Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis.

STUDY DESIGN: Single-center retrospective analysis of prospectively collected data. OBJECTIVE: Our aim was to compare the correction capacity in 3 planes of the VCA technique versus the AD technique in neuromuscular scoliosis patients. METHODS: We analized patients with neuromuscular scoliosis that underwent posterior spinal fusion from 2013 to 2017 using 2 different techniques for correction: vertebral coplanar alignment (VCA) that takes into consideration the fact that the medial cortex is more resistant than the lateral cortex, with more anchor points for better distribution of forces and ligamentotaxis and the more widely spread apical derotation (AD) technique. Clinical, surgical, and radiographic information of patients operated on with the AD technique were compared to those operated on with the VCA technique in the coronal, sagittal and axial plane at pre-op, immediate post-op, and 2 year follow-up. RESULTS: 64 patients met inclusion criteria, 34 patients underwent the VCA technique and 30 patients underwent the AD technique. The 2 cohorts did not differ in terms of demographics, clinical presentation or preoperative alignment. There were no significant differences in the correction ability between both techniques regarding curve magnitude, apical vertebral rotation, or pelvic obliquity. There was a significant decrease in thoracic kyphosis in the AD group compared to the VCA group in the immediate postop period (4.2 ± 26.6º for VCA and 13.2 ± 21.3º for AD (p = 0.048)). CONCLUSION: Both apical derotation technique and vertebral coplanar alignment allow for correction in the 3 planes for patients with neuromuscular scoliosis. VCA is a less hypokyphosing technique than AD.

Neural Networks Multiobjective Learning With Spherical Representation of Weights.

This article presents a novel representation of artificial neural networks (ANNs) that is based on a projection of weights into a new spherical space defined by a radius r and a vector of angles Θ . This spherical representation of ANNs further simplifies the multiobjective learning problem, which is usually treated as a constrained optimization problem that requires great computational effort to maintain the constraints. With the proposed spherical representation, the constrained optimization problem becomes unconstrained, which simplifies the formulation and computational effort required. In addition, it also allows the use of any nonlinear optimization method for the multiobjective learning of ANNs. Results presented in this article show that the proposed spherical representation of weights yields more accurate estimates of the Pareto set than the classical multiobjective approach. Regarding the final solution selected from the Pareto set, our approach was effective and outperformed some state-of-the-art methods on several data sets.

Limits of Brazil's Forest Code as a means to end illegal deforestation.

The 2012 Brazilian Forest Code governs the fate of forests and savannas on Brazil's 394 Mha of privately owned lands. The government claims that a new national land registry (SICAR), introduced under the revised law, could end illegal deforestation by greatly reducing the cost of monitoring, enforcement, and compliance. This study evaluates that potential, using data from state-level land registries (CAR) in Pará and Mato Grosso that were precursors of SICAR. Using geospatial analyses and stakeholder interviews, we quantify the impact of CAR on deforestation and forest restoration, investigating how landowners adjust their behaviors over time. Our results indicate rapid adoption of CAR, with registered properties covering a total of 57 Mha by 2013. This suggests that the financial incentives to join CAR currently exceed the costs. Registered properties initially showed lower deforestation rates than unregistered ones, but these differences varied by property size and diminished over time. Moreover, only 6% of registered producers reported taking steps to restore illegally cleared areas on their properties. Our results suggest that, from the landowner's perspective, full compliance with the Forest Code offers few economic benefits. Achieving zero illegal deforestation in this context would require the private sector to include full compliance as a market criterion, while state and federal governments develop SICAR as a de facto enforcement mechanism. These results are relevant to other tropical countries and underscore the importance of developing a policy mix that creates lasting incentives for sustainable land-use practices.

A critical look at prospective surveillance using a scan statistic.

The scan statistic is a very popular surveillance technique for purely spatial, purely temporal, and spatial-temporal disease data. It was extended to the prospective surveillance case, and it has been applied quite extensively in this situation. When the usual signal rules, as those implemented in SaTScan(TM) (Boston, MA, USA) software, are used, we show that the scan statistic method is not appropriate for the prospective case. The reason is that it does not adjust properly for the sequential and repeated tests carried out during the surveillance. We demonstrate that the nominal significance level α is not meaningful and there is no relationship between α and the recurrence interval or the average run length (ARL). In some cases, the ARL may be equal to ∞, which makes the method ineffective. This lack of control of the type-I error probability and of the ARL leads us to strongly oppose the use of the scan statistic with the usual signal rules in the prospective context.

Maximum linkage space-time permutation scan statistics for disease outbreak detection.

BACKGROUND: In disease surveillance, the prospective space-time permutation scan statistic is commonly used for the early detection of disease outbreaks. The scanning window that defines potential clusters of diseases is cylindrical in shape, which does not allow incorporating into the cluster shape potential factors that can contribute to the spread of the disease, such as information about roads, landscape, among others. Furthermore, the cylinder scanning window assumes that the spatial extent of the cluster does not change in time. Alternatively, a dynamic space-time cluster may indicate the potential spread of the disease through time. For instance, the cluster may decrease over time indicating that the spread of the disease is vanishing. METHODS: This paper proposes two irregularly shaped space-time permutation scan statistics. The cluster geometry is dynamically created using a graph structure. The graph can be created to include nearest-neighbor structures, geographical adjacency information or any relevant prior information regarding the contagious behavior of the event under surveillance. RESULTS: The new methods are illustrated using influenza cases in three New England states, and compared with the cylindrical version. A simulation study is provided to investigate some properties of the proposed arbitrary cluster detection techniques. CONCLUSION: We have successfully developed two new space-time permutation scan statistics methods with irregular shapes and improved computational performance. The results demonstrate the potential of these methods to quickly detect disease outbreaks with irregular geometries. Future work aims at performing intensive simulation studies to evaluate the proposed methods using different scenarios, number of cases, and graph structures.

New approaches to estimating national rates of invasive pneumococcal disease.

National infectious disease incidence rates are often estimated by standardizing locally derived rates using national-level age and race distributions. Data on other factors potentially associated with incidence are often not available in the form of patient-level covariates. Including characteristics of patients' area of residence may improve the accuracy of national estimates. The authors used data from the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance program (2004-2005), adjusted for census-based variables, to estimate the national incidence of invasive pneumococcal disease (IPD). The authors tested Poisson and negative binomial models in a cross-validation procedure to select variables best predicting the incidence of IPD in each county. Including census-level information on race and educational attainment improved the fit of both Poisson and negative binomial models beyond that achieved by adjusting for other census variables or by adjusting for an individual's race and age alone. The Poisson model with census-based predictors led to a national estimate of IPD of 16.0 cases per 100,000 persons as compared with 13.5 per 100,000 persons using an individual's age and race alone. Accuracy of, and confidence intervals for, these estimates can only be determined by obtaining data from other randomly selected US counties. However, incorporating census-derived characteristics should be considered when estimating national incidence of IPD and other diseases.

Population-based multicentric survey of hepatitis B infection and risk factor differences among three regions in Brazil.

This multicentric population-based study in Brazil is the first national effort to estimate the prevalence of hepatitis B (HBV) and risk factors in the capital cities of the Northeast, Central-West, and Federal Districts (2004-2005). Random multistage cluster sampling was used to select persons 13-69 years of age. Markers for HBV were tested by enzyme-linked immunosorbent assay. The HBV genotypes were determined by sequencing hepatitis B surface antigen (HBsAg). Multivariate analyses and simple catalytic model were performed. Overall, 7,881 persons were included; < 70% were not vaccinated. Positivity for HBsAg was less than 1% among non-vaccinated persons and genotypes A, D, and F co-circulated. The incidence of infection increased with age with similar force of infection in all regions. Males and persons having initiated sexual activity were associated with HBV infection in the two settings; healthcare jobs and prior hospitalization were risk factors in the Federal District. Our survey classified these regions as areas with HBV endemicity and highlighted the risk factors differences among the settings.