Management of Patients With Rheumatoid Arthritis in Latin America A Consensus Position Paper From Pan-American League of Associations of Rheumatology and Grupo Latino Americano De Estudio de Artritis Reumatoide

Objective: A consensus meeting of representatives of 18 Latin-American and Caribbean countries gathered in Renaca, Chile, for 2 days to identify problems and provide recommendations for the care of patients with rheumatoid arthritis (RA) in Latin America, a region where poverty and other health priorities make the efforts to provide effective and high quality care difficult. This report includes recommendations for health professionals, patients, and health authorities in Latin America, with an emphasis oil education and therapeutic issues. Methods: Fifty-one rheumatologists (list available only online on the JCR website) from 18 Latin-American and Caribbean countries with a special interest in RA participated in the consensus meeting. Participants were experts identified and appointed by the National Societies of Rheumatology affiliated with the Pan-American League of Associations for Rheumatology (PANLAR) and by the Grupo Latino Americano De Estudio de Artritis Reumatoide (GLADAR)-an independent group of Latin American rheumatologist researchers were also invited to the meeting. Eight topics were identified as priorities: patient, community and allied health professional education, health policy and decision making, programs for early detection and appropriate treatment of RA, role of classic disease modifying antirheumatic drugs (DMARDs), role of biologic therapy, and drug safety surveillance. To reach consensus, a survey with questions relevant to the topic of interest was sent to all participants before the meeting. During a 2 day meeting, the answers of the survey were reviewed and discussed by each group, with final recommendations on action items. Results: The specific topic of the survey was answered by 86% of the participants and 68% of them answered the entire survey. It was agreed that RA and rheumatic diseases which are currently not but should be public health priorities in Latin America, because of their prevalence and impact on quality of life. Conclusions: Strategic areas identified as priorities for our region included: early diagnosis and access to care by multidisciplinary teams, creation of databases to identify infections with the use of biologic agents in RA which are relevant to Latin America, and overall efforts to improve the care of RA patients in accordance with international standards. Implementation of educational programs aimed to improve self-management for patients with RA was also considered crucial.

Hygroexpansivity profiles on a commercial paper machine

Paper products show dimensional changes when subjected to moisture content modification. Hygroexpansivity was investigated in a commercial paper machine operating at 1256 m/min by a set of measurements on 75 g/m(2) reprographic bleached eucalyptus pulp paper samples. The present work shows hygroexpansivity development in different sections of the paper machine along the manufacturing direction. The measurement results demonstrate the effects of papermaking process operations on paper hygroexpansivity and lead to the confirmation of fiber orientation degree, drying restraint and shrinkage and paper tension as significant influencing factors. Structural, strength and elastic properties of paper were also measured as a function of machine direction position and presented for discussion purposes.

The position of the Amazonian Craton in supercontinents

This paper examines the extensive regions of Proterozoic accretionary belts that either formed most of the Amazonian Craton, or are marginal to its southeastern border. Their overall geodynamic significance is considered taking into account the paleogeographic reconstruction of Columbia, Rodinia and Gondwana. Amazonia would be part of Columbia together With Laurentia, North China and Baltica, forming a continuous, continental landmass linked by the Paleo- to Mesoproterozoic mobile belts that constitute large portions of it. The Rodinia supercontinent was formed in the Mesoproterozoic by the agglutination of the existing cratonic fragments, such as Laurentia and Amazonia, during contemporary continental collisions worldwide. The available paleomagnetic data suggest that Laurentia and Amazonia remained attached until at least 600 Ma. Since all other cratonic units Surrounding Laurentia have already rifted away by that time, the separation between Amazonia and Laurentia marks the final break-up of Rodinia with the opening of the lapetus ocean. (C) 2009 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Analysis of contamination of endodontic absorbent paper points

PURPOSE: The aim of this study was to assess the contamination status of endodontic absorbent paper points from sterilized or not sterilized commercial packs, as well as paper points exposed to the dental office environment. METHODS: Twenty absorbent paper points were evaluated for contamination status packed under different conditions: commercial/sterilized pack, commercial/non-sterilized pack, exposed to the clinical environment, and intentionally contaminated (positive control). Contamination was determined qualitatively and quantitatively by aerobiosis, capnophilic growth, and pour plate. The Petri dishes were analyzed with a colony counter, and the results were expressed as colony-forming units. The data were analyzed by Kruskal-Wallis test (α=0.05). RESULTS: No difference in colony-forming units was found among the groups of endodontic absorbent paper points. All groups were contaminated by fungi and bacteria. CONCLUSION: It can be concluded that the sterilization of absorbent endodontic paper points before clinical use should be recommended regardless of commercial presentation

Correlação entre padrão facial e relação sagital entre os arcos dentários no estágio de dentadura decídua: considerações epidemiológicas

OBJETIVO: A inter-relação oclusão e morfologia facial é fundamental para o diagnóstico e planejamento em ortodontia, bem como para determinação do prognóstico de tratamento. De um modo geral, a relação sagital entre os arcos dentários (Classe) tende a refletir o comportamento sagital do esqueleto facial (Padrão). O presente trabalho avalia a correlação entre as características morfológicas sagitais da face (Padrão) e da oclusão (Classe) no estágio de dentadura decídua. METODOLOGIA: A amostra foi composta por 2009 crianças, entre 03 e 06 anos de idade, no período de dentadura decídua completa, de 20 pré-escolas do Município de Bauru - SP. Os resultados demonstraram uma correlação estreita entre o Padrão facial e a Classe. No Padrão I predominou a Classe I (62,99%), seguida pela Classe II (35,82%) e Classe III (1,18%). No Padrão II, a Classe II foi predominante (81,35%) acompanhada de uma incidência baixa de Classe I (18,64%). No Padrão III, a Classe III estava presente em 50% das crianças, seguida pela Classe I, em 48,64%, e Classe II, em 1,35%. RESULTADOS: A expectativa se comprovou. Há uma tendência da Classe acompanhar o Padrão, desde o estágio de dentadura decídua. Isso foi mais explícito no Padrão II. Os resultados também esclarecem que a oclusão guarda alguma independência em relação ao Padrão. CONCLUSÃO: A maior heterogeneidade na distribuição das Classes ficou para os Padrões I e III. No Padrão II, as Classes se comportaram de forma mais homogênea, com mais de 80% das crianças exibindo Classe II.

Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats

PURPOSE: To compare the effectiveness of mechanical ventilation of supine versus prone position in hydrochloric acid (HCl)-induced lung dysfunction. METHODS: Twenty, adult, male, Wistar-EPM-1 rats were anesthetized and randomly grouped (n=5 animals per group) as follows: CS-MV (mechanical ventilation in supine position); CP-MV (mechanical ventilation in prone position); bilateral instillation of HCl and mechanical ventilation in supine position (HCl+S); and bilateral instillation of HCl and mechanical ventilation in prone position (HCl+P). All groups were ventilated for 180 minutes. The blood partial pressures of oxygen and carbon dioxide were measured in the time points 0 (zero; 10 minutes before lung injury for stabilization), and at the end of times acid injury, 60, 120 and 180 minutes of mechanical ventilation. At the end of experiment the animals were euthanized, and bronchoalveolar lavages (BALs) were taken to determine the contents of total proteins, inflammatory mediators, and lungs wet-to-dry ratios. RESULTS: In the HCl+P group the partial pressure of oxygen increased when compared with HCl+S (128.0±2.9 mmHg and 111.0±6.7 mmHg, respectively) within 60 minutes. TNF-α levels in BAL do not differ significantly in the HCl+P group (516.0±5.9 pg/mL), and the HCl+S (513.0±10.6 pg/mL). CONCLUSION: The use of prone position improved oxygenation, but did not reduce TNF-α in BAL upon lung dysfunction induced by HCl.

Ergonomic Aspects Related to Surgeon Position in Laparoscopic Radical Prostatectomy

Purpose: The aim is to evaluate the level of inclination of the surgeon's spinal column (ISSC) while performing laparoscopic radical prostatectomy (LRP) when using one trocar on each side of the patient abdomen (""torero"" position) in two scenarios: With and without a thin head supporter adapted to the table. Materials and Methods: Based on trigonometric principles, we elaborated a formula to calculate the ISSC for a determined surgeon and surgical table while performing LRP in the torero position. The parameters considered were the width of the surgical table (m), the distance between the surgeon's anterior superior iliac spines (q), and the distance from the central point between the surgeon's anterior superior iliac spines to the surgeon's head (h). We used the formula alpha = 90 degree-cos(-1)(b/h) (where b = q/2 + m/2) in an Excel sheet to calculate the angle of inclination of the surgeon's spinal column. We applied the measures of 12 surgeons with different biotypes of our staff to calculate the ISSC with and without the thin head supporter. Results: The use of a thin head supporter reduced the mean ISCC in the torero position from 36.1 +/- 3.73 degrees (range 31.3 to 49.8 degrees) to 22.1 +/- 4.9 degrees (range 18.7 to 32.9 degrees), which corresponds to a reduction of 38.8% in the mean angle of inclination. This difference was statistically significant (P < 0.001). Conclusion: The use of a thin head supporter adapted to the surgical table objectively reduces lateral inclination of the surgeon's spinal column in the torero position, making LRP a more comfortable procedure.

DESCRIPTION OF ADULTS AND NYMPH, AND REDESCRIPTION OF THE LARVA, OF ORNITHODOROS MARINKELLEI (ACARI: ARGASIDAE), WITH DATA ON ITS PHYLOGENETIC POSITION

The argasid tick Ornithodoros marinkellei Kohls, Clifford, and Jones, 1969 was described 4 decades ago based on larval specimens collected from bats (Pteronotus spp.) in Colombia and Panama. Thereafter, larval O. marinkellei parasitizing bats were reported from Venezuela, Guyana, and Brazil. Herein, we describe the adults and nymph, and redescribe the larva of O. marinkellei based on specimens recently collected in the western Brazilian Amazon region. In contrast to all other known adult argasids, the idiosoma of both males and females of O. marinkellei is covered with sclerotized plaques. The idiosoma of the nymph of O. marinkellei is entirely micromamillated, and differs from the adults by the absence of plaques. The larva of O. marinkellei is morphologically similar to the larvae of the 2 other species belonging to the subgenus Subparmatus, i.e., Ornithodoros viguerasi Cooley and Kohls, 1941 and Ornithodoros mormoops Kohls, Clifford, and Jones, 1969. Because of the long and narrow dorsal plate, the larva of O. marinkellei is readily distinguished from O. viguerasi and O. mormoops. Comparison of our larvae from Brazil with O. marinkellei paratype specimens from Colombia confirmed their taxonomic identification. However, a few morphological differences, particularly in the size of the gnathosoma, were observed. Further studies are necessary to clarify whether O. marinkellei is a complex of different species, or a single species represented by morphologically polymorphic, and geographically distinct populations. Partial mitochondrial 16S rDNA gene sequences were generated for O. marinkellei specimens from Brazil, and compared with available homologous sequences in GenBank. Phylogenetic analyses revealed O. marinkellei to be distinct from the remaining argasid species available in GenBank, including other bat-associated tick species that are found in sympatry with O. marinkellei in the Neotropical region.

Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment

Objective: To determine the changes in the position and form of the temporomandibular joint articular disc in adolescents with Class II division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliance (phase II). Materials and Methods: Thirty-two consecutive adolescents went through phase I of treatment and 23 completed phase II. The temporomandibular joints were evaluated qualitatively by means of magnetic resonance images at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3), and at the end of phase II (T4). Results: Significant changes in disc position were not observed with the mouth closed between T1 X T3 (P = .317), T3 X T4 (P = .287), or T1 X T4 (P = .261). At T2, on average, the disc was positioned regressively. With the mouth open, no difference was observed between T1 X T3 (P = .223) or T1 X T4 (P = .082). We did observe a significant difference between T3 X T4 (P < .05). Significant changes in the disc form were found with the mouth closed between T1 X T2 (P < .001) and T2 X T3 (P < .001). Conclusions: At the end of the two-phase treatment, in general terms, the position and form of the initial articular discs were maintained; however, in some temporomandibular joints some seemingly adverse effects were observed at T4. (Angle Orthod. 2010;80:843-852.)

Phylogenetic position of the acariform mites: sensitivity to homology assessment under total evidence

Background: Mites (Acari) have traditionally been treated as monophyletic, albeit composed of two major lineages: Acariformes and Parasitiformes. Yet recent studies based on morphology, molecular data, or combinations thereof, have increasingly drawn their monophyly into question. Furthermore, the usually basal (molecular) position of one or both mite lineages among the chelicerates is in conflict to their morphology, and to the widely accepted view that mites are close relatives of Ricinulei. Results: The phylogenetic position of the acariform mites is examined through employing SSU, partial LSU sequences, and morphology from 91 chelicerate extant terminals (forty Acariformes). In a static homology framework, molecular sequences were aligned using their secondary structure as guide, whereby regions of ambiguous alignment were discarded, and pre-aligned sequences analyzed under parsimony and different mixed models in a Bayesian inference. Parsimony and Bayesian analyses led to trees largely congruent concerning infraordinal, well-supported branches, but with low support for inter-ordinal relationships. An exception is Solifugae + Acariformes (P. P = 100%, J. = 0.91). In a dynamic homology framework, two analyses were run: a standard POY analysis and an analysis constrained by secondary structure. Both analyses led to largely congruent trees; supporting a (Palpigradi (Solifugae Acariformes)) clade and Ricinulei as sister group of Tetrapulmonata with the topology (Ricinulei (Amblypygi (Uropygi Araneae))). Combined analysis with two different morphological data matrices were run in order to evaluate the impact of constraining the analysis on the recovered topology when employing secondary structure as a guide for homology establishment. The constrained combined analysis yielded two topologies similar to the exclusively molecular analysis for both morphological matrices, except for the recovery of Pedipalpi instead of the (Uropygi Araneae) clade. The standard (direct optimization) POY analysis, however, led to the recovery of trees differing in the absence of the otherwise well-supported group Solifugae + Acariformes. Conclusions: Previous studies combining ribosomal sequences and morphology often recovered topologies similar to purely morphological analyses of Chelicerata. The apparent stability of certain clades not recovered here, like Haplocnemata and Acari, is regarded as a byproduct of the way the molecular homology was previously established using the instrumentalist approach implemented in POY. Constraining the analysis by a priori homology assessment is defended here as a way of maintaining the severity of the test when adding new data to the analysis. Although the strength of the method advocated here is keeping phylogenetic information from regions usually discarded in an exclusively static homology framework; it still has the inconvenience of being uninformative on the effect of alignment ambiguity on resampling methods of clade support estimation. Finally, putative morphological apomorphies of Solifugae + Acariformes are the reduction of the proximal cheliceral podomere, medial abutting of the leg coxae, loss of sperm nuclear membrane, and presence of differentiated germinative and secretory regions in the testis delivering their products into a common lumen.

CMB in a box: Causal structure and the Fourier-Bessel expansion

This paper makes two points. First, we show that the line-of-sight solution to cosmic microwave anisotropies in Fourier space, even though formally defined for arbitrarily large wavelengths, leads to position-space solutions which only depend on the sources of anisotropies inside the past light cone of the observer. This foretold manifestation of causality in position (real) space happens order by order in a series expansion in powers of the visibility gamma = e(-mu), where mu is the optical depth to Thomson scattering. We show that the contributions of order gamma(N) to the cosmic microwave background (CMB) anisotropies are regulated by spacetime window functions which have support only inside the past light cone of the point of observation. Second, we show that the Fourier-Bessel expansion of the physical fields (including the temperature and polarization momenta) is an alternative to the usual Fourier basis as a framework to compute the anisotropies. The viability of the Fourier-Bessel series for treating the CMB is a consequence of the fact that the visibility function becomes exponentially small at redshifts z >> 10(3), effectively cutting off the past light cone and introducing a finite radius inside which initial conditions can affect physical observables measured at our position (x) over right arrow = 0 and time t(0). Hence, for each multipole l there is a discrete tower of momenta k(il) (not a continuum) which can affect physical observables, with the smallest momenta being k(1l) similar to l. The Fourier-Bessel modes take into account precisely the information from the sources of anisotropies that propagates from the initial value surface to the point of observation-no more, no less. We also show that the physical observables (the temperature and polarization maps), and hence the angular power spectra, are unaffected by that choice of basis. This implies that the Fourier-Bessel expansion is the optimal scheme with which one can compute CMB anisotropies.

Position-dependent noncommutativity in quantum mechanics

The model of the position-dependent noncommutativity in quantum mechanics is proposed. We start with given commutation relations between the operators of coordinates [(x) over cap (i), (x) over cap (j)] = omega(ij) ((x) over cap), and construct the complete algebra of commutation relations, including the operators of momenta. The constructed algebra is a deformation of a standard Heisenberg algebra and obeys the Jacobi identity. The key point of our construction is a proposed first-order Lagrangian, which after quantization reproduces the desired commutation relations. Also we study the possibility to localize the noncommutativity.

Active waveguide effects from porous anodic alumina: An optical sensor proposition

We present in this paper an active waveguide effect observed in porous anodic alumina (PA), which can be applied in optical sensors. The spectral position, shape, and polarization effect of the narrow waveguide modes is described. An analytical test with a commercial pesticide was performed. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3447375]

TAXONOMIC POSITION OF GUIRATINGIA MENDESI (MEGADESMIDAE) AND THE EVOLUTION OF PERMIAN ENDEMIC BIVALVE FAUNA OF THE PARANA BASIN, BRAZIL

The unusual bivalve Guiratingia mendesi is redescribed from the original material. Detailed analysis of hinge and muscle scars allows more refined designation of its taxonomic position and affinities to other Permian bivalves from the Parana Basin. Guiratingia mendesi is characterized by very small, anteriorly expanded shells, with a great number of muscle striae within the area delimited by the pallial line. A flattened area is noted alongside the commissure of shell. The presence of a triangular blunt tooth in the right valve allows its designation to Megadesmidae. The absence of accessory muscle scars ""a"" and ""b"" and pedal elevator indicate that the genus belongs to the Plesiocyprinellinae, a group of bivalves considered endemic to the Passa Dois Group. Guiratingia mendesi is found, however, in limestones of the Palermo Formation (Middle Artinskian), nearly 100 in below the base of the Irati Formation (Late Artinskian). Until now, it was believed that within the Permian succession of Parana Basin, pre-Irati bivalves were all gondwanic or cosmopolitan. Guiratingia mendesi was an endemic, active burrower that resembles Runnegariella fragilis from the Permian Teresina Formation. This indicates that during Palermo times restricted paleogeographic conditions have existed within the huge Parana epeiric sea, favoring endemicity, probably in marine bayments close to its margins. The presence of an anteriorly expanded shell in G mendesi is a condition also seen in other Mesozoic and Cenozoic anomalodesmatans, demonstrating the recurrence of shell forms in distinct lineages of this interesting group of bivalves.

Programmable diagnostic devices made from paper and tape

This paper describes three-dimensional microfluidic paper-based analytical devices (3-D mu PADs) that can be programmed (postfabrication) by the user to generate multiple patterns of flow through them. These devices are programmed by pressing single-use 'on' buttons, using a stylus or a ballpoint pen. Pressing a button closes a small space (gap) between two vertically aligned microfluidic channels, and allows fluids to wick from one channel to the other. These devices are simple to fabricate, and are made entirely out of paper and double-sided adhesive tape. Programmable devices expand the capabilities of mu PADs and provide a simple method for controlling the movement of fluids in paper-based channels. They are the conceptual equivalent of field-programmable gate arrays (FPGAs) widely used in electronics.