Referral letters in oral medicine: standard versus non-standard letters

Usually referral letters are the only means of communication between general practitioners and specialists in the health area. However, they are inadequate if important basic data are omitted. The aim of this study was to compare the content of standard and non-standard letters. A total of 1956 files from the Oral Medicine Service were consecutively evaluated (March 1996 to September 2000). Key items were considered for analysis and the results were stored in a database using the Epinfo 6.04 program. The X-2 test (a=0.05) was applied to the results. of the 1956 files examined, 34% (662) had a referral letter, 31% of them being standard letters and 69% non-standard letters. Most standard letters (87%) were from professionals of public health institutions. Most percent discrepancies between standard and non-standard letters were observed for patient address (14.90 vs 1.32%), patient age (54.81 vs 9.47%), chief complaint (32.21 vs 8.37%), fundamental lesion (29.33 vs 13.66%), and symptoms (27.81 vs 15.42%,,). Statistically significant differences were observed for patient age, professional referring the patient, chief complaint, and site of the lesion. The quality and quantity of the information differed significantly between the two types of letters. The standard letters were more complete and contained information commonly absent in the non-standard letters. We suggest the use of standard letters for improving the quality of communication among professionals.

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Numerical simulation of viscous three-dimensional flow over aerospace vehicles using Euler/boundary-layer zonal approach

This paper presents a viscous three-dimensional simulations coupling Euler and boundary layer codes for calculating flows over arbitrary surfaces. The governing equations are written in a general non orthogonal coordinate system. The Levy-Lees transformation generalized to three-dimensional flows is utilized. The inviscid properties are obtained from the Euler equations using the Beam and Warming implicit approximate factorization scheme. The resulting equations are discretized and approximated by a two-point fmitedifference numerical scheme. The code developed is validated and applied to the simulation of the flowfield over aerospace vehicle configurations. The results present good correlation with the available data.

Paracoccidioidomycosis: Survey and clinical aspects from the Department of Dermatology of the School of Medicine of Botucatu (Sao Paulo - Brazil)

Background - Paracoccidioidomycosis is the most frequent among the systemic mycoses in Brazil. Objective: To study the cases of paracoccidioidomycosis diagnosed from 1976 to 1996 at the Department of Dermatology of the School of Medicine of Botucatu. Methods - Descriptive study obtained from specific protocols comprising anamnesis, clinical- dermatological-laboratorial examination, treatment and follow-up of the patients. Results - Paracoccidioidomycosis was diagnosed in 1.04% of the dermatologic outpatients assisted from 1976 to 1996. In 315 cases, 89.8% were male, 61.9% were over forty and 53.7% were rural workers. The complaints were related more to oropharyngolaryngeal (53.6%) or cutaneous (23.8%) lesions or adenopathy (10.2%). Seventy patients had already been treated in other health services. The chronic multifocal clinical from was the most common: 80.6% of the cases, followed by the acute-subacute (juvenile type) 15.5%. The disease was pulmonary in 80.0%, oropharyngolaryngeal in 69.2% and cutaneous in 45.7%. Th treatment: Amphotericin B in 146 patients, Ketoconazole - 88, Itraconazole - 56, Sulfonamide derivatives - 146 and Terbinafine in 3. The lethality index resulting from the disease or its treatment was 2.0%. Conclusions - The high number of cases, showing the regional relevance of the disease and the high percentage of tegumentary complaints and the high number of relapsing are remarkable.

Antimicrobial activity of essential oils from plants used in Brazilian popular medicine

Essential oils from, Salvia officinalis L. (SO), Mentha sylvestris L. (MS), Casearia sylvestris Sw. (CS), Mentha piperita L. (MP), Ocimum micrantum Willd. (OM) and Mentha arvensis L. (MA), plants used in Brazilian popular medicine were extracted using method I, as described in the Brazilian Pharmacopoeia, in order to obtain the phytochemical profile and to evaluate their antimicrobial activity against the following microorganisms: Bacillus subtilis, Staphylococcus aureus, Micrococcus luteus, Escherichia coli, Serratia marcescens, Candida albicans and Aspergilus oryzae. Test was made by means of the disk-plaque diffusion test in liquid medium using 1% essential oil. In the disk-plaque diffusion test, all the essential oils exhibited activity against B. subtilis, but OM showed the greatest inhibition zone and was the only one to show activity against S. aureus. Samples of SO, MS, MP, OM and MA were active against M. luteus, E. coli and S. marcescens, while A. oryzae was sensitive to MS, MP, OM and MA. No sample, however, was active against C. albicans. In the liquid medium test, significant results were observed for OM and MA, which inhibited the growth of all microorganisms for 24 hours, and OM continued active against E. coli and A. oryzae until the last reading.

Production of Ti-35Nb alloy by powder metallurgy for aerospace application

Titanium and its alloys provide high strength-to-weight ratios, good fatigue strength and increased corrosion resistance compared with others materials. Its acceptance in aerospace has been limited by costs considerations such as high cost of raw material, high buy-to-fly ratios and expensive machining operations. Significant cost reductions can be obtained by vacuum sintering and powder metallurgy (P/M) techniques by producing near net shapes and consequently minimizing material waste and machining time. The Ti 35Nb alloy exhibit a low modulus of elasticity. Stemming from the unique combination of high strength, low modulus of elasticity and low density, this alloy is intrinsically more resistant to shock and explosion damages than most other engineering materials. Samples were produced by mixing of initial metallic powders followed by uniaxial and cold isostatic pressing with subsequent densification by sintering between 900 and 1600 °C, in vacuum. Sintering behavior was studied by means of dilatometry. Sintered samples were characterized for phase composition, microstructure and microhardness by X-ray diffraction, scanning electron microscopy and Vickers indentation, respectively. Density was measured by Archimedes method. Copyright © 2004 Society of Automotive Engineers, Inc.

Characterization of cure of carbon/epoxy prepreg used in aerospace field

Carbon/epoxy 8552 prepreg is a thermoplastic toughened high-performance epoxy being used in the manufacture of advanced army material. Understanding the cure behavior of a thermosetting system is essential in the development and optimization of composite fabrication processes. The cure kinetics and rheological behavior were evaluated using a differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA) and a rheometer. Values of the kinetic parameters were obtained from dynamic DSC scans using an nth order reaction model. Rheological measurements as a function of temperature and time were made for the prepreg system. The manufacturer's recommended cure cycle was evaluated and considered adequate to consolidated the studied system.

Students' preferred teaching techniques for biochemistry in biomedicine and medicine courses

The aim of this study was to investigate the students' preferred teaching techniques, such as traditional blackboard, power-point, or slide-projection, for biochemistry discipline in biomedicine and medicine courses from São Paulo State University, UNESP, Botucatu, São Paulo, Brazil. Preferences for specific topic and teaching techniques were determined from questionnaires on a Liquert scale from 1 to 5 (strongly disagree; disagree; neither agree, nor disagree; agree; strongly agree) distributed at the end of biochemistry discipline to 180 biomedical students (30 students/year) and 540 medical students (90 students/year), during the years 2000-2005. Despite of the different number of hours applied to the course topics for the two groups of students, the majority of undergraduates from biomedicine and medicine preferred metabolic topics. Although the perception of a medical student is expected to be different than that of a biomedical student, as the aims of the two programs are different, 92.4% of students from each course agreed or strongly agreed with the biochemistry topics, and 92.1% thought highly on this subject. The majority of students, a number of 139 undergraduates from biomedicine and 419 from medicine course, preferred traditional blackboard teaching than slide-projection, or power-point class. In conclusion, it is imperative that the health courses reflect on sophisticated technology and data presentation with high density of information in biochemistry discipline. The traditional classes with blackboard presentation were most favored by students from biomedicine and medicine courses. The use of students' preferred teaching techniques might turn biochemistry more easily understood for biomedical and medical students. © 2007 by The International Union of Biochemistry and Molecular Biology.

Measuring the efficiency of outsourcing: An illustrative case study from the aerospace industry

Outsourcing is related to the action which an organization deals with its suppliers through a kind of business contract where a specific activity or service has been hired to be made. The outsourcing of some activities has become a common practice in the industry, nowadays. It reduces costs, significantly, in the production process and, at the same time, adds some values to the business organization. However it is necessary to measure the performance of these activities. Data Envelopment Analysis (DEA) is a non-parametric method useful to measure comparative performance. It has a wide range of applications measuring comparative efficiency. The Analytic Hierarchy Process (AHP) is a multiple criteria decision-making method that uses hierarchic structures to represent a decision problem and then develops priorities for the alternatives based on the decision-maker's judgments. This paper presents an integrated application based on DEA and AHP to evaluate the efficiency of subcontracted companies in a Brazilian aerospace factory. © 2007 Springer-Verlag London Limited.

Ozone therapy in medicine and dentistry

Aim: The purpose of this review is to present the potential for the incorporation of ozone therapy into the practice of dentistry. Background: Ozone gas has a high oxidation potential and is 1.5 times greater than chloride when used as an antimicrobial agent against bacteria, viruses, fungi, and protozoa. It also has the capacity to stimulate blood circulation and the immune response. Such features justify the current interest in its application in medicine and dentistry and have been indicated for the treatment of 260 different pathologies. It can be used for the treatment of alveolitis as a replacement for antibiotic therapy, as a mouthwash for reducing the oral microflora, as well as the adherence of microorganisms to tooth surfaces. Ozone has been shown to stimulate remineralization of recent caries-affected teeth after a period of about six to eight weeks. Conclusion: The future of ozone therapy must focus on the establishment of safe and well-defined parameters in accordance with randomized, controlled trials to determine the precise indications and guidelines in order to treat various medical and dental pathologies. Scientific support, as suggested by demonstrated studies, for ozone therapy presents a potential for an atraumatic, biologically-based treatment for conditions encountered in dental practice.

Highlights from the I international symposium of thrombosis and anticoagulation in internal medicine, October 23-25, 2008, Sao Paulo, Brazil

The importance of thrombosis and anticoagulation in clinical practice is rooted firmly in several fundamental constructs that can be applied both broadly and globally. Awareness and the appropriate use of anticoagulant therapy remain the keys to prevention and treatment. However, to assure maximal efficacy and safety, the clinician must, according to the available evidence, choose the right drug, at the right dose, for the right patient, under the right indication, and for the right duration of time. The first International Symposium of Thrombosis and Anticoagulation in Internal Medicine was a scientific program developed by clinicians for clinicians. The primary objective of the meeting was to educate, motivate and inspire internists, cardiologists and hematologists by convening national and international visionaries, thought-leaders and dedicated clinician-scientists in Sao Paulo, Brazil. This article is a focused summary of the symposium proceedings. © Springer Science+Business Media, LLC 2009.

Digital radiography for the inspection of weld seams of pipelines - better sensitivity

Conventional radiography, using industrial radiographic films, has its days numbered. Digital radiography, recently, has taken its place in various segments of products and services, such as medicine, aerospace, security, automotive, etc. As well as the technological trend, the digital technique has brought proven benefits in terms of productivity, sensitivity, the environment, tools for image treatment, cost reductions, etc. If the weld to be inspected is on a serried product, such as, for example, a pipe, the best option for the use of digital radiography is the plane detector, since its use can reduce the length of the inspection cycle due to its high degree of automation. This work tested welded joints produced with the submerged arc process, which were specially prepared in such a way that it shows small artificial cracks, which served as the basis forcomparing the sensitivity levels of the techniques involved. After carrying out the various experiments, the digital meth odshowed the highest sensitivity for the image quality indicator (IQI) of the wire and also in terms of detecting small discontinuities, indicating that the use of digital radiography using the plane detector had advantages over the conventional technique (Moreira et al. Digital radiography, the use of plane detectors for the inspection of welds in oil pipes and gas pipes.9th COTEQ and XXV National Testing Congress for Non Destructive Testing and Inspection; Salvador, Bahia, Brazil and Bavendiek et al. New digital radiography procedure exceeds film sensitivity considerably in aerospace applications. ECNDT; 2006; Berlin). The works were carried out on the basis of the specifications for oil and gas pipelines, API 5L 2004 edition (American Petroleum Institute. API 5L: specification for line pipe. 4th ed. p. 155; 2004) and ISO 3183 2007 edition (International Organization for Standardization, ISO 3183. Petroleum and gas industries - steel pipes for pi pelines transportation systems. p. 143; 2007). © 2010 Taylor & Francis.

Supply chain risk management: An exploratory research in Brazilian aerospace industry

This paper aimed to analyse supply chain risk factors in aerospace industry. It was conducted an exploratory research at an important Brazilian aerospace company. This company has a major role at the global aerospace industry. Senior managers assessed risk factors such as quality, productivity, supply chain, business strategy, organisation, environmental and natural political, indicators, product management, and information system. Analytic hierarchy process was applied to prioritise these factors. The most relevant were quality and productivity. Copyright © 2011 Inderscience Enterprises Ltd.

Development of silicon carbide substrates for aerospace applications

Payload and high-tech are important characteristics when the goals are aerospace applications. The development of the technologies associated to these applications has interests that transcend national boundaries and are of strategic importance to the nations. Ultra lightweight mirrors, supports and structures for optical systems are important part of this subject. This paper reports the development of SiC substrates, obtained by pressing, to be applied on embedded precision reflective optics. Different SiC granulometries, having YAG as sintering additive, were processed by: ball milling, drying and deagglomeration, sift, uniaxial and isostatic pressing, and, finally, argon atmosphere sintering at 1900°C. Different porosities were obtained according to the amount of organic material added. Into one side of the samples pellets of organic material were introduced to generate voids to reduce the weight of samples as a whole. The substrates were grinding and polished, looking for a SiC surface having low porosity, as porosity is directly related to light scattering that should be avoided on optical surfaces. Laser surface treatments were applied (using or not SiC barbotine) as a method to improve the surface quality. The samples were characterized by optical and laser confocal microscopy, roughness measurements and mechanical tests. The results are very promissory for future applications. © 2012 Materials Research Society.

Annona sp: Plants with multiple applications as alternative medicine - a review

Annona species have been used as a natural remedy for a variety of illnesses with antiparasitic, antispasmodic, antidiarrheal, antiulcer, sedative, analgesic, hypotensive, and vermifugal effects. These properties are due to the presence of a number of bioactive compounds on the leaves, fruit, seeds, and stem. The aim of this review is to show the main species of Annona, their medicinal properties and the chemical constituents that may be related to these effects. In the leaves it is possible to find acetogenins, annopentocins A, B, and C, cis- and trans-annomuricin-D-ones, goniothalamicin, arianacin, and javoricin, related to anticancer properties. Quercetin-3-O-glucoside, also found in the leaves mediates antidiabetic and antioxidative effects. In the fruit are found annonaine, nornuciferine and asimilobine, associated to antidepressive effects. In the seeds are found muricatetrocin A and muricatetrocin B, longifolicin, corossolin, corossolone, uvarigrandin A, bullatacin, squamotatin. These acetogenins are associated with anticancer effects. Cyclosquamosin B, quercetin, and cyclosquamosin from the seeds have respectively vasorelaxant, antithyroidal and, antiinflammatory activity. In the stem parts there are several components as N-trans-feruloyltyramine, N-p-coumaroyltyramine, and N-trans-caffeoyltyramine, lignans, syringaresinol, syringaldehyde, beta-sitosterol and beta-sitosterol-beta-D-glucoside which exhibit antiplatelet aggregation activity. Copaene, patchoulane, 1H-cycloprop (e) azulene and kaur-16-en-19-oic acid found in the barks exhibit significant central as well as peripheral analgesic and antiinflammatory activities. The properties of the biological compounds in Annona species support information that may provide validation for its medicinal uses, but further studies should be performed to establish ideal and safe doses of consumption to ensure the effectiveness of the benefits. © 2012 Bentham Science Publishers.