Academic literature on the topic 'Diagnosis. eng'

Objectives 1) Compare the VEMP to the ENG test in the diagnosis of vestibular disease. 2) Learn clinical usefulness of the VEMP test. Methods We prospectively evaluated 166 patients complaining of dizziness with a complete neurotologic examination. VEMP and ENG testing were done on 160 patients. Brain scans were done when indicated. We compared the clinical diagnosis to the VEMP and ENG test results separately for 4 commonly seen vestibular conditions. Results 44 patients had no VEMP response and were excluded. Of the 116 patients there were 32 cases of Vestibular Neuronitis, 17 of Meniere's disease, 15 of BPPV, 12 of central vestibular dysfunction, 13 other vestibular diagnoses, and 27 with no vestibular diagnosis. Using a 2×2 contingency table and Fisher Exact Probability Test, there was a statistical difference between the VEMP and ENG tests only in diagnosis of Vestibular Neuronitis (p<0.001) when analyzed individually, and because this difference was so strong, there was a statistical difference with the diagnoses taken all together (p<0.001). Conclusions The ENG test remains the gold standard for diagnosis of vestibular disease. The VEMP test is useful in diagnosis of several vestibular disorders, including the 4 considered in this study. There is a strong bias toward the ENG test mainly because the diagnosis of vestibular neuronitis relies heavily on an abnormal caloric response. The VEMP test is administered in a much shorter time than the ENG test and provides valuable information regarding the inferior vestibular nerve and it has a lower false positive rate than the ENG test.

This paper covers the measurement of biopotentials for diagnosis: the electrical voltages that can be measured from electrodes placed on the skin or within the body. Biopotentials include: the electrocardiogram (ECG), electroencephalogram (EEG), electrocortogram (ECoG), electromyogram (EMG), electroneurogram (ENG), electrogastrogram (EGG), action potential (AP), electroretinogram (ERG), electro-oculogram (EOG). This paper also covers skin conductance, pulse oximeters, urology, wearable systems and important therapeutic devices such as: the artificial cardiac pacemaker, defibrillator, cochlear implant, hemodialysis, lithotripsy, ventilator, anesthesia machine, heart-lung machine, infant incubator, infusion pumps, electrosurgery, tissue ablation, and medical imaging. It concludes by covering electrical safety. It provides future subjects for research such as a blood glucose sensor and a permanently implanted intracranial pressure sensor.

Orientador: Leopoldino Capelozza Filho
Banca: Francisco Antonio Bertoz
Banca: Hugo Nary Filho
Banca: José Roberto Pereira Lauris
Banca: Laurindo Zanco Furquim
Resumo: O objetivo deste trabalho foi classificar e determinar a prevalência dos indivíduos portadores de comprometimento vertical nas relações faciais, conforme a severidade da discrepância e, especialmente, dos portadores de Padrão Face Longa, de acordo com grupos raciais, sexo e grupos etários. A amostra constou de 5020 sujeitos de nacionalidade brasileira, de ambos os sexos, com idades entre 10 anos e 16 anos e 11 meses, matriculados no Ensino Fundamental do município de Bauru-SP. Na anamnese foram coletados: nome completo, sexo, raça, data de nascimento e série do Ensino Fundamental. O exame da morfologia facial constou da observação direta da face, em norma frontal e lateral, sempre com os lábios em repouso, buscando identificar aqueles indivíduos que apresentassem comprometimento vertical nas relações faciais. Estes, uma vez identificados, foram classificados considerando-se a severidade, em três subtipos: moderado, médio e grave. Para fins de determinação da prevalência dos portadores de Padrão Face Longa, apenas os classificados como dos subtipos médio e grave foram considerados. Observou-se uma prevalência de 34,94% de comprometimento vertical nas relações faciais e 14,06% de Padrão Face Longa. Proporcionalmente, a raça preta apresentou maior prevalência para os portadores de comprometimento vertical, seguida pelas raças parda, amarela e branca. Para os portadores de Padrão Face Longa, a raça preta apresentou, novamente, maior prevalência, seguida pelas raças parda, branca e amarela. O sexo masculino foi mais prevalente nos portadores de comprometimento vertical, com exceção da raça preta, na qual o sexo feminino foi mais prevalente na amostra avaliada. O Padrão Face Longa foi mais prevalente para o sexo masculino na raça branca, e com significância estatística, para as raças parda e amarela.
Abstract: This study aimed to classify and determine the prevalence of individuals with vertical alteration of facial relationships, according to the severity of discrepancy, especially individuals with long face pattern, according to ethnicity, gender and age. The sample was composed of 5,020 individuals of Brazilian nationality, of both genders, aged 10 years to 16 years 11 months, attending fundamental schools at the city of Bauru-SP. The anamnesis comprised collection of full name, gender, ethnicity, birth date and grade at the fundamental school. Examination of facial morphology comprised direct observation of the face in frontal and lateral views, always with the lip at rest, aiming to identify the individuals presenting vertical alteration of facial relationships. After identification, these individuals were scored, according to severity, into three subtypes, namely mild, moderate and severe. The prevalence of individuals with long face pattern considered only the individuals scored as subtypes moderate and severe. There was prevalence of 34.94% of vertical alteration of facial relationships and 14.06% of long face pattern. Proportionally, individuals of black ethnicity exhibited higher prevalence of vertical alteration, followed by mixed, Asian and white ethnicities. Long face pattern was also more prevalent among individuals of black ethnicity, followed by mixed, white and Asian ethnicities. The male gender was more prevalent among individuals with vertical alteration, except for the black ethnicity, in which the female gender was more prevalent in the study sample. The long face pattern was more prevalent for males for white ethnicity, with statistically significant difference for the mixed and Asian ethnicities. For the black ethnicity, despite the absence of statistical significance, the females presented higher prevalence.
Doutor

Orientador: José Anchieta Gomes Neto
Banca: Joaquim de Araújo Nobrega
Banca : Ana Rita de Araújo Nogueira
Banca : Marco Aurélio Zezzi Arruda
Banca : Cassiana Seimi Nomura
Resumo: A diagnose foliar é uma ferramenta para avaliar o estado nutricional das plantas, corrigir deficiências ou excessos de nutrientes, otimizar a produção e avaliar os requerimentos de fertilizantes. Desenvolver novas metodologias analíticas para determinações multielementares de macro (Ca, K, Mg, P e S) e micronutrientes (B, Cu, Fe, Mn, Mo e Zn) em folhas de cana-de-açúcar e de laranjeira por espectrometria de absorção atômica com fonte contínua e de alta resolução (HR-CS FAAS) foi o objetivo deste trabalho. A determinação multielementar de Cu, Fe, Mn, Zn, Ca, Mg e K em folhas de cana-de-açúcar por HR-CS FAAS foi feita após digestão das folhas em forno de micro-ondas. Usando linhas atômicas principais para Cu (324,754 nm), Fe (248,327 nm), Mn (279,482 nm) e Zn (213,857 nm), linhas secundárias para Ca (239,856 nm) e K (404,414 nm) e linha adjacente (202,588 nm) a linha secundária (202,582 nm) para Mg, curvas analiticas nos intervalos 0,1-0,5 mg L−1 Cu, 0,5-4,0 mg L−1 Fe, 0,5-4,0 mg L−1 Mn, 0,2-1,0 mg L−1 Zn, 10,0-100,0 mg L−1 Ca, 5,0-40,0 mg L−1 Mg e 50,0-250,0 mg L−1 K foram obtidas. A interferência espectral causada pela molécula de NO na linha principal do Zn (213,857 nm) foi removida com correção pelo algoritmo dos mínimos quadrados (LSBC). Exatidão e precisão foram avaliadas pela análise de 5 materiais de referência certificados e os resultados foram concordantes ao nível de 95% de confiança. Folhas de cana-de-açúcar foram analisadas e os resultados foram próximos dos obtidos por LS FAAS. As recuperações variaram de 84-114% para todos os analitos. Os limites de detecção foram 0,6 mg L-1 Ca, 0,4 mg L-1 Mg, 0,4 mg L-1 K, 7,7 μg L-1 Cu, 7,7 μg L-1 Fe, 1,5 μg L-1 Mn e 5,9 μg L-1 Zn. Um preparo de amostras alternativo foi proposto para determinar B, Ca, Cu, Fe, K, Mg, Mn, Mo, P, S e Zn por HR-CS FAAS... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Foliar diagnosis is a tool for evaluating nutritional state of plants, correcting nutrient deficiencies or excesses, optimizing crop production and evaluating fertilizer requirements. The goal of this work was to develop new methodologies for multielement determination of macro (Ca, K, Mg, P and S) and micronutrients (B, Cu, Fe, Mn, Mo, and Zn) in sugarcane and orange leaves by high resolution continuum source atomic absorption spectrometry (HR-CS FAAS). The multielement determination of Cu, Fe, Mn, Zn, Ca, Mg and K in sugarcane leaves by HR-CS FAAS was carried out after microwave-assisted sample digestion. Using main lines for Cu (324.754 nm), Fe (248.327 nm), Mn (279.482 nm) and Zn (213.857 nm), secondary lines for Ca (239.856 nm) and K (404.414 nm), and side line (202.588 nm) at wing of secondary line (202.582 nm) for Mg, analytical curves in the 0.1-0.5 mg L−1 Cu, 0.5- 4.0 mg L−1 Fe, 0.5-4.0 mg L−1 Mn, 0.2-1.0 mg L−1 Zn, 10.0-100.0 mg L−1 Ca, 5.0-40.0 mg L−1 Mg e 50.0-250.0 mg L−1 K intervals were obtained. Spectral interference caused by NO molecule on the main line for Zn (213.857 nm) was removed with least squares background correction (LSBC). Accuracy and precision were evaluated by analysis of 5 certified reference materials and the results were in agreement at 95% confidence level. Sugarcane leaves were analyzed and the results were close to those obtained by LS FAAS. Recoveries varied from 84 to 114% for all analytes. The limits of detection were 0.6 mg L-1 Ca, 0.4 mg L-1 Mg, 0.4 mg L-1 K, 7.7 μg L-1 Cu, 7.7 μg L-1 Fe, 1.5 μg L-1 Mn and 5.9 μg L-1 Zn. An alternative sample preparation was proposed for determining B, Ca, Cu, Fe, K, Mg, Mn, Mo, P, S and Zn by HR-CS FAAS. Sugarcane and orange leaves were submitted to dry ashing and solubilized in hydrochloric acid. This digest was divided in 3: one for B, P and S determination; other for Cu, Fe, Mn, Zn, Ca... (Complete abstract click electronic access below)
Doutor

Orientadora: Mirela Tinucci Costa
Banca: Gervásio Henrique Bechara
Banca: Paulo Cesar Ciarlini
Resumo: A babesiose e a erliquiose canina são doenças comuns em cães, transmitidas pelo vetor Rhipicephalus sanguineus. Os sinais e sintomas dessas doenças não são específicos. A detecção dos parasitos em esfregaços sanguíneos nem sempre é possível e a detecção sorológica pode indicar apenas que o animal teve contato com o agente, mas não necessariamente a doença ativa. Na Colômbia existem poucas pesquisas sobre a epidemiologia e diagnóstico de erliquiose e babesiose em cães, as poucas existentes se basearam na detecção dos hemoparasitas em esfregaços sanguíneos, ou de anticorpos específicos. Sendo assim propos-se este estudo com o objetivo de pesquisar a erliquiose e a babesiose em esfregaços sangüíneos associados a provas sorológicas e moleculares em cães da região centro-oriental de Colômbia. Amostras de sangue e soro de 91 cães, provenientes das cidades de Bogotá (n=21), Villavicencio (n=31) e Bucaramanga (n=39) foram submetidas a pesquisa parasitológica, detecção de anticorpos anti-B. canis e anti-E. canis e detecção molecular de Babesia canis e Ehrlichia canis. Os resultados mostraram que dentre as 91 amostras testadas, 4% e 5% delas apresentaram E. canis e B. canis, respectivamente nas pesquisas parasitológicas dos esfregaços sanguíneos. Nas mesmas amostras, 82% e 51% delas apresentaram anticorpos anti-E. canis e anti-B. canis, respectivamente e, em 40% e 5%, foram detectados os DNA de E. canis e de B. canis, respectivamente. Os amplicons foram confirmados por seqüenciamento e o DNA de E. canis e de B. canis obtidos mostraram similaridade genética de 98% a 99% com amostras de E. canis e de B. canis isoladas em outros países, as árvores filogenéticas dos agentes pesquisados foram
Abstract: Canine babesiosis and ehrlichiosis are common diseases in dogs, and are transmitted by the vector Rhipicephalus sanguineus. The clinical signs of these diseases are not specific. Detection of parasites in blood smears is not always possible and the serological detection could only indicate that the animal has had contact with the agent and not necessarily that the disease is being developed. In Colombia, there are few reports on canine babesiosis and ehrlichiosis's epidemiology and diagnosis, being them based only on the detection of haemoparasites in blood smears and detection of antibodies. The purpose of the present study was to investigate the presence of Ehrlichia sp. and Babesia sp. in blood smears, associated with serological and molecular detection of these parasites in dog blood samples from the middle east region of Colombia. Blood and sera samples from 91 dogs from Bogotá (n=21), Villavicencio (n=31) and Bucaramanga cities (n=39) were submitted to parasitological, serological and molecular detection of B. canis and E. canis. Among the 91 samples tested, 4% and 5% presented E. canis morulae and B. canis piroplasms in blood smears, respectively. Moreover, 82% and 51% of samples presented antibodies anti-E. canis and anti-B. canis, respectively. E. canis and B. canis DNA were detected in 40% and 5% of samples, respectively. The amplicons were confirmed by sequencing and the found DNA from E. canis and B. canis showed a genetic identity of 98% to 99% among samples from E. canis and B. canis isolated from other countries. Finally, phyllogenetic trees were constructed from both agents
Mestre

Resumo: Atrelado ao desenvolvimento econômico vem o consumo crescente de energia e recursos naturais, esse tipo de desenvolvimento tende a ser insustentável, pois leva ao esgotamento dos recursos naturais, dos quais a humanidade depende. Nos últimos anos vem crescendo a procura de meios para harmonizar o desenvolvimento econômico com a conservação ambiental. Baseado nesses paradigmas este trabalho tem como objetivo elaborar o diagnóstico integrado de síntese da bacia hidrográfica do Rio Capivara, Município de Botucatu - SP, para obter uma interpretação da situação atual do sistema a vista de sua trajetória histórica e evolução previsível com o auxilio do SIG Ilwis 3.4 e imagens orbitais CBERS 2B, nas bandas pancromáticas, obtidas no dia 12/07/2008. O diagnóstico integrado foi obtido através da modelagem do meio físico, diagnóstico de problemas ambientais, diagnóstico de potencialidades para o desdobramento agropecuário e Matriz DAFO que determina as Debilidades, Ameaças, Fortalezas e Oportunidades presentes no ambiente de estudo e aponta possíveis linhas de ação para minimizar os impactos e alcançar o desenvolvimento sustentável da região. A bacia do rio Capivara apresenta mais de 70% da sua área ocupada por desdobramentos antrópicos, com um predomínio da pecuária extensiva, plantação florestal, laranja e cana-de-açúcar. A problemática da bacia é expressa em 13 problemas que geram uma instabilidade para o futuro. A área próxima ao leito do rio principal e a parte das vertentes orientais possuem problemas de menor intensidade e com uma maior capacidade de reversão, na parte sul, encontram-se os problemas mais críticos, comprometendo a saúde ambiental da região. O restante da bacia apresenta uma problemática severa, e sua capacidade de recuperação está associada à adoção de medidas corretivas intensas por um período prolongado... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Attached to the development comes the increase consume of energy and natural resources, this kind of development tend to be unbearable, because leads to the natural resources exhaustion. In the last few years the search for the harmonizing means to the economical development with environment conservation has been increased. Based in this paradigm this work has the objective to elaborate the integrated synthesis diagnostic of the Capivara River Hydrographic basin, in the Botucatu - SP municipal district, to obtain an interpretation of the system actual situation through the historical trajectory and possible evolution with the assistance of the SIG Ilwis 3.4 and orbital images CBERS 2B, in the pancromatics bands, obtained in 12/07/2008. The integrate diagnosis was obtained through the physical mean modeling, environment problems diagnosis, potentialities of the farming expand diagnosis and DWOT matrix with one determine the debilities, treats, strengthens and opportunities presents in the studied environment and shows possible line actions to minimize the impacts e reach a sustainable development to the region. The Capivara river basin presents more than 70% of your areas occupied by the anthropic expanding, with the extensive farming predominance, forestall planting, orange and sugar cane. The basin problematic is express in 13 problems that generate instability to the future. The close area of the river bed and the parts of the oriental watershed has minor intensity problems and minor capacity of reversion, in southern part, encounters the most critical problems, compromising the environment health of the region. The remaining basin presents several problematic, and your recuperation capability was associated to the adoption of intense corrective majors for a long period. In the potentiality diagnostic analyses notes the good quality of the basin to the farming expand... (Complete abstract click electronic access below)
Orientador: Sérgio Campos
Coorientador: Zacarias Xavier de Barros
Banca: Lincoln Gehring Cardoso
Banca: Osmar Delmanto Junior
Banca: Teresa Cristina Tarlé Pissara
Banca: Fernanda Leite Ribeiro
Doutor

Orientador: Rita de Cássia Loiola Cordeiro
Banca: Lourdes Aparecida Martins dos Santos Pinto
Banca: Jonas de Almeida Rodrigues
Resumo: As propostas dos estudos foram avaliar in vitro: o desempenho do exame visual (ICDAS), do exame radiográfico convencional e de métodos baseados em indução de fluorescência, DIAGNOdent 2095 (DD, Kavo, Biberach, Alemanha), DIAGNOdent 2190 (DDpen, Kavo, Biberach, Alemanha) e câmera intraoral VistaProof (CI, Dürr Dental, Bietigheim-Bissingen, Alemanha), na detecção e na determinação da profundidade de lesões de cárie oclusais em molares decíduos, bem como o desempenho do DIAGNOdent 2190 (DDpen) e do exame radiográfico convencional (ER) na detecção e na determinação da profundidade da lesão de cárie proximal em dentes anteriores decíduos e permanentes. Para a primeira pesquisa, foram selecionados 78 molares decíduos recém-extraídos e para a segunda, 123 dentes anteriores, sendo 72 decíduos e 51 permanentes. Todos os dentes foram coletados imediatamente após a extração e apresentavam suas superfícies hígidas ou com sinais que sugeriam a presença da lesão de cárie. Esses dentes foram armazenados em ambiente com 100% de umidade e mantidos congelados a -20oC. Foram excluídos aqueles que apresentavam destruição coronária ou restaurações, hipoplasias ou hipomineralizações de esmalte. Um sítio na superfície oclusal de cada dente foi selecionado para a primeira pesquisa, e na segunda pesquisa, toda a face proximal foi analisada. Dois examinadores treinados realizaram os exames duas vezes com intervalo de uma semana, utilizando os métodos citados acima. Após os exames, os dentes foram preparados para validação histológica e tanto a presença como a profundidade da lesão de cárie foram avaliadas. Foram calculados os valores de sensibilidade, especificidade, acurácia e comparados pelo teste de McNemar (p<0.05), e as áreas sob a curva ROC calculadas... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The aim of this in vitro studies was to assess: the performance of the visual inspection (ICDAS criteria), radiographic examination and light-induced Fluorescence: DIAGNOdent 2095 (LF, KaVo, Germany), DIAGNOdent 2190 (LFpen, KaVo, Germany) and fluorescence camera (FC, Dürr Dental,Germany), for detection of occlusal caries lesions and deepness in primary teeth. And the performance of the light-induced Fluorescence DIAGNOdent 2190 (LFpen, KaVo, Germany) and the radiographic examination for approximal caries lesions detection and deepness. It was selected, for the first study, seventy-eight primary molars, and for the second research, seventy-two primary and fifty-one permanent anterior teeth. The inclusion criteria was teeth with intact surfaces or varying from sound to different degrees of caries lesions and the exclusion criteria was surfaces restorated and decayded, enamel's hipoplasic and hypomineralisation. The teeth were stored frozen at -200C. For de first research, one site of each occlusal surface was selected, and for second research, the approximal surface was evaluated. The teeth were independently measured by two examiners who assessed the surfaces twice with a 1-week interval. After the assessments, teeth were histologically prepared and assessed for caries extension. Optimal cut-off limits were established for LF, LFpen and FC. The results of the first research showed that at D2 threshold the sensitivity values did not shown statistical difference among the methods. For D1 and D3 thresholds, the sensitivity values were statistically significant difference, the values were improved for 0.83 (FC) and 0.75 (ICDAS) at D1, and for 1.00 (LF pen) at D3. The highest specificity values were exhibited by 1.00 (ER) at D1, 0.94 (FC) at D2, and for D3 threshold 0.92 (LF), 0.94 (ICDAS) and 0.94 (ER) did not... (Complete abstract click electronic access below)
Mestre

Resumo: A redução da dose de radiação ao paciente é aceita em Radiologia Odontológica, com a finalidade de diminuir os riscos associados ao exame radiográfico. Para atingir este objetivo, além do avanço tecnológico ocorrido nas últimas décadas, devemos considerar a importância do Critério de Seleção para o paciente e da prescrição radiográfica na indicação correta do tipo de radiografia necessária para cada um deles. O objetivo deste trabalho foi avaliar a prescrição radiográfica de pacientes atendidos pelo Serviço de Medicina Bucal da Faculdade de Odontologia de Araraquara - UNESP durante o período de 1989 a 1993. Selecionamos 396 prontuários que constituiu a totalidade dos que continham exames radiográficos. Para a análise da prescrição radiográfica, consideramos as informações obtidas da ficha clínica e da interpretação das radiografias, utilizando os Critérios de Seleção e a análise de decisão clínica. Os resultados demonstraram um alto índice de pacientes com prescrição incorreta (44,0%); tendo em 24,7% dos pacientes ocorrido mais de uma radiografia prescrita incorretamente. Com relação ao tipo de técnica com prescrição incorreta, em 31,6% dos pacientes foi realizada a radiografia panorâmica, vindo a seguir a oclusal (28,7%), outro (17,2%) e a associação da panorâmica e oclusal (12,6%). Pacientes portadores de doenças e alterações de tecido mole tiveram a mais alta freqüência de prescrições incorretas, seguidos pelos portadores de doenças das glândulas salivares (13,5%) (incluindo os tumores); outros (10,1%); distúrbios da A.T.M. (9,0%); inflamação e infecção dos maxilares (6,8%); tumores benignos (5,6%) e tumores malignos (5,6%). Em 62,9% dos pacientes, o exame radiográfico contribuiu para o diagnóstico e tratamento. A alta porcentagem de prescrição incorreta encontrada evidencia a necessidade de... (Resumo completo, clicar acesso eletrônico abaixo).
Abstract: The reduction in the exposure rate to the patient is very known in Oral Radiology for reducing the patient risk from radiographic examination.Besides the thecnological advances in last decades, development of Selection Criteria for radiographic examination has also been instrumental in patient dose's reduction. A correct radiographic prescription means the correct radiographic view for each individual patient is used. The purpose of this study was to analyse the radiographic prescription of patients in the Oral Medicine Clinic, at Araraquara Dental School - UNESP, during the period between 1989 and 1993. The sample of this study was all of the files that had any type of radiographic examination (396). For the radiographic prescription we have considered the informations from the files and the radiographic interpretation based on Selection Criteria and clinical decision analysis methods.The results showed a high percentage of patients with incorrect prescription ( 44.0%); 24.7% had at least more than one incorrect prescription.From the radiographic views, the panoramic radiographic was prescribed incorrectly in 31.6% of the patients, following by an occlusal view (28.7%) , others (17.2%) and the association of panoramic and occlusal views (12.6%). The patients with soft tissues diseases have had the highest percentage of incorrect prescription (35.0%), following by salivary gland diseases, including the tumors (13.5%); others (10.1%); TMJ disorders (9.0%); jaw's inflamation and infections (6.8%); benign tumors (5.6%) and malignant tumors (5.6%). The radiographic examination contributed for diagnosis and treatment in 62.9% of the patients.The high percentage of incorrect radiographic prescription shows the importance to develop the guidelines in Oral Medicine.

Resumo: As plantas de aceroleira apresentam intenso crescimento na Região do Nordeste brasileiro, onde produzem de quatro a seis safras por ano. Em função disso, é de se esperar que o teor de nutrientes das folhas e as exportações de elementos minerais pela colheita dos frutos variem em função da época do ano e dos distintos genótipos, entre outros fatores. O conhecimento destas variações é importante para balizar a diagnose foliar e o manejo da cultura. Por isso, este trabalho foi conduzido no Campo Experimental da Embrapa Agroindústria Tropical, em Pacajus, CE (4º10' S; 38º27' W), no ano agrícola 1999/2000, com o objetivo de determinar a variação sazonal do teor de nutrientes nas folhas e a exportação por frutos de diferentes genótipos de aceroleira. Foram avaliadas as folhas e os frutos de seis progênies, plantas com 2,5 anos de idade, cultivadas em sistema de sequeiro, em seis épocas do ano. Adotou-se o delineamento em blocos casualizados, em esquema de parcelas (6 progênies) subdivididas no tempo (6 épocas de colheita), com 4 repetições. Foram observadas poucas diferenças no teor de macronutrientes das folhas das distintas progênies de aceroleiras. O período de junho a outubro apresenta boa estabilidade nos teores de macronutrientes em progênies de aceroleira no Estado do Ceará. O mês de junho é o mais indicado para amostragem de folhas visando à diagnose foliar. As progênies de aceroleira têm habilidades diferenciadas na manutenção dos teores de Cu, Mn e Zn nas folhas. A maior exportação de nutrientes ocorreu nos meses de maior precipitação (Fevereiro e abril). De forma geral as progênies estudadas não diferiam entre si quanto à habilidade em exportar macronutrientes. As progênies P-52, P- 93 e P-97 exportaram maior quantidade de Cu e Zn. A seqüência de exportação de nutrientes por tonelada de frutos frescos de aceroleira foi: K>N>P>Mg>Ca>S>Fe>Zn>Mn>Cu.
Abstract: The West Indian cherry plants show intense growth in the brazilian northeast region, and fruits are harvested in four to six times along the year. Then, it is expected that nutrient concentrations in the leaves and their exportation by fruits may vary among progenys and harvest times, and this knowledge are important for plant nutritional diagnosys and culture management. Thus, this work was carried out at the experimental field of the Embrapa Tropical Agroindustry, located in Pacajus - CE (4º10' S; 38º27' W), Brazil, on 1999/2000 cicle, aiming to determine the sazonal variations of levels of nutrients in the leaves and exportation by fruits harvested from six progenys, and six harvest times on plants of 2.5 years old, without irrigation. It was utilized a complete randomized block design, with split plot in time (progenys in plots, and harvest times as sub-plots) with four replications. It was observed little difference on macronutrients in leaves of distinct progenys studied. The period from june to October showed good stability of macronutrients in the leaves. June was the most suitable month for leaf sampling aiming to plant nutritional diagnosys. The studied lineages presented different habilities to keep Cu, Mn and Zn concentrations in leaves. Nutrient exportation was greater in the period with more volume of rains (from February to April). Progenys do not induced important difference on macronutrients exportations by fruit harvests. Progenys P-52, P- 93 e P-97 exported greater amounts of Cu and Zn. Also, the exportation sequence of nutrients was: K>N>P>Mg>Ca>S>Fe>Zn>Mn>Cu.
Orientador: Jairo Osvaldo Cazetta
Coorientador: Dalmo Lopes de Siqueira
Banca: Renato de Mello Prado
Banca: Carlos Ruggiero
Banca: Edvan Alves Chagas
Banca: Sérgio Yoshimitsu Motoike
Doutor

Orientador: Maria Jaqueline Mamprim
Banca: Maria Denise Lopes
Banca: Franklin de Almeida Sterman
Resumo: A ultra-sonografia é um método de grande utilidade na Medicina Veterinária, apresentando grande valia no diagnóstico gestacional em cadelas, por ser um método precoce, acompanhar o desenvolvimento e a viabilidade embrionária e fetal. Entretanto possui algumas limitações para estimar a idade fetal, quando comparada com a Medicina Humana, principalmente devido a grande variação do porte nos cães. Foi realizado acompanhamento ultra-sonográfico em 27 cadelas prenhes de diferentes raças distribuídas em grupos segundo o peso corpóreo, com o objetivo de estudar a utilização do exame ultra-sonográfico como método de diagnóstico e acompanhamento gestacional, avaliando o desenvolvimento embrionário e fetal (organogênese), além de comparar os métodos de avaliação da idade gestacional e dias anteriores ao parto propostos por diversos autores, sendo utilizados para os cálculos as mensurações da vesícula embrionária, crânio, corpo e coração em três diferentes fases gestacionais, visando auxiliar o médico veterinário na escolha dos cálculos mais indicados para cada fase gestacional nos diferentes grupos de cadelas.
Abstract: Ultrasonography is a useful technique in veterinary medicine, showing high value in gestational diagnosis in bitches, because its use for early pregnancy detection as well as easiness to follow embrionary and fetal viability and development. However, as compared with human medicine, veterinary ultrasound technique has some limitations in estimating fetal age mainly because the high variation in size of dogs. Ultrasound accompaniments of 27 pregnant, all age and breed bitches separated in groups, were performed, with the objective of studying the ultrasound as a technique for gestational diagnosis and further observation, evaluating both embrionary and fetal development (organogenesis), and comparing previous evaluation techniques of gestational age on days before parturition proposed by different author. Mensurations of embryonic vesicles, skull, body size and heart at three different gestational stages were achieved, to help practitioners in choosing the most accurate estimation method at each gestational stage in different groups of bitches.
Mestre

Resumo: O objetivo deste estudo foi padronizar a reação de Imunofluorescência direta (IFD) para detecção de oocistos de Cryptosporidium parvum em amostras fecais de bezerros. Os anticorpos policlonais anti-C. parvum foram produzidos em dois coelhos adultos da raça Nova Zelândia, e titulados por meio do ensaio imuno-enzimático indireto (ELISA). A fração de imunoglobulina G (IgG) foi purificada a partir do soro do coelho imunizado, utilizando-se diálise em sulfato de amônio seguida de cromatografia em coluna de DEAE celulose e conjugação com isotiocianato de fluoresceína. Por meio da IFD padronizada, foi testada a reatividade cruzada do conjugado produzido contra outras espécies de Cryptosporidium (C. andersoni e C. serpentis) e com outros agentes etiológicos presentes em fezes de bovinos (Escherichia coli, Eimeria sp. e Candida sp.). A IFD foi comparada à microscopia com contraste de fase em solução de Sheather (MCF), avaliando a capacidade de detecção de oocistos de Cryptosporidium sp. em alíquotas de fezes de bezerro inoculadas com oocistos de C. parvum, e em amostras fecais de bezerros naturalmente infectados provenientes de 37 propriedades leiteiras da região de Araçatuba, SP. Nas amostras comprovadas como positivas, foi ainda feita uma análise semi-quantitativa de oocistos de Cryptosporidium sp., visualizados por campo de microscopia em ambas as técnicas. O conjugado anti-C. parvum apresentou reatividade com C. andersoni e C. serpentis. A IFD foi utilizada com sucesso para detecção de oocistos de C. parvum em fezes de bezerros, apresentando sensibilidade para detecção de até 104 oocistos em 3 g de fezes. Entre as 300 amostras fecais de bezerros naturalmente infectados, 19,67% (59/300) foram positivas para a presença de oocistos de Cryptosporidium sp. pela IFD, apresentando diferença estatisticamente significante (p<0.05) em relação às amostras positivas pela MCF
Abstract: The objective of this experiment was to standardize the direct immunofluorescence assay (DIF) for detection of Cryptosporidium parvum oocysts in fecal samples of calves. The anti-C. parvum polyclonal antibodies were produced in two adult rabbits of New Zealand breed, and titrated by an indirect enzyme-linked immunosorbent (ELISA). The immunoglobulin G (IgG) was purified from the serum of immunized rabbits by dialysis in ammonium sulfate followed by column chromatography on DEAE cellulose, and conjugated with fluorescein isothiocyanate. Using DIF the anti-C. parvum conjugate was tested for the presence of cross-reactivity against other species of Cryptosporidium (C. andersoni and C. serpentis), and other infectious agents present in cattle fecal samples (Escherichia coli, Eimeria sp. and Candida sp.). A comparison between the DIF and phase contrast microscopy in Sheather solution (MCF) was accomplished for evaluation of the efficiency of both techniques for detection of Cryptosporidium sp. oocysts in fecal samples of calves seeded with C. parvum oocysts, and in fecal samples from naturally infected calves from 37 dairy farms in the region of Araçatuba, SP. A semi-quantitative analysis of Cryptosporidium sp. oocysts per microscopic field was accomplished for both techniques. The anti-C. parvum conjugate showed cross-reactivity with C. andersoni and C. serpentis oocysts. The DIF has been used successfully in the detection of C. parvum oocysts in fecal samples of calves, with sensitivity for detecting 104 oocysts in 3 g of fecal samples. Among the 300 fecal samples from naturally infected calves, 19.67% (59/300) were positive for Cryptosporidium oocysts by DIF, with significant statistical difference (p <0.05) when compared to the number of positive samples by MCF
Orientador: Marcelo Vasconcelos Meireles
Coorientador: Cáris Maroni Nunes
Banca: Ricardo Velludo Gomes de Soutello
Banca: Luzia Helena Queiroz
Mestre

"Embedded systems and the Internet of Things (IoT) enable new procedures, measurement and analysis methods in the field of biomedical systems. The measurement of data, based on electrocardiogram (ECG)-, electromyogram (EMG)- or electroneurogram (ENG)-signals, allows a multitude of new approaches in diagnosis, prevention or rehabilitation. As part of a project for ENG-based control of prostheses, a platform has been designed, called smart modular biosignal acquisition, identification and control system (SMoBAICS), that also uses IoT-devices. In this paper, different IoT-devices are presented and described. In the context of an analysis of use cases, it becomes clear that the platform represents a toolbox, which provides appropriate modules and module configurations for different requirements. The designed IoT-devices use standard interfaces in order to integrate a specific additional function into the system. In the focus are two microcontroller (mC)-devices with different characteristics and a front-end system that enables the connection of a variety of Force Sensing Resistor (FSR)-sensors. Based on this platform architecture, many applications were presented, and examples were given of how the required functionality for the corresponding application can be achieved with the help of these IoT-systems. This platform enables a fusion of the various sensor data with the objective of motion identification and prosthesis control based on this by reading out various data (forces, acceleration, ENG-data, etc.) and integrating identification algorithms."

The article discusses existing trends in the development of diagnostic methods. A description of diagnostic methods is provided. The problem of preventing complete diagnosis is considered. Negative consequences of diagnosing a hydraulic drive without taking into account dead-end branches are given.

Utilizing an easy and safe procedure for fetal blood sampling in utero. we have studied 123 fetuses for congenital oracquire hemorrhagic disorders.Usually, the diagnosis is performed at the 18th week of gestation. To date, no fetal less or premature labor has beenattributed to these fetal samplings. Theduration of the procedure was less than 10 minutes in 90 % of the cases. Direct blood sampling with a needle guided by ultrasound is safer for fetuses and simpler for the patients than fetoscopy. Among the 1.465 samplings the mortality rateis 0.2 %. We have established the basis values for fetal hemostasis when the samplings were performed for non hematological purpose, and could determine the fetal sex which play a role in hereditary disorders. Hemophilia A and B [92 cases]. Willebrand disease, factor XIII, V and VII deficiencies were diagnosed on the existence of a specific fetal deficit. Theknowledge of the fetal primary hemostasis let us to establish the diagnosis of May Hegglin syndrome. Gray platelet syndrome. and Glanzmann's thrombasthenia. There were no diagnostic errors. This procedure offers a new possibility of easily taking iterative samples, until the end of pregnancy, which represents a particular interest in prenatal diagnosis.

Microfluidic lab-on-a-chip (MLOC) technology is a promising approach for point-of-care (POC) diagnosis; low reagent consumption, high sensitivity and quick analysis time are the most prominent benefits. However, microfabrication of MLOCs utilizes specialized techniques and infrastructure, making conventional fabrication time consuming and difficult. While relatively inexpensive production techniques exist for POC diagnoses, such as replication of polymer-based (e.g., PDMS) microfluidic POC devices on lithographic molds, this approach has limitations including: further hydrophilic surface modifications of PDMS, inability to change lithographic mold Z dimensions, and slow prototyping. In contrast, stereo-lithographical (SLA) printing can integrate all of the necessary fabrication resources in one instrument, allowing highly versatile microfluidic devices to be made at low cost. In this paper, we report two microfabrication approaches of microfluidics utilizing (SLA) 3D printing technology: I) Direct SLA printing of channels and structures of a monolithic microfluidic POC device; II) Indirect fabrication, utilizing SLA 3D printed molds for PDMS based microfluidic device replication. Additionally, we discuss previous work providing a proof of concept of applications in POC diagnosis, using direct 3D printing fabrication (approach I). The robustness and simplicity of these protocols allow integrating 3D design and microfabrication with smartphone-based disease diagnosis as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries.

Non-negative tensor factorization has been shown effective for discovering phenotypes from the EHR data with minimal human supervision. In most cases, an interaction tensor of the elements in the EHR (e.g., diagnoses and medications) has to be first established before the factorization can be applied. Such correspondence information however is often missing. While different heuristics can be used to estimate the missing correspondence, any errors introduced will in turn cause inaccuracy for the subsequent phenotype discovery task. This is especially true for patients with multiple diseases diagnosed (e.g., under critical care). To alleviate this limitation, we propose the hidden interaction tensor factorization (HITF) where the diagnosis-medication correspondence and the underlying phenotypes are inferred simultaneously. We formulate it under a Poisson non-negative tensor factorization framework and learn the HITF model via maximum likelihood estimation. For performance evaluation, we applied HITF to the MIMIC III dataset. Our empirical results show that both the phenotypes and the correspondence inferred are clinically meaningful. In addition, the inferred HITF model outperforms a number of state-of-the-art methods for mortality prediction.

In modern gas turbine health monitoring systems, the diagnostic algorithms based on gas path analysis may be considered as principal. They analyze gas path measured variables and are capable of identifying different faults and degradation mechanisms of gas turbine components (e.g. compressor, turbine, and combustor) as well as malfunctions of the measurement system itself. Gas path mathematical models are widely used in building fault classification required for diagnostics because faults rarely occur during field operation. In that case, model errors are transmitted to the model-based classification, which poses the problem of rendering the description of some classes more accurate using real data. This paper looks into the possibility of creating a mixed fault classification that incorporates both model-based and data-driven fault classes. Such a classification will combine a profound common diagnosis with a higher diagnostic accuracy for the data-driven classes. A gas turbine power plant for natural gas pumping has been chosen as a test case. Its real data with cycles of compressor fouling were used to form a data-driven class of the fouling. Preliminary qualitative analysis showed that these data allow creating a representative class of the fouling and that this class will be compatible with simulated fault classes. A diagnostic algorithm was created based on the proposed classification (real class of compressor fouling and simulated fault classes for other components) and artificial neural networks. The algorithm was subjected to statistical testing. As a result, probabilities of a correct diagnosis were determined. Different variations of the classification were considered and compared using these probabilities as criteria. The performed analysis has revealed no limitations for realizing a principle of the mixed classification in real monitoring systems.

In the manufacturing industry, product quality control is often treated as a completely different problem than process diagnostics. Diagnostics methods are used to quickly identify faults during the process, whereas product quality is assessed at the final inspection stage, after the process is completed. The large amount of data that is collected to enable the on-line diagnostics, however, can be used to predict the product quality before the part is measured at the final inspection stage. This predicted quality can be used as feedback to a control system that improves the process quality by adjusting the process inputs. In this paper we propose a predictive inspection based process control solution for a manufacturing process. A manufacturing process is modelled as an input-output system with the machine settings as inputs and two kinds of outputs: diagnostic data and quality. This model is obtained from off-line experiments using a combination of process inputs and external disturbances. In the online implementation the predictive process model is updated with the diagnostic data collected during runtime and quality is improved by using a two-loop control strategy, on a part-to-part or run-to-run (R2R) basis. The proposed approach is applied to and developed for an end milling operation and simulation and experimental results are presented.

The automatic diagnosis has been suffering from the problem of inadequate reliable corpus to train a trustworthy predictive model. Besides, most of the previous deep learning based diagnosis models adopt the sequence learning techniques (CNN or RNN), which is difficult to extract the complex structural information, e.g. graph structure, between the critical medical entities. In this paper, we propose to build the diagnosis model based on the high-standard EMR documents from real hospitals to improve the accuracy and the credibility of the resulting model. Meanwhile, we introduce the Graph Convolutional Network into the model that alleviates the sparse feature problem and facilitates the extraction of structural information for diagnosis. Moreover, we propose the mutual attentive network to enhance the representation of inputs towards the better model performance. The evaluation conducted on the real EMR documents demonstrates that the proposed model is more accurate compared to the previous sequence learning based diagnosis models. The proposed model has been integrated into the information systems in over hundreds of primary health care facilities in China to assist physicians in the diagnostic process.

Limited information exists about enrollment in Part D prescription coverage by Medicare beneficiaries with cancer. Part D coverage may increase access to medicines. This study evaluated patterns of Part D uptake and costs and assessed the effects of coverage on hospitalizations and emergency department (ED) use among people with colorectal cancer (CRC). We analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data on fee-for-service (FFS) Medicare beneficiaries with at least 36 months of follow-up who were diagnosed with CRC at any point from January 2007 through December 2010, and a matched cohort of beneficiaries without cancer. Dual (Medicare/Medicaid) enrollees were excluded because they are automatically enrolled in Part D. Among beneficiaries with CRC (n=12,774), 39 percent had complete Part D coverage, defined as coverage in the diagnosis year and 2 subsequent years; the rate was 38 percent in the matched comparison cohort (P=.119). Among those with complete Part D coverage, there was no significant difference in annual prescription drug costs between people with CRC ($3,157, 95% confidence interval [CI]: $3,098–$3,216) and without ($3,113, 95% CI: $3,054–$3,172). Among people with CRC, odds of ED use ranged from unchanged to marginally higher for those with no or partial Part D coverage, (adjusted odds ratio: 1.09, 95% CI: 1.00–1.18), compared with those with complete Part D coverage. Lack of continuous Part D coverage was associated with more ED use among Medicare FFS beneficiaries with CRC in 2007–2013. Among people with Part D coverage, prescription drug costs varied little between those with CRC and matched beneficiaries without cancer.

Med denna rapport vill vi förmedla hopp till unga, öka kunskapen, med-vetenheten och minska skammen kring psykisk ohälsa. Unga uttrycker själva att de vill ha mer kunskap om psykisk hälsa och skolan lyfts ofta som en bra plattform. Många unga vet inte vart de ska vända sig för att få hjälp med psykiska besvär och de har behov av att bli lyssnade på. När-varande vuxna som lyssnar behövs, dock saknar många vuxna kunskap om psykiska besvär och diagnoser kopplat till psykisk ohälsa.Psykisk hälsa bland unga är en viktig samhällsfråga som de senaste åren har fått mer uppmärksamhet i samhällsdebatten. Flera satsningar har gjorts av civilsamhällesaktörer och offentliga aktörer. Samtidigt visar den internationella kartläggningen att det är svårt att påvisa långsiktiga effek-ter av alla de satsningar som görs. Det kan finnas flera orsaker till detta. Det finns dock insatser som verkar mer lovande och här finns en möjlighet för beslutsfattare att göra skillnad för ungas psykiska hälsa. Förutom att bespara unga onödigt lidande är dessa insatser ofta samhällsekonomisktkostnadseffektiva, eftersom de på sikt leder till minskat vårdsökande och bättre förutsättningar för unga att klara skolan och i förlängningen arbets-livet. Sådana satsningar går även i linje med Barnkonventionen artikel 24 om alla barns rätt till bästa möjliga hälsa, som sedan 2020 är lag i Sverige. Utifrån kartläggningen har vi följande rekommendationer 1. Rusta unga med färdigheter om psykisk ohälsaUnga bör få tillgång till de kunskaper och färdigheter som enligt forsk-ning visat sig lovande för att främja psykisk hälsa och förebygga ohälsa. Internationellt ges flera av dessa insatser inom ramen för sko-lan. De behöver utveckla sina färdigheter i hur man tolkar och förstår sina egna känslor och sin kropp och vad som är vanlig livssmärta, hur man kan hantera den och när man behöver kontakta vården. Därför bör ett nationellt initiativ som når alla barn tas för att främja barn och ungas kunskap och färdigheter om psykisk hälsa för att rusta dem för livet. Det bör även inkludera information om vart man kan vända sig om man behöver ytterligare stöd eller vård. Unga ska vara delaktiga i utformningen av ett sådant initiativ. 2. Ge vuxna kunskap och verktyg om psykisk hälsa – för att underlätta stöd till ungaBarn och unga behöver närvarande vuxna som har förmågan att lyssna, fånga upp och vägleda dem. Det är inte ovanligt att vuxna i barns och ungas närhet upplever osäkerhet och saknar kunskap om psykiska besvär och diagnoser. Därför behöver vuxna, framförallt föräldrar och yrkes-verksamma som jobbar nära unga, få bättre kunskap och verktyg för hur de ska möta unga på ett bättre sätt. Satsningar på att höja föräldrars kun-skap om psykisk hälsa bör göras, exempelvis i form av föräldrastödspro-gram och folkbildning. Lärare bör även ges grundläggande kunskaper om psykisk hälsa inom ramen för lärarutbildningen. 3. Insatser bör följas upp under en längre tidInsatser för att främja psykisk hälsa bör planeras, implementeras och ut-värderas med långtidsuppföljningar (>12 månader). Detta för att bättre kunna bedöma de långsiktiga effekterna och för att kunna utveckla och anpassa insatserna efterhand.

Invasive meningococcal disease (IMD) is a contagious bacterial infection that can occur sporadically in healthy individuals. Symptoms are typically similar to other common diseases, which can result in delayed diagnosis and treatment until patients are critically ill. In the United States, IMD outbreaks are rare and unpredictable. During an outbreak, rapidly marshalling the personnel and monetary resources to respond is paramount to controlling disease spread. If a community lacks necessary resources for a quick and efficient outbreak response, the resulting economic cost can be overwhelming. We developed a conceptual framework of activities implemented by universities, health departments, and community partners when responding to university-based IMD outbreaks. Next, cost data collected from public sources and interviews were applied to the conceptual framework to estimate the economic cost, both direct and indirect, of a university-based IMD outbreak. We used data from two recent university outbreaks in Oregon as case studies. Findings indicate a university-based IMD outbreak response relies on coordination between health care providers/insurers, university staff, media, government, and volunteers, along with many other community members. The estimated economic cost was $12.3 million, inclusive of the cost of vaccines ($7.35 million). Much of the total cost was attributable to wrongful death and indirect costs (e.g., productivity loss resulting from death). Understanding the breadth of activities and the economic cost of such a response may inform budgeting for future outbreak preparedness and development of alternative strategies to prevent and/or control IMD.

Objectives. Survival rates for pediatric cancer have dramatically increased since the 1970s, and the population of childhood cancer survivors (CCS) exceeds 500,000 in the United States. Cancer during childhood and related treatments lead to long-term health problems, many of which are poorly understood. These problems can be amplified by suboptimal survivorship care. This report provides an overview of the existing evidence and forthcoming research relevant to disparities and barriers for pediatric cancer survivorship care, outlines pending questions, and offers guidance for future research. Data sources. This Technical Brief reviews published peer-reviewed literature, grey literature, and Key Informant interviews to answer five Guiding Questions regarding disparities in the care of pediatric survivors, barriers to cancer survivorship care, proposed strategies, evaluated interventions, and future directions. Review methods. We searched research databases, research registries, and published reviews for ongoing and published studies in CCS to October 2020. We used the authors’ definition of CCS; where not specified, CCS included those diagnosed with any cancer prior to age 21. The grey literature search included relevant professional and nonprofit organizational websites and guideline clearinghouses. Key Informants provided content expertise regarding published and ongoing research, and recommended approaches to fill identified gaps. Results. In total, 110 studies met inclusion criteria. We identified 26 studies that assessed disparities in survivorship care for CCS. Key Informants discussed subgroups of CCS by race or ethnicity, sex, socioeconomic status, and insurance coverage that may experience disparities in survivorship care, and these were supported in the published literature. Key Informants indicated that major barriers to care are providers (e.g., insufficient knowledge), the health system (e.g., availability of services), and payers (e.g., network adequacy); we identified 47 studies that assessed a large range of barriers to survivorship care. Sixteen organizations have outlined strategies to address pediatric survivorship care. Our searches identified only 27 published studies that evaluated interventions to alleviate disparities and reduce barriers to care. These predominantly assessed approaches that targeted patients. We found only eight ongoing studies that evaluated strategies to address disparities and barriers. Conclusions. While research has addressed disparities and barriers to survivorship care for childhood cancer survivors, evidence-based interventions to address these disparities and barriers to care are sparse. Additional research is also needed to examine less frequently studied disparities and barriers and to evaluate ameliorative strategies in order to improve the survivorship care for CCS.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.