Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Effects of extreme cooling methods on mechanical properties and shear bond strength of bilayered porcelain/3Y-TZP specimens

Objectives: This study investigated the effect of extreme cooling methods on the flexural strength, reliability and shear bond strength of veneer porcelain for zirconia. Methods: Vita VM9 porcelain was sintered on zirconia bar specimens and cooled by one of the following methods: inside a switched-off furnace (slow), at room temperature (normal) or immediately by compressed air (fast). Three-point flexural strength tests (FS) were performed on specimens with porcelain under tension (PT, n = 30) and zirconia under tension (ZT, n = 30). Shear bond strength tests (SBS, n = 15) were performed on cylindrical blocks of porcelain, which were applied on zirconia plates. Data were submitted to one-way ANOVA and Tukey's post hoc tests (p < 0.05). Weibull analysis was performed on the PT and ZT configurations. Results: One-way ANOVA for the PT configuration was significant, and Tukey's test revealed that fast cooling leads to significantly higher values (p < 0.01) than the other cooling methods. One-way ANOVA for the ZT configuration was not significant (p = 0.06). Weibull analysis showed that normal cooling had slightly higher reliability for both the PT and ZT configurations. Statistical tests showed that slow cooling decreased the SBS value (p < 0.01) and showed less adhesive fracture modes than the other cooling methods. Clinical Significance: Slow cooling seems to affect the veneer resistance and adhesion to the zirconia core; however, the reliability of fast cooling was slightly lower than that of the other methods. © 2013 Elsevier Ltd.

Parametric VaR with goodness-of-fit tests based on EDF statistics for extreme returns

Parametric VaR (Value-at-Risk) is widely used due to its simplicity and easy calculation. However, the normality assumption, often used in the estimation of the parametric VaR, does not provide satisfactory estimates for risk exposure. Therefore, this study suggests a method for computing the parametric VaR based on goodness-of-fit tests using the empirical distribution function (EDF) for extreme returns, and compares the feasibility of this method for the banking sector in an emerging market and in a developed one. The paper also discusses possible theoretical contributions in related fields like enterprise risk management (ERM). © 2013 Elsevier Ltd.

Previsão de carga multinodal utilizando redes neurais de regressão generalizada

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A regional basic income: towards the eradication of extreme poverty in Central America

Incluye Bibliografía

Analysis of extreme events in the Caribbean 1990-2008

This study presents an analysis of extreme events in the Caribbean subregion for the period 1990 to 2008, and forms part of a similar, wider study focused on the Latin America and the Caribbean region (Central America and South America being the other two subregional components). It explores the economic costs of climate change through an examination of adaptation costs to extreme events. ECLAC, through its Subregional Headquarters for the Caribbean, is pleased to have been able to undertake this study with the financial support of DFID and to have ensured its successful execution in collaboration with technical expertise from the University of the West Indies.

Axial loads on implant-supported partial fixed prostheses for external and internal hex connections and machined and plastic copings: strain gauge analysis

The aim of this in vitro study was to use strain gauge (SG) analysis to compare the effects of the implant-abutment joint, the coping, and the location of load on strain distribution in the bone around implants supporting 3-unit fixed partial prostheses. Three external hexagon (EH) implants and 3 internal hexagon (IH) implants were inserted into 2 polyurethane blocks. Microunit abutments were screwed onto their respective implant groups. Machined cobalt-chromium copings and plastic copings were screwed onto the abutments, which received standard wax patterns. The wax patterns were cast in a cobalt-chromium alloy (n = 5): group 1 = EH/machined. group 2 = EH/plastic, group 3 = IH/machined, and group 4 = IH/plastic. Four SGs were bonded onto the surface of the block tangentially to the implants. Each metallic structure was screwed onto the abutments and an axial load of 30 kg was applied at 5 predetermined points. The magnitude of microstrain on each SG was recorded in units of microstrain (mu epsilon). The data were analyzed using 3-factor repeated measures analysis of variance and a Tukey test (alpha = 0.05). The results showed statistically significant differences for the type of implant-abutment joint, loading point, and interaction at the implant-abutment joint/loading point. The IH connection showed higher microstrain values than the EH connection. It was concluded that the type of coping did not interfere in the magnitude of microstrain, but the implant/abutment joint and axial loading location influenced this magnitude.

Feasibility Study of Solar Driven Underground Cooling System

In the United States the peak electrical use occurs during the summer. In addition, the building sector consumes a major portion of the annual electrical energy consumption. One of the main energy consuming components in the building sector is the Heating, Ventilation, and Air-Conditioning (HVAC) systems. This research studies the feasibility of implementing a solar driven underground cooling system that could contribute to reducing building cooling loads. The developed system consists of an Earth-to-Air Heat Exchanger (EAHE) coupled with a solar chimney that provides a natural cool draft to the test facility building at the Solar Energy Research Test Facility in Omaha, Nebraska. Two sets of tests have been conducted: a natural passively driven airflow test and a forced fan assisted airflow test. The resulting data of the tests has been analyzed to study the thermal performance of the implemented system. Results show that: The underground soil proved to be a good heat sink at a depth of 9.5ft, where its temperature fluctuates yearly in the range of (46.5°F-58.2°F). Furthermore, the coupled system during the natural airflow modes can provide good thermal comfort conditions that comply with ASHRAE standard 55-2004. It provided 0.63 tons of cooling, which almost covered the building design cooling load (0.8 tons, extreme condition). On the other hand, although the coupled system during the forced airflow mode could not comply with ASHRAE standard 55-2004, it provided 1.27 tons of cooling which is even more than the building load requirements. Moreover, the underground soil experienced thermal saturation during the forced airflow mode due to the oversized fan, which extracted much more airflow than the EAHE ability for heat dissipation and the underground soil for heat absorption. In conclusion, the coupled system proved to be a feasible cooling system, which could be further improved with a few design recommendations.

Predicting the behaviour of structures under impact loads using geometrically distorted scaled models

When a scaled structure (model or replica) is used to predict the response of a full-size compound (prototype), the model geometric dimensions should relate to the corresponding prototype dimensions by a single scaling factor. However, owing to manufacturing technical restrictions, this condition cannot be accomplished for some of the dimensions in real structures. Accordingly, the distorted geometry will not comply with the overall geometric scaling factor, infringing the Pi theorem requirements for complete dynamic similarity. In the present study, a method which takes geometrical distortions into account is introduced, leading to a model similar to the prototype. As a means to infer the performance of this method, three analytical problems of structures subjected to dynamic loads are analysed. It is shown that the replica developed applying this technique is able to accurately predict the full-size structure behaviour even when the studied models have some of their dimensions severely distorted. (C) 2012 Elsevier Ltd. All rights reserved.

Integration of spatial and temporal models to predict extreme water table depths

The objective of this work was to evaluate extreme water table depths in a watershed, using methods for geographical spatial data analysis. Groundwater spatio-temporal dynamics was evaluated in an outcrop of the Guarani Aquifer System. Water table depths were estimated from monitoring of water levels in 23 piezometers and time series modeling available from April 2004 to April 2011. For generation of spatial scenarios, geostatistical techniques were used, which incorporated into the prediction ancillary information related to the geomorphological patterns of the watershed, using a digital elevation model. This procedure improved estimates, due to the high correlation between water levels and elevation, and aggregated physical sense to predictions. The scenarios showed differences regarding the extreme levels - too deep or too shallow ones - and can subsidize water planning, efficient water use, and sustainable water management in the watershed.

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. Study Design: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of >= 1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012

A large Cervidae Holocene accumulation in Eastern Brazil: an example of extreme taphonomical control in a cave environment

A remarkable cervid bone accumulation occurs at a single passage (named Cervid Passage; CP) at Lapa Nova, a maze cave in eastern Brazil. CP lies away from cave entrances, is a typical pitfall passage and contains bone remains of at least 121 cervids, besides few bats, peccaries and rodents remains. There is no evidence of water (or sediment) flow at the site and in general bones lack post depositional alterations and display anatomical proximity, suggesting that the majority of the remains found inside CP (mainly cervids) are due to animals that after entering the cave got trapped in the site. Observations suggest that two entrances could have provided access to cervids (and the few other animals, besides bats), either by falling inside the cave or by entering by their own free will. Once inside the cave, the maze pattern would make route finding difficult, and of all passage intersections, only the one leading to CP would result in a non-return situation, starving the animal to death. Radiocarbon dates suggest that animal entrapment occurred during at least 5 thousand years, during the Holocene. The reasons why mainly cervids were found are unknown but they are probably related to the biology of this group coupled with the fact that caves provide several specific taphonomic processes that may account for a strong bias in bone accumulation. Indeed, the frequent occurrence of Cervidae in both the fossil and sub-fossil record in Brazilian caves may be related to an overall high faunal abundance or may suggest that these animals were especially prone to enter caves, perhaps in search of nutrients (as cave saltpetre) or water.

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward. Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.