Dissertations / Theses on the topic 'AIDS; PCP'

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) initially emerged in the 1980s and ever since, a battle has been underway with regard to understanding some of the root issues attributed to behavior and HIV/AIDS. AIDS is prevalent in the men sleeping with men (MSM) community. There is lack of studies evaluating the quality and quantity of communication between MSM and medical professionals, which can be a catalyst to help reduce HIV/AIDS within this community. The aim of this quantitative study was to evaluate the relationship between quantity and quality of medical professionals' communication and regular HIV screening and testing, as well as modifying high-risk behaviors attributing to HIV/AIDS MSM behaviors, controlled for race/ethnicity, educational level, and income. Universal precautions theory and health belief model were the theoretical framework of this study. A total of 126 MSM were evaluated via survey research. Chi-square analysis revealed that MSM who have ever visited a medical professional about HIV/AIDS were tested in significantly higher frequency compared with those that did not visit medical professional for this reason (51.5% vs. 18.5%, respectively, p < .001). Also, significantly more participants changed their sexual behavior during the last 5 years and considered that the approach of the medical professional contributed in this change, compared with those who changed their sexual behavior but did not consider this approach helpful (73.7% vs. 26.7%, p < .001). This research can provide positive social change to the MSM community as well as medical professionals, by encouraging MSM to seek more information pertaining to safe sexual health practices, prevention, and awareness.

Made available in DSpace on 2014-06-12T18:29:11Z (GMT). No. of bitstreams: 2 arquivo3566_1.pdf: 7927294 bytes, checksum: add9c73fe4506901113309a0dc549513 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009<br>Conselho Nacional de Desenvolvimento Científico e Tecnológico<br>O diagnóstico da neurotoxoplasmose em portadores de aids pode ser difícil, requerendo distinção com outras neuroinfecções e lesões tumorais. Os exames complementares disponíveis trazem limitações para a confirmação da doença. A tese esteve composta por uma revisão da literatura, abordando o estado de arte dos métodos disponíveis para diagnóstico de neurotoxoplasmose, e por dois artigos: No primeiro, sob título Lesão cerebral única de origem toxoplásmica, foram analisados aspectos de ressonância magnética convencional de 10 pacientes com neurotoxoplasmose e lesão cerebral única, uma vez que essa forma de apresentação impõe maior dificuldade diagnóstica sendo pouco explorada na literatura. As imagens foram avaliadas quanto à localização das lesões, intensidade de sinal, tipo de realce após contraste, presença de alvo excêntrico e captação meníngea, em aparelho Phillips 1,5 Tesla, modelo Achieva®. As lesões não tiveram localização preferencial e ocorreram igualmente em regiões córtico-subcorticais e profundas. Na seqüência T2, houve variabilidade de sinal, porém, no T1, predominaram padrões de iso ou hipossinal, edema perilesional e realce anelar após contraste, aspectos similares aos de lesões múltiplas, descritos na literatura. Concluiu-se que a presença desses padrões em lesões únicas pode ser sugestiva da neurotoxoplasmose. O segundo artigo, sob título Influência de características da neurotoxoplasmose na sensibilidade da PCR em tempo real em pacientes com aids, consistiu de estudo de validação fase III da reação em cadeia da polimerase em tempo real para detecção do gene B1 em sangue e líquor de pacientes com aids e diagnóstico presuntivo de neurotoxoplasmose. O DNA foi extraído com kit QiAmp DNA®, marca Qiagen®; amplificado com uso de primers da marca Applied Biosystem®, com seqüência específica de 98 pares de bases do gene B1. As amostras foram processadas em termociclador Icicle®, marca Biorad®, operado pelo programa PrimerExpress. Foram incluídos 135 pacientes com sintomatologia neurológica encefálica, distribuídos em dois grupos: grupo I - 85 casos de neurotoxoplasmose e grupo II - 50 pacientes com manifestações neurológicas não toxoplásmicas. A PCR em tempo real em sangue revelou sensibilidade de 1,5% (IC 95% 0,1% - 9%), especificidade igual a 100% (IC 95% 87,7% - 100%), valor preditivo positivo de 100% (IC 95% 5,5% - 100%) e valor preditivo negativo de 34,3% (IC 95% 25,4% - 44,4%). No líquor, houve sensibilidade igual a 35,8% (IC 95% 25,7% - 47,3%), especificidade igual a 100,0% (IC 95% 89,6% - 100,0%), valor preditivo positivo de 100.0% (IC 95% 85,4% - 100,0%) e valor preditivo negativo de 44,7% (IC 95% 34,5% - 55,3%). Nos pacientes do grupo I com pleocitorraquia e quatro ou mais lesões encefálicas pelo T gondii, a positividade liquórica da PCR foi significantemente maior do que a daqueles com normocitorraquia (p=0,021) e com até três lesões encefálicas (p=0,026). Concluiu-se que a PCR em tempo real no sangue não se mostrou útil ao diagnóstico; no LCR, o teste demonstrou baixa sensibilidade, mas alta especificidade para o diagnóstico da neurotoxoplasmose. Maior número de lesões e maior celularidade liquórica podem melhorar a sensibilidade do método. Sugerem-se novas pesquisas que correlacionem esses aspectos com os parâmetros de acurácia do método

Vector borne-diseases make up a significant portion of morbidity and mortality worldwide, being responsible for around 700,000 deaths annually according to the World Health Organization. Neglected, tropical diseases such as Chagas disease have a significant impact on people in Latin America, affecting millions, and especially those residing in rural areas. Chagas disease is the number one cause for heart disease in Latin America, and is caused by the Trypanosoma cruzi parasite, carried by Triatominae insect vectors. The intricate life cycle of the parasite, ecology and behavior of the vector, and lack of disease treatment options, make Chagas disease challenging to control. Prevention measures are highly sought after, and implementation science approaches such as Ecohealth management engage affected communities in disease prevention. Knowing what insect vectors are feeding on sheds light on vector ecology and behavior, aiding in vector management which is pivotal in disease prevention. While DNA-based methods have traditionally been used to study vector blood meals, they come with limitations and challenges, such as the need for fresh, high abundance blood meals. Therefore, the goal of this research was to evaluate Chagas vector blood meal sources using an innovative protein mass spectrometry-based approach. We demonstrate first the ability to utilize liquid chromatography tandem mass spectrometry (LC-MS/MS) to correctly identify hemoglobin protein peptides from mouse blood and subsequently identify Chagas vector blood meal sources from field-collected insect vectors where blood meal identification is compared with traditional DNA-based methods as a control. An experimental feeding study allowed us to then demonstrate the longevity of hemoglobin protein peptides for blood meal detection, showing LC-MS/MS-based blood meal identification outperforms DNA-based polymerase chain reaction (PCR) at least 4 weeks post-feeding and 12 weeks post-molting. This allowed us to test the limits of our innovative detection method experimentally and comparatively. Finally, we evaluated blood meals in field-caught insect vectors collected as part of a large collaborative Ecohealth project in Central America. LC-MS/MS identified two times as many blood meals in insect vectors, including those that did not have blood meals detected with DNA-based PCR. As single vectors often feed on multiple sources, we also validated our ability to decipher multiple blood meals from an individual vector and showed the ability to quantify a blood meal using synthetic AQUA (Absolute QUAntification) peptides, a first step in using quantification data for identifying blood meals not currently in our underlying database. Furthermore, we show that lower resolution mass spectrometers are able to identify blood meals from taxa correctly, an important and strong attribute of our LC-MS/MS-based method, opening the door to using proteomics in countries where Chagas disease is endemic and resources are limited. Even though expertise and resources of research labs differ in locations across the globe, herein is described how LC-MS/MS is a valuable additional tool for fighting neglected tropical diseases. Ultimately, hemoglobin-based LC-MS/MS vector blood meal identification is a complementary technique to available molecular methods and can confidently identify Chagas vector blood meal sources to aid in understanding vector biology and ecology, and aid in developing appropriate Ecohealth vector control measures.

Submitted by Caroline Falcao (caroline.rfalcao@ufpe.br) on 2017-04-06T16:49:28Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 2012-tese-YvanaMariaMaiaAlbuquerque.pdf: 1555304 bytes, checksum: ce271c42fa04e7796e60750e627bc8d8 (MD5)<br>Made available in DSpace on 2017-04-06T16:49:28Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 2012-tese-YvanaMariaMaiaAlbuquerque.pdf: 1555304 bytes, checksum: ce271c42fa04e7796e60750e627bc8d8 (MD5) Previous issue date: 2012-05-25<br>O diagnóstico da tuberculose apresenta dificuldades em pacientes soropositivos para o vírus da imunodeficiência humana (HIV). Os doentes coinfectados HIV/M.tuberculosis(MTB)nos estágios mais avançados de imunocomprometimento apresentam manifestações clínicas atípicas e o exame direto, rotineiramente utilizado, tem baixa sensibilidade. A cultura apesar de ter maior sensibilidade fornece resultados tardios. Evidencia-se nesta população a necessidade de testes diagnósticos mais eficientes. A tese será apresentada no formato de dois artigos científicos. No primeiro, estudou-se a utilidade da Reação em Cadeia da Polimerase em tempo real quantitativa (qPCR) para diagnóstico da tuberculose pulmonar em escarro de pacientes com HIV/aids. No segundo, descreveu-se as alterações radiográficas do tórax de pacientes com tuberculose pulmonar confirmado por cultura de escarro. Foram incluídos no estudo 140 pacientes com HIV/aids e suspeita clínica de tuberculose pulmonar, atendidos no período de agostode 2009 a janeiro de 2012, em dois hospitais de referência para atendimento de pacientes infectados pelo HIV em Recife-PE. Coletou-se uma amostra de escarro de cada paciente, e caso não houvesse escarro suficiente, realizou-se nebulização com solução salina para indução do escarro. O padrão ouro do estudo foi à cultura realizada em meios Löwenstein-Jensen e 7H9. A cultura e a qPCR para tuberculose foram realizadas em laboratório privado situado no Recife. Dos 140 pacientes em 47 (33,6%), diagnosticou-se tuberculose pulmonar pelo padrão ouro. A sensibilidade, especificidade e acurácia da qPCR foram respectivamente 87,2%, 98,9% e 95%. Foram realizados exames radiográficos do tórax em 42 pacientes coinfectados com cultura de escarro positiva, que foram avaliados por dois radiologistas experientes. A alteração radiológica isolada mais frequente observada foi a consolidação parenquimatosa, que acometeu seis (14,3%) dos pacientes, seguida pelo infiltrado intersticial e micronodular difuso, além da associação infiltrado e consolidação. Concluiu-se que a qPCR realizada no escarro de pacientes coinfectados HIV/MTB apresentou boa sensibilidade, especificidade e acurácia, sendo útil no diagnóstico de tuberculose pulmonar nesses pacientes. Com relação aos achados radiográficos de tórax, estes demonstraram ser de pouco auxílio no diagnóstico da tuberculose pulmonar nos coinfectados, exceto quando o padrão cavidade e infiltrado micronodular difuso estão presentes.<br>Tuberculosis’ diagnosis is difficult in HIV soropositivepatients. The patients co-infected HIV/M.tuberculosis(MTB) in severe immune deficiency stage present atypical clinical manifestation and direct sputum smear, usually used, shows low sensitivity.The culture, despite better sensitivity, obtains later results. The thesis will be presented in form of two articles. In the first, it has studied the utility of quantitative real time PCR for tuberculosis’ diagnosis among AIDS patients’ sputum smear. In the second, it has been described the major thoracic radiographic alterations among AIDS patients’ and pulmonary tuberculosis confirmed by sputum culture. A total of 140 HIV/AIDS patients were included in the study, with clinical suspicion of pulmonary tuberculosis, from August 2009 to January 2012, were attended at two referral hospitals for HIV/AIDS in Recife-PE. A sputum sample was collected from each patient, and if they were unable to produce spontaneous sputum, they were saline nebulized, for sputum induction. The culture, in Löwenstein-Jensen solid medium and 7H9, was the gold standard. The culture and qPCR for tuberculosis have been done in a private laboratory in Recife-PE. From all the 140 studied patients, 47 (33,6%) pulmonary tuberculosis was diagnosis by gold standard. The sensitivity, specificity and accuracy were 87,7%, 98,9% and 95% respectively. There were evaluated chest X-rays from 42 co-infected HIV/MTB patients with positive culture by two experienced radiologists, the most common radiological alteration was parenchymal consolidation, encountered in six (14,3%) patients, followed by interstitial infiltrate, difuse micronodular (military) pattern an association between interstitial infiltrate and parenchymal consolidation. It was concluded that qPCR, has given a good sensitivity, specificity and accuracy and it can be recommender for use in the management of HIV/AIDS patients. However, thoracic radiographic findings were not specific and thorax RX is not sufficient initself to establish a pulmonary tuberculosis diagnosis in co-infected HIV/MTB patients, except when cavity and micronodular pattern are presented.

INTRODUÇAO: A leishmaniose atinge milhões de indivíduos mundialmente, relacionada a mudanças ambientais, urbanização, migração e susceptibilidade do hospedeiro. O aumento de casos de leishmaniose visceral (LV) em áreas urbanas pode ser explicado, não só pela adaptação do vetor a diferentes situações ambientais, circulação do parasito e introdução de hospedeiro infectado, como também pela intersecção com áreas de transmissão do HIV. No Brasil, a distribuição dos coinfectados acompanha os grupos de risco para HIV/AIDS (adultos, sexo masculino). A coinfecção LV-HIV/AIDS é registrada com grande frequência no Estado de São Paulo, onde há aumento da prevalência desta coinfecção, assim como da recidiva e da letalidade por LV. Fatores contribuintes para esta elevação, como possíveis determinantes da gravidade da LV em pacientes HIV/AIDS, não estão claros, sejam relacionados ao hospedeiro ou ao parasito. OBJETIVOS: Avaliar o comportamento clínico, epidemiológico, terapêutico e imunológico e a variação genotípica do parasito na coinfecção LV-HIV/AIDS, comparando com pacientes HIV-negativos, em pacientes do Estado de São Paulo. MATERIAIS E MÉTODOS: Coorte retrospectiva, utilizando dados secundários de programas de rotina epidemiológica da Secretaria de Estado da Saúde de São Paulo e do Ministério da Saúde do Brasil, entre 1999-2010. Análise molecular por PCR-RFLP do kDNA de Leishmania (L.) infantum de aspirado de medula óssea para desenvolvimento de uma árvore fenética, comparando os indivíduos entre si quanto ao desfecho, sexo, idade e infecção pelo HIV. RESULTADOS: 1614 casos de LV e 117 (7,25%) de coinfectados LV-HIV/AIDS, com predomínio destes no sexo masculino, entre os 31-50 anos de idade. Tríade febre e hepatoesplenomegalia foi mais frequente no grupo HIV-negativo. Maior letalidade por LV (24,2 x 8,2 - p =0,000) e recidiva (10,5 x 1,8 - p = 0,000) nos pacientes HIV-positivos comparando aos HIVnegativos. Entre os coinfectados, observou-se maior taxa de cura quando a LV foi tratada com Antimonial Pentavalente (69,44%) e Anfotericina B lipossomal (63,82%), p=0,223. Maiores falhas (16,66%, p = 0,034) e letalidade (41,66%, p = 0,192) quando tratado com Anfotericina B deoxicolato. Maiores recidivas (14,89% - p = 0,076) e nenhuma falha com Anfotericina B lipossomal. Houve maior mediana de linfócitos T CD4+ (135) e T CD8+ (550) no grupo de cura dos pacientes LV-HIV/AIDS e houve 50% de recidivas em uso de terapia antirretroviral. A distribuição dos genótipos de Leishmania (L.) infantum não apresentou relação com nenhum dos desfechos avaliados. CONCLUSÕES: Os resultados obtidos revelam pela primeira vez a magnitude da comorbidade LV-HIV/AIDS no Estado de São Paulo, com repercussão direta na recidiva e na letalidade da LV. Há aumento do número de casos de LV e LV-HIV/AIDS nessa região, com maior prevalência de coinfectados em adultos do sexo masculino. Maior letalidade e recidiva nos HIV-positivos e com pior desfecho quando tratado com Anfotericina B deoxicolato. Recidiva elevada quando tratado com Anfotericina B lipossomal, embora sem falhas. Pouca proteção da terapia antirretroviral na proteção das recidivas. Muitos dados incompletos quanto à infecção pelo HIV. PCR-RFLP não discrimina casos HIV-positivos dos HIV-negativos, nem mostra relação direta das recidivas e óbitos com um genótipo específico do parasita, podendo a evolução do paciente estar relacionada diretamente com a resposta do hospedeiro<br>INTRODUCTION: Leishmaniasis affects millions of individuals worldwide, related to environmental changes, urbanization, migration, and host susceptibility. The increase in cases of visceral leishmaniasis (VL) in urban areas can be explained not only by the vector adaptation to different environmental situations, movement of the parasite and introduction infected host, as well as the intersection with areas of HIV transmission. In Brazil, the distribution of coinfected is accompanying risk groups for HIV/AIDS (adult male). Coinfection VL-HIV/AIDS is recorded with great frequency in São Paulo State, where there is an increased prevalence of co-infection, as well as relapse and lethality by VL. Factors contributing to this increase, as possible determinants of severity of VL in HIV/AIDS patients are not clear, either related to the host or the parasite. OBJECTIVES: To evaluate the clinical, epidemiological, therapeutic and immunological aspects of coinfection VL-HIV/AIDS and genotypic variation in the parasite, compared with HIV-negative patients in the State of São Paulo. MATERIALS AND METHODS: Retrospective cohort study using secondary data from epidemiological routine programs of the State Department of Health of São Paulo and the Ministry of Health of Brazil, between 1999 to 2010. Molecular analysis by PCRRFLP kDNA of Leishmania (L.) infantum from bone marrow aspirate to develop a phenetic tree, comparing individuals with each other about the outcome, gender, age and HIV infection. RESULTS: 1614 cases of VL and 117 (7.25%) of coinfected VLHIV/ AIDS, predominantly those in males, between 31-50 years old. Triad of fever and hepatosplenomegaly was more frequent among HIV-negative. Increased mortality by VL (24.2 x 8.2 - p =0,000) and recurrence (10.5 x 1.8 - p = 0,000) in HIV-positive patients compared to HIV-negative. Among coinfected, there was a higher cure rate when the VL was treated with pentavalent antimony (69.44%) and liposomal amphotericin B (63.82%), p = 0.223. Major failures (16.66%, p = 0.034) and mortality (41.66%, p = 0.192) when treated with amphotericin B deoxycholate. Major recurrences (14.89% - p = 0.076) and no failure with amphotericin B liposome. There were a higher median TCD4+ (135) and TCD8+ (550) lymphocytes in the group of cures and relapse was 50% in those using antiretroviral therapy. The genotype distribution of Leishmania (L.) infantum was not associated with any of the outcomes assessed. CONCLUSIONS: These results show for the first time the magnitude of comorbidity VL-HIV/AIDS in São Paulo State, with direct impact on recurrence and mortality of VL. There are increasing numbers of cases of VL and VL-HIV/AIDS in this region, with the highest prevalence of coinfection in adult males. There is an increased mortality and recurrence in HIV-positive and with worse outcome when treated with amphotericin B deoxycholate. High relapse when treated with liposomal amphotericin B, although flawless. There is little protection of antiretroviral therapy in relapses. There are many incomplete data regarding HIV infection. PCR-RFLP does not discriminate HIVpositive cases from HIV-negative ones or showed direct nexus from recurrences and deaths with a specific genotype of the parasite, but instead could be directly related to the host response

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-01-14T16:38:41Z No. of bitstreams: 2 Dissertação - Rebeka Cristine de Bastos Costa - 2015.pdf: 2127820 bytes, checksum: 8789b51096d386c4def09d0d1ee4da0d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-01-15T09:55:51Z (GMT) No. of bitstreams: 2 Dissertação - Rebeka Cristine de Bastos Costa - 2015.pdf: 2127820 bytes, checksum: 8789b51096d386c4def09d0d1ee4da0d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Made available in DSpace on 2016-01-15T09:55:51Z (GMT). No. of bitstreams: 2 Dissertação - Rebeka Cristine de Bastos Costa - 2015.pdf: 2127820 bytes, checksum: 8789b51096d386c4def09d0d1ee4da0d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-08-25<br>Toxoplasmosis is a zoonotic disease in which mammals and birds can join the cycle as intermediate hosts, and felids as definitive hosts. Felis catus is recognized as the main responsible for the environmental contamination by Toxoplasma gondii oocysts. Serological diagnosis reveals little about the elimination of oocysts of T. gondii into the environment, principally by F. catus, which plays an important role in Public Health. There are few data on the frequency of feline toxoplasmosis in the State of Goiás. Therefore, the aim of this research was to evaluate the frequency of toxoplasmosis infection in domestic cats and their potential role in its transmission through the oocyst elimination into the environment and the respective factors associated with the infection. For this, we collected 102 blood samples and 98 fecal samples from 102 cats from Goiânia, State of Goiás. The animals were divided into groups according to age, gender and free access to the street or not. Indirect hemagglutination test was performed to determine the level of anti-T. gondii and indirect ELISA for the detection of infection by feline immunodeficiency virus (FIV). For search and detection of T. gondii oocysts elimination in the feces of cats we performed a centrifugal-flotation with Sheather's solution, subsequently we extracted DNA and used conventional PCR. The results showed that 18.63% (19/102) of the cats were positive for T. gondii, with titers ranging from 1:32 to 1: 8.192, while none of the fecal samples were positive in the PCR. The frequency of positive animals for FIV was 55.91% (52/93), and 18.28% (17/93) presented coinfection. By multivariate logistic regression we found the associated factors were the same for both infections, but one did not interfere with another. The factors associated with infection by T. gondii and feline immunodeficiency virus were free life and age under six months, since the sex was not statistically related to any of the illnesses.<br>A toxoplasmose é uma zoonose na qual, mamíferos e aves podem participar do seu ciclo como hospedeiros intermediários e os felídeos como hospedeiros definitivos. O Felis catus é reconhecido como o principal responsável pela contaminação ambiental por oocistos de Toxoplasma gondii. O diagnóstico sorológico pouco revela sobre a eliminação de tal fase no ambiente, o que representa o real impacto daquela espécie na Saúde Pública frente à toxoplasmose. São escassos os dados da frequência da toxoplasmose felina no Estado de Goiás. Assim sendo, objetivou-se com esta pesquisa avaliar a frequência da infecção da toxoplasmose em gatos domésticos e o seu potencial papel na sua transmissão, através da eliminação de oocistos no ambiente e dos respectivos fatores associados à infecção. Para isto, foram coletadas 102 amostras de sangue e 98 amostras fecais, de 102 gatos provenientes de Goiânia-Goiás. Os animais foram divididos em grupos de acordo com a faixa etária, gênero e livre acesso à rua ou não. Foi realizada a hemaglutinção indireta para a determinação do nível de anticorpos anti-T. gondii e o ELISA indireto para a detecção da infecção pelo vírus da imunodeficiência felina (FIV). Para a pesquisa e detecção da eliminação de oocistos de T. gondii nas fezes dos gatos foi feita a centrifugo-flutuação em solução de Sheather, posterior extração de DNA e realização da PCR convencional. Os resultados revelaram que 18,63% (19/102) dos gatos foram positivos para o T. gondii, com títulos variando entre 1:32 a 1:8.192, sendo que nenhuma das amostras fecais foi positiva na PCR. A frequência de positivos para o FIV foi de 55,91% (52/93), com coinfecção de 18,28% (17/93). Com a regressão logística multivariada verificou-se que os fatores associados foram os mesmos para as duas infecções, porém uma não interferiu diretamente na outra. Os fatores associados para a infecção pelo T. gondii e pelo vírus da imunodeficiência felina foram a vida livre e a idade igual ou superior a seis meses, já o gênero não apresentou relação estatística com nenhuma das enfermidades.

This study aims to investigate how dimensionality reduction of neuroimaging data prior to training support vector machines (SVMs) affects the classification accuracy of bipolar disorder. This study uses principal component analysis (PCA) for dimensionality reduction. An open source data set of 19 bipolar and 31 control structural magnetic resonance imaging (sMRI) samples was used, part of the UCLA Consortium for Neuropsychiatric Phenomics LA5c Study funded by the NIH Roadmap Initiative aiming to foster breakthroughs in the development of novel treatments for neuropsychiatric disorders. The images underwent smoothing, feature extraction and PCA before they were used as input to train SVMs. 3-fold cross-validation was used to tune a number of hyperparameters for linear, radial, and polynomial kernels. Experiments were done to investigate the performance of SVM models trained using 1 to 29 principal components (PCs). Several PC sets reached 100% accuracy in the final evaluation, with the minimal set being the first two principal components. Accumulated variance explained by the PCs used did not have a correlation with the performance of the model. The choice of kernel and hyperparameters is of utmost importance as the performance obtained can vary greatly. The results support previous studies that SVM can be useful in aiding the diagnosis of bipolar disorder, and that the use of PCA as a dimensionality reduction method in combination with SVM may be appropriate for the classification of neuroimaging data for illnesses not limited to bipolar disorder. Due to the limitation of a small sample size, the results call for future research using larger collaborative data sets to validate the accuracies obtained.<br>Syftet med denna studie är att undersöka hur dimensionalitetsreduktion av neuroradiologisk data före träning av stödvektormaskiner (SVMs) påverkar klassificeringsnoggrannhet av bipolär sjukdom. Studien använder principalkomponentanalys (PCA) för dimensionalitetsreduktion. En datauppsättning av 19 bipolära och 31 friska magnetisk resonanstomografi(MRT) bilder användes, vilka tillhör den öppna datakällan från studien UCLA Consortium for Neuropsychiatric Phenomics LA5c som finansierades av NIH Roadmap Initiative i syfte att främja genombrott i utvecklingen av nya behandlingar för neuropsykiatriska funktionsnedsättningar. Bilderna genomgick oskärpa, särdragsextrahering och PCA innan de användes som indata för att träna SVMs. Med 3-delad korsvalidering inställdes ett antal parametrar för linjära, radiala och polynomiska kärnor. Experiment gjordes för att utforska prestationen av SVM-modeller tränade med 1 till 29 principalkomponenter (PCs). Flera PC uppsättningar uppnådde 100% noggrannhet i den slutliga utvärderingen, där den minsta uppsättningen var de två första PCs. Den ackumulativa variansen över antalet PCs som användes hade inte någon korrelation med prestationen på modellen. Valet av kärna och hyperparametrar är betydande eftersom prestationen kan variera mycket. Resultatet stödjer tidigare studier att SVM kan vara användbar som stöd för diagnostisering av bipolär sjukdom och användningen av PCA som en dimensionalitetsreduktionsmetod i kombination med SVM kan vara lämplig för klassificering av neuroradiologisk data för bipolär och andra sjukdomar. På grund av begränsningen med få dataprover, kräver resultaten framtida forskning med en större datauppsättning för att validera de erhållna noggrannheten.

Desde a descoberta do herpes vírus humano tipo 8 (HHV-8) como o agente etiológico do sarcoma de Kaposi (SK) nas suas diferentes formas clínico-epidemiológicas, vários estudos vêm sendo conduzidos com o intuito de determinar as vias de transmissão desse vírus em populações endêmicas e de risco epidemiológico. Em regiões endêmicas, a transmissão viral foi relacionada à transmissão horizontal de mães para filhos e entre irmãos e a sexual principalmente, nos casos de SK/aids. Com o objetivo de determinar segmentos do genoma viral em fluídos biológicos e consequentemente seu potencial infectante foi conduzido o presente trabalho. Foram avaliados quanto à presença de segmentos localizados em posições estratégicas do genoma do HHV-8 em sangue, saliva e urina de 76 pacientes com SK/aids, 19 pacientes com HIV/aids, 4 casos de SK clássico e 11 indivíduos sadios (HIV-soronegativos, sem SK). Foram utilizadas as técnicas de PCR "nested" para as ORF K1, ORF 25, ORF 26, ORF K8.1 e ORF 73 em DNA extraído de material de biópsia de lesão de SK (controle positivo), células do sangue periférico, saliva e urina. Os resultados de PCR positivo para o HHV-8 foram analisados quanto a variáveis epidemiológicas, clínicas e laboratoriais. Foram consideradas como variáveis: sexo, cor, origem étnica, tempo de infecção por HIV e de acompanhamento do SK, terapia ARV e para SK, contagem de células CD4+ e sorologia para o HHV-8 (IFI-LANA e IFI-Lítico). Os testes estatísticos de regressão logística e de razão de chances foram usados para detectar as associações estatisticamente significantes entre as PCRs positivas e as variáveis estudadas nos grupos SK/aids e HIV/aids. Os subtipos do HHV-8 foram também determinados pela técnica de PCR-RFLP da ORF K1 (VR1). Os resultados obtidos mostraram a detecção de DNA/HHV-8 em 80,2% do material de biópsia, 69,7% no sangue, 59,2% na saliva e 21,0% na urina de pacientes com SK/aids. No grupo HIV/aids, a PCR para o HHV-8 resultou positiva em 47,4% dos casos no sangue e em 26,3% na saliva e urina. Já no grupo SK clássico 100% das biópsias e salivas resultaram PCR positiva, 67% do sangue e 33% das urinas. A avaliação sorológica revelou 73,3% de reatividade para IFI-LANA e 85,3% para a IFI-Lítico no grupo SK/aids, enquanto o grupo HIV/aids mostrou reatividade de 15,8% para IFI-LANA e 47,4% para IFI-Lítico; todos os pacientes apresentaram resultados reagentes nas duas sorologias para o HHV-8 no grupo de SK clássico. No grupo controle sadio não houve reatividade na sorologia para o HHV-8, com exceção de um caso, que mostrou ser reagente na IFI-LANA. Foi possível realizar a subtipagem do HHV-8 em amostras de 69 pacientes, sendo detectadas 27 cepas do subtipo A, 13 do subtipo B, 28 do subtipo C e 1 do subtipo E. Após as análises estatísticas foi verificado que as PCRs que identificam as regiões ORF 26, ORF K8.1 e ORF 73 foram as que apresentaram melhor desempenho na identificação de DNA/HHV-8. Houve associação entre a reatividade de IFI-Lítico e a presença do vírus no sangue periférico, assim como a reatividade para IFI-LANA e a detecção de DNA/HHV-8 na saliva. Houve uma tendência dos subtipos B e C de HHV-8 serem detectados em pacientes com infecção profunda ou disseminada de SK. Estes resultados sugerem que a boca pode ser um sítio de latência da infecção por HHV-8 e confirmam a atuação de sangue, saliva e urina como fluídos potencialmente infectantes.<br>Since the discovery of the human herpesvirus 8 (HHV-8) as the etiological agent of Kaposi’s sarcoma (KS), several studies have been conducted in order to determine routes of virus transmission, mostly in endemic and at risk populations. The main of the present study was to determine target segments of the HHV-8 genoma and consequently infected bodily fluids. DNA sequences of ORF K1, ORF 25, ORF 26, ORF K8.1 and ORF 73 strategically localized in viral genoma were searched using nested PCR techniques in KS lesions (positive control), blood, saliva, and urine from 76 KS/aids patients, 19 HIV/aids patients, 4 classic KS patients, and among 11 healthy individuals (HIV-1 seronegative, without KS). HHV-8 subtypes were determined by PCR-RFLP of the ORF K1 (VR1), and HHV-8 antibodies by IFA-LANA and IFA-Lytic assays. The results obtained were analyzed according to epidemiological, clinical and laboratorial data, and the c2 test, logistic regression and odds ratio were applied to identify statistical association among variables in KS/aids and HIV/aids groups. The results obtained showed HHV-8 DNA in 80.2% of biopsies, 69.7% of blood, 59.2% of saliva, and 21% of urines from KS/aids group. Among HIV/aids patients, 47.4% resulted PCR positive in blood, 26.3% in saliva and urine. In classic KS cases, all biopsies and saliva resulted PCR positive, 67% in blood, and 33% in urine. The serology in KS/aids group showed 73.3% frequency of anti-latent antibodies, and 85.3% frequency of anti-lytic antibodies, while in HIV/aids group the frequencies were 15.8% and 47.4%, respectively. All classic KS cases resulted HHV-8 seroposite, while all individuals from control group resulted HHV-8 seronegative. Molecular characterization of 69 HHV-8 strains disclosed: 27 of subtype A, 13 of subtype B, 28 of subtype C, and 1 of subtype E. The ORF 26, ORF K8.1 and ORF 73 were the best segments for identifying HHV-8 DNA in bodily fluids. It was observed an association between antibodies to lytic antigens and the presence of HHV-8 in blood, and antibodies to latent antigens and the detection of HHV8 DNA in saliva of KS/aids patients. Indeed, HHV-8 subtypes B and C were detected mostly in disseminated KS cases. Taken together, the results obtained suggest that the mouth could be one site of HHV-8 latency, and confirm that blood, saliva and urine were potentially infectious bodily fluids.

<p>In many forensic cases, such as mass disasters reconstruction cases, the recovered DNA is highly degraded. In such incidences, typing of STR loci has become one of the most powerful tools for retrieving information from the degraded DNA. However, as DNA degradation proceeds, three phenomena occur consecutively: loci imbalance, allele dropout and no amplification. To solve the problem of degraded DNA, redesigned primer sets have been developed in which the primers were positioned as close as possible to the STR repeat region. These reduced primer sets were called Miniplexes. Unfortunately, a few of the CODIS STR loci cannot be made into smaller amplicons. For this reason non-CODIS miniSTRs have been developed. The present study was undertaken for the population genetic analysis of microsatellite variation in four South African populations<br>Afrikaner, Xhosa, Mixed Ancestry and Asian Indian using eight non-CODIS miniSTR loci. These miniSTRs loci were characterized within the populations by estimating the levels of diversity of the markers, estimating the population genetic parameters, and studying the inter-population relationships. All of the miniSTRs were amplified successfully and the genetic variability parameters across all loci in Afrikaner, Mixed Ancestry, Asian Indian and Xhosa were estimated to be in the range of 3 (D4S2364) to 12 (D9S2157) alleles, the total number of alleles over all loci ranged from 100 to 204, the allelic richness ranged from 3.612 to 10.307 and the heterozygosity ranged from 0.4360 to 0.8073. Genetic distance was least between Afrikaner and Asian Indian and highest between Xhosa and Mixed Ancestry. Deviations from Hardy-Weinberg equilibrium were not observed for most of the loci. The low mean FIS (-0.027) and FIT (-0.010) and FST (0.017) values across the populations indicated low level of inbreeding within (FIS) and among (FST) the populations. The Asian Indian population showed higher levels of the inbreeding coefficient, indicating less gene exchange between it and other populations. These 8 markers can be used for genetic investigations and assessing population structure. The study contributed to the knowledge and genetic characterization of four South African populations. In addition, these MiniSTRs prove to be useful in cases where more genetic information is needed.</p>

Cryptococcus neoformans (C. neoformans), um fungo que se encontra disseminado em várias partes do mundo, inclusive no Brasil, é o responsável pela criptococose infecção oportunista mais comum em pacientes com a síndrome da imunodeficiência adquirida (SIDA). O caráter sistêmico da criptococose pode levar esses pacientes a óbito. A finalidade de se obter um diagnóstico laboratorial rápido e acurado de C. neoformans, principalmente para o seguimento dos pacientes HIV nos levou a investigar \"seqüências iniciadoras\" (Si) A, B e C das regiões 18SrDNA, 5,8SrDNA e ITS do Cryptococcus spp. Pela Nested PCR com estas seqüências, sugerimos a melhor delas para o desenvolvimento de um diagnóstico molecular em relação aos métodos usuais. Para tal, foram avaliadas amostras de soro e líquor de 39 pacientes, que já haviam recebido tratamento clínico. Todos os casos foram selecionados em grupos, como segue:7 com criptococose (GIII), 14 HIV positivos (GIV), 18 HIV positivos associados com a criptococose (GV) em relação a 10 controles - indivíduos sadios (GI) e amostras de culturas referência (GII). Os resultados obtidos pela Nested PCR com as \"Sis\" A, B e C foram comparados àqueles obtidos pelos métodos de diagnóstico convencionais. As análises desse estudo mostraram que as \"Sis\" A, B e C detectam C. neoformans com especificidade variada, tanto no soro (SiA 91,66%, SiB-100%, SiC 75%), como no líquor (SiA 83,33%, SiB 100% e SiC 75%) mas não apresentaram falso positivo, quando esses resultados foram comparados aos obtidos das culturas heterólogas (GVI). A SiB, em líquor, apresentou sensibilidade, acurácia, valores preditivo positivo e negativo, e especificidade de 100% para a detecção de C. neoformans da mesma forma que no soro, porém neste o valor preditivo negativo foi 89%, acurácia 94% e a sensibilidade 88%. Em amostras de soro e líquor, os testes Tinta da China e Látex, mostraram resultados falso positivos para o GIV e falso negativos nos grupos GIII e GV. As análises comparativas entre as técnicas mostraram que a ordem de eficiência da sensibilidade para detecção de C. neoformans no soro foi SiB>SiA=Látex>SiC e no líquor foi SiB> SiA>tinta da China>Látex=SiC. No soro, a especificidade entre as técnicas foi SiB>SiA=Látex>SiC e no líquor foi SiB=tinta da China>Látex>SiA>SiC. De acordo com nossos dados, concluímos que, independente da doença associada (HIV) ou se o paciente for tratado, a SiB foi a melhor seqüência para a detecção de C. neoformans, tanto em amostras diretamente de soro, como de líquor para todos os grupos estudados. Tendo em vista os fatos, acreditamos que, a aplicação da técnica da Nested PCR com a \"SiB\", em amostras de líquor e soro, é um método viável e acurado para realizar o diagnóstico molecular do C. neoformans em pacientes HIV. O uso de amostras de soro, para o segmento dos pacientes com SIDA, durante o tratamento, pode ser a forma menos invasiva em relação ao líquor para a detecção do C. neoformans, com vantagens sobre os métodos utilizados<br>Cryptococcus neoformans (C. neoformans), a fungus that is widespread in many parts of the world, including Brazil, is responsible for cryptococcosis the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). The systemic character of cryptococcosis may be fatal. In order to obtain a rapid and accurate laboratory diagnosis to follow - up of HIV-cryptococcosis patients led us to investigate the sensibility and especificity of three primers (A, B and C) of 18SrDNA, 5,8SrDNA and ITS regions of Cryptococcus spp. Using Nested PCR with those primers we suggest the best among them to be used as a method of molecular diagnosis in relation to the usual techniques. For this purpose, the serum and cerebrospinal fluid (CSF) of 39 patients, who had received medical treatment, were evaluated. All cases were separated in groups, as follows: 7 with cryptococcosis (group III), 14 HIV positive (group IV), 18 HIV positive associated with cryptococcosis (group V) were compared to, 10 healthy subjects (group I) controls, as well as to reference cultures (group II) samples. The results obtained by nested PCR with primers A and B and C were compared to those obtained by conventional diagnostic methods. The analyses of primers A, B and C detected C. neoformans both in serum (SiA 91,6%, SiB-100%, SiC 75%), and in CSF (SiA 83,3%, SiB 100% e SiC 75%). Besides, they were specific for the identification of C. neoformans and showed that there were no false positives when compared with heterologous cultures (group VI) samples. The primer B in CSF showed 100% sensitivity, 100% accuracy and 100% predictive values (positive and negative), and 100% specificity for the detection of C. neoformans, the same that occurs in serum, but in this case, with 88% in sensitivity, 89% predictive value negative and 94% accuracy. In serum and CSF samples the China Ink and the Latex tests showed false positive results for group IV and false negative for III and V groups. The comparative analysis among the techniques (Nested PCR, China Ink, Latex) indicated that the efficiency order of sensitivity for the detection of C. neoformans were PrB> PrA = Latex> PrC in serum and PrB > PrA > China Ink> Latex = PrC in CSF. For the serum and CSF specificities the same techniques were used with the following results: PrB>PrA=Latex>PrC and PrB=China Ink>Latex>PrA>PrC. According to our data we conclude that, whether the patients had been under treatment or not, the Nested PCR by PrB was the best way to detect C. neoformans both in serum and in CSF for all groups. The following up of AIDS patients, throughout the course of therapy was found to be feasible, accurate and less invasive to detect C. neoformans by using serum samples (directly)

Mestrado em Desenvolvimento e Cooperação Internacional<br>Para a prossecução dos Objectivos de Desenvolvimento do Milénio (ODM), que se assumem como o maior desafio global da cooperação do século XXI, é imprescindível ter em conta todo o conjunto de políticas nacionais e internacionais com impactos nos países em desenvolvimento, no sentido de estruturar eficaz e eficientemente as políticas de cooperação e desenvolvimento. Particularmente, muitas são as contradições que se verificam na definição e execução das políticas europeias que produzem impactos negativos nesses países, representando elevados custos económicos para os mesmos e para os próprios doadores e respectivos contribuintes. Neste sentido, o conceito de Coerência das Políticas para o Desenvolvimento (CPD) surge como um instrumento de alinhamento das políticas de diversas áreas com os objectivos de Desenvolvimento, contribuindo para a erradicação da pobreza e a promoção da eficácia da Ajuda. O Projecto Enhancing Policy Coherence: Making Development Work Better, em Portugal, Coerência.pt - O Desafio do Desenvolvimento, executado pelo Instituto Marquês de Valle Flôr (IMVF), visa exactamente promover a CPD através da sensibilização, monitorização e mobilização dos decisores políticos, funcionários públicos, ONGD e da opinião pública em geral.<br>In order to achieve the Millennium Development Goals (MDG), which are the main international challenge of development cooperation for the 21st century, it is crucial to take into account the group of national and international policies with impacts on the developing countries, in order to structure effectively and efficiently the development and cooperation policies. Particularly, there are plenty of contradictions regarding European policies with negative impacts for the developing countries and economic costs for those and for the donors themselves. In that sense, the concept of Policy Coherence for Development (PCD) emerged as an instrument of alignment between the policies of different areas with the development aims, contributing to the eradication of poverty and to the promotion of aid effectiveness. The Project Enhancing Policy Coherence: Making Development Work Better, in Portugal, Coerência.pt - O Desafio do Desenvolvimento, carried out by Instituto Marquês de Valle Flôr (IMVF), aims exactly to promote PCD through the awareness, monitoring and mobilization of policy makers, civil servants, NGOD and general public opinion.

Mestrado em Desenvolvimento e Cooperação Internacional<br>A Cooperação Internacional para o Desenvolvimento (CID) tem sofrido grandes alterações nos últimos dez anos. O aparecimento de novos actores, novas modalidades de ajuda e novas abordagens do conceito de desenvolvimento têm contribuído para essas alterações. No entanto, estas mudanças tornaram evidentes velhas e novas contradições da CID que têm posto em causa todo um novo consenso internacional em torno da questão da sua eficácia no combate à pobreza. Parece ser claro que muito dificilmente se conseguirão atingir os Objectivos de Desenvolvimento do Milénio (ODM) e as metas de Monterrey, o que leva a uma maior preocupação em utilizar bem os fundos disponíveis e melhorar a eficácia da ajuda concedida. O futuro da ajuda depende, não só da sua eficácia na contribuição para o desenvolvimento, mas também da Coerência das Políticas para o Desenvolvimento (CPD), que é um elemento importante para influenciar esses mesmos resultados e uma necessidade para se continuar a prosseguir com os objectivos de um desenvolvimento mais justo e global. Neste trabalho procuramos, desta forma, identificar as linhas orientadoras da actual política de cooperação internacional para o desenvolvimento, dando ênfase às suas principais características e contradições actuais, detectando os constrangimentos à eficácia da ajuda tanto no doador como no receptor; analisar o conceito de CPD, os obstáculos à sua concretização e as formas de a promover; analisar a estrutura da cooperação portuguesa para os seus principais países parceiros, ou seja, Países Africanos de Língua Oficial Portuguesa (PALOP) e situar a política de ajuda portuguesa em relação às actuais contradições da política de ajuda internacional, tendo em conta os compromissos traçados e a prática em curso na sua política externa de cooperação.<br>The International Development Cooperation has undergone major changes in the last ten years. The emergence of new players, new aid modalities and new approaches to the concept of development has contributed to these changes. However, these modifications brought to light the old and new contradictions of development cooperation that have called into question a completely new international consensus around its effectiveness on poverty reduction. It seems clear that we will hardly achieve the Millennium Development Goals (MDG) and the goals of Monterrey, which leads to greater concern about using the funds properly and how to improve the effectiveness of aid. The future of aid depends not only on their effectiveness in contributing to sustainable development, but also on the Policy Coherence for Development (PCD), a major factor influencing these same results and as a need to continue to pursue the objectives of more equitable and global development. In this work, we aim to identify the guidelines of the current policy of development cooperation, emphasizing their main existing characteristics and contradictions; detecting the constraints of aid effectiveness in both the donor and the recipient; review the concept of PCD, the obstacles to their implementation and how to promote it; analyse the structure of the Portuguese cooperation for its main partner countries, i.e. Portuguese-speaking African countries and state the Portuguese aid policy in relation to the current contradictions of the international aid policy, taking into account the commitments outlined and the current practice of their cooperation policy.

This dissertation is a challenge to the Pentecostal churches, particularly, the Apostolic Faith Mission Church in Tumahole, to take an action in meeting the challenges posed by HIV/AIDS. This disease, HIV/AIDS, is the latest enemy to human life that the nations are faced with. In the newspapers like Sowetan, there is an article almost daily about HIV and AIDS. In this dissertation, I have tried to show shocking figures of how this disease is spreading in Africa. The seriousness of the disease, unlike other diseases, is its in curability. The secular organisations are far ahead of the churches in as far as the relevant programmes on combating HIV/AIDS are concerned. Despite these massive programmes, the disease is spreading like the wild fire. Deducing from this background, it is no longer the question of whether the Pentecostal churches have any role to play, but what specific role should the church play in this challenge. In this challenging times, many people look at the church as one of the most important institute that would play a positive role in bringing hope to the hopeless.<br>Christian Spirituality, Church History and Missiology<br>M. Th. (Missiology (Urban Ministry))

碩士<br>國立臺北教育大學<br>自然科學教育學系<br>103<br>This study aims to improve pre-service teachers’ Entomology curriculum teaching knowledge ability in the elementary school. With qualitative research as the major method and quantitative research as the assistance, this study took 35 elementary school pre-service teachers major in Entomology curriculum of Natural Science Department, National Taipei University of Education by purpose sampling. The university not only open Entomology curriculum to teach insect knowledge, but also table game aids, science course skills and thinking intelligence and other educational knowledge. Pre-service teachers develop insect table aids by ADDIE model and design science course skill test and thinking intelligence test according to table game teaching aids. Finally, it applies insect table teaching aids, science course skill test and thinking intelligence test into the teaching in elementary schools to explore whether insect table game teaching aids can cultivate elementary school students’ science course skills and thinking intelligence. The researcher conducted curriculum observation, took pictures of pre-service teachers’ learning conditions on Entomology curriculum and collected their test papers of elementary school science teachers’ insect concept recognition and teaching strategy, designed insect table game teaching aids, science course skill test, thinking intelligence test and practical teaching condition in the elementary school for data analysis. The research results are listed below: 1.Elementary school pre-service teachers obtained insect concept recognition learning. In the 7 insect concepts, the concrete concepts are life history, reproductive behaviors, ecological environment, insect and human life. It needs to enhance concept for construction, function, category and defense. 2.The developed insect table game teaching aids of 7 groups of elementary school pre-service teachers obtained AA and AAA evaluation levels, showing they had the ability to develop insect table game teaching aids. 3.The developed science course skill test and thinking intelligence test of 7 groups of elementary school pre-service teachers obtained good and excellent levels after evaluation, showing that they had the ability to develop science course skill test and thinking intelligence test. 4.After elementary school pre-service teachers went to the elementary school to conduct insect extension teaching and took pretest and posttest on elementary school students by science course skill test papers and t-test, the results show significant difference and insect table game teaching aids can cultivate elementary school students’ science course skill. 5.Elementary school pre-service teachers went to elementary schools for insect extension teaching and analyzed elementary school students’ thinking intelligence test paper. The results find the percentage of students who obtained 3 score in solving intelligence problem in the thinking intelligence, showing that students can apply course experience and science knowledge to solve situation problem after playing insect table game teaching aids.

碩士<br>實踐大學<br>財務金融學系碩士班<br>106<br>Taiwan's insurance coverage rate has continued to increase every year since 2002. In 2016, the insurance coverage rate has reached 240.35%, with an average of 2 or more policies per person. In the past, to buy insurance products, usually only from the insurance company's practitioners to get relevant information. But with the development of the Internet and technology, and the changes in consumption patterns, people will get used to searching and comparing on the Internet before buying things. That is to say, in the context of continuous technological advancement, the insurance purchase model will change. The development of the Internet also allows people to find other people who share the same risks through the Internet, using P2P to solve the risk problem, so it is not necessary to transfer risks through traditional insurance companies. While the P2P insurance in advanced countries is developing rapidly, Taiwan's traditional insurers are bound to face the impact of P2P insurance. Therefore, whether insurers should also start thinking about developing a new P2P business model to provide niche reciprocal insurance. This study uses the literature discussion method to explore the definition of P2P insurance and the operational mode of P2P mutual insurance in various countries. Then, through questionnaires, the insurance company and specific people's understanding and acceptance of the P2P insurance operation model are confirmed, and the results of the questionnaire are confirmed through an independent sample T check. Through the above methods, it can be found that insurance companies and the public have a certain degree of understanding of the operation mode of various P2P mutual insurances, and believe that P2P insurance will not threaten the operation of traditional life insurance companies, and more than 60% of respondents are willing to pass P2P. Way to buy insurance.

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate<br>Health Studies<br>M.A. (Public Health)