930 resultados para supplemental coverage option
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Scholars have investigated witness to distant suffering (WTDS) almost entirely in visual media. This study examines it in print. This form of reporting will be examined in two publications of the religious left as contrasted with the New York Times. The thesis is that, more than any technology, WTDS consists of the journalist’s moral commitment and narrative skills and the audience’s analytical resources and trust. In the religious journals, liberation theology provides the moral commitment, the writers and editors the narrative skills and trust and the special vision of the newly empowered poor the analytical foundation. In bearing witness to those who have suffered state or guerilla terrorism in El Salvador and Nicaragua during the 1980s, we will investigate a distinction between “worthy” and “unworthy victims.” This last issue has a special ethical and political significance. Media witnessing to the suffering of strangers can help them become known, and so “worthy.” It can help them, and their plight and cause, become better recognized. This is the power of the media.
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Aim: The aim of this randomized controlled clinical study was to compare the use of an acellular dermal matrix graft (ADMG) with or without the enamel matrix derivative (EMD) in smokers to evaluate which procedure would provide better root coverage. Material and Methods: Nineteen smokers with bilateral Miller Class I or II gingival recessions >= 3 mm were selected. The test group was treated with an association of ADMG and EMD, and the control group with ADMG alone. Probing depth, relative clinical attachment level, gingival recession height, gingival recession width, keratinized tissue width and keratinized tissue thickness were evaluated before the surgeries and after 6 months. Wilcoxon test was used for the statistical analysis at significance level of 5%. Results: No significant differences were found between groups in all parameters at baseline. The mean gain recession height between baseline and 6 months and the complete root coverage favored the test group (p = 0.042, p = 0.019 respectively). Conclusion: Smoking may negatively affect the results achieved through periodontal plastic procedures; however, the association of ADMG and EMD is beneficial in the root coverage of gingival recessions in smokers, 6 months after the surgery.
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Aim This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. Materials and Methods Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. Results There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. Conclusions The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).
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Today it is known that severe burns can be accompanied by the phenomenon of vasoplegic syndrome (VS), which is manifested by persistent and diffuse vasodilation, hypotension and low vascular resistance, resulting in circulatory and respiratory failure. The decrease in systemic vascular resistance observed in VS is associated with excessive production of nitric oxide (NO). In the last 2 decades, studies have reported promising results from the administration of an NO competitor, methylene blue (MB), which is an inhibitor of the soluble guanylate cyclase (sGC), in the treatment of refractory cases of vasoplegia. This medical hypothesis rationale is focused on the tripod of burns/vasoplegia catecholamine resistant/methylene blue. This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment.
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Objectives: The main objective of this study was to investigate whether the interaction of malocclusion (open bite or increased overjet) combined with inadequate lip coverage strengthens its association with traumatic dental injury (TDI) in the primary teeth of preschool children compared to the presence of malocclusion alone. Subjects and methods: A cross-sectional survey was conducted with 376 children aged 3659 months who attended the National Day of Childrens Vaccination. Presence of TDI, tooth discoloration, and sinus tract were evaluated in the children. Variables associated with occlusion were also evaluated. A Poisson regression analysis was performed to verify the association between the explanatory variables and TDI as well as possible interactions among the variables. Then, the prevalence ratio was calculated. Results: The prevalence of TDI was 27.7%. The maxillary central incisor was the most affected tooth, without differences between the right and left sides. Boys had more dental trauma than girls (P = 0.04). The most common TDI was crown fracture restricted to the enamel (58.4%). Children with a combination of anterior open bite or increased overjet and inadequate lip coverage presented a higher prevalence of TDI than when the malocclusions were presented alone (P < 0.05). The same trends were observed when we included, in the final adjusted model, increased overjet instead of open bite. Conclusions: Anterior malocclusions of primary teeth such as increased overjet and anterior open bite are statistically significantly associated with dental trauma only when inadequate lip coverage is also present.
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This study evaluated the yield, components of production and oil content of two castor bean cultivars through drip irrigation with different water depths. The research was conducted in 2009 in an Oxisol clay in the experimental field in Dourados, Mato Grosso do Sul State. The experimental design was randomized blocks in factorial scheme with five water depths (0, 25, 50, 100 and 150% of evapotranspiration for drip irrigation) in two castor bean cultivars (IAC 2028 and IAC 80) with four replications. The irrigation schedule was predetermined up to two irrigations per week except on rainy days. The increase of irrigation provided significant increase in most components of production and crop yield without changing the oil content of seeds. The application of higher water depth increased yield by 80% in relation to the treatment that received no supplemental irrigation.
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This work aimed to evaluate the influence of specific operational conditions on the performance of a spiral-wound ultrafiltration pilot plant for direct drinking water treatment, installed at the Guarapiranga's reservoir, in the Sao Paulo Metropolitan Region. Results from operational tests showed that the volume of permeate produced in the combination of periodic relaxation with flushing and chlorine dosage procedures was 49% higher than the volume obtained when these procedures were not used. Two years of continuous operation demonstrated that the ultrafiltration pilot plant performed better during fall and winter seasons, higher permeate flow production and reduced chemical cleanings frequency. Observed behavior seems to be associated with the algae bloom events in the reservoir, which are more frequent during spring and summer seasons, confirmed by chlorophyll-a analysis results. Concentrate clarification using ferric chloride was quite effective in removing NOM and turbidity, allowing its recirculation to the ultrafiltration feed tank. This procedure made it possible to reach almost 99% water recovery considering a single 54-hour recirculation cycle. Water quality monitoring demonstrated that the ultrafiltration pilot plant was quite efficient, and that potential pathogenic organisms, Escherichia coil and total coliforms, turbidity and apparent color removals were 100%, 95.1%, and 91.5%, respectively. (C) 2012 Elsevier B.V. All rights reserved.
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Abstract Introduction Hydronephrosis, reflux and renal failure are serious complications that occur in patients with neurogenic bladder associated with myelomeningocele. When the bladder compliance is lost, it is imperative to carry out surgery aimed at reducing bladder storage pressure. An ileocystoplasty, and for patients not suitable for intermittent catheterization, using the Mitrofanoff principle to form a continent stoma and the subsequent closure of the bladder neck, can be used. We report here, for the first time to the best of our knowledge, an association between two previously described techniques (the Mitrofanoff principle and the technique of Monti), that can solve the problem of a short appendix in obese patients. Case presentation A 33-year-old male Caucasian patient with myelomeningocele and neurogenic bladder developed low bladder compliance (4.0 mL/cm H2O) while still maintaining normal renal function. A bladder augmentation (ileocystoplasty) with continent derivation principle (Mitrofanoff) was performed. During surgery, we found that the patient's appendix was too short and was insufficient to reach the skin. We decided to make an association between the Mitrofanoff conduit and the ileal technique of Monti, through which we performed an anastomosis of the distal stump of the appendix to the bladder (with an antireflux valve). Later, the proximal stump of the appendix was anastomosed to an ileal segment of 2.0 cm that was open longitudinally and reconfigured transversally (Monti technique), modeled by a 12-Fr urethral catheter, and finally, the distal stump was sutured at the patient's navel. After the procedure, a suprapubic cystostomy (22 Fr) and a Foley catheter (10 Fr) through the continent conduit were left in place. The patient had recovered well and was discharged on the tenth day after surgery. He remained with the Foley catheter (through the conduit) for 21 days and cystostomy for 30 days. Six months after surgery he was continent with good bladder compliance without reflux and fully adapted to catheterization through the navel. Conclusion The unpublished association between the Mitrofanoff and Monti techniques is feasible and a very useful alternative in urologic cases of derivation continent in which the ileocecal appendix is too short to reach the skin (i.e., in obese patients).
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Lo scopo della tesi è quello di affrontare la progettazione con un approccio,quanto più attuale e per certi versi avanguardista, chiamato Parametric design (progettazione parametrica), accoppiato efficacemente col concetto di Arte generativa (in questo caso Architettura). Già nel 1957 Luigi Moretti affrontò il tema dell’architettura parametrico-generativa fondando l’IRMOU (Istituto per la Ricerca Matematica e Operativa applicata all'Urbanistica) e oggi è una mentalità molto diffusa nei più grandi studi del mondo. Il tema non è solo tecnologico o informatico strumentale, ma è proprio un modo di pensare e immaginare il possibile, costruito o naturale che sia. E’ un modo di vivere la propria creatività. L’aggettivo “generativa” è legato al fatto che l’arte in esame è generata seguendo regole preimpostate e ben definite dal progettista, coerentemente agli obiettivi e alle finalità del progetto. L’evoluzione delle stesse, seguendo relazioni molto semplici, può dar vita a risultati sorprendenti e inaspettati, dotati di una notevole complessità che però, se letta nell’insieme, è perfettamente in armonia con l’idea progettuale di partenza. Il fascino di questa materia è il legame entusiasmante che crea tra architettura, ingegneria, poesia, filosofia, matematica, biologia, fisica, pittura ecc ecc. Questo perché i concetti di evoluzione, di relazione e di generazione appartengono a tutto ciò che ci circonda, e quindi alla concezione umana di vita. E’ possibile in questo modo permeare il costrutto progettuale con principi e regole oggettivamente riconoscibili e apprezzabili dallo spettatore perché instrisi di una forte veridicità processuale. Il titolo "Oxymoron" è la traduzione inglese della figura retorica ossimoro,la quale è strettamente connessa all’ispirazione progettuale: proviene dall’indagine approfondita di processi evolutivi (distruttivi in questo caso) caratterizzanti realtà naturali che, esplorate con sempre più accuratezza, determinano morfologie e forme aventi profonde radici strutturali. La distruzione che crea lo spazio. La genesi stessa della forma segue predominanti algoritmi matematici governati e corretti da variabili di diversa natura che definiscono l'enviroment di influenze interagenti ed agenti sul campione di studio. In questo caso la ricerca è focalizzata su processi erosivi fisici e chimici, di agenti esterni (quali vento e sali rispettivamente) ,di cui materiali inorganici, quali minerali e aggregati degli stessi (rocce), sono soggetti. In particolare, l’interesse è approfondito su fenomeni apparentemente emergenti dei tafoni e dei cosiddetti Micro canyon. A tal scopo si sfrutterà un metodo di soft kill option (SKO) di ottimizzazione topologica (optimization topology) attraverso gli strumenti informatici più idonei quali software di modellazione parametrica e di calcolo computazionale. La sperimentazione sta proprio nell'utilizzare uno strumento concepito per uno scopo, con un'ottica strettamente ingegneristica, per un'altra meta, ossia ricavare e ottenere se possibile un metodo di lavoro o anche solo un processo generativo tale da riprodurre o simulare casi e situazioni riscontrabili in natura negli eventi soggetti a erosione. Il tutto coerente con le regole che stanno alla base della genesi degli stessi. Il parallelismo tra singolarità naturale e architettura risiede nella generazione degli spazi e nella combinazione di questi. L’ambizioso obiettivo è quello di innescare un ciclo generativo, che messo in comunicazione diretta con un contesto variegato ed eterogeneo, dia vita a una soluzione progettuale dall'alto contenuto morfologico e spaziale.
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Background: Neisseria meningitides represents a major cause of meningitis and sepsis. The meningococcal regulator NadR was previously shown to repress the expression of the Neisserial Adhesin A (NadA) and play a major role in its phase-variation. NadA is a surface exposed protein involved in epithelial cell adhesion and colonization and a major component of 4CMenB, a novel vaccine to prevent meningococcus serogroup B infection. The NadR mediated repression of NadA is attenuated by 4-HPA, a natural molecule released in human saliva. Results: In this thesis we investigated the global role of NadR during meningogoccal infection, identifying through microarray analysis the NadR regulon. Two distinct types of NadR targets were identified, differing in their promoter architectures and 4HPA responsive activities: type I are induced, while type II are co-repressed in response to the same 4HPA signal. We then investigate the mechanism of regulation of NadR by 4-HPA, generating NadR mutants and identifying classes or residues involved in either NadR DNA binding or 4HPA responsive activities. Finally, we studied the impact of NadR mediated repression of NadA on the vaccine coverage of 4CMenB. A selected MenB strains is not killed by sera from immunized infants when the strain is grown in vitro, however, in an in vivo passive protection model, the same sera protected infant rats from bacteremia. Finally, using bioluminescent reporters, nadA expression in the infant rat model was induced in vivo at 3 h post-infection. Conclusions: Our results suggest that NadR coordinates a broad transcriptional response to signals present in the human host, enabling the meningococcus to adapt to the relevant host niche. During infectious disease the effect of the same signal on NadR changes between different targets. In particular NadA expression is induced in vivo, leading to efficient killing of meningococcus by anti-NadA antibodies elicited by the 4CMenB vaccine.
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In my work I derive closed-form pricing formulas for volatility based options by suitably approximating the volatility process risk-neutral density function. I exploit and adapt the idea, which stands behind popular techniques already employed in the context of equity options such as Edgeworth and Gram-Charlier expansions, of approximating the underlying process as a sum of some particular polynomials weighted by a kernel, which is typically a Gaussian distribution. I propose instead a Gamma kernel to adapt the methodology to the context of volatility options. VIX vanilla options closed-form pricing formulas are derived and their accuracy is tested for the Heston model (1993) as well as for the jump-diffusion SVJJ model proposed by Duffie et al. (2000).
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The performance of microchannel heat exchangers was assessed in gas-to-liquid applications in the order of several tens of kWth . The technology is suitable for exhaust heat recovery systems based on organic Rankine cycle. In order to design a light and compact microchannel heat exchanger, an optimization process is developed. The model employed in the procedure is validated through computational fluid-dynamics analysis with commercial software. It is shown that conjugate effects have a significant impact on the heat transfer performance of the device.
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Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.Bone Marrow Transplantation advance online publication, 3 May 2010; doi:10.1038/bmt.2010.100.