidade de vida. Objetivo Apresentar as etapas de construção da escala intitulada Biological Rhythm Interview of Assessment in Neuropsychiatry - Kids (BRIAN-K), criada para medir disrupturas do ritmo biológico em crianças e adolescentes brasileiros. Métodos Os itens foram desenvolvidos seguindo a versão adulta da escala. A análise das características psicométricas da escala se baseou nas respostas de 373 pais/cuidadores de crianças em idade escolar (7 e 8 anos). Resultados Um modelo teórico de 17 itens, com o objetivo de avaliar quatro domínios do ritmo biológico (sono, atividades, ritmo social e padrão alimentar) foi determinado usando análise fatorial exploratória (AFE) e pela identificação de um fator geral. As propriedades psicométricas da BRIAN-K mostraram-se satisfatórias. Conclusão Apenas dois itens precisaram ser reescritos. São necessários mais estudos para investigar a adequação do instrumento a diferentes faixas etárias e evidências adicionais de validade e confiabilidade.

Validation of the Korean Version of the Biological Rhythms Interview of Assessment in Neuropsychiatry

OBJECTIVE: The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) is a scale used to clinically evaluate disturbances in biological rhythm. In this study, we aimed to examine the reliability and validity of the Korean version of the BRIAN (K-BRIAN) in a Korean population. METHODS: A total of 181 participants, including 141 outpatients with bipolar disorder (BD; type I, 62; type II, 79) and 40 controls, were recruited. Construct validity was tested by comparing the mean K-BRIAN scores of the BD patients and control subjects. Concurrent validity was tested by evaluating the association between the K-BRIAN and the Morningness-Eveningness Questionnaire (MEQ). RESULTS: The mean K-BRIAN scores of the control subjects and patients with BD differed significantly (p < 0.001). Particularly, the mean K-BRIAN score was considerably lower among control subjects (mean±standard deviation=35.00±8.88) than among patients with BD type I (41.19±12.10) and type II (50.18±13.73). The Cronbach’s alpha for the K-BRIAN was 0.914. The K-BRIAN was found to correlate with the MEQ (r=-0.45, p < 0.001). CONCLUSION: The findings affirm that the K-BRIAN has good construct validity and internal consistency. This suggests that the K-BRIAN can be used to assess biological rhythms in the Korean population, especially for patients with mood disorder.

Seasonality of tuberculosis in the Republic of Korea, 2006–2016 / 한국역학회지

OBJECTIVES: While the seasonality of notified tuberculosis has been identified in several populations, there is not a descriptive epidemiological study on the seasonality of tuberculosis in Korea. This study aimed to evaluate the seasonality of tuberculosis in Korea from 2006 to 2016. METHODS: Data regarding notified cases of tuberculosis by year and month was obtained from the Infectious Diseases Surveillance Yearbook, 2017 published by the Korea Centers for Disease Control and Prevention. Seasonal decomposition was conducted using the method of structural model of time series analysis with simple moving averages. RESULTS: While the trough season was winter from 2006 to 2016, the peak season was summer between 2006 and 2012, but shifted to spring between 2013 and 2016. CONCLUSION: Notified tuberculosis in Korea also showed seasonality. It is necessary to evaluate factors related to the seasonality of tuberculosis for controlling tuberculosis.