Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

Background: The rapid shallow breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager (TM) Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH(2)O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79 +/- 4.67 and 60.95 +/- 24.64) and FG (38.64 +/- 12.31 and 80.09 +/- 20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79 +/- 14.67 and 38.64 +/- 12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95 +/- 24.64) and FG (80.09 +/- 20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient breathing spontaneously without the aid of pressure support.

Axioms for the coincidence index of maps between manifolds of the same dimension

We study the coincidence theory of maps between two manifolds of the same dimension from an axiomatic viewpoint. First we look at coincidences of maps between manifolds where one of the maps is orientation true, and give a set of axioms such that characterizes the local index (which is an integer valued function). Then we consider coincidence theory for arbitrary pairs of maps between two manifolds. Similarly we provide a set of axioms which characterize the local index, which in this case is a function with values in Z circle plus Z(2). We also show in each setting that the group of values for the index (either Z or Z circle plus Z(2)) is determined by the axioms. Finally, for the general case of coincidence theory for arbitrary pairs of maps between two manifolds we provide a set of axioms which characterize the local Reidemeister trace which is an element of an abelian group which depends on the pair of functions. These results extend known results for coincidences between orientable differentiable manifolds. (C) 2012 Elsevier B.V. All rights reserved.

The impact of mortality from external causes on human development in the Brazilian borderland

This article estimates the impact of mortality from external causes on the human development index (HDI) along the Brazilian borderland from 2000 to 2005. Data obtained from Brazilian government agencies were combined using the methodology defined by the United Nations Development Program, revealing the HDI according to actual conditions. Subsequently, deaths from external causes were excluded in order to estimate their impact on the index, recalculating life expectancy using the technique of competing causes. HDI showed a gradual increase from North to South, with the most developed regions concentrated in the South, consistent with studies using other sets of economic indicators. By excluding mortality from external causes, the highest gains appeared in regions where the HDI (under actual conditions) were lower, and the magnitude of gains declined towards the South.

Palynostratigraphy and sedimentary facies of Middle Miocene fluvial deposits of the Amazonas Basin, Brazil

Palynostratigraphic and sedimentary fades analyses were made on sedimentary deposits from the left bank of the Solimoes River, southwest of Manaus. State of Amazonas, Brazil. These provided the age-elating and subdivision of a post-Cietaceous stratigraphic succession in the Amazonas Basin. The Novo Remanso Formation is subdivided into upper and lower units, and delineated by discontinuous surfaces at its top and bottom. The formation consists primarily of sandstones and minor mudstones and conglomerates, reflecting fluvial channel, point bar and floodplain facies of a fluvial meandering paleosystem. Fairly well-preserved palynoflora was recovered from four palynologically productive samples collected in a local irregular concentration of gray clay deposits, rich in organic material and fossilized wood, at the top of the Nova Remanso Formation upper unit. The palynoflora is dominated by terrestrial spores and pollen grains, an d is characterized by abundant angiosperm pollen grains (Tricolpites, Grimsdalea, Perisyncolporites, Tricolporites and Malvacearumpollis). Trilete spores are almost as abundant as the angiosperm pollen, and are represented mainly by the genera Deltoidospora. Verrutriletes, and Hamulatisporis. Gymnosperm pollen is scarce. The presence of the index species Grimsdalea magnaclavata Germeraad et al. (1968) indicates that these deposits belong to the Middle Miocene homonymous palynozone (Lorente, 1986; Hoorn, 1993; Jaramillo et al., 2011). Sedimentological characteristics (poorly sorted, angular to sub-angular, fine to very-coarse quartz sands facies) are typical of the NOW Remanso Formation upper part. These are associated with a paleoflow to the NE-E and SE-E, and with a a entirely lowland-derived palinofloristic content with no Andean ferns and gymnosperms representatives. All together, this suggests a cratonic origin for this Middle Miocene fluvial paleosystem, which was probably born in the Purus Arch eastern flank and areas surrounding the crystalline. The palynological analysis results presented herein are the first direct and unequivocal evidence of the occurrence of Middle Miocene deposits in the central part of the Amazonas Basin. They also provide new perspectives for intra- and interbasin correlations, as well as paleogeographic and paleoenvironmental interpretations for the later deposition stages in the northern Brazilian sedimentary basins. (C) 2011 Elsevier Ltd. All rights reserved.

FEEDING HABITS OF THE ATLANTIC SPOTTED DOLPHIN, Stenella frontalis, IN SOUTHEASTERN BRAZIL

This study presents new information on the feeding habits of the Atlantic spotted dolphins, Stenella frontalis, in the Western South Atlantic. Nine stomach contents of S. frontalis incidentally caught in fishing operations conducted by the gillnet fleet based on main harbour of Cananeia (25 degrees 00' S; 47 degrees 55'W), southeastern Brazil, were analyzed. These specimens were captured between 2005 and 2007. A total of 1 422 cephalopod beaks, 147 otoliths and three crustaceans were recovered from the stomach contents. The dolphins assessed preyed on at least eight different fish species of the families Trichiuridae, Carangidae, Sparidae, Merluccidae, Engraulidae, Sciaenidae, Congridae and Scombridae, five cephalopod species of the families Loliginidae, Sepiolidae, Tremoctopodidae and Thysanoteuthidae, and one shrimp species of the Penaeidae family. Based on the analysis of the Index of Relative Importance (IRI), the Atlantic cutlassfish, Trichiurus lepturus, was the most important fish species represented. Of the cephalopods, the squid Doryteuthis plei was by far the most representative species. Several items were reported for the first time as prey of the S. frontalis: Xiphopenaeus kroyeri, Tremoctopus violaceus, Semirossia tenera, Merluccius hubbsi, Pagrus pagrus and Paralonchurus brasiliensis. S. frontalis presented teuthophagous and ichthyofagous feeding habits, with apparent predominance of the first, and preyed mainly on pelagic and demersal items.

Evolution of Precambrian life in the Brazilian geological record

Precambrian rocks comprise nearly one-quarter of the surface of Brazil and range from Paleoarchean (ca. 3.6 Ga) to the latest Ediacaran (0.542 Ga) in age. Except for controversial phosphatized 'embryo-like' microfossils like those from the lower Ediacaran Doushantuo Formation, China and complex rangeomorphs, Brazilian research has revealed all major categories of Precambrian life forms described elsewhere - microbialites, biomarkers, silicified microfossils, palynomorphs, vase-shaped microfossils, macroalgae, metazoans, vendobionts and ichnofossils - but the paleobiological significance of this record has been little explored. At least four occurrences of these fossils offer promise for increased understanding of the following aspects of Precambrian biospheric evolution: (i) the relationship of microbialites in 2.1-2.4 Ga old carbonates of the Minas Supergroup in the Quadrilatero Ferrifero, Minas Gerais (the oldest Brazilian fossils) to the development of the early oxygenic atmosphere and penecontemporaneous global tectonic and climatic events; (ii) the evolutionary and biostratigraphic significance of Mesoproterozoic to Ediacaran organic-walled microfossils in central-western Brazil; (iii) diversity and paleoecological significance of vase-shaped heterotrophic protistan microfossils in the Urucum Formation (Jacadigo Group) and possibly the Bocaina Formation (Corumba Group), of Mato Grosso do Sul; and (iv) insights into the record of skeletogenesis and paleoecology of latest Ediacaran metazoans as represented by the abundant organic carapaces of Corumbella and calcareous shells of the index fossil Cloudina, of the Corumba Group, Mato Grosso do Sul. Analysis of the Brazilian Precambrian fossil record thus holds great potential for augmenting paleobiological knowledge of this crucial period on Earth and for developing more robust hypotheses regarding possible origins and evolutionary pathways of biospheres on other planets. Received 26 February 2012, accepted 17 May 2012, first published online 18 June 2012

Calibration of a Species-Specific Spectral Vegetation Index for Leaf Area Index (LAI) Monitoring: Example with MODIS Reflectance Time-Series on Eucalyptus Plantations

The leaf area index (LAI) is a key characteristic of forest ecosystems. Estimations of LAI from satellite images generally rely on spectral vegetation indices (SVIs) or radiative transfer model (RTM) inversions. We have developed a new and precise method suitable for practical application, consisting of building a species-specific SVI that is best-suited to both sensor and vegetation characteristics. Such an SVI requires calibration on a large number of representative vegetation conditions. We developed a two-step approach: (1) estimation of LAI on a subset of satellite data through RTM inversion; and (2) the calibration of a vegetation index on these estimated LAI. We applied this methodology to Eucalyptus plantations which have highly variable LAI in time and space. Previous results showed that an RTM inversion of Moderate Resolution Imaging Spectroradiometer (MODIS) near-infrared and red reflectance allowed good retrieval performance (R-2 = 0.80, RMSE = 0.41), but was computationally difficult. Here, the RTM results were used to calibrate a dedicated vegetation index (called "EucVI") which gave similar LAI retrieval results but in a simpler way. The R-2 of the regression between measured and EucVI-simulated LAI values on a validation dataset was 0.68, and the RMSE was 0.49. The additional use of stand age and day of year in the SVI equation slightly increased the performance of the index (R-2 = 0.77 and RMSE = 0.41). This simple index opens the way to an easily applicable retrieval of Eucalyptus LAI from MODIS data, which could be used in an operational way.

Is podoplanin expression associated with the proliferative activity of ameloblastomas?

Oral Diseases (2012) 18, 673679 Objectives: The aim of this study was to investigate the relationship between podoplanin expression and proliferative activity of ameloblastomas and remnants of the odontogenic epithelium from dental follicles (DF) of unerupted teeth. Subjects and methods: Thirty-three paraffin-embedded ameloblastomas and thirty-two DF obtained of unerupted teeth were analyzed by immunohistochemistry using anti-human podoplanin and anti-Ki-67 antibodies. Podoplanin expression in odontogenic epithelial cells was evaluated using a scoring method, and the Ki-67 labeling index was determined by the percentage of positive odontogenic cells. Results: All ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands. Membranous expression of podoplanin in ameloblastomas was stronger than in the remnants of odontogenic epithelium (P = 0.001). Statistically significant difference was observed between the cytoplasmic and membranous expression of podoplanin in the remnants of odontogenic epithelium (P = 0.001). The index of epithelial odontogenic proliferative activity, verified by Ki-67 expression, was higher in ameloblastomas vs remnants of odontogenic epithelium (P < 0.001). No statistically significant correlation was identified between podoplanin and the cellular odontogenic proliferative activity in ameloblastomas and DF (P > 0.05). Conclusions: These results provide evidence that there is no connection between podoplanin immunostaining and odontogenic cellular proliferative activity and suggest a role for membranous podoplanin expression in the local invasion of ameloblastomas.

The impact of the medical speciality in primary health-care problem solving in Belo Horizonte, Brazil: homeopaths versus family doctors: a preliminary quantitative study

Introduction: This research project examined influence of the doctors' speciality on primary health care (PHC) problem solving in Belo Horizonte (BH) Brazil, comparing homeopathic with family health doctors (FH), from the management's and the patients' viewpoint. In BH, both FH and homeopathic doctors work in PHC. The index of resolvability (IR) is used to compare resolution of problems by doctors. Methods: The present research compared IR, using official data from the Secretariat of Health and test requests made by the doctors and 482 structured interviews with patients. A total of 217,963 consultations by 14 homeopaths and 67 FH doctors between 1 July 2006 and 30 June 2007 were analysed. Results: The results show significant differences greater problem resolution by homeopaths compared to FH doctors. Conclusion: In BH, the medical speciality, homeopathy or FH, has an impact on problem solving, both from the managers' and the patients' point of view. Homeopaths request fewer tests and have better IR compared with FH doctors. Specialisation in homeopathy is an independent positive factor in problem solving at PHC level in BH, Brazil. Homeopathy (2012) 101, 44-50.

Is 2-mm Punch Biopsy Useful in the Diagnosis of Malignant Eyelid Tumors?

Purpose: Two-millimeter punch biopsy is a swift and practical diagnostic tool in the outpatient setting. However, few studies have evaluated the efficacy of the method for diagnosis of malignant eyelid tumors. Methods: This was an observational study of patients with suspicion of malignant eyelid tumor attending the Ocular Plastic Surgery Center at Hospital das Clinicas, University of Sao Paulo School of Medicine. Following standard procedures, preoperative biopsies were taken with a 2-mm trephine and surgical excision was performed with safety margins, followed by reconstruction. Anatomopathologic analysis of the surgical specimen was used as gold standard to evaluate the accuracy of diagnosis by punch biopsy. Results: The study included 50 periocular tumors with suspicion of malignancy. The indicators of efficacy in the identification of malignancy by 2-mm punch biopsy were: sensitivity 88%, specificity 100%, positive predictive value 100%, and negative predictive value 64%. Accuracy was 90% for malignancy and 80% for histologic type. The. index of agreement between the diagnostic methods was 0.722 (p < 0.001). Conclusion: A positive result with 2-mm punch biopsy is a safe indication for surgical excision of the tumor, whereas a negative result does not necessarily imply benignity. In cases of high clinical suspicion, a second biopsy should be taken from a different part of the tumor to rule out malignancy. (Ophthal Plast Reconstr Surg 2012;28:282-285)

The expanded spectrum of neuromyelitis optica - evidences for a new definition

Neuromyelitis optica (NMO) has been traditionally described as the association of recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM). Identification of aquaporin-4 antibody (AQP4-IgG) has deeply changed the concept of NMO. A spectrum of NMO disorders (NMOSD) has been formulated comprising conditions which include both AQP4-IgG seropositivity and one of the index events of the disease (recurrent or bilateral optic neuritis and LETM). Most NMO patients harbor asymptomatic brain MRI lesions, some of them considered as typical of NMO. Some patients with aquaporin-4 autoimmunity present brainstem, hypothalamic or encephalopathy symptoms either preceding an index event or occurring isolatedly with no evidence of optic nerve or spinal involvement. On the opposite way, other patients have optic neuritis or LETM in association with typical lesions of NMO on brain MRI and yet are AQP4-IgG seronegative. An expanded spectrum of NMO disorders is proposed to include these cases.

Benchmarking sustainable urban mobility: The case of Curitiba, Brazil

Transportation planning is currently being confronted with a broader planning view, which is given by the concept of mobility. The Index of Sustainable Urban Mobility (I_SUM) is among the tools developed for supporting this new concept implementation. It is a tool to assess the current mobility conditions of any city, which can also be applied for policy formulation. This study focus on the application of I_SUM in the city of Curitiba, Brazil. Considering that the city is known worldwide as a reference of successful urban and transportation planning, the index application must confirm it. An additional objective of the study was to evaluate the index itself, or the subjacent assessment method and reference values. A global I_SUM value of 0.747 confirmed that the city has indeed very positive characteristics regarding sustainable mobility policies. However, some deficiencies were also detected, particularly with respect to non-motorized transport modes. The application has also served to show that a few I_SUM indicators were not able to capture some of the positive aspects of the city, what may suggest the need of changes in their formulation. Finally, the index application in parts of the city suggests that the city provides fair and equitable mobility conditions to all citizens throughout the city. This is certainly a good attribute for becoming a benchmark of sustainable mobility, even if it is not yet the ideal model. (C) 2012 Elsevier Ltd. All rights reserved.

The expanded spectrum of neuromyelitis optica: evidences for a new definition

Neuromyelitis optica (NMO) has been traditionally described as the association of recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM). Identification of aquaporin-4 antibody (AQP4-IgG) has deeply changed the concept of NMO. A spectrum of NMO disorders (NMOSD) has been formulated comprising conditions which include both AQP4-IgG seropositivity and one of the index events of the disease (recurrent or bilateral optic neuritis and LETM). Most NMO patients harbor asymptomatic brain MRI lesions, some of them considered as typical of NMO. Some patients with aquaporin-4 autoimmunity present brainstem, hypothalamic or encephalopathy symptoms either preceding an index event or occurring isolatedly with no evidence of optic nerve or spinal involvement. On the opposite way, other patients have optic neuritis or LETM in association with typical lesions of NMO on brain MRI and yet are AQP4-IgG seronegative. An expanded spectrum of NMO disorders is proposed to include these cases.

Feeding habits of the atlantic spotted dolphin, Stenella frontalis, in southeastern Brazil

This study presents new information on the feeding habits of the Atlantic spotted dolphins, Stenella frontalis, in the Western South Atlantic. Nine stomach contents of S. frontalis incidentally caught in fishing operations conducted by the gillnet fleet based on main harbour of Cananéia (25°00'S; 47°55'W), southeastern Brazil, were analyzed. These specimens were captured between 2005 and 2007. A total of 1 422 cephalopod beaks, 147 otoliths and three crustaceans were recovered from the stomach contents. The dolphins assessed preyed on at least eight different fish species of the families Trichiuridae, Carangidae, Sparidae, Merluccidae, Engraulidae, Sciaenidae, Congridae and Scombridae, five cephalopod species of the families Loliginidae, Sepiolidae, Tremoctopodidae and Thysanoteuthidae, and one shrimp species of the Penaeidae family. Based on the analysis of the Index of Relative Importance (IRI), the Atlantic cutlassfish, Trichiurus lepturus, was the most important fish species represented. Of the cephalopods, the squid Doryteuthis plei was by far the most representative species. Several items were reported for the first time as prey of the S. frontalis: Xiphopenaeus kroyeri, Tremoctopus violaceus, Semirossia tenera, Merluccius hubbsi, Pagrus pagrus and Paralonchurus brasiliensis. S. frontalis presented teuthophagous and ichthyofagous feeding habits, with apparent predominance of the first, and preyed mainly on pelagic and demersal items.

Feeding habits of Guiana dolphins, Sotalia guianensis, from south-eastern Brazil: new items and a knowledge review

This study presents new information on feeding habits of Guiana dolphins, Sotalia guianensis, in south-eastern Brazil, together with new regression equations to evaluate the weight and length of fish from otoliths, showing an overview on the knowledge about this species' diet in this area. Eighteen stomach contents had been analysed and compared to 180 samples collected in another eight feeding studies. The analysed specimens were either incidentally caught in gillnets used in coastal waters by the fleet based in the Cananeia main harbour (25 degrees 00'S 47 degrees 55'W), south of Sao Paulo State, or found dead in inner waters of the Cananeia estuary between 2003 and 2009. Based on the index of relative importance analysis, the most important fish species were the banded croaker, Paralonchurus brasiliensis. Doryteuthis plei was the most representative cephalopod species. Stellifer rastrifer was the most important fish species observed in dolphins in inner estuarine waters and P. brasiliensis in recovered dolphins from coastal waters. Loliguncula brevis is the only cephalopod species reported from dolphins found in inner estuarine waters up to date. Doryteuthis plei was the most important cephalopod species observed in coastal dolphins. When considering other feeding studies, the most representative fish family in the diet of S. guianensis was Sciaenidae, which is mainly represented by demersal fishes. The main preys of S. guianensis are abundant in the studied areas, which may indicate an opportunistic feeding habit. The majority of them are not the most important target species by the commercial fishery in south-eastern Brazil.