Dimensionamento de um edifício destinado a centro de dia para idosos e creche

Trabalho de Projeto para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização em Estruturas

Considerações anatómicas sobre o envelhecimento do aparelho estomatognático

Introdução: com o crescente aumento da expectativa de vida, o conhecimento das alterações anatómicas e fisiológicas que ocorrem no aparelho estomatognático durante o envelhecimento é de suma importância para a correta avaliação do paciente idoso. Objetivos: descrição e abordagem das principais estruturas anatómicas do indivíduo, adulto e idoso. Estabelece-se uma anatomia comparativa e evolutiva durante o processo de envelhecimento. Pretende-se contribuir para o conhecimento e reflexão sobre o tema em questão e demonstrar a aplicabilidade deste conhecimento em contexto clínico. Métodos: realizou-se pesquisa bibliográfica, nas bases de dados Pubmed, b-on SciElo e Elsevier, no período entre 2006-2016. Resultados: Maxila - ocorre reabsorção óssea, alteração no contorno do arco da maxila, retrusão maxilar, rotação da maxila no sentido horário, diminuição gradual e constante do ângulo maxilar e redução vertical da altura maxilar. Mandíbula - aumento do ângulo da mandíbula, diminuição da densidade e volume ósseo. Articulação gonfose e Articulação Temporo-Mandibular - pode ocorrer tanto anquilose, como perda das estruturas de suporte. Observa-se degeneração e/ou perfuração do disco radicular e alteração do formato do côndilo. Dentes - cáries radiculares, fraturas dentárias e desgaste dentário. Ocorrem modificações histológicas no esmalte, dentina e polpa dentária. Periodonto: reabsorção do osso alveolar, gengiva atrófica com tendência a migração apical, deposição apical das camadas incrementais e desgaste de cemento exposto, ligamento periodontal fino, irregular e diminuição do espaço periodontal. Conclusões: as alterações anatómicas decorrentes do envelhecimento fisiológico são múltiplas. O Médico Dentista diante de um paciente idoso, deverá conhecer e distinguir entre uma alteração decorrente do envelhecimento fisiológico e uma alteração patológica, para o correto diagnóstico clínico e uma excelente decisão terapêutica. O Médico Dentista deverá contribuir para o envelhecimento saudável e para tal deve ser conhecedor em pleno da temática do presente trabalho.

A formação de educadores para a pedagogia da alternância no Brasil nos movimentos italiano e francês: limitações e possibilidades

The Pedagogy of Alternation (PA), it is a type of education designed to rural people, whose perspective on the idea of combining theory and practice, alternating different times and spaces. On the Brazil, this education modality act from the perspective of two movements: Italian and French. Because it is a distinct mode of traditional, recommends that educators who work in this context also have a different outline. In this sense, it is relevant that there is a training for the educators that meets their needs. It is in these by understand how is the training of these professionals that the study proposes to analyze the educators training processes of PA on Brazil in movements Italian and French, presenting differences and similarities between them. For this, part it of a bibliographic and documental research, which were make initially theoretical surveys about expansion context of method, as well as theirtheoreticalandmethodologicalfoundationsandthePublicPolicybyeducators training. Then, were analyzed educational documents of both movements, laws, ordinances, statutes and field diaries, in order to verify how occurs the educators training process, and from that were stablished differences and similarities between both. The results point that in both movements there were advances in training processes, and despite of there were many similarities in trajectory of the movement, a multitude of issues boosted significant differences. On the Italian movement notes a greater harmony with the original principles of the PA, more engagement and organization by the movement. Because keeps collaborate ships with public authorities and institutions, without, however, losing its autonomy in decision-making and referrals to preserve the principles and foundations of this educational modality. This has encouraged and strengthened the educator’s formation and consequently the quality of education. On the other hand, the French movement it is shown weakened, especially in the state of Paraná, in which the movement is weakened. The small number of students, among other factors, pushed the closure of classes and consequently schools, this has interfered with the continuity of the movement. Many are the limitations by which the French movement has passed, especially with regard to training of their teachers, however, the search for new partner ships, as well as the community and the redemption of the original principles and foundations can be a way to paralyze this retraction and strengthens it.

Caso imagiológico

Introdução: A tosse constitui um dos principais motivos de consulta médica e, apesar de na maioria dos casos ser de etiologia vírica ou alérgica, por vezes surgem diagnósticos inesperados. Caso Clínico: Criança do sexo feminino, 19 meses, sem antecedentes relevantes. Recorreu ao Serviço de Urgência por tosse produtiva há 3 semanas e rinorreia serosa, sem febre. Noção materna de dificuldade respiratória e recusa alimentar parcial. À admissão, polipneica, com tiragem subcostal e gemido expiratório. Auscultatoriamente, murmúrio vesicular globalmente diminuído, tempo expiratório aumentado e sibilos dispersos. Analiticamente sem alterações. A radiografia torácica evidenciou volumosa imagem quística no hemitórax direito. A TC to- rácica documentou estômago intratorácico. Foi submetida a laparoscopia que constatou hérnia do hiato paraesofágica. Após Fundoplicatura de Nissen ficou assintomática. Discussão: A hérnia do hiato é rara em idade Pediátrica, tendo sido um achado inesperado no caso clínico descrito. Consideramos assim que, apesar da sua raridade, as anomalias anatómicas devem ser consideradas no diagnóstico diferencial da tosse persistente.

Formulação e caracterização de matérias-primas para revestimento cerâmico Semi-Poroso com adição de chamote de telhas

The ceramics industry in Piauí is nowadays with 55 industries where 11 are in Teresina which is the mainstream of the state, producing 55 million shingles; in which 10 % is of this production is wasted being sometimes thrown on the margins of rivers, roads and highways provoking an environmental degradation. The main goal of this work is to verify the potential of producing semi porous ceramic using grog of shingles, on the first part of this work bodies-of-proof were produced from a basic formula of an industry, doping it with 5 %, 10 %, 15 % and 20 % in mass and in the second part of this work some bodies-of-proof were produced from a formula where one raw material was substituted by 50 % of grog and another substituting it all by grog, bodies-of-proof made of a basic formula previously announced was used for experiment control.The grog and the raw materials were characterized by: particle size analysis , thermal differential analysis, X ray diffraction , X ray fluorescence, an thermal gravimetric analysis and rational analyses. The bodies-of-proof were sintetisized in an industrial oven obeying the normal cycle adopted by an industry, with peak temperatures of 1135 oC and a fast burning cycle of 25 minutes having as energetic fuel liquefied petroleum gas . The pieces that were obtained by this were submersed in rehearsed physics of: water absorption of, apparent specific mass, apparent porosity, lineal retraction, rupture tension to the flexural and dilatometry; mineralogical analysis for X ray diffraction; and microstructural for electronic microscope of sweeping. For all the formulas with addition of grog, superior priorities to the requested by the requirements for semi porous and for the formula to F2-2,5 superior priorities to standard formulas which justifies the incorporation of the shingles in mass for the semi porous ceramic

Influência do teor de calcário no comportamento físico, mecânico e microestrutural de cerâmicas estruturais

There are ores of clay in Piauí State that are used for red structural ceramics, which are naturally contaminated with calcareous vein. This is one thing that impedes its exploration in an adequate way, especially for tile production. The present work aims at verifying the influence of the calcareous contents in the technological structural ceramics area, seeking to determine a maximum permissible calcareous proportion/contents in the ceramic mass using the patterns of the local industry production. For the consecution of this paper, it was characterized the clay and calcareous material by FRX, DRX, TGA and DTA. It was also configurated by extrusion and burnt in the temperatures of 850°C, 900°C, 950°C and 1000°C pieces of the corpus with 0, 5, 10, 15 e 20% of calcareous proportion. After that, it was carried out technological samples of linear retraction, water absortion, apparent porosity, specific apparent mass and mechanic resistance. The results showed the possibility of using calcareous in the ceramic mass and in some cases the technological properties got better

Desenvolvimento de cerâmica vermelha utilizando rejeitos da construção civil

The Industry of the Civil Construction has been one of the sectors that most contribute to the pollution of the environment, due to the great amount of residues generated by the construction, demolition and the extraction of raw material. As a way of minimizing the environmental impacts generated by this industry, some governmental organizations have elaborated laws and measures about the disposal of residues from the building construction (CONAMA - resolution 307). This work has as objective the reutilization of residues compound of sand, concrete, cement, red bricks and blocks of cement and mortar for the production of red ceramic, with the objective of minimizing costs and environmental impacts. The investigated samples contained 0% to 50% of residues in weight, and they were sintered at temperatures of 950°C, 1000°C, 1050°C, 1100°C and 1150°C. After the sinterization, the samples were submitted to tests of absorption of water, linear retraction, resistance to bending, apparent porosity, specific density, XRD and SEM. Satisfactory results were obtained in all studied compositions, with the possible incorporation of up to 50% of residues in ceramic mass without great losses in the mechanical strength, giving better results to the incorporation of 30% of residues in the fabrication of ceramic parts, such as roofing tiles, bricks masonry and pierced bricks

As atitudes e conhecimentos dos profissionais de saúde mental face aos grupos de ajuda mútua na doença mental no contexto público e privado

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Obtenção de filtro cerâmico a partir da diatomita e casca de arroz carbonizada visando tratamento de efluente têxtil

The effluents released by the textile industry have high concentrations of alkali, carbohydrates, proteins, in addition to colors containing heavy metals. Therefore, a filter was prepared aiming primarily to the removal of color. In order to prepare this filter, rice hulls and diatomite were used, which have in their structure, basically amorphous hydrated silica. The silica exists in three crystalline forms: quartz, tridymite and cristobalite. In accordance with the above considerations, this study was divided into two stages; the first corresponds to the preparation of the filter and the second to carry out the tests in the effluent/filter in order to verify the efficiency of the color removal. First, the raw material was subjected to a chemical analysis and XRD, and then the diatomite was mixed, via humid, with a planetarium windmill with 20 %, 40 %, 60 % and 80 % of rice husk ash. To the mixture, 5 % carboxymethylcellulose (CMC) was added as a binder at room temperature. The samples were uniaxially compacted into metallic matrix of 0.3 x 0.1 cm² of area at a pressure of 167 MPa by means of hydraulic press and then sintered at temperatures of 1,000 °C, 1,200 °C and 1,400 °C for 1 h and submitted to granulometry test using laser, linear retraction, water absorption, apparent porosity and resistance to bending, DTA, TMA and XRD. To examine the pore structure of the samples scanning electron microscope (SEM) was used. Also tests were carried out in a mercury porosimeter to verify the average size of the pores and real density of the samples. In the second stage, samples of the effluent were collected from a local industry, whose name will be preserved, located in Igapó, in the State of Rio Grande do Norte - RN. The effluent was first pretreated before filtration and then subjected to a treatment of flotation. The effluent was then characterized before and after filtration, with parameters of color, turbidity, suspended solids, pH, chemical and biochemical oxygen demand (COD and BOD). Thus, through the XRD analysis the formation of cristobalite α in all samples was observed. The best average size of pore was found to be 1.75 μm with 61.04 % apparent porosity, thus obtaining an average 97.9 % color removal and 99.8 % removal of suspended solid

Guided Migration and Collective Behavior: Cell Dynamics during Cancer Progression

This dissertation focuses on gaining understanding of cell migration and collective behavior through a combination of experiment, analysis, and modeling techniques. Cell migration is a ubiquitous process that plays an important role during embryonic development and wound healing as well as in diseases like cancer, which is a particular focus of this work. As cancer cells become increasingly malignant, they acquire the ability to migrate away from the primary tumor and spread throughout the body to form metastatic tumors. During this process, changes in gene expression and the surrounding tumor environment can lead to changes in cell migration characteristics. In this thesis, I analyze how cells are guided by the texture of their environment and how cells cooperate with their neighbors to move collectively. The emergent properties of collectively moving groups are a particular focus of this work as collective cell dynamics are known to change in diseases such as cancer. The internal machinery for cell migration involves polymerization of the actin cytoskeleton to create protrusions that---in coordination with retraction of the rear of the cell---lead to cell motion. This actin machinery has been previously shown to respond to the topography of the surrounding surface, leading to guided migration of amoeboid cells. Here we show that epithelial cells on nanoscale ridge structures also show changes in the morphology of their cytoskeletons; actin is found to align with the ridge structures. The migration of the cells is also guided preferentially along the ridge length. These ridge structures are on length scales similar to those found in tumor microenvironments and as such provide a system for studying the response of the cells' internal migration machinery to physiologically relevant topographical cues. In addition to sensing surface topography, individual cells can also be influenced by the pushing and pulling of neighboring cells. The emergent properties of collectively migrating cells show interesting dynamics and are relevant for cancer progression, but have been less studied than the motion of individual cells. We use Particle Image Velocimetry (PIV) to extract the motion of a collectively migrating cell sheet from time lapse images. The resulting flow fields allow us to analyze collective behavior over multiple length and time scales. To analyze the connection between individual cell properties and collective migration behavior, we compare experimental flow fields with the migration of simulated cell groups. Our collective migration metrics allow for a quantitative comparison between experimental and simulated results. This comparison shows that tissue-scale decreases in collective behavior can result from changes in individual cell activity without the need to postulate the existence of subpopulations of leader cells or global gradients. In addition to tissue-scale trends in collective behavior, the migration of cell groups includes localized dynamic features such as cell rearrangements. An individual cell may smoothly follow the motion of its neighbors (affine motion) or move in a more individualistic manner (non-affine motion). By decomposing individual motion into both affine and non-affine components, we measure cell rearrangements within a collective sheet. Finally, finite-time Lyapunov exponent (FTLE) values capture the stretching of the flow field and reflect its chaotic character. Applying collective migration analysis techniques to experimental data on both malignant and non-malignant human breast epithelial cells reveals differences in collective behavior that are not found from analyzing migration speeds alone. Non-malignant cells show increased cooperative motion on long time scales whereas malignant cells remain uncooperative as time progresses. Combining multiple analysis techniques also shows that these two cell types differ in their response to a perturbation of cell-cell adhesion through the molecule E-cadherin. Non-malignant MCF10A cells use E-cadherin for short time coordination of collective motion, yet even with decreased E-cadherin expression, the cells remain coordinated over long time scales. In contrast, the migration behavior of malignant and invasive MCF10CA1a cells, which already shows decreased collective dynamics on both time scales, is insensitive to the change in E-cadherin expression.

Estudo de massa cerâmica triaxial visando à otimização do ciclo de queima da indústria de cerâmica estrutural

Over recent years the structural ceramics industry in Brazil has found a very favorable market for growth. However, difficulties related to productivity and product quality are partially inhibiting this possible growth. An alternative for trying to solve these problems and, thus, provide the pottery industry the feasibility of full development, is the substitution of firewood used in the burning process by natural gas. In order to contribute to this process of technological innovation, this paper studies the effect of co-use of ceramic phyllite and kaolin waste on the properties of a clay matrix, verifying the possible benefits that these raw materials can give to the final product, as well as the possibility of such materials to reduce the heat load necessary to obtain products with equal or superior quality. The study was divided into two steps: characterization of materials and study of formulations. Two clays, a phyllite and a residue of kaolin were characterized by the following techniques: laser granulometry, plasticity index by Atterberg limits, X-ray fluorescence, X-ray diffraction, mineralogical composition by Rietveld, thermogravimetric and differential thermal analysis. To study the formulations, specifically for evaluation of technological properties of the parts, was performed an experimental model that combined planning involving a mixture of three components (standard mass x phyllite x kaolin waste) and a 23 factorial design with central point associated with thermal processing parameters. The experiment was performed with restricted strip-plot randomization. In total, 13 compositional points were investigated within the following constraints: phyllite ≤ 20% by weight, kaolin waste ≤ 40% by weight, and standard mass ≥ 60% by weight. The thermal parameters were used at the following levels: 750 and 950 °C to the firing temperature, 5 and 15 °C/min at the heating rate, 15 and 45min to the baseline. The results showed that the introduction of phyllite and/or kaolin waste in ceramic body produced a number of benefits in properties of the final product, such as: decreased absorption of water, apparent porosity and linear retraction at burn; besides the increase in apparent specific mass and mechanical properties of parts. The best results were obtained in the compositional points where the sum of the levels of kaolin waste and phyllite was maximal (40% by weight), as well as conditions which were used in firing temperatures of 950 °C. Regarding the prospect of savings in heat energy required to form the desired microstructure, the phyllite and the residue of kaolin, for having small particle sizes and constitutions mineralogical phases with the presence of fluxes, contributed to the optimization of the firing cycle.

Guided Migration and Collective Behavior: Cell Dynamics during Cancer Progression

This dissertation focuses on gaining understanding of cell migration and collective behavior through a combination of experiment, analysis, and modeling techniques. Cell migration is a ubiquitous process that plays an important role during embryonic development and wound healing as well as in diseases like cancer, which is a particular focus of this work. As cancer cells become increasingly malignant, they acquire the ability to migrate away from the primary tumor and spread throughout the body to form metastatic tumors. During this process, changes in gene expression and the surrounding tumor environment can lead to changes in cell migration characteristics. In this thesis, I analyze how cells are guided by the texture of their environment and how cells cooperate with their neighbors to move collectively. The emergent properties of collectively moving groups are a particular focus of this work as collective cell dynamics are known to change in diseases such as cancer. The internal machinery for cell migration involves polymerization of the actin cytoskeleton to create protrusions that---in coordination with retraction of the rear of the cell---lead to cell motion. This actin machinery has been previously shown to respond to the topography of the surrounding surface, leading to guided migration of amoeboid cells. Here we show that epithelial cells on nanoscale ridge structures also show changes in the morphology of their cytoskeletons; actin is found to align with the ridge structures. The migration of the cells is also guided preferentially along the ridge length. These ridge structures are on length scales similar to those found in tumor microenvironments and as such provide a system for studying the response of the cells' internal migration machinery to physiologically relevant topographical cues. In addition to sensing surface topography, individual cells can also be influenced by the pushing and pulling of neighboring cells. The emergent properties of collectively migrating cells show interesting dynamics and are relevant for cancer progression, but have been less studied than the motion of individual cells. We use Particle Image Velocimetry (PIV) to extract the motion of a collectively migrating cell sheet from time lapse images. The resulting flow fields allow us to analyze collective behavior over multiple length and time scales. To analyze the connection between individual cell properties and collective migration behavior, we compare experimental flow fields with the migration of simulated cell groups. Our collective migration metrics allow for a quantitative comparison between experimental and simulated results. This comparison shows that tissue-scale decreases in collective behavior can result from changes in individual cell activity without the need to postulate the existence of subpopulations of leader cells or global gradients. In addition to tissue-scale trends in collective behavior, the migration of cell groups includes localized dynamic features such as cell rearrangements. An individual cell may smoothly follow the motion of its neighbors (affine motion) or move in a more individualistic manner (non-affine motion). By decomposing individual motion into both affine and non-affine components, we measure cell rearrangements within a collective sheet. Finally, finite-time Lyapunov exponent (FTLE) values capture the stretching of the flow field and reflect its chaotic character. Applying collective migration analysis techniques to experimental data on both malignant and non-malignant human breast epithelial cells reveals differences in collective behavior that are not found from analyzing migration speeds alone. Non-malignant cells show increased cooperative motion on long time scales whereas malignant cells remain uncooperative as time progresses. Combining multiple analysis techniques also shows that these two cell types differ in their response to a perturbation of cell-cell adhesion through the molecule E-cadherin. Non-malignant MCF10A cells use E-cadherin for short time coordination of collective motion, yet even with decreased E-cadherin expression, the cells remain coordinated over long time scales. In contrast, the migration behavior of malignant and invasive MCF10CA1a cells, which already shows decreased collective dynamics on both time scales, is insensitive to the change in E-cadherin expression.

Desenvolvimento de argamassa para restauração utilizando resíduo do polimento do porcelanato

The coatings mortars are essential elements of building structures because they execute an important role in protecting walls and are particularly exposed to aggressive action responsible for its degradation over time. The importance of wall coverings has been the subject of discussion and analysis in the conservation and rehabilitation of old buildings. Are sometimes removed and replaced with inappropriate solutions of constructive point of view or architecture. The most commonly used coatings on walls of old buildings is based on traditional hydraulic lime mortars. The present study aims at the formulation of new lime- based mortars and aerial fine aggregate, in order to contribute to a better field of conservation and restoration mortar coating of old buildings. Residue was used for polishing porcelain as fine aggregate, replacing the aggregate (sand), in percentages 05-30% by mass. We conducted a thorough evaluation of the mortar properties in fresh and hardened state by comparing the performance of the same with a reference mortar. The residue used was characterized as the density, bulk density, and particle size laser, scanning electron microscopy, X-ray diffraction and X-ray fluorescence. Formulations were produced 7, 6 with residue and one commonly used formulation, which served as a reference. In the formulations of lime mortars air (hydrated lime powder CH-I) has been adopted a stroke volume (1:3) with constant binder, was varied and the water / binder and aggregate and waste. For evaluation of mortars fresh, proceeded to consistency analysis, specific gravity, water retention and air content embedded. In the hardened state assays were performed in specific gravity, water retention, modulus of elasticity, tensile strength in bending, compressive strength, water absorption by capillary action, adhesion, tensile strength, resistance to shrinkage and salts by of crystallization trials with resources chloride solution, nitrate and sulfate all sodium in prismatic at 90 days of age, in addition to the micro structural analysis of mortars. Based on the results we can see that the mortar formulated with 10% content of waste and the reference free retraction feature more stable closer to neutrality. The composition of 10% was obtained better performance against the action of the salt crystallization. The mortar with 15% residue obtained better density, lower air content embedded and high capacity for water retention developing good workability. The replacement of 20% of waste generates a satisfactory utilization of resistance to compression, flexion and traction grip the base. And, finally, it can be seen that the mortar with 10, 15 and 20% residual show, in principle, good suitability as coatings, thus enabling a final result consistent with durability, workability and aesthetics developing therefore a material with better performance to repair or replace existing mortars in old buildings

Aproveitamento de resíduo de beneficiamento do caulim na produção de porcelanato cerâmico

Nowadays, industries from all sectors have great concerns over the disposition of the residues generated along the productive process. This is not different in the mineral sector, as this generates great volumes of residues. It was verified that the kaolin improvement industry generates great volumes of residue basically constituted of kaolinite, muscovite mica and quartz, which are basic constitution elements to formularisations of ceramics masses to the production of covering of stoneware tiles type. This happens because the methodology applied to the improvement process is still very rudimentary, what causes a very low yield, only ¼ from all the material volume that enters the improvement process, in the end, is marketable. The disposal of this residue, in a general way, causes a very big negative environmental impact, what has justified the researches efforts aiming to find a rational solution to this problem. In this way, the intention of this present work is the utilization of this residue in the manufacture of products to high quality ceramics covering, stoneware tiles in an industrial scale. For this purpose, the influence of the addition of the residue to a standard ceramics mass used by a ceramics sector company, already established in the market, with the intention of verifying the possibility of use of this residue as the mass complementary raw material and even the possible partial or total substitution of one of the components of the mass for the raw material in evidence will be studied. To the accomplishment of this work, the kaolin improvement residue generated by an industry of exploitation and improvement of kaolin, located in the region of Equador-RN, in the levels 1,2,4,8, 16 and 32% will be added to the standard mass already used for the production of stoneware tiles. The raw materials used, kaolin residue and the standard mass, were characterized through DRX, FRX, DTA, TGA and dilatometry. After the sintering of the bodies of test, tests of water absorption, apparent porosity, post burning linear retraction, apparent specific mass and flexural strength (3 point bending) were realized to determinate the technological properties of these materials. The results show the studied residue can be considered raw material of great potential to the industry of floor and ceramics covering of the stoneware tiles type

The prevalence of tympanic membrane and related middle ear pathology in children:a large longitudinal cohort study followed from birth to age ten

OBJECTIVE: To record with video-otoscopy the appearance of the tympanic membranes of a cross section of children aged 9 to 10 years. STUDY DESIGN: Cross-sectional study nested within an established longitudinal study of childhood development, the Avon Longitudinal Study of Parents and Children. SETTING: South West England, U.K. PARTICIPANTS: Approximately 6908 of 7261 children with ages ranging from 105 to 140 months born between April 1, 1991, and December 31, 1992, were examined by trained technicians with video-otoscopy. MAIN OUTCOME MEASURES: Two photographs were taken of each child's tympanic membranes to show the features of the pars tensa and the pars flaccida. RESULTS: In just less than three quarters of the children, both ears were normal. Retraction of the pars flaccida was present in 9.6% of children, and that of the pars tensa was present in 7.9%. Most of these changes were mild with few severe retractions. There were 15 cases of overt or suspected cholesteatoma. CONCLUSION: The tympanic membrane changes reflect most of the middle ear disease seen in 9- to 10-year-old children. The prevalence is low, and few children have serious disease at this stage.