RAS-RAF-miR-296-3p signaling axis increases Rad18 expression to augment radioresistance in pancreatic and thyroid cancers.

Oncogenic RAS and RAF signaling has been implicated in contributing to radioresistance in pancreatic and thyroid cancers. In this study, we sought to better clarify molecular mechanisms contributing to this effect. We discovered that miRNA 296-3p (miR-296-3p) is significantly correlated with radiosensitivity in a panel of pancreatic cancer cells, and miR-296-3p is highly expressed in normal cells, but low in cancer cell lines. Elevated expression of miR-296-3p increases radiosensitization while decreasing the expression of the DNA repair enzyme RAD18 in both pancreatic and thyroid cancer cells. RAD18 is overexpressed in both pancreatic and thyroid tumors compared to matched normal controls, and high expression of RAD18 in tumors is associated with poor prognostic features. Modulating the expression of mutant KRAS in pancreatic cancer cells or mutant BRAF in thyroid cancer cells demonstrates a tight regulation of RAD18 expression in both cancer types. Depletion of RAD18 results in DNA damage and radiation-induced cell death. Importantly, RAD18 depletion in combination with radiotherapy results in marked and sustained tumor regression in KRAS mutant pancreatic cancer orthotopic tumors and BRAF mutant thyroid heterotopic tumors. Overall, our findings identify a novel coordinated RAS/RAF-miR-296-3p-RAD18 signaling network in pancreatic and thyroid cancer cells, which leads to enhanced radioresistance.

Planning feasible and efficient operational scenarios for a university hospital through multimethodology.

The COVID-19 pandemic required managerial and structural changes inside hospitals to address new admission demands, frequently reducing their care capacity for other diseases. In this regard, this study aims to support the recovery of hospital productivity in the post-pandemic context. The major challenge will be to make use of all the resources the institution has obtained (equipment, beds, temporarily hired human resources) and to increase production to meet the existing repressed demand. To support evidence-based decision-making at a major university hospital in Rio de Janeiro, hospital managers and operations research analysts designed an approach based on multiple methodologies. Besides multimethodology, one important novelty of this study is the application of a productivity frontier function to future scenario planning through the quantitative DEA methodology. Concept maps were used to structure the problem and emphasize stakeholders' perspectives. In sequence, data envelopment analysis (DEA) was applied, as it combines benchmarking best practices and assigns weights to inputs and outputs. To guarantee that the efficiency measurement considers all inputs and outputs before any inclusion of expert judgment, the scope was redirected to full dimensional efficient facet, if any, or to maximum efficient faces. The results indicate that production scenarios proposed by stakeholders based on the Ministry of Health parameters overestimate the viable production framework and that the scenario that maintains temporary human resource contracts is more compatible with quality in health provision, teaching, and research. These findings will serve as a basis for decision-making by the governmental agency that provided temporary contracts. The present methodology can be applied in different settings and scales.

New Diagnostic Criteria for Overmedication in Systemic Arterial Hypertension.

BACKGROUND: Guidelines on managing arterial blood pressure have begun to include lower targets, despite the risk for overmedication-induced hypotension. Because there is no consensus as to what constitutes overmedication in the treatment of hypertension, we conducted a study to develop relevant diagnostic criteria. METHODS: We used ambulatory monitoring during a 24-hour period to measure blood pressure in 567 patients with medication-controlled hypertension. We then divided this cohort into 3 groups. Group A (n = 413 [72.8%]) comprised patients in whom less than 10% of systolic blood pressure measurements were less than 100 mm Hg (no or mild hypotension). Group B (n = 154 [27.2%]) comprised patients in whom 10% or more of the measurements were less than 100 mm Hg, signifying overmedication. Group C comprised those patients in Group B in whom 20% or more of the measurements were less than 100 mm Hg (n = 74 [48.1%]; attributed to "accentuated" overmedication). Group C patients were prescribed significantly more antihypertensive drugs than were group A patients. RESULTS: Our findings support a 2-part definition of overmedication in hypertension treatment: (1) mild overmedication, in which 10% or more but less than 20% of systolic blood pressure measurements are less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep; and (2) accentuated overmedication, characterized by 20% or more of valid systolic blood pressure measurements less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep, during a 24-hour period. CONCLUSION: We think this guidance will help to avoid overmedicating and consequences such as fainting and falls when systolic blood pressure is too low.

Development and validation of a heated drying air diffusion system to optimize rotary dryers and final coffee quality.

The final quality of pre-processed coffees is influenced by the applied drying technology. Thus, the aim of the study was to develop and validate a heated air flow diffusion system to optimize and reduce the drying time of rotary dryers and improve the final quality of coffee. Computational fluid dynamics was used for the simulation of the air fluid dynamics in the combustion chamber of the heat generator. It was observed that the energy losses in the upper and lower walls of the heat generator chamber were higher with an increase in the convective heat transfer coefficient. It was found that the rate of fluid flow presented a fully developed profile, in which the higher speed value was found in the central region of the outlet. The reduction in moisture content during coffee drying was directly proportional to the increase in temperature. The Midilli model shows the best fit to describe the drying curves of the coffee. The effective diffusion coefficient increases with increasing temperature of the drying air. It was observed that the adjustments of the fluid dynamics in the burning of gas and the adaptation of the diffuser system significantly influenced the drying time and final quality of naturally processed and pulped coffees. In conclusion, the adapted technological set, a rotary dryer with gas heating and diffusion of heated air, had a high performance in the final quality of the coffee, and for this reason it is recommended to producers and the industry.

A novel form of wasp mimicry in a new species of praying mantis from the Amazon rainforest, Vespamantoida wherleyi gen. nov. sp. nov. (Mantodea, Mantoididae).

A wasp mimicking praying mantis (Mantodea) of the early evolving Mantoididae family was discovered in 2013 at a research station near the Amazon River in Northern Peru. This adult specimen exhibited a striking bright red/orange and black coloration pattern that was undocumented in all known praying mantis species. We tested the status of this new specimen using external morphology, male genital dissections, and geographic distribution. Our findings demonstrate the specimen to represent a new species, Vespamantoida wherleyi gen. nov. sp. nov., that is closely allied with a recently described species, Mantoida toulgoeti Roy, 2010, both of which are included within the newly erected genus. To support our actions, we present high resolution images of museum preserved and living specimens, morphological illustrations, a generic-level distribution map, and recorded video of the behavior of the holotype taken in the field at the time of collection. The bright red/orange coloration contrasted with black markings, the general appearance of a hymenopteran that includes a narrowed wasp waist, and the locomotory patterns and antennal movements mark this newly discovered species as unique among all hymenopteran mimicking Mantoididae as well as all other praying mantises.

Trends in suicide rates in Brazil from 1997 to 2015

Objectives: To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target. Methods: This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020. Results: Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds. Conclusion: Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.

Trends in suicide rates in Brazil from 1997 to 2015.

OBJECTIVES: To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target. METHODS: This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020. RESULTS: Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds. CONCLUSION: Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.

Value of the intraoperative cytology examination of sentinel lymph node in breast cancer / Valor do exame citológico intraoperatório do linfonodo sentinela no câncer de mama

Objective: Evaluate the value of imprint cytology in the intraoperative analysis of sentinel lymph node (SLN) in patients with breast cancer. Methods: An agreement study for the evaluation of the imprint cytology technique as a diagnostic test for intraoperative SLN among patients diagnosed with breast cancer from January 2007 to January 2017. Results: We studied 210 cases of breast cancer patients submitted to intraoperative sentinel node imprint cytology, aged between 24 and 86 years (mean age 59 years and median age 60 years). The sensitivity of the intraoperative study was 58.3% (95%CI 46.1­69.8%) and the specificity was 97.8% (95%CI 93.8­99.5). The positive predictive value (PPV) was 93.3% (95%CI 81.7­98.6) and the negative predictive value (NPV) was 81.8% (95%CI 75.1­87.4). From the analyzed variables, the presence of macrometastasis was the only one that significantly increased the sensitivity of the imprint to 73.2% (95%CI 59.7­84.2), while micrometastasis presented a sensitivity of only 6.3% (95%CI 0.2­30.2). Conclusion: The use of imprint cytology in the intraoperative SLN study showed good accuracy in predicting axillary status. However, the surgeon and pathologist are fully aware of the set of clinical and histological variables that can influence the sensitivity of the method.

Objetivo: Avaliar o valor do imprint citológico na análise intraoperatória do linfonodo sentinela (LS) em pacientes com câncer de mama. Métodos: Estudo de concordância para avaliação da técnica do imprint citológico como teste diagnóstico do LS no intraoperatório, entre pacientes com diagnóstico de câncer de mama, no período de janeiro de 2007 a janeiro de 2017. Resultados: Foram estudados 210 casos de pacientes com câncer de mama submetidas à citologia de impressão (IC) do linfonodo sentinela no intraoperatório, com idade entre 24 e 86 anos (média de 59 anos e mediana de 60 anos). A sensibilidade do estudo intraoperatório foi de 58,3% (IC95% 46,1­69,8) e a especificidade de 97,8% (IC95% 93,8­99,5). O valor preditivo positivo (VPP) foi de 93,3% (IC95% 81,7­98,6) e o valor preditivo negativo (VPN) de 81,8% (IC95% 75,1­87,4%). Das variáveis analisadas, a presença de macrometástase foi a única que aumentou significativamente a sensibilidade do imprint para 73,2% (IC95%, 59,7­84,2%), enquanto na micrometástase apresentou sensibilidade de apenas 6,3% (IC95% 0,2­30,2). Conclusão: A utilização do imprint citológico no estudo intraoperatório do LS apresentou boa acurácia na previsão do status axilar. Entretanto, é importante o pleno conhecimento, pelo cirurgião e patologista, do conjunto de variáveis clínicas e histológicas que podem influenciar a sensibilidade do método

A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study.

BACKGROUND: The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents' interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown. OBJECTIVE: In this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents. METHODS: We implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students "mirrored" the pupils' altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil. RESULTS: We measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence. CONCLUSIONS: The photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study.

A Cretaceous-aged Palaeotropical dispersal established an endemic lineage of Caribbean praying mantises.

Recent phylogenetic advances have uncovered remarkable biogeographic histories that have challenged traditional concepts of dispersal, vicariance and diversification in the Greater Antilles. Much of this focus has centred on vertebrate lineages despite the high diversity and endemism of terrestrial arthropods, which account for 2.5 times the generic endemism of all Antillean plants and non-marine vertebrates combined. In this study, we focus on three Antillean endemic praying mantis genera, Callimantis, Epaphrodita and Gonatista, to determine their phylogenetic placement and geographical origins. Each genus is enigmatic in their relation to other praying mantises due to their morphological affinities with both Neotropical and Old World groups. We recovered the three genera as a monophyletic lineage among Old World groups, which was supported by molecular and morphological evidence. With a divergence at approximately 107 Ma, the lineage originated during the break-up of Gondwana. Ancestral range reconstruction indicates the lineage dispersed from an African + Indomalayan range to the Greater Antilles, with a subsequent extinction in the Old World. The profound ecomorphic convergence with non-Caribbean groups obscured recognition of natural relationships within the same geographical distribution. To the best of our knowledge, the lineage is one of the oldest endemic animal groups in the Greater Antilles and their morphological diversity and restricted distribution mark them as a critical taxon to conserve.

An elusive Neotropical giant, Hondurantemna chespiritoi gen. n. & sp. n. (Antemninae, Mantidae): a new lineage of mantises exhibiting an ontogenetic change in cryptic strategy.

We present the description of a new genus and new species of praying mantis, Hondurantemna chespiritoigen. n. & sp. n. This species of cryptic mantis, collected in National parks in Mexico and Honduras, remained unknown despite its considerable body size. Based on a phylogenetic analysis with molecular data and traditional morphological analysis, we place this new genus within Antemninae, a monotypic Mantidae subfamily. We update the subfamily concept for Antemninae and provide a key to the two genera. We describe the external morphology of immatures and adults of the new species as well as the genital complexes of both sexes and the ootheca of Antemna rapax. The observed morphological changes between immature and adult females suggests that the selection for an alternate strategy for crypsis is a response to size increase of the abdomen during development. Immatures exploit a stick/branch habitat based on their morphological appearance while adult females appear as a leaf to disguise the profile of the body.

ResumenSe presenta la descripción de un nuevo género y una nueva especie de mantis religiosa, Hondurantemna chespiritoigen. n. & sp. n. Esta nueva especie de mantis críptica, colectada en ciertos parques nacionales de México y Honduras, había permanecido hasta ahora desconocida para la ciencia a pesar de su gran tamaño corporal. Utilizando un análisis filogenético con datos moleculares y junto con análisis tradicional de morfología, se logró clasificar a este nuevo género dentro de la subfamilia monotípica Antemninae que pertenece a la familia Mantidae. Como resultado se actualiza el concepto taxonómico de Antemninae y se presenta una clave para identificar los dos géneros atribuidos a esta subfamilia. Se describe la morfología externa de los juveniles y adultos de la nueva especie, así como el complejo genital de ambos sexos y la ooteca de Antemna rapax. La diferencia morfológica observada entre juveniles y adultos sugiere que existen fuerzas selectivas divergentes, posiblemente en respuesta al aumento del tamaño del abdomen durante el desarrollo, para así mantener su camuflaje a lo largo de su ciclo de vida. Sobre la base de su apariencia general, los juveniles utilizarían una estrategia críptica asemejando ramas, mientras que las hembras adultas asemejan hojas verdes para ocultar el contorno corporal.

Selection for predation, not female fecundity, explains sexual size dimorphism in the orchid mantises.

Here we reconstruct the evolutionary shift towards floral simulation in orchid mantises and suggest female predatory selection as the likely driving force behind the development of extreme sexual size dimorphism. Through analysis of body size data and phylogenetic modelling of trait evolution, we recovered an ancestral shift towards sexual dimorphisms in both size and appearance in a lineage of flower-associated praying mantises. Sedentary female flower mantises dramatically increased in size prior to a transition from camouflaged, ambush predation to a floral simulation strategy, gaining access to, and visually attracting, a novel resource: large pollinating insects. Male flower mantises, however, remained small and mobile to facilitate mate-finding and reproductive success, consistent with ancestral male life strategy. Although moderate sexual size dimorphisms are common in many arthropod lineages, the predominant explanation is female size increase for increased fecundity. However, sex-dependent selective pressures acting outside of female fecundity have been suggested as mechanisms behind niche dimorphisms. Our hypothesised role of predatory selection acting on females to generate both extreme sexual size dimorphism coupled with niche dimorphism is novel among arthropods.

Taxonomic revision of Stagmatoptera Burmeister, 1838 (Mantodea: Mantidae, Stagmatopterinae).

Stagmatoptera Burmeister, 1838 includes medium to large-sized (49.8-98.7mm) praying mantises distributed in the Neotropical region. They are characterized for having a central, circular spot on each forewing, and 2-4 carinae in the head's frontal shield. This study is an updated revision of the genus on the basis of type and non-type material deposited in various scientific collections from Europe and the Americas. The following nomenclatural procedures were conducted: Stagmatoptera nova is a new junior synonym of Stagmatoptera pia, Stagmatoptera ignota as the junior synonym of Stagmatoptera femoralis, and Stagmatoptera flavipennis is reinstated as the junior synonym of Stagmatoptera supplicaria. Two new species are described: Stagmatoptera diana Rodrigues sp. n. from Colombia and Venezuela, and Stagmatoptera cerdai Rodrigues sp. n. from Trinidad & Tobago and Venezuela. Stagmatoptera now includes 14 species, two of which (Stagmatoptera abdominalis and Stagmatoptera indicator) are considered as species inquirenda. We provide detailed morphological descriptions of all species, a species-level identification key, in addition to abundant visual material to assist identification. Female genitalia, a structure seldom used for taxonomic purposes, was a useful character system to distinguish among species of the genus. Distribution maps for all species are also provided.

Dynamic network data envelopment analysis for university hospitals evaluation.

OBJECTIVE: To develop an assessment tool to evaluate the efficiency of federal university general hospitals. METHODS: Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013. RESULTS: The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research. CONCLUSIONS: The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.

Factors associated with opinions in favor of (or against) legalizing marihuana in a sample of university lecturers and students / Fatores associados à opinião favorável (ou contrária) à liberação da maconha em uma amostra de docentes e discentes universitários / Factores asociados a la opinión favorable (o contraria) a la liberación de la marihuana en una muestra de docentes y discentes universitarios

The objective was to discover factors associated with opinions in favor of (or against) legalizing marihuana in a sample of university lecturers and students. This was a cross-sectional exploratory-descriptive study with a quantitative approach, of 288 undergraduate lecturers and students in Nursing and Law in a private higher education institution in Teresina, PI. The data were collected in 2014 using a self-applied questionnaire and analyzed using the Statistical Package for Social Sciences program. The main results show that the majority were female, with a mean age of 25 years, single, Catholic and approximately 75% were against legalizing marihuana. It was concluded that, in Brazil, there is a lack of research on the topic of legalizing marihuana, especially concerning the views of lecturers and students in higher education.

Objetivou-se conhecer fatores associados à opinião favorável (ou contrária) à liberação da maconha, em uma amostra de docentes e discentes universitários. Estudo exploratório-descritivo e transversal, com abordagem quantitativa, com 288 docentes e discentes dos cursos de graduação em Enfermagem e Direito de uma instituição de ensino superior privada, em Teresina, PI. Os dados foram coletados por meio de questionário autoaplicável, em 2014, e analisados no programa estatístico Statistical Package for Social Sciences. Os principais resultados revelaram que a maioria era do sexo feminino, média de 25 anos, solteiros, católicos e aproximadamente 70% mostraram-se contrários à liberação da maconha. Conclui-se que há carência de pesquisas sobre o tema da liberação da maconha no Brasil, principalmente em relação à visão de docentes e discentes de nível superior.

Se objetivó conocer factores asociados a la opinión favorable (O contraria) a la liberación de la marihuana, en una muestra de docentes y discentes universitarios. Estudio exploratorio, descriptivo y transversal, con abordaje cuantitativo, con 288 docentes y discentes de los cursos de graduación en Enfermería y Derecho de una institución de enseñanza superiora privada, en Teresina, PI. Los datos fueron colectados por medio de cuestionario autoaplicable, en 2014, y analizados en el programa estadístico Statistical Package for Social Sciences. Los principales resultados revelaron que la mayoría era del sexo femenino, media de 25 años, solteros, católicos y aproximadamente 70% se mostraron contrarios a la liberación de la marihuana. Se concluye que hay carencia de investigaciones sobre el tema de la liberación de la marihuana en Brasil, principalmente con relación a la visión de docentes y discentes de nivel superior.

Amblyomma sculptum tick saliva: α-Gal identification, antibody response and possible association with red meat allergy in Brazil.

The anaphylaxis response is frequently associated with food allergies, representing a significant public health hazard. Recently, exposure to tick bites and production of specific IgE against α-galactosyl (α-Gal)-containing epitopes has been correlated to red meat allergy. However, this association and the source of terminal, non-reducing α-Gal-containing epitopes have not previously been established in Brazil. Here, we employed the α-1,3-galactosyltransferase knockout mouse (α1,3-GalT-KO) model and bacteriophage Qß-virus like particles (Qß-VLPs) displaying Galα1,3Galß1,4GlcNAc (Galα3LN) epitopes to investigate the presence of α-Gal-containing epitopes in the saliva of Amblyomma sculptum, a species of the Amblyomma cajennense complex, which represents the main tick that infests humans in Brazil. We confirmed that the α-1,3-galactosyltransferase knockout animals produce significant levels of anti-α-Gal antibodies against the Galα1,3Galß1,4GlcNAc epitopes displayed on Qß-virus like particles. The injection of A. sculptum saliva or exposure to feeding ticks was also found to induce both IgG and IgE anti-α-Gal antibodies in α-1,3-galactosyltransferase knockout mice, thus indicating the presence of α-Gal-containing epitopes in the tick saliva. The presence of α-Gal-containing epitopes was confirmed by ELISA and immunoblotting following removal of terminal α-Gal epitopes by α-galactosidase treatment. These results suggest for the first known time that bites from the A. sculptum tick may be associated with the unknown etiology of allergic reactions to red meat in Brazil.

Dynamic network data envelopment analysis for university hospitals evaluation / Análise envoltória de dados dinâmica em redes na avaliação de hospitais universitários

ABSTRACT OBJECTIVE To develop an assessment tool to evaluate the efficiency of federal university general hospitals. METHODS Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013. RESULTS The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research. CONCLUSIONS The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.

RESUMO OBJETIVO Desenvolver ferramenta de avaliação de eficiência de hospitais universitários federais de perfil geral. MÉTODOS A análise envoltória de dados, técnica de programação linear, constrói uma fronteira de melhores práticas pela comparação da produção observada dadas as quantidades de recursos despendidas. O modelo é orientado a produto, e considera retornos variáveis de escala. A análise envoltória de dados em redes considera variáveis de ligação que pertencem a mais de uma dimensão (no modelo, médicos residentes, internações ajustadas e projetos de pesquisa). A análise envoltória de dados dinâmica usa variáveis de transporte (no modelo, receita) para analisar o deslocamento da fronteira em anos subsequentes. Os dados foram coletados do sistema de informações do MEC, 2010 a 2013. RESULTADOS Os escores médios de assistência, ensino e pesquisa no período foram: 58,0%, 86,0% e 61,0%, respectivamente. Em 2012, ano de melhor desempenho, para que todas as unidades atingissem a fronteira, seria necessário aumento médio de consultas de 65,0%; de internações, de 34,0%; de alunado de graduação, de 12,0%, de residência multiprofissional, de 13,0%, de pós-graduação, de 48,0%; de projetos de pesquisa, de 7,0%; além de queda de 9,0% de residentes médicos. No mesmo ano, para melhora da fronteira de produção assistencial, seria necessária a injeção de um aporte adicional de receita de 0,9%. Observou-se progressão da eficiência no ensino; oscilação na assistência e estagnação na pesquisa na avaliação dinâmica. CONCLUSÕES O modelo proposto gera parâmetros de planejamento e programação em saúde pública por meio do cálculo dos escores de eficiência e das projeções necessárias para alcance das fronteiras de melhores práticas.