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Bovine tuberculosis (bTB) impacts considerably animal production and one health worldwide. To describe the prevalence, risk factors, and spatial pattern of the disease in the state of Paraná, Brazil, a cross-sectional study was conducted from September 2018 to February 2019. The area was divided into seven regions. Within each region, farms were randomly selected, and a predetermined number of cows was selected and tested by a comparative cervical tuberculin test. 17,210 animals were tested across 1757 farms. Herd prevalence of bTB-infected herds in Paraná was 2.5% [1.87-3.00%]. It has varied from 0.8 to 3.98% among seven regions, with clustering being detected in the west, central, and northeast areas. Animal prevalence was 0.35% [0.21-0.59%] and has varied from 0.08 to 0.6% among the pre-set regions. No major shifts in the prevalence of bTB were detected since 2007. Large-sized herds, dairy production, and feeding with whey were detected to be correlated with the presence of bTB. Exclusively among dairy herds, veterinary assistance from cooperatives, possession of self-owned equipment to cool milk, and feeding with whey were correlated with the disease. Considering these results, it is recommended that the state of Paraná seek to implement a surveillance system for the detection of bTB-infected herds transforming them into free ones, if possible, incorporating elements of risk-based surveillance. Health education is also recommended to inform farmers about the risks of introducing animals without testing and of feeding raw whey to calves.

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Seroprevalence and risk factors of bovine brucellosis (Brucella abortus) in herds and cattle were estimated by a cross-sectional study in the state of Paraná, Brazil. The state was divided into seven regions and a random, two-stage sampling was performed on properties and cattle from each region between 2018 and 2019. Serum samples were collected from 11,592 cows over 24 months from 1,757 properties and a questionnaire was applied to identify potential risk factors. As recommended by the National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis (PNCEBT), serological testing for the detection of anti-Brucella antibodies included the buffered plate agglutination test (screening test) and the fluorescence polarization assay (confirmatory test). The seroprevalence of bovine brucellosis on properties and in cattle was 4.87% (95% confidence interval [CI]: 3.98-5.93%) and 2.24% (95% CI: 1.47-3.41%), respectively. Multiple logistic regression analysis identified larger herd size and failure to test for brucellosis as risk factors for the presence of anti-B. abortus antibodies. These results demonstrate no change in the prevalence when comparing initial studies conducted in 2002. Given our findings, it is recommended that policies for brucellosis control include a widespread vaccination program for higher prevalence areas and eradication approach to lower prevalence areas. All steps related to correct immunization of the herds should be verified and improved by training and education. Health education action must be carried out informing farmers about the risks of introducing animals not tested for brucellosis into their herds and the benefits of testing their herds regularly.

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Bovine tuberculosis is an infectious disease caused by Mycobacterium bovis (M. bovis), that leads to economic losses in infected herds and it is also considered an important zoonosis. The molecular typing methods of M. bovis isolates are fundamental for the bovine tuberculosis surveillance system, and spoligotyping is the standard genotyping technique for this species. Thus, the aim of the present study is to analyze the spatial and cluster distribution of M. bovis strains from several regions of Brazil through molecular typing. Spoligotyping technique was applied on 422 isolates identified as M. bovis, and Ripley's K function was used to perform the spatial and cluster analysis of each identified profile. Forty-three (43) different profiles were identified and spoligotype SB0121 was the most frequent and showed a uniform pattern in the spatial distribution while spoligotypes SB0295, SB1380 and SB1050 formed clusters. In addition, three novel spoligotype profiles (SB2361, SB2362, SB2364) were identified in different herds. In this perspective, it is believed that molecular identification and typing can significantly improve the performance of surveillance systems for bovine tuberculosis in Brazil.

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Management issues like resource optimization, cost cuts, quality gains, and improvements in care have become increasingly important and are essential to the sustainability of healthcare organizations. This study analyzed the efficiency of public outpatient care, where the high rate of patient no-show leads to low use of resources, while paradoxically the demand for medical care clearly exceeds the supply. A quantitative and descriptive approach analyzed the use of "overbooking" to reduce the effects of patient no-show in a public outpatient clinic. Using statistical and mathematical methods and based on patient and appointment data collected from a survey, an interesting comparison was made between levels of overbooking and the respective resource utilization rates and service levels for each scenario. The findings point to important gains in efficiency, thus demonstrating the potential of increasing the number of services in the same asset base.

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Aspectos como otimização de recursos, redução de custos, ganhos de qualidade e melhoria no atendimento receberam importância e são fundamentais para a sustentabilidade das organizações. Este trabalho analisa a eficiência no atendimento público ambulatorial, onde a alta taxa de absenteísmo por parte dos usuários implica baixa utilização de recursos, enquanto que, paradoxalmente, a demanda por atendimento médico é nitidamente superior à oferta. A abordagem, quantitativa e de caráter descritivo, analisa a utilização da técnica de overbooking para reduzir os efeitos do absenteísmo em um ambulatório da rede pública. Mediante o uso de métodos estatísticos e matemáticos, com base em dados de pacientes e agendamentos coletados em pesquisa, desenhou-se um interessante comparativo entre níveis de overbooking e respectivas taxas de utilização de recursos e níveis de serviço para cada cenário analisado. Os resultados obtidos apontam ganhos expressivos de eficiência, demonstrando o potencial de aumento do número de atendimentos para uma mesma base de ativos.

Management issues like resource optimization, cost cuts, quality gains, and improvements in care have become increasingly important and are essential to the sustainability of healthcare organizations. This study analyzed the efficiency of public outpatient care, where the high rate of patient no-show leads to low use of resources, while paradoxically the demand for medical care clearly exceeds the supply. A quantitative and descriptive approach analyzed the use of “overbooking” to reduce the effects of patient no-show in a public outpatient clinic. Using statistical and mathematical methods and based on patient and appointment data collected from a survey, an interesting comparison was made between levels of overbooking and the respective resource utilization rates and service levels for each scenario. The findings point to important gains in efficiency, thus demonstrating the potential of increasing the number of services in the same asset base.

Aspectos de gestión, tales como la optimización de recursos, reducción de costes, mejora de la calidad y servicio han adquirido cada vez más importancia y son fundamentales para mantener organizaciones sosteniblemente. Esta investigación analiza la eficiencia del servicio médico ambulatorio público, donde no se presenta una alta tasa de pacientes, lo que lleva a una baja utilización de los recursos existentes, mientras que, paradójicamente, la demanda de servicios médicos es claramente superior a su disponibilidad. El enfoque cuantitativo y descriptivo analiza la utilización de un exceso de reservas técnicas, con el fin de reducir el efecto de pacientes que no se dirigen, finalmente, a un servicio médico público ambulatorio. Se aplicaron métodos estadísticos y matemáticos en la información proporcionada por pacientes y en la recogida de información de la base de datos de consultas, que dieron lugar a una interesante comparación entre los niveles de exceso de reservas y su tasa de utilización, respecto a los recursos y niveles de servicio dentro de cada uno de los escenarios analizados. Los resultados obtenidos muestran un aumento significativo en la eficiencia.

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Objetivo: Avaliar a experiência de cárie dentária, identificar os grupos de polarização e verificar os fatores associados à doença cárie dentária em escolares e pré-escolares do município de Pirassununga, SP Materiais e Métodos: A coleta de dados foi realizada por levantamento epidemiológico em 2006, em pré-escolares de 5 anos (n = 113) e escolares de 12 anos (n = 117). Foram utilizados os códigos e critériospadronizados pela OMS. Em seguida, realizou-se análise de regressão de Poisson entre grupos com presençade cárie dentária (CPOD/ceod > 0) e grupo SiC (Significant Caries Index). Resultados: Aos 5 anos, 62,8% daamostra era composta por crianças livres de cárie, com média do ceod de 2,0 (dp = 2,9) e média do SiC 4,0 (dp =3,6). Aos 12 anos, a média de CPOD foi de 1,2 (dp = 1,9), a média do SiC foi de 3,1 (dp = 2,4) e 53,8% eram livresde cárie. As variáveis que se apresentaram associadas à cárie dentária aos 5 anos no grupo com experiência de cárie dentária (ceod > 0) foram: ter procurado o dentista por motivo de dor/cárie (p = 0,00) e ter como responsável pelo sustento o pai ou a mãe (p = 0,053). No grupo de polarização (SiC) foram: frequência de escovação de 1 a 2 vezes ao dia (p = 0,052) e ter visitado o dentista no último ano (p = 0,025). Aos 12 anos, no grupo com experiência de cáriedentária (CPOD > 0), as variáveis com força de associação foram: meio de transporte ônibus/bicicleta (p= 0,026)e ter faltado à escola por dor/cárie (p = 0,011). No SIC, as variáveis encontradas foram: meio de transporte ônibus/bicicleta (p = 0,034) e ter visitado o dentista no último ano (p = 0,023). Conclusão: Em ambos os grupos etários, na dentição decídua e dentição permanente, em ambos os grupos (CPOD e SiC), a experiência de cárie foi associado a fatores socioeconômicos, sóciocomportamentais e de acesso.

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Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex, is the most common agent of cattle tuberculosis, a zoonosis that causes losses in meat and milk production in several countries. In order to support epidemiological studies aimed at controlling the disease, several methods for molecular discrimination of M. bovis isolates have recently been developed. The most frequently used are spacer oligonucleotide typing (spoligotyping), mycobacterial interspersed repetitive units (MIRU), and exact tandem repeat (ETR), but they all have different discriminatory power. In the present study, allelic diversity was calculated for each MIRU and ETR locus, and the Hunter-Gaston discriminatory index (HGI) was calculated for spoligotyping, 10 MIRUs, and 3 ETRs, in 116 isolates of M. bovis obtained from cattle. The analysis of allelic diversity indicated that MIRUs 16, 26, and 27, and ETRs A, B, and C, showed the greatest diversity between the assayed loci. The HGIs for each of the techniques were: spoligotyping=0.738381; MIRU=0.829835; and ETR=0.825337. The associations of the methods' improved discriminatory power were: spoligotyping+MIRU=0.930585; spoligotyping+ETR=0.931034; and MIRU+ETR=0.953373. The greatest discriminatory power was obtained when the three techniques were associated (HGI=0.98051). Considering the analyses of the present study, spoligotyping should be the first method to be used because it differentiates M. bovis from the other members of the Mycobacterium tuberculosis complex. As the associations of MIRU and ETR with spoligotyping resulted in nearly identical HGIs, ETR seems to be the best choice after spoligotyping, because it is faster and more economical than MIRU. Finally, MIRU should be the last method used. In spite of this finding, the choice of the method used should be based on the discriminatory power necessary for the objective at hand.

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Bayon et al. (Reports, 9 March 2012, p. 1219) interpreted unusually high aluminum-potassium ratio values in an Atlantic sediment core as indicating anthropogenic deforestation around 2500 years before the present (B.P.). We argue that there is no terrestrial evidence for forest destruction by humans and that the third millennium B.P. rainforest crisis can be clearly attributed mostly to climatic change.

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OBJETIVO: Desenvolver método para planejamento e avaliação de campanhas de vacinação contra a raiva animal. MÉTODOS: O desenvolvimento da metodologia baseou-se em sistemas de informação geográfica para estimar a população e a densidade animal (canina e felina) por setores censitários e subprefeituras do município de São Paulo, em 2002. O número de postos de vacinação foi estimado para atingir uma dada cobertura vacinal. Foram utilizadas uma base de dados censitários para a população humana, e estimativas para razões cão:habitante e gato:habitante. RESULTADOS: Os números estimados foram de 1.490.500 cães e 226.954 gatos em São Paulo, uma densidade populacional de 1.138,14 animais domiciliados por km². Foram vacinados, na campanha de 2002, 926.462 animais, garantindo uma cobertura vacinal de 54 por cento. O número total estimado de postos no município para atingir uma cobertura vacinal de 70 por cento...

OBJECTIVE: To develop a method to assist in the design and assessment of animal rabies control campaigns. METHODS: A methodology was developed based on geographic information systems to estimate the animal (canine and feline) population and density per census tract and per subregion (known as "Subprefeituras") in the city of São Paulo (Southeastern Brazil) in 2002. The number of vaccination units in a given region was estimated to achieve a certain proportion of vaccination coverage. Census database was used for the human population, as well as estimates ratios of dog:inhabitant and cat:inhabitant. RESULTS: Estimated figures were 1,490,500 dogs and 226,954 cats in the city, i.e. an animal population density of 1138.14 owned animals per km². In the 2002 campaign, 926,462 were vaccinated, resulting in a vaccination coverage of 54 percent. The estimated number of vaccination units to be able to reach a 70 percent...

OBJETIVO: Desarrollar método para planificación y evaluación de campañas de vacunación contra la rabia animal. MÉTODOS: El desarrollo de la metodología se basó en sistemas de información geográfica para estimar la población y la densidad animal (canina y felina) por sectores censales y sub-prefecturas del municipio de Sao Paulo (Sureste de Brasil), en 2002. El número de puestos de vacunación fue estimado para atender una determinada cobertura de vacunación. Se utilizaron una base de datos censales para la población humana, y estimativas para razones perro: habitante y gato: habitante. RESULTADOS: Los números estimados fueron de 1.490.500 perros y 226.954 en Sao Paulo, una densidad poblacional de 1.138,14 animales domiciliados por km2. Fueron vacunados, en la campaña de 2002, 926.462 animales, garantizando una cobertura de vacunas de 54 por ciento. El número total estimado de puestos en el municipio para atender una cobertura de vacunación de 70 por ciento...

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OBJECTIVE: To develop a method to assist in the design and assessment of animal rabies control campaigns. METHODS: A methodology was developed based on geographic information systems to estimate the animal (canine and feline) population and density per census tract and per subregion (known as "Subprefeituras") in the city of São Paulo (Southeastern Brazil) in 2002. The number of vaccination units in a given region was estimated to achieve a certain proportion of vaccination coverage. Census database was used for the human population, as well as estimates ratios of dog:inhabitant and cat:inhabitant. RESULTS: Estimated figures were 1,490,500 dogs and 226,954 cats in the city, i.e. an animal population density of 1138.14 owned animals per km(2). In the 2002 campaign, 926,462 were vaccinated, resulting in a vaccination coverage of 54%. The estimated number of vaccination units to be able to reach a 70%-vaccination coverage, by vaccinating 700 animals per unit on average, was 1,729. These estimates are presented as maps of animal density according to census tracts and "Subprefeituras". CONCLUSIONS: The methodology used in the study may be applied in a systematic way to the design and evaluation of rabies vaccination campaigns, enabling the identification of areas of critical vaccination coverage.

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Sperm are attracted by chemical substances which are released by the egg. This process is called chemotaxis. Several molecules that are involved in chemotactic signaling of sperm from marine invertebrates are described and a model of the signaling pathway is presented. We discuss the motor response during chemotaxis and propose a model of the navigation strategy of sperm.

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A 50-year-old surgeon was working with his electrical circle saw as a do-it-yourselfer. He was alone, nobody witnessed his mishap when he amputated his left index finger. He claimed high financial compensation from two accident insurance companies because of his disability. A long series of medical expertises followed. The juridical procedures took 12 years in total. All higher authorities had to deal with the forensic medical implications. Finally, the high court (Bundesgerichtshof) decided that the complainant would receive no compensation because he gave two very different descriptions. Concerning the reconstruction of the accident, the first version was unlikely from a biomechanical point of view. The decision of the court was solely based on the violation of the obligation to give a clear presentation of the course of events (Obliegenheitsverletzung).

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Sperm become attracted by chemical substances that are released from the outer coating of the egg, a process called chemotaxis. In this paper the cellular pathway and the motor response during chemotaxis of sperm from sea urchin and starfish are briefly outlined.

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We have prepared a mutant RecA protein in which proline 67 and glutamic acid 68 in the NTP binding site were replaced by a glycine and alanine residue, respectively. The [P67G/E68A]RecA protein catalyzes the single-stranded DNA-dependent hydrolysis of ATP and is able to promote the standard ATP-dependent three-strand exchange reaction between a circular bacteriophage phiX174 (phiX) single-stranded DNA molecule and a homologous linear phiX double-stranded (ds) DNA molecule (5.4 kilobase pairs). The strand exchange activity differs from that of the wild type RecA protein, however, in that it is (i) completely inhibited by an ATP regeneration system, and (ii) strongly stimulated by the addition of high concentrations of ADP to the reaction solution. These results indicate that the strand exchange activity of the [P67G/E68A]RecA protein is dependent on the presence of both ATP and ADP. The ADP dependence of the reaction is reduced or eliminated when (i) a shorter linear phiX dsDNA fragment (1.1 kilobase pairs) is substituted for the full-length linear phiX dsDNA substrate, or (ii) the Mg(2+) concentration is reduced to a level just sufficient to complex the ATP present in the reaction solution. These results indicate that it is the branch migration phase (and not the initial pairing step) of the [P67G/E68A]RecA protein-promoted strand exchange reaction that is dependent on ADP. It is likely that the [P67G/E68A]RecA mutation has revealed a requirement for ADP that also exists (but is not as readily apparent) in the strand exchange reaction of the wild type RecA protein.

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A combination of hydrodynamic and cross-linking studies were used to investigate self-assembly of the Escherichia coli DNA repair protein UvrB. Though the procession of steps leading to incision of DNA at sites flanking damage requires that UvrB engage in an ordered series of complexes, successively with UvrA, DNA, and UvrC, the potential for self-association had not yet been reported. Gel permeation chromatography, nondenaturing polyacrylamide gel electrophoresis, and chemical cross-linking results combine to show that UvrB stably assembles as a dimer in solution at concentrations in the low micromolar range. Smaller populations of higher order oligomeric species are also observed. Unlike the dimerization of UvrA, an initial step promoted by ATP binding, the monomer-dimer equilibrium for UvrB is unaffected by the presence of ATP. The insensitivity of cross-linking efficiency to a 10-fold variation in salt concentration further suggests that UvrB self-assembly is driven largely by hydrophobic interactions. Self-assembly is significantly weakened by proteolytic removal of the carboxyl terminus of the protein (generating UvrB*), a domain also known to be required for the interaction with UvrC leading to the initial incision of damaged DNA. This suggests that the C terminus may be a multifunctional binding domain, with specificity regulated by protein conformation.

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The case of a self-amputation of the left-sided forefinger is presented. It was an isolated smooth amputation near the basic ankle of the finger without any accompanying injury of other fingers. The victim (a physician) claimed financial compensation from his accident-insurance; his contract included special disability taxes for finger injuries. However, the insurance company did not pay but was able to demonstrate--by means of a medico-legal reconstructive expertise--that the amputation was voluntary and self-inflicted. The argumentation concerning self-mutilation is presented (including the so-called execution-position of the finger and ergonometric aspects). Concerning the surgical care, intervention and diagnostic procedures a detailed documentation of the case history and the morphology of the injury pattern are recommended (especially in isolated finger-amputations of the non-working hand.

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The DNA-dependent ATPase activity of UvrB is required to support preincision steps in nucleotide excision repair in Escherichia coli. This activity is, however, cryptic. Elicited in nucleotide excision repair by association with the UvrA protein, it may also be unmasked by a specific proteolysis eliminating the C-terminal domain of UvrB (generating UvrB*). We introduced fluorescent reporter groups (tryptophan replacing Phe47 or Asn51) into the ATP binding motif of UvrB, without significant alteration of behavior, to study both nucleotide binding and those conformational changes expected to be essential to function. The inserted tryptophans occupy moderately hydrophobic, although potentially heterogeneous, environments as evidenced by fluorescence emission and time-resolved decay characteristics, yet are accessible to the diffusible quencher acrylamide. Activation, via specific proteolysis, is accompanied by conformational change at the ATP binding site, with multiple changes in emission spectra and a greater shielding of the tryptophans from diffusible quencher. Titration of tryptophan fluorescence with ATP has revealed that, although catalytically incompetent, UvrB can bind ATP and bind with an affinity equal to that of the active UvrB* form (Kd of approximately 1 mM). The ATP binding site of UvrB is therefore functional and accessible, suggesting that conformational change either brings amino acid residues into proper alignment for catalysis and/or enables response to effector DNA.

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27 cases of questionable self-mutilation among physicians (concerning finger and hand injuries) were analyzed retrospectively. The evaluation based on files of the insurance companies, reconstructive examinations and experimental investigations. Three typical cases are described in detail, the "victims" were suspected to have committed a special kind of fraud in order to claim financial compensation from their accident-insurance companies; the contract included special invalidity payments for finger injures (so-called "Gliedertaxe"). Many of these physicians had worked in the surgical field: apart from one 38-year-old female all of them were males, aged between 41 and 66 years. The mutilating instruments were often circular saws, sometimes chain saws and a great variety of other tools, for example hatchet, big scissors and other sharp instruments. By means of forensic-medical expertise and criminalistic investigations the insurance companies were able to demonstrate clearly that the amputation was voluntarily self-inflicted. The forensic-medical argumentation concerning intentional self-mutilation included the so-called execution position of the finger, the injury pattern, the investigations of blood stains and ergonometric aspects.

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The results of 131 forensic exhumations performed by the Institute für Legal Medicine in Hamburg from 1971 up to 1995 are presented and analysed. 50 exhumations have been ordered by legal authorities concerning criminalistic aspects. 81 cases have been commissioned by insurance companies. 7 categories of cases have been established which are separately analysed (e.g. suspicion of intoxication, accidental cases, occupational diseases). A synopsis presents the evidence of several pathological findings in regard to the body's lay-days in the grave compared with similar studies. The study gives evidence of the value of specific findings even if the body had been buried one or two years before exhumation. In 65 of 92 cases the suspected cause of death could be confirmed. In 121 cases the cause of death was definitely cleared up by autopsy. 125 exhumations (approximately 95%) have been successful concerning the underlaying question that gave reason for further examinations. Exhumations turned out to be very useful in order to clarify insurance-related medical questions.

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We report two cases of generalized nonviolent hepatogenic fat embolism. A 63-year-old woman was sent to the hospital with suspected mushroom poisoning. Shock symptoms occurred quickly and could not be treated effectively; the patient died 24 h after admission. Postmortem examination showed acute yellow dystrophy of the liver with a severe preexisting fatty liver. Any intoxication including Amanita phalloides could be excluded. In all probability, a fulminant viral hepatitis caused liver dystrophy, and the decay of the fatty liver cells led to generalized fat embolism as the cause of death. The second patient, a 46-year-old man, was reported to have suffered from an acute illness while in prison and died after having been transferred to the local hospital. Histological examinations showed an acute liver dystrophy probably caused by fulminant viral hepatitis with fatty degeneration. In this case, the cause of death was also found to be generalized fat embolism.

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