Preliminary core sets of measures for disease activity and damage assessment in juvenile systemic lupus erythematosus and juvenile dermatomyositis

Objective. To identify preliminary core sets of outcome variables for disease activity and damage assessment in juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). Methods. Two questionnaire surveys were mailed to 267 physicians from 46 different countries asking each member to select and rank the response variables used when assessing clinical response in patients with JSLE or JDM. Next, 40 paediatric rheumatologists from 34 countries met and, using the nominal group technique, selected the domains to be included in the disease activity and damage core sets for JSLE and JDM. Results. A total of 41 response variables for JSLE and 37 response variables for JDM were selected and ranked through the questionnaire surveys. In the consensus conference, domains selected for both JSLE and JDM activity or damage core sets included the physician and parent/patient subjective assessments and a global score tool. Domains specific for JSLE activity were the immunological tests and the kidney function parameters. Concerning JDM, functional ability and muscle strength assessments were indicated for both activity and damage core sets, whereas serum muscle enzymes were included only in the activity core set. A specific paediatric domain called 'growth and development' was introduced in the disease damage core set for both diseases and the evaluation of health-related quality of life was advised in order to capture the influence of the disease on the patient lifestyle. Conclusions. We developed preliminary core sets of measures for disease activity and damage assessment in JSLE and JDM. The prospective validation of the core sets is in progress.

Spinning reserve opportunity cost in hydroelectric plants

Starting from the deregulated process of the Electric Sector, there was the need to attribute responsibilities to several agents and to elaborate appropriate forms of remuneration of the services rendered by the same. One of the services of great importance within this new electric sector is the Ancillary Services. Among the various types of Ancillary Services, Spinning Reserve is a service necessary for maintaining the integrity of the transmission system from either generation interruptions or load variations. This paper uses the application of the Economic Dispatch theory with the objective of quantifies the availability of Spinning Reserve supply in hydroelectric plants. The proposed methodology utilizes the generating units as well as their efficiencies so as to attend the total demand with the minimum water discharge. The proposed methodology was tested through the data provided by the Água Vermelha Hydroelectric Power Plant. These tests permitted the opportunity cost valuation to the Spinning Reserve supply in hydroelectric plants. © 2005 IEEE.

Digital monitoring of broiler breeder behavior for assessment of thermal welfare

The assessment of welfare issues has been a challenge for poultry producers, and lately welfare standards needs to be reached in order to agree with international market demand. This research proposes the use of continuous behavior monitoring in order to contribute for assessing welfare. A software was developed using the language Clarium. The software managed the recording of data as well as the data searching in the database Firebird. Both software and the observational methodology were tested in a trial conducted inside an environmental chamber, using three genetics of broiler breeders. Behavioral pattern was recorded and correlated to ambient thermal and aerial variation. Monitoring video cameras were placed on the roof facing the used for registering the bird's behavior. From video camera images were recorded during the total period when the ambient was bright, and for analyzing the video images a sample of 15min observation in the morning and 15 min in the afternoon was used, adding up to 30 min daily observation. A specific model so-called behavior was developed inside the software for counting specific behavior and its frequency of occurrence, as well as its duration. Electronic identification was recorded for 24h period. Behavioral video recording images was related to the data recorded using electronic identification.. Statistical analysis of data allowed to identify behavioral differences related to the change in thermal environment, and ultimately indicating thermal stress and departure from welfare conditions.

Scanning electron microscope assessment of several resharpening techniques on the cutting edges of gracey curettes

Aim: Treatment of periodontal diseases is based on efficient scaling and root planing (SRP) and adequate maintenance of the patient. The effectiveness of SRP is influenced by operator skill, access to the subgingival area, root anatomy, and the quality and type of instrument used for SRP. The aim of this study was to evaluate the cutting edges of Gracey curettes after manufacturing and after resharpening using several techniques. Methods and Material: The cutting edges of a total of 41 new #5-6 stainless steel Gracey curettes were evaluated blindly using scanning electron microscopy (SEM). The quality of the cutting edges was evaluated blindly by a calibrated examiner using micrographs. Data were analyzed using a Kruskal Wallis test and nonparametric two-way multiple comparisons. Results and Conclusions: Different sharpening techniques had significantly different effects on the sharpeness of cutting edges (p<0.05). Sharpening by passing the lateral face of curettes over a sharpening stone and then a #299 Arkansas stone produced a high frequency of smooth, sharp edges or slightly irregular edges between the lateral and coronal faces of the curettes. Sharpening by passing a blunt stone over the curette's lateral face produced the poorest quality cutting edge (a bevel). Sharpening of the coronal curette face produced extremely irregular cutting edges and non-functional wire edges. Sharpening with rotary devices produced extremely irregular cutting edges.

In vitro assessment of pulp chamber temperature of different teeth submitted to dental bleaching associated with LED/laser and halogen lamp appliances

This study sought to assess the pulp chamber temperature in different groups of human teeth that had been bleached using hydrogen peroxide gel activated with halogen lamps or hybrid LED/laser appliances. Four groups of ten teeth (maxillary central incisors, mandibular incisors, mandibular canines, and maxillary canines) were used. A digital thermometer with a K-type thermocouple was placed inside pulp chambers that had been filled with thermal paste. A 35% hydrogen peroxide-based red bleaching gel was applied to all teeth and photocured for a total of three minutes and 20 seconds (five activations of 40 seconds each), using light from an LED/laser device and a halogen lamp. The temperatures were gauged every 40 seconds and the data were analyzed by three-way ANOVA, followed by Tukey's test. Regardless of the light source, statistically significant differences were observed between the groups of teeth. The mean temperature values (±SD) were highest for maxillary central incisors and lowest for mandibular canines. The halogen lamp appliance produced more pulp chamber heating than the LED/laser appliance. The increase in irradiation time led to a significant increase in temperature.

Running behavior and its energy cost in mice selectively bred for high voluntary locomotor activity

Locomotion is central to behavior and intrinsic to many fitnesscritical activities (e.g., migration, foraging), and it competes with other life-history components for energy. However, detailed analyses of how changes in locomotor activity and running behavior affect energy budgets are scarce. We quantified these effects in four replicate lines of house mice that have been selectively bred for high voluntary wheel running (S lines) and in their four nonselected control lines (C lines). We monitored wheel speeds and oxygen consumption for 24-48 h to determine daily energy expenditure (DEE), resting metabolic rate (RMR), locomotor costs, and running behavior (bout characteristics). Daily running distances increased roughly 50%-90% in S lines in response to selection. After we controlled for body mass effects, selection resulted in a 23% increase in DEE in males and a 6% increase in females. Total activity costs (DEE - RMR) accounted for 50%-60% of DEE in both S and C lines and were 29% higher in S males and 5% higher in S females compared with their C counterparts. Energetic costs of increased daily running distances differed between sexes because S females evolved higher running distances by running faster with little change in time spent running, while S males also spent 40% more time running than C males. This increase in time spent running impinged on high energy costs because the majority of running costs stemmed from postural costs (the difference between RMR and the zero-speed intercept of the speed vs. metabolic rate relationship). No statistical differences in these traits were detected between S and C females, suggesting that large changes in locomotor behavior do not necessarily effect overall energy budgets. Running behavior also differed between sexes: within S lines, males ran with more but shorter bouts than females. Our results indicate that selection effects on energy budgets can differ dramatically between sexes and that energetic constraints in S males might partly explain the apparent selection limit for wheel running observed for over 15 generations. © 2009 by The University of Chicago. All rights reserved.

The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

Background: Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). Methods: Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. Results: Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. Conclusion: Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies. Copyright © 2010 International Psychogeriatric Association.

Clinical assessment of ethinylestradiol and cyproterone acetate in menstrual irregularities of hyper-androgenic origin

We report on the results of a double-blind, randomized, controlled clinical trial comparing two preparations of ethinylestradiol and cyproterone acetate in the treatment of women of reproductive age presenting menstrual irregularities of hyper-androgenic origin. After obtaining informed consent, subjects were randomized to a 4-month treatment period consisting of one daily dose of 0.035mg ethinylestradiol + 2mg cyproterone acetate. The treatment regimen cycle consisted of one pill, once daily for 21 days, followed by a 7-day pill-free period. We compared the efficacy of two presentations of the drug combination after each treatment cycle (Visits 2, 3, 4, and 5) in establishment and maintenance of menstrual regulation, intensity of menstrual flow, and dysmenorrhea, as well as a comparison of the two presentations in terms of Global Satisfaction and Drug Satisfaction assessments performed by the patients and the investigating physician. At each study visit, drug compliance and use of concomitant medications, as well as incidence, severity and duration of adverse events were recorded. A total of 86 subjects were randomized to treatment, with 43 subjects in each treatment group. At Visit 2 and each subsequent visit, all patients in both treatment groups reported an episode of withdrawal bleeding during the 7-day hormone-free period. We observed a statistically significant (p<0.0001) decrease in the incidence of dysmenorrhea at each study visit in relation to the pretreatment assessment. There was a significant reduction (p<0.0001) in the number of subjects reporting intermenstrual bleeding at each study visit in both treatment groups. Global Satisfaction scores by the patient and physician increased significantly at each successive study visit in both treatment groups. There were no clinically significant changes in vital signs, weight, and body mass index throughout the study period in either group. The number of subjects reporting adverse events at each visit did not vary between treatment groups. The combined oral contraceptive pill containing ethinylestradiol and cyproterone acetate was found to be both effective and safe in the menstrual irregularities of hyper-androgenic origin (amenorrhea, dysmenorrhea, and intermenstrual bleeding) assessed in this study. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

The energetic cost of maintenance in ruminants: From classical to new concepts and prediction systems

The cost of maintenance makes up a large part of total energy costs in ruminants. Metabolizable energy (ME) requirement for maintenance (MEm) is the daily ME intake that exactly balances heat energy (HE). The net energy requirement for maintenance (NEm) is estimated subtracting MEm from the HE produced by the processing of the diet. Men cannot be directly measured experimentally and is estimated by measuring basal metabolism in fasted animals or by regression measuring the recovered energy in fed animals. MEm and NEm usually, but not always, are expressed in terms of BW0.75. However, this scaling factor is substantially empirical and its exponent is often inadequate, especially for growing animals. MEm estimated by different feeding systems (AFRC, CNCPS, CSIRO, INRA, NRC) were compared by using dairy cattle data. The comparison showed that these systems differ in the approaches used to estimate MEm and for its quantification. The CSIRO system estimated the highest MEm, mostly because it includes a correction factor to increase ME as the feeding level increases. Relative to CSIRO estimates, those of NRC, INRA, CNCPS, and AFRC were on average 0.92, 0.86, 0.84, and 0.78, respectively. MEm is affected by the previous nutritional history of the animals. This phenomenon is best predicted by dynamic models, of which several have been published in the last decades. They are based either on energy flows or on nutrient flows. Some of the different approaches used were described and discussed.

Straightforward systematic approach for fuel efficiency and emissions assessment in automotive systems

At this time, each major automotive market bares its own standards and test procedures to regulate the vehicle green house gases emissions and, thus, fuel consumption. Hence, much are the ways to evaluate the overall efficiency of motor vehicles. The majority of such standards rely on dynamometer cycle tests that appraise only the vehicle as a whole, but fail to assess emissions for each component or sub-system. Once the amount of work generated by the power source of an ICE vehicle to overcome the driving resistance forces is proportional to the energy contained in the required amount of fuel, the power path of the vehicle can be straightforwardly modeled as a set of mechanical systems, and each sub-system evaluated for its share on the total fuel consumption and green house gases emission. This procedure enables the estimation of efficiency gains on the system due to improvement of particular elements on the vehicle's driveline. In this work a simple systematic mechanical model of an arbitrary smallsized hatch back was assembled and total required energy calculated for different regulatory cycles. All the modeling details of the energy balance throughout the system are presented. Afterward, each subsystem was investigated for its role on the fuel consumption and the generated emission quantified. Furthermore, the application of the modeling technique for different sets of sub-systems was introduced. Copyright © 2011 SAE International.

Continuous measurement of cerebral oxygen saturation (rSO 2) for assessment of cardiovascular status during hemorrhagic shock in a swine model

Background: Early trauma care is dependent on subjective assessments and sporadic vital sign assessments. We hypothesized that near-infrared spectroscopy-measured cerebral oxygenation (regional oxygen saturation [rSO 2]) would provide a tool to detect cardiovascular compromise during active hemorrhage. We compared rSO 2 with invasively measured mixed venous oxygen saturation (SvO2), mean arterial pressure (MAP), cardiac output, heart rate, and calculated pulse pressure. Methods: Six propofol-anesthetized instrumented swine were subjected to a fixed-rate hemorrhage until cardiovascular collapse. rSO 2 was monitored with noninvasively measured cerebral oximetry; SvO2 was measured with a fiber optic pulmonary arterial catheter. As an assessment of the time responsiveness of each variable, we recorded minutes from start of the hemorrhage for each variable achieving a 5%, 10%, 15%, and 20% change compared with baseline. Results: Mean time to cardiovascular collapse was 35 minutes ± 11 minutes (54 ± 17% total blood volume). Cerebral rSO 2 began a steady decline at an average MAP of 78 mm Hg ± 17 mm Hg, well above the expected autoregulatory threshold of cerebral blood flow. The 5%, 10%, and 15% decreases in rSO 2 during hemorrhage occurred at a similar times to SvO2, but rSO 2 lagged 6 minutes behind the equivalent percentage decreases in MAP. There was a higher correlation between rSO 2 versus MAP (R =0.72) than SvO2 versus MAP (R =0.55). Conclusions: Near-infrared spectroscopy- measured rSO 2 provided reproducible decreases during hemorrhage that were similar in time course to invasively measured cardiac output and SvO2 but delayed 5 to 9 minutes compared with MAP and pulse pressure. rSO 2 may provide an earlier warning of worsening hemorrhagic shock for prompt interventions in patients with trauma when continuous arterial BP measurements are unavailable. © 2012 Lippincott Williams & Wilkins.

Assessment of the chemical profile, polyphenol content and antioxidant activity in extracts of Psidium Guajava L. fruits

Fruits and vegetables that are rich in polyphenolic compounds, especially flavonoids, may be used to benefit human health by reducing the incidence of cancers and cardiovascular diseases. Previous studies have demonstrated the antioxidant activity of guava, a fruit widely available in Brazil, possibly due to the presence of these polyphenolic compounds. The aim of this study was to analyze the total phenolic and flavonoid contents of various guava extracts, assay their antioxidant activity and record the chromatographic profiles of these extracts, to determine a simple and low way of extracting these compounds efficiently from guava. The results confirmed the presence of polyphenols in guava, including flavonoids, and its antioxidant activity. Furthermore, it was demonstrated that the 70% ethanol (by volume) was the most effective solvent to extract these compounds from the fruit, among those tested.

An assessment of a sequence of yoga exercises to patients with arterial hypertension

This quasi-experimental study describes the effects of a yoga sequence following hemodynamic and biochemical parameters in patients with hypertension. Thirty-three volunteers participated in the study (control = 16 and yoga = 17) for four months. Blood pressure measurements, cardiac and respiratory rate were collected monthly, while the biochemical profile was taken at the beginning and end of the program. To analyze the data, Student's t test and repeated measures analyses were performed. The yoga group showed a significant reduction of systolic blood pressure, heart and respiratory rate (p < 0.05). As for the biochemical profile, the yoga group showed correlation coefficients between initial values and final responses greater than the control of fasting glucose, total cholesterol, LDL-cholesterol and triglycerides. The elaborated sequence practice promoted significant cardiovascular and metabolic benefits. The yoga exercises performed in the proposed sequence constitute complementary non-pharmacological control of blood pressure in patients with hypertension. © 2012 Elsevier Ltd.

Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine.

Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.