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The objective of this research is to identify the roles performed by managers of incubators and incubated companies, in the light of Mintzberg's studies on the nature of managerial work, as well as to emphasize the administrative functions performed by them. The directors of five incubators located in Manaus, capital of the state of Amazonas, Brazil and thirteen managers of the incubated companies participated in the study through a structured questionnaire. The results show that the most important roles played by incubator managers are monitor, leader, contact and disseminator. The most cited roles performed by the managers of the incubated companies are the leader, entrepreneur, contact and resource allocator. [ABSTRACT FROM AUTHOR]

Background: As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy. Methods: This paper explores the case of the health system's collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic. Results: Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance. Conclusions: Through a systems analysis approach, this study describes the implicit strategy of "living with Covid-19", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19. [ABSTRACT FROM AUTHOR]

This paper discusses transport modes supporting Uncertainty Supply Chain Model (USCM) in the case of Manaus Industrial Pole (PIM), an industrial cluster in the Brazilian Amazon that hosts six hundred factories with diverse logistics and supply chain managerial strategies. USCM (Lee, 2002; Fisher, 1997) develops a dot matrix classification of the supply chains considering several attributes (e.g., agility, cost, security, responsiveness) and argues that emergent economies industrial clusters, in the effort to keep attractiveness for technological frontier firms, need to adapt supply chain strategies according to USCM attributes. The paper takes a further step, discussing which transport modes are suitable to each supply chain classified at the USCM in PIM's case. The research's methods covered the use of PIM's statistical official database (secondary data), interviews with the main logistical services providers of PIM and phone survey with a sample of firms (primary data). Findings confirm the theoretical argument that different supply chains will demand different transport modes running at the same time in the same industrial cluster (Oliveira, 2009). In the case of PIM, this implies investments on port and airport infrastructure and a strategic focus on air transport mode, due to (1) short life cycle of products, (2) distance from suppliers, (3) quick response to demand and (4) the fact that even PIM's standard products use, in average, forty per cent of air transport at inbound logistics. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Oftalmologia is the property of Sociedade Brasileira de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The indirect effect of atmospheric aerosol particles on the Earth's radiation balance remains one of the most uncertain components affecting climate change throughout the industrial period. The large uncertainty is partly due to the incomplete understanding of aerosol–cloud interactions. One objective of the GoAmazon2014/5 and the ACRIDICON (Aerosol, Cloud, Precipitation, and Radiation Interactions and Dynamics of Convective Cloud Systems)-CHUVA (Cloud Processes of the Main Precipitation Systems in Brazil) projects was to understand the influence of emissions from the tropical megacity of Manaus (Brazil) on the surrounding atmospheric environment of the rainforest and to investigate its role in the life cycle of convective clouds. During one of the intensive observation periods (IOPs) in the dry season from 1 September to 10 October 2014, comprehensive measurements of trace gases and aerosol properties were carried out at several ground sites. In a coordinated way, the advanced suites of sophisticated in situ instruments were deployed aboard both the US Department of Energy Gulfstream-1 (G1) aircraft and the German High Altitude and Long-Range Research Aircraft (HALO) during three coordinated flights on 9 and 21 September and 1 October. Here, we report on the comparison of measurements collected by the two aircraft during these three flights. Such comparisons are challenging but essential for assessing the data quality from the individual platforms and quantifying their uncertainty sources. Similar instruments mounted on the G1 and HALO collected vertical profile measurements of aerosol particle number concentrations and size distribution, cloud condensation nuclei concentrations, ozone and carbon monoxide mixing ratios, cloud droplet size distributions, and downward solar irradiance. We find that the above measurements from the two aircraft agreed within the measurement uncertainties. The relative fraction of the aerosol chemical composition measured by instruments on HALO agreed with the corresponding G1 data, although the total mass loadings only have a good agreement at high altitudes. Furthermore, possible causes of the discrepancies between measurements on the G1 and HALO are examined in this paper. Based on these results, criteria for meaningful aircraft measurement comparisons are discussed. [ABSTRACT FROM AUTHOR]

Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system. Author summary: Brazil has implemented tafenoquine and quantitative G6PD testing as a crucial component of its comprehensive strategy to eliminate Plasmodium vivax malaria. Training of healthcare professionals (HCPs) has played a pivotal role in facilitating the adoption of these new strategies. In any implementation, it is necessary to identify barriers and facilitators and consider data that cannot typically be collected in purely quantitative studies. This qualitative study describes the perceptions of HCPs regarding the training they received and the knowledge gaps that only became apparent in their professional practice after the training. These insights were instrumental in developing various communication and continuing education strategies that enhanced HCP knowledge following training. Finally, the study presents a training approach for applying quantitative G6PD testing and the tafenoquine treatment regimen, including the most effective educational activities and materials to support the HCP learning process. [ABSTRACT FROM AUTHOR]

Copyright of Exacta is the property of Exacta - Engenharia de Producao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. METHODS: Using a three‐stage process and a stakeholder‐engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter‐rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. RESULTS: Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S‐CVI] 0.93) and relevance ratings (S‐CVI 0.85) between expert panels. The identified cut‐off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. DISCUSSION: Using a stakeholder‐engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Highlights: Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals. [ABSTRACT FROM AUTHOR]

Background: Plasmodium vivax is the main species responsible for human malaria in Brazil, and one of its manifestations is splenic malaria, though there are still challenges in its diagnosis. The present study aimed to standardize Plasmodium sp. DNA extraction from histological slices of spleen and diagnosis using real-time qPCR. Methods: This study performed a microtomy of a paraffin-embedded spleen as a positive control for P. vivax from a patient who had been previously diagnosed with the parasite. The sample was deparaffinized with xylol and ethanol, then DNA extraction was performed with two commercial kits. qPCR was carried out with the Taqman system for detection of Plasmodium sp. and was made species-specific using PvmtCOX1 gene. From 2015 to 2019, 200 spleen samples were obtained from trauma patients subjected to splenectomy in Manaus, Amazonas. All the samples were tested for cell-free human DNA (cfDNA). Results: The deparaffinization and the Plasmodium vivax DNA extraction method was successfully standardized, and the control sample was positive for P. vivax. Of the 200 samples, all qPCRs were negative, but they were positive for human PCR. Conclusion: Paraffinization is practical and efficient for the preservation of samples, but the formation of bonds between proteins and DNA makes extraction difficult. Despite this, in this study, it was possible to standardize a method of DNA extraction for detecting P. vivax. [ABSTRACT FROM AUTHOR]

Background: Malaria and dengue are the most prevalent vector-borne diseases worldwide and represent major public health problems. Both are endemic in tropical regions, propitiating co-infection. Only few co-infection cases have been reported around the world, with insufficient data so far to enhance the understanding of the effects of co-infection in the clinical presentation and severity. Methodology/Principal Findings: A cross-sectional study was conducted (2009 to 2011) in hospitalized patients with acute febrile syndrome in the Brazilian Amazon. All patients were submitted to thick blood smear and PCR for Plasmodium sp. detection, ELISA, PCR and NS1 tests for dengue, viral hepatitis, HIV and leptospirosis. In total, 1,578 patients were recruited. Among them, 176 (11.1%) presented P. vivax malaria mono-infection, 584 (37%) dengue fever mono-infection, and 44 (2.8%) were co-infected. Co-infected patients had a higher chance of presenting severe disease (vs. dengue mono-infected), deep bleeding (vs. P. vivax mono-infected), hepatomegaly, and jaundice (vs. dengue mono-infected). Conclusions/Significance: In endemic areas for dengue and malaria, jaundice (in dengue patients) and spontaneous bleeding (in malaria patients) should raise the suspicion of co-infection. Besides, whenever co-infection is confirmed, we recommend careful monitoring for bleeding and hepatic complications, which may result in a higher chance of severity, despite of the fact that no increased fatality rate was seen in this group. Author Summary: Malaria and dengue fever are typical diseases in tropical regions of developing countries; such as the Brazilian Amazon. They become serious problems in public health as they mostly affect vulnerable populations. Both diseases are mosquito-borne. These diseases present similar signs and symptoms. Brazil registers most of the malaria cases in the Amazon. The four dengue serotypes also circulate in this region. Similar to malaria, there are records of dengue outbreaks during the first months of the year, and isolated cases in the remaining months. Official records of malaria and dengue co-infection are infrequent in Brazil; however, we believe that this event is more frequent than usually reported. Our study detected high prevalence of the co-infection in the hospitalized patients infected with malaria or dengue in a tertiary health care unit, reference in the treatment of tropical and infectious diseases in Manaus, Amazonas, Brazil. We highlight the high likelihood of co-infected patients to present clinical complications. Besides, we observed that the presence of jaundice in dengue patients, and bleeding in malaria patients, are possible indications of co-infection. Therefore, this paper is useful to physicians working in the tropics, enabling the clinical suspicion of a not so rare condition. [ABSTRACT FROM AUTHOR]

The Amazon represents the world's greatest biodiversity and covers different countries in South America, including Brazil with the largest area. The interaction between the resident population of this area and its ecosystem is responsible for an intense exposure to venomous animals, which are considered an important health issue in the region. Therefore, the 1st International Symposium on Research in Venomous Animals, held from 2 May to 5 May 2023 in the city of Manaus in the state of Amazonas in Brazil, aimed to address animal envenomation aspects in the Brazilian Amazon and the exchange of ideas and knowledge between research groups from around the world. The event was attended by graduate students as well as renowned researchers from the Americas, Europe, and Asia. The event presented a multidisciplinary and translational approach in the area of toxinology, including themes such as clinical envenomation (clinical management, pathophysiology, and public policy strategies), preclinical studies, biological aspects of venomous animals' venoms (venom composition/variation and geographical distribution), interdisciplinary studies on health anthropology and economics, and bioprospecting aspects (toxins with therapeutic and/or technological potential). [ABSTRACT FROM AUTHOR]

The objective was to study the impacts of the implementation of fish farming projects (fish breeding), the quality of water effluents from these enterprises, in upland streams on properties in the municipalities of Manaus and Iranduba. We chose to monitor some physical-chemical attributes such as turbidity, dissolved oxygen, chlorophyll-a, ammonia, nitrite, nitrate and phosphorus because they are able to establish a relationship between fish farming and the loss of environmental quality of water. For this study, 16 sample units were analyzed, with two collection points each, upstream and downstream in the fish farming enterprises in uplands of continuous land (continuous flow), in two different periods in the year 2016 and 2017. The main variables studied in the analysis stage of an aquatic ecosystem, including fishing grounds, they can be: water temperature, pH, turbidity, concentration of nutrients (nitrite, nitrate and ammonia, total phosphorus), dissolved oxygen, chlorophyll. There was no significant difference in temperature, dissolved oxygen, ammonia and nitrate. There was a significant difference for the depth, turbidity and nitrite parameters. There was a significant difference for phosphorus and pH and no difference was observed for chlorophyll-a. The analyzed parameters were sufficient to demonstrate that the fish farming activity in Igarapé alters turbidity, nitrite and phosphorus and pH. Based on these parameters, better control of water quality in fish farming in Igarapé is suggested as water flow and better quality of the feed offered to fish. [ABSTRACT FROM AUTHOR]

In regions of significant social, economic, and environmental vulnerability, such as the Amazon, managing municipal solid waste (MSW) is challenging because of limited infrastructure, climatic and demographic characteristics, and the need to preserve indigenous areas. This study analyzes the eco-efficiency transition of MSW management systems in the Amazon , considering both environmental and economic factors as an instrument to support decision-making. The database used was supported by a gravimetric evaluation of MSW in Humaitá, Amazonas State, Brazil, together with consideration of environmental, social, economic, and logistical aspects. We performed a life cycle assessment (LCA) analysis, integrated with economic performance, quantified the environmental impacts and evaluated the financial viability of the base scenario (Sbase) (100% of the waste sent to landfills) and four other scenarios with increasing levels of waste separation (metals, Polyethylene terephthalate (PET), paper, and cardboard), with subsequent shipment along the Madeira River to the recycling market in the city of Manaus, in addition to composting organic waste. The transition from Sbase to a scenario of 100% composting of organic waste generated in the urban area, together with 100% separation of PET and metals generated in urban, rural, and indigenous areas, led to the best eco-efficiency transition, shown by a reduction of 152.70 Mpt per US$ invested. The results demonstrate the potential of the eco-efficiency transition approach to assist decision-making in MSW management in the Amazon environment. The analysis performed enables the evaluation of the effects of implementing different scenarios in progressive stages, aiming to achieve continuous improvement in similar sectors of society. • The eco-efficiency in solid waste management (SWM) in the Amazon was studied. • The method applied Life Cycle Assessment associated with the economic performance. • The higher recyclables segregation increases, at most, 25% of the SWM current cost. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Administração e Inovação (RAI) is the property of Revista de Administracao e Inovacao- RAI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Public health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions. Methods: A multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency. Results: Educational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had haemolysis. All of them recovered. Conclusions: Under real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme. [ABSTRACT FROM AUTHOR]

Copyright of Rodriguésia is the property of Revista Rodriguesia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency, prevalent in many malaria-endemic countries. G6PD-deficient individuals are susceptible to hemolysis during oxidative stress, which can occur from exposure to certain medications, including 8-aminoquinolines used to treat Plasmodium vivax malaria. Accordingly, access to point-of-care (POC) G6PD testing in Brazil is critical for safe treatment of P. vivax malaria. Methodology/Principal findings: This study evaluated the performance of the semi-quantitative, POC STANDARD G6PD Test (SD Biosensor, Republic of Korea). Participants were recruited at clinics and through an enriched sample in Manaus and Porto Velho, Brazil. G6PD and hemoglobin measurements were obtained from capillary samples at the POC using the STANDARD and HemoCue 201+ (HemoCue AB, Sweden) tests. A thick blood slide was prepared for malaria microscopy. At the laboratories, the STANDARD and HemoCue tests were repeated on venous samples and a quantitative spectrophotometric G6PD reference assay was performed (Pointe Scientific, Canton, MI). G6PD was also assessed by fluorescent spot test. In Manaus, a complete blood count was performed. Samples were analyzed from 1,736 participants. In comparison to spectrophotometry, the STANDARD G6PD Test performed equivalently in determining G6PD status in venous and capillary specimens under varied operating temperatures. Using the manufacturer-recommended reference value thresholds, the test's sensitivity at the <30% threshold on both specimen types was 100% (95% confidence interval [CI] venous 93.6%–100.0%; capillary 93.8%–100.0%). Specificity was 98.6% on venous specimens (95% CI 97.9%–99.1%) and 97.8% on capillary (95% CI 97.0%–98.5%). At the 70% threshold, the test's sensitivity was 96.9% on venous specimens (95% CI 83.8%–99.9%) and 94.3% on capillary (95% CI 80.8%–99.3%). Specificity was 96.5% (95% CI 95.0%–97.6%) and 92.3% (95% CI 90.3%–94.0%) on venous and capillary specimens, respectively. Conclusion/Significance: The STANDARD G6PD Test is a promising tool to aid in POC detection of G6PD deficiency in Brazil. Trial registration: This study was registered with ClinicalTrials.gov (identifier: NCT04033640). Author summary: G6PD deficiency affects an estimated 500 million people worldwide and is prevalent in many malaria-endemic settings. People with G6PD deficiency are at risk of hemolysis when exposed to certain medications, including 8-aminoquinoline drugs used to treat Plasmodium vivax malaria. Increased access to testing for G6PD deficiency at or near the point of care is critical for expanding the safe treatment of P. vivax malaria. In this study, we aimed to evaluate the performance of a point-of-care, semi-quantitative test for G6PD deficiency, the STANDARD G6PD Test, in a malaria-endemic setting in Brazil. The test was evaluated on both capillary and venous blood samples across a broad range of operating temperatures. The findings show that the STANDARD G6PD Test performed equivalently to the reference test in its ability to diagnose G6PD deficiency at the point of care. The STANDARD G6PD Test is a promising tool to aid in detecting G6PD deficiency at the point of care in Brazil. [ABSTRACT FROM AUTHOR]

Background: Alpha Thalassemia (α-thal) is a heterogeneous group of hereditary alterations caused by deletions that affect alpha regulatory genes, and the 3.7Kb deletion is the most frequent worldwide. The prevalence ranges from 20% and 35% in Brazil, depending mainly on race, predominant in Afro-descendants. Purpose: The aim was to determine α-thal -α3.7Kb and -α4.2Kb deletions, estimating their frequency in individuals from six regions of Amazonas State. Methods: Volunteers age between 18-59 years old of both genders participated in the study. Blood was collected from March 2014 to September 2017 at the health centers of each participant city. α-thal3.7Kbwas performed by GAP-PCR, while α-thal4.2Kb by Multiplex-PCR. The total samples collected from each city were: Manaus (capital), 356 (19.7%); Iranduba 232 (12.8%); Manacapuru, 287 (15.9%); Presidente Figueiredo, 370 (20.5%); Itacoatiara, 301 (16.6%); and Coari, 263 (14.5%). Results: The average age among males was 35.3±14.8, while for females, it was 36.7±14.9 years old. Microcytosis (MCV <80fL) was found in 158 individuals (8,46%) and α-thal diagnosed in 143 individuals (7.9%), and all of these individuals carried the 3.7Kb deletion 5.95% in heterozygous and 1.95% in homozygous. α-thal4.2Kb was not found in any volunteer. The association analyses to the α-thal3.7Kb genotypes were statistically significant for all hematological parameters (p<.001), except serum iron and serum ferritin analyses. Conclusion: This study highlights α-thal 3.7Kb deletion as an important public health problem, especially in a population not yet characterized about this disease. Thus, epidemiological studies using molecular tools become relevant in regions where the disease is underestimated, contributing to a better understanding of thalassemia incidence and iron deficiency anemias incidence of the participating cities. We reinforce that future molecular studies in North Region from Brazil can be utilized to describe other genetic anemias as structural hemoglobinopathies that have already proven to be highly prevalent in Brazil. [ABSTRACT FROM AUTHOR]

Background: Cryptococcosis is a disease of wide geographic distribution. It is most critical when it affects immunocompromised patients, with AIDS, tuberculosis or other diseases that require prolonged hospitalization. Methods: This study described a case report, molecular epidemiology, the phylogenetic relationship, along with antifungal susceptibility test of a new ST 623 of C. neoformans isolated in a patient with non-Hodgkin's Lymphoma, from Manaus, Brazil. Results: The new C. neoformans was susceptible to all antifungal drugs tested. Our results showed that ST623 new clone has no evident evolutionary proximity to any other ST of the VNI subtype group identified in Brazil. Conclusions: In the context of phylogenetic analysis, this new genotype belongs to VNI subtype, and subsequencing complete genome studies are necessary to better understand the phylogenetic relationships amongst STs in this group. [ABSTRACT FROM AUTHOR]

The realistic representation of aerosol–cloud interactions is of primary importance for accurate climate model projections. The investigation of these interactions in strongly contrasting clean and polluted atmospheric conditions in the Amazon region has been one of the motivations for several field campaigns, including the airborne "Aerosol, Cloud, Precipitation, and Radiation Interactions and Dynamics of Convective Cloud Systems–Cloud Processes of the Main Precipitation Systems in Brazil: A Contribution to Cloud Resolving Modeling and to the GPM (Global Precipitation Measurement) (ACRIDICON-CHUVA)" campaign based in Manaus, Brazil, in September 2014. In this work we combine in situ and remotely sensed aerosol, cloud, and atmospheric radiation data collected during ACRIDICON-CHUVA with regional, online-coupled chemistry-transport simulations to evaluate the model's ability to represent the indirect effects of biomass burning aerosol on cloud microphysical and optical properties (droplet number concentration and effective radius). We found agreement between the modeled and observed median cloud droplet number concentration (CDNC) for low values of CDNC, i.e., low levels of pollution. In general, a linear relationship between modeled and observed CDNC with a slope of 0.3 was found, which implies a systematic underestimation of modeled CDNC when compared to measurements. Variability in cloud condensation nuclei (CCN) number concentrations was also underestimated, and cloud droplet effective radii (reff) were overestimated by the model. Modeled effective radius profiles began to saturate around 500 CCN cm -3 at cloud base, indicating an upper limit for the model sensitivity well below CCN concentrations reached during the burning season in the Amazon Basin. Additional CCN emitted from local fires did not cause a notable change in modeled cloud droplet effective radii. Finally, we also evaluate a parameterization of CDNC at cloud base using more readily available cloud microphysical properties, showing that we are able to derive CDNC at cloud base from cloud-side remote-sensing observations. [ABSTRACT FROM AUTHOR]

Urbanization and deforestation have important impacts on atmospheric particulate matter (PM) over Amazonia. This study presents observations and analysis of PM 1 concentration, composition, and optical properties in central Amazonia during the dry season, focusing on the anthropogenic impacts. The primary study site was located 70 km downwind of Manaus, a city of over 2 million people in Brazil, as part of the GoAmazon2014/5 experiment. A high-resolution time-of-flight aerosol mass spectrometer (AMS) provided data on PM 1 composition, and aethalometer measurements were used to derive the absorption coefficient babs,BrC of brown carbon (BrC) at 370 nm. Non-refractory PM 1 mass concentrations averaged 12.2 µ g m -3 at the primary study site, dominated by organics (83 %), followed by sulfate (11 %). A decrease in babs,BrC was observed as the mass concentration of nitrogen-containing organic compounds decreased and the organic PM 1 O:C ratio increased, suggesting atmospheric bleaching of the BrC components. The organic PM 1 was separated into six different classes by positive-matrix factorization (PMF), and the mass absorption efficiency Eabs associated with each factor was estimated through multivariate linear regression of babs,BrC on the factor loadings. The largest Eabs values were associated with urban (2.04±0.14 m 2 g -1) and biomass-burning (0.82±0.04 to 1.50±0.07 m 2 g -1) sources. Together, these sources contributed at least 80 % of babs,BrC while accounting for 30 % to 40 % of the organic PM 1 mass concentration. In addition, a comparison of organic PM 1 composition between wet and dry seasons revealed that only part of the 9-fold increase in mass concentration between the seasons can be attributed to biomass burning. Biomass-burning factor loadings increased by 30-fold, elevating its relative contribution to organic PM 1 from about 10 % in the wet season to 30 % in the dry season. However, most of the PM 1 mass (>60 %) in both seasons was accounted for by biogenic secondary organic sources, which in turn showed an 8-fold seasonal increase in factor loadings. A combination of decreased wet deposition and increased emissions and oxidant concentrations, as well as a positive feedback on larger mass concentrations are thought to play a role in the observed increases. Furthermore, fuzzy c -means clustering identified three clusters, namely "baseline", "event", and "urban" to represent different pollution influences during the dry season. The baseline cluster, representing the dry season background, was associated with a mean mass concentration of 9±3 µ g m -3. This concentration increased on average by 3 µ g m -3 for both the urban and the event clusters. The event cluster, representing an increased influence of biomass burning and long-range transport of African volcanic emissions, was characterized by remarkably high sulfate concentrations. The urban cluster, representing the influence of Manaus emissions on top of the baseline, was characterized by an organic PM 1 composition that differed from the other two clusters. The differences discussed suggest a shift in oxidation pathways as well as an accelerated oxidation cycle due to urban emissions, in agreement with findings for the wet season. [ABSTRACT FROM AUTHOR]

The Amazon's ability to draw tourists is thought to be strongly associated with the opportunity to have sight of and interact with iconic wild animals. Tourism leaders are calling for the private and public sectors to develop wildlife focused ecotourism in this region. However, specific information regarding current practice and their impact on wildlife is lacking. Although wildlife ecotourism here remains in its relative infancy, our study demonstrates that a wide variety of wildlife-focused activities are already being promoted and provided to tourists who visit the city of Manaus in Brazil. Issues of potential wildlife conservation and animal welfare concern include wildlife-baiting, swim-with free-ranging pink river dolphin activity, the use of captive wild animals as photo props and the sale of wildlife body parts as souvenirs. We found that tour guides actively promoted these activities on 77% of excursions attended, which involved a range of different wild animals, representing at least 10 different species from three different taxonomic classes. From a legal perspective, despite the potential risks imposed to wildlife and tourist well-being, there are still no specific laws regulating feeding, touching and swimming with pink river dolphins in Brazil. However, the illegality of advertising and providing direct physical contact wildlife 'photo prop' tourism is demonstrated by enforcement action taken by wildlife authorities during our study. We suggest that tourist focused human behavior change initiatives should become a critical component of a wider holistic approach to effectively balance wildlife protection goals and any expansion of wildlife ecotourism in the Amazon. [ABSTRACT FROM AUTHOR]

The remote atmosphere over the Amazon can be similar to oceanic regions in terms of aerosol conditions and cloud type formations. This is especially true during the wet season. The main aerosol-related disturbances over the Amazon have both natural sources, such as dust transport from Africa, and anthropogenic sources, such as biomass burning or urban pollution. The present work considers the impacts of the latter on the microphysical properties of warm-phase clouds by analysing observations of the interactions between the Manaus pollution plume and its surroundings, as part of the GoAmazon2014/5 Experiment. The analysed period corresponds to the wet season (specifically from February to March 2014 and corresponding to the first Intensive Operating Period (IOP1) of GoAmazon2014/5). The droplet size distributions reported are in the range 1 µm ≤ D ≤ 50 µm in order to capture the processes leading up to the precipitation formation. The wet season largely presents a clean background atmosphere characterized by frequent rain showers. As such, the contrast between background clouds and those affected by the Manaus pollution can be observed and detailed. The focus is on the characteristics of the initial microphysical properties in cumulus clouds predominantly at their early stages. The pollution-affected clouds are found to have smaller effective diameters and higher droplet number concentrations. The differences range from 10 to 40% for the effective diameter and are as high as 1000% for droplet concentration for the same vertical levels. The growth rates of droplets with altitude are slower for pollution-affected clouds (2.90 compared to 5.59 µm km-1), as explained by the absence of bigger droplets at the onset of cloud development. Clouds under background conditions have higher concentrations of larger droplets (>20 µm) near the cloud base, which would contribute significantly to the growth rates through the collision-coalescence process. The overall shape of the droplet size distribution (DSD) does not appear to be predominantly determined by updraught strength, especially beyond the 20 µm range. The aerosol conditions play a major role in that case. However, the updraughts modulate the DSD concentrations and are responsible for the vertical transport of water in the cloud. The larger droplets found in background clouds are associated with weak water vapour competition and a bimodal distribution of droplet sizes in the lower levels of the cloud, which enables an earlier initiation of the collision-coalescence process. This study shows that the pollution produced by Manaus significantly affects warmphase microphysical properties of the surrounding clouds by changing the initial DSD formation. The corresponding effects on ice-phase processes and precipitation formation will be the focus of future endeavours. [ABSTRACT FROM AUTHOR]

Introduction: The clinical outcome to Leishmania-infection is determined by the individual adaptive immune T helper cell responses and their interactions with parasitized host cells. An early development of a proinflammatory immune response (Th1 response) is necessary for Leishmania-infection resolution. The Toll-interacting protein (TOLLIP) regulates human Toll-like receptors signaling pathways by down regulating the proinflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) and inducing the ant-inflammatory cytokine interleukin-10 (IL-10). Polymorphisms in the TOLLIP gene are associated with infectious diseases. Material and Methods: The polymorphisms rs5743899 and rs3750920 in the TOLLIP gene were genotyped by polymerase chain reaction and restriction fragment length polymorphism (RFLP) analysis in 631 patients with cutaneous leishmaniasis (CL) caused by L. guyanensis and 530 individuals with no history of leishmaniasis. Results: The G and T alleles of the rs5743899 and rs3750920 were more common in patients with CL than in healthy individuals (P = 2.6 x10-8 ; odds ratio [OR], 1.7 [ 95% confidence interval (CI) 1.4–2.0] and P = 1.9 x10-8 ; OR, 1.6 [95% CI 1.4–1.9] respectively). The r2 and D' linkage disequilibrium between the two polymorphisms are 0.05 and 0.473 with a confidence bounds of 0.37 to 0.57 respectively. Conclusion: The two polymorphisms are independently associated with an increased risk of developing CL. Author Summary: Leishmaniasis is an infectious disease caused by the protozoan parasite of the Leishmania genus. It is transmitted by infected sandfly (the phlebotomines) and caused either visceral or tegumentary leishmaniasis depending on the species. In areas of endemicity for leishmaniasis, not all individuals exposed to the same environment develop the disease. It has been suggested that the genetic background of the individual may play a key role. The peri-rural regions of Manaus, the capital city of the Amazonas state of Brazil has become over the years endemic areas of mainly L. guyanensis American Tegumentary Leishmaniasis because of the constant deforestation and new settlements. Infected symptomatic patients most often develop localized cutaneous leishmaniasis (CL), characterized by a single or multiple well-demarcated cutaneous ulcer with raised borders and granulomatous center. In this study, we tried to understand why some individuals develop cutaneous leishmaniasis while other in the same area do not by genotyping two polymorphisms situated the TOLLIP gene and we saw that both polymorphisms are associated with cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]