Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil

The aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. A retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the Centers for Disease Control and Prevention. To estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. Their costs were estimated from the minimum values according to the Brazilian Medical Association. The estimated cost of the antibiotics used was also obtained. The total length of stay in the ward was 976 days, at a cost of US$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of US$ 5,031.37. Forty-two debridement procedures were performed, at a cost of US$ 5,798.06, and 1965 tests (laboratory and imaging) were also performed, at a cost of US$ 15,359.25. US$ 20,845.01 was spent on antibiotics and US$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. The total additional cost of these cases of hospital infection in 2006 and 2007 was of US$ 91,843.75. Based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.

Padrões de distribuição geográfica das espécies de Schefflera J. R. Forst. & G. Forst. (Araliaceae) do Brasil extra-amazônico

Uma análise da distribuição geográfica de Schefflera no Brasil extra-amazônico foi realizada com base em mapas atualizados plotando as ocorrências conhecidas das 26 espécies do gênero encontradas nessa grande área: S. angustissima (Marchal) Frodin, S. aurata Fiaschi, S. botumirimensis Fiaschi & Pirani, S. burchellii (Seem.) Frodin & Fiaschi, S. calva (Cham.) Frodin & Fiaschi, S. capixaba Fiaschi, S. cephalantha (Harms) Frodin, S. cordata (Taub.) Frodin & Fiaschi, S. distractiflora (Harms) Frodin, S. fruticosa Fiaschi & Pirani, S. gardneri (Seem.) Frodin & Fiaschi, S. glaziovii (Taub.) Frodin & Fiaschi, S. grandigemma Fiaschi, S. kollmannii Fiaschi, S. longipetiolata (Pohl ex DC.) Frodin & Fiaschi, S. lucumoides (Decne. & Planch. ex Marchal) Frodin & Fiaschi, S. macrocarpa (Cham. & Schltdl.) Frodin, S. malmei (Harms) Frodin, S. morototoni (Aubl.) Maguire, Steyermark & Frodin, S. racemifera Fiaschi & Frodin, S. ruschiana Fiaschi & Pirani, S. selloi (Marchal) Frodin & Fiaschi, S. succinea Frodin & Fiaschi, S. villosissima Fiaschi & Pirani, S. vinosa (Cham. & Schltdl.) Frodin & Fiaschi e S. aff. varisiana Frodin. Dois centros de endemismo associados com áreas de altitude elevada foram reconhecidos: Cadeia do Espinhaço em Minas Gerais e florestas montanas do Estado do Espírito Santo. Os padrões de distribuição geográfica ilustrados são discutidos com base em dados obtidos para outros grupos de angiospermas e em estudos fitogeográficos das principais fitocórias do Brasil extra-amazônico. São apresentadas também hipóteses acerca de prováveis relações filogenéticas entre alguns táxons, visando à busca de possíveis correlações entre estas e a biogeografia do grupo.

Nutritional reserves of Vochysiaceae seeds: chemical diversity and potential economic uses

Contents of proteins, carbohydrates and oil of seeds of 57 individuals of Vochysiaceae, involving one species of Callisthene, six of Qualea, one of Salvertia and eight of Vochysia were determined. The main nutritional reserves of Vochysiaceae seeds are proteins (20% in average) and oils (21. 6%). Mean of carbohydrate contents was 5. 8%. Callisthene showed the lowest protein content (16. 9%), while Q. cordata was the species with the highest content (30% in average). The contents of ethanol soluble carbohydrates were much higher than those of water soluble carbohydrates. Oil contents lay above 20% for most species (30. 4% in V. pygmaea and V. pyramidalis seeds). The predominant fatty acids are lauric (Q. grandiflora), oleic (Qualea and Salvertia) or acids with longer carbon chains (Salvertia and a group of Vochysia species). The distribution of Vochysiaceae fatty acids suggests for seeds of some species an exploitation as food sources (predominance of oleic acid), for other species an alternative to cocoa butter (high contents or predominance of stearic acid) or the production of lubricants, surfactants, detergents, cosmetics and plastic (predominance of acids with C20 or C22 chains) or biodiesel (predominance of monounsaturated acids). The possibility of exploitation of Vochysiaceae products in a cultivation regimen and in extractive reserves is discussed.

Trade unions and the economic performance of brazilian establishments

Este artigo analisa, pela primeira vez na literatura, o impacto dos sindicatos de trabalhadores em vários indicadores de desempenho econômico de firmas industriais brasileiras. Realizou-se uma pesquisa retrospectiva sobre a densidade sindical de 1000 estabelecimentos industriais brasileiros e seus resultados foram combinados aos indicadores de desempenho econômico da Pesquisa Industrial Anual (PIA) de 1990 a 2000. Os resultados indicam que a relação entre a densidade sindical na firma e seus salários, emprego e produtividade, é não-linear, ou seja, um aumento no grau de sindicalização leva a um melhor desempenho, porém a taxas decrescentes. Observou-se, também, uma relação negativa entre sindicalização e rentabilidade. Finalmente, estabelecimentos que introduziram mecanismos de 'participação nos lucros' aumentaram sua produtividade e rentabilidade no período e pagaram maiores salários nas firmas onde o grau de sindicalização era maior.

Economic impact of a rotavirus vaccine in Brazil

The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$ 7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio.

Vibration-induced extra torque during electrically-evoked contractions of the human calf muscles

Background: High-frequency trains of electrical stimulation applied over the lower limb muscles can generate forces higher than would be expected from a peripheral mechanism (i.e. by direct activation of motor axons). This phenomenon is presumably originated within the central nervous system by synaptic input from Ia afferents to motoneurons and is consistent with the development of plateau potentials. The first objective of this work was to investigate if vibration (sinusoidal or random) applied to the Achilles tendon is also able to generate large magnitude extra torques in the triceps surae muscle group. The second objective was to verify if the extra torques that were found were accompanied by increases in motoneuron excitability. Methods: Subjects (n = 6) were seated on a chair and the right foot was strapped to a pedal attached to a torque meter. The isometric ankle torque was measured in response to different patterns of coupled electrical (20-Hz, rectangular 1-ms pulses) and mechanical stimuli (either 100-Hz sinusoid or gaussian white noise) applied to the triceps surae muscle group. In an additional investigation, M(max) and F-waves were elicited at different times before or after the vibratory stimulation. Results: The vibratory bursts could generate substantial self-sustained extra torques, either with or without the background 20-Hz electrical stimulation applied simultaneously with the vibration. The extra torque generation was accompanied by increased motoneuron excitability, since an increase in the peak-to-peak amplitude of soleus F waves was observed. The delivery of electrical stimulation following the vibration was essential to keep the maintained extra torques and increased F-waves. Conclusions: These results show that vibratory stimuli applied with a background electrical stimulation generate considerable force levels (up to about 50% MVC) due to the spinal recruitment of motoneurons. The association of vibration and electrical stimulation could be beneficial for many therapeutic interventions and vibration-based exercise programs. The command for the vibration-induced extra torques presumably activates spinal motoneurons following the size principle, which is a desirable feature for stimulation paradigms.

Polymorphisms and DNA methylation of gene TP53 associated with extra-axial brain tumors

The p53 tumor suppressor gene is the most frequently mutated gene in human cancer; this gene is mutated in up to 50% of human tumors. It has a critical role in the cell cycle, apoptosis and cell senescence, and it participates in many crucial physiological and pathological processes. Polymorphisms of p53 have been suggested to be associated with genetically determined susceptibility in various types of cancer. Another process involved with the development and progression of tumors is DNA hypermethylation. Aberrant methylation of the promoter is an alternative epigenetic change in genetic mechanisms, leading to tumor suppressor gene inactivation. In the present study, we examined the TP53 Arg72Pro and Pro47Ser polymorphisms using PCR-RFLP and the pattern of methylation of the p53 gene by methylation-specific PCR in 90 extra-axial brain tumor samples. Patients who had the allele Pro of the TP53 Arg72Pro polymorphism had an increased risk of tumor development ( odds ratio, OR = 3.23; confidence interval at 95%, 95% CI = 1.71-6.08; P = 0.003), as did the allele Ser of TP53 Pro47Ser polymorphism (OR = 1.28; 95% CI = 0.03-2.10; P = 0.01). Comparison of overall survival of patients did not show significant differences. In the analysis of DNA methylation, we observed that 37.5% of meningiomas, 30% of schwannomas and 52.6% of metastases were hypermethylated, suggesting that methylation is important for tumor progression. We suggest that TP53 Pro47Ser and Arg72Pro polymorphisms and DNA hypermethylation are involved in susceptibility for developing extra-axial brain tumors.

Effectiveness of 980-mm Diode and 1064-nm Extra-Long-Pulse Neodymium-Doped Yttrium Aluminum Garnet Lasers in Implant Disinfection

Objective: To evaluate the potential of 980-nm gallium aluminum arsenide (GaAlAs) and 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers to reduce bacteria after irradiation of implant surfaces contaminated with Enterococcus faecalis and Porphyromonas gingivalis and on irradiated implant surface morphology. Background: Despite the frequency of implant success, some implant loss is related to peri-implantitis because of difficulty in eliminating the biofilm. Methods: Implants (3.75 x 13 mm) with machined surfaces, surfaces sand blasted with titanium oxide (TiO(2)), and sand-blasted and acid-etched surfaces were exposed to P. gingivalis and E. faecalis cultures and irradiated with 980-nm GaAlAs or 1064-nm Nd: YAG lasers. After laser treatments, the number of remaining colony-forming units and implant surface morphology were analyzed using scanning electron microscopy (SEM). Results: The Nd: YAG laser was able to promote a total contamination reduction on all implants irradiated. The results with the GaAlAs laser showed 100% bacteria reduction on the implants irradiated with 3 W. Irradiation with 2.5 W and 3 W achieved 100% of bacteria reduction on P. gingivalis-contaminated implants. Decontamination was not complete for the sand-blasted TiO(2) (78.6%) and acid-etched surfaces (49.4%) contaminated with E. faecalis and irradiated with 2.5 W. SEM showed no implant surface changes. Conclusion: The wavelengths used in this research provided bacteria reduction without damaging implant surfaces. New clinical research should be encouraged for the use of this technology in the treatment of peri-implantitis.

Extra phase noise from thermal fluctuations in nonlinear optical crystals

We show theoretically and experimentally that scattered light by thermal phonons inside a second-order nonlinear crystal is the source of additional phase noise observed in optical parametric oscillators. This additional phase noise reduces the quantum correlations and has hitherto hindered the direct production of multipartite entanglement in a single nonlinear optical system. We cooled the nonlinear crystal and observed a reduction in the extra noise. Our treatment of this noise can be successfully applied to different systems in the literature.

Testing for large extra dimensions with neutrino oscillations

We consider a model where sterile neutrinos can propagate in a large compactified extra dimension giving rise to Kaluza-Klein (KK) modes and the standard model left-handed neutrinos are confined to a 4-dimensional spacetime brane. The KK modes mix with the standard neutrinos modifying their oscillation pattern. We examine former and current experiments such as CHOOZ, KamLAND, and MINOS to estimate the impact of the possible presence of such KK modes on the determination of the neutrino oscillation parameters and simultaneously obtain limits on the size of the largest extra dimension. We found that the presence of the KK modes does not essentially improve the quality of the fit compared to the case of the standard oscillation. By combining the results from CHOOZ, KamLAND, and MINOS, in the limit of a vanishing lightest neutrino mass, we obtain the stronger bound on the size of the extra dimension as similar to 1.0(0.6) mu m at 99% C.L. for normal (inverted) mass hierarchy. If the lightest neutrino mass turns out to be larger, 0.2 eV, for example, we obtain the bound similar to 0.1 mu m. We also discuss the expected sensitivities on the size of the extra dimension for future experiments such as Double CHOOZ, T2K, and NO nu A.

Economic viability of doses and split-applications of nitrogen fertilization in corn crop in a eutrophic Red Latosol

Nitrogen is the nutrient that is most absorbed by the corn crop, with the most complex management, and has the highest share on the cost of corn production. The objective of this work was to evaluate the economic viability of different rates and split-applications of nitrogen fertilization, as such as urea, in the corn crop in a eutrophic Red Latosol (Oxisol). The study was carried out in the Experimental Station of the Regional Pole of the Sao Paulo Northwest Agribusiness Development (APTA), in Votuporanga, State of Sao Paulo, Brazil. The experimental design was randomized complete blocks with nine treatments and four replications, consisting of five N rates: 0, 55, 95, 135 and 175 kg ha(-1), 15 kg ha-l applied in the seeding and the remainder in top dressing: 40 and 80 kg ha(-1) N at forty days after seeding (DAS), or 1/2 + 1/2 at 20 and 40 DAS; 120 kg ha-1 N split in 1/2 + 1/2 or 1/3 + 1/3 + 1/3 at 20, 40 or 60 DAS; 160 kg ha(-1) N split in 1/4 + 3/8 + 3/8 or 114 + 1/4 + 1/4 + 1/4 at 20, 40, 60 and 80 DAS. The application of 135 kg ha-l of N split in three times provided the best benefit/cost ratio. The non-application of N provided the lowest economic return, proving to be unviable.

The use of contingent valuation for evaluating protected areas in the developing world: Economic valuation of Morro do Diabo State Park, Atlantic Rainforest, Sao Paulo State (Brazil)

The Brazilian Atlantic Rainforest is internationally recognised as one of the most biodiverse and threatened tropical forests in the world [Myers, N., Mittermeier, R.A., Mittermeier, C.G., da Fonseca, G.A.B., Kent, J., 2000. Biodiversity hotspots for conservation priorities. Nature 403, 853-858]. The Seasonal Semi-Deciduous Forest is among the most fragmented and threatened biomes of the Atlantic Rainforest Domain. The largest remnant of this biome (35,000 ha) is protected by the Morro do Diabo State Park (MDSP), situated in the area known as the Pontal do Paranapanema, in Sao Paulo State, Brazil. Despite its environmental importance, the park is under political, economic and demographic pressure. The main aim of our research was to estimate the population`s willingness to pay (WTP) for the conservation of MDSP and for the Atlantic Rainforest`s remnants in Sao Paulo State as a whole, by means of the contingent valuation method (CVM). The results featured a high incidence of null WTP and of protest votes. Nevertheless, the population is willing to pay US$ 2,113,548.00/year (R$ 7,080,385.00/year) for the conservation of the MDSP (use and existence values), or US$ 60.39 ha/year (R$ 202.30/ha/year). The results indicate that the preservation value is strongly associated to the population`s ability to pay, increasing with income levels. Qualitative research questions showed that the population considers protected areas to be very important. Still, the valuation of MDSP revealed a gap between the government budget allotted to the park and the value assigned to the area by the public. (C) 2007 Elsevier B.V. All rights reserved.

Vibration-enhanced posture stabilization achieved by tactile supplementation: May blind individuals get extra benefits?

Diminished balance ability poses a serious health risk due to the increased likelihood of falling, and impaired postural stability is significantly associated with blindness and poor vision. Noise stimulation (by improving the detection of sub-threshold somatosensory information) and tactile supplementation (i.e. additional haptic information provided by an external contact surface) have been shown to improve the performance of the postural control system. Moreover, vibratory noise added to the source of tactile supplementation (e.g. applied to a surface that the fingertip touches) has been shown to enhance balance stability more effectively than tactile supplementation alone. In view of the above findings, in addition to the well established consensus that blind subjects show superior abilities in the use of tactile information, we hypothesized that blind subjects may take extra benefits from the vibratory noise added to the tactile supplementation and hence show greater improvements in postural stability than those observed for sighted subjects. If confirmed, this hypothesis may lay the foundation for the development of noise-based assistive devices (e.g. canes, walking sticks) for improving somatosensation and hence prevent falls in blind individuals. (C) 2011 Elsevier Ltd. All rights reserved.

Using economic instruments to address emissions from air transport in the European Union

Air transport has become a vital component of the global economy. However, greenhouse-gas emissions from this sector have a significant impact on global climate, being responsible for over 3.5% of all anthropogenic radiative forcing. Also, the accrued visibility of aircraft emissions greatly affects the public image of the industry. In this context, incentive-based regulations, in the form of price or quantity controls, can be envisaged as alternatives to mitigate these emissions. The use of environmental charges in air transport, and the inclusion of the sector in the European Union Emissions Trading Scheme (EU ETS), are considered under a range of scenarios. The impacts of these measures on demand are estimated, and results suggest that they are likely to be minimal-mainly due to the high willingness to pay for air transport. In particular, in the EU ETS scenario currently favoured by the EU, demand reductions are less than 2%. This may not be true in the longer run, for short trips, or if future caps become more stringent. Furthermore, given current estimates of the social Cost Of CO2 as well as typical EU ETS prices, supply-side abatement would be too costly to be encouraged by these policies in the short term. The magnitude of aviation CO2 emissions in the EU is estimated, both in physical and monetary terms; the results are consistent with Eurocontrol estimates and, for the EU-25, the total social cost of these emissions represents only 0.03% of the region`s GDP. It is concluded that the use of multisector policies, such as the EU ETS, is unsuitable for curbing emissions from air transport, and that stringent emission charges or an isolated ETS would be better instruments. However, the inclusion of aviation in the EU ETS has advantages under target-oriented post-2012 scenarios, such as policy-costs dilution, certainty in reductions, and flexibility in abatement allocation. This solution is also attractive to airlines, as it would improve their public image but require virtually no reduction of their own emissions, as they would be fully capable of passing on policy costs to their customers.