Decision-making in lumbar spinal stenosis: A survey on the influence of the morphology of the dural sac.

Surgical decision-making in lumbar spinal stenosis involves assessment of clinical parameters and the severity of the radiological stenosis. We suspected that surgeons based surgical decisions more on dural sac cross-sectional area (DSCA) than on the morphology of the dural sac. We carried out a survey among members of three European spine societies. The axial T2-weighted MR images from ten patients with varying degrees of DSCA and morphological grades according to the recently described morphological classification of lumbar spinal stenosis, with DSCA values disclosed in half the assessed images, were used for evaluation. We provided a clinical scenario to accompany the images, which were shown to 142 responding physicians, mainly orthopaedic surgeons but also some neurosurgeons and others directly involved in treating patients with spinal disorders. As the primary outcome we used the number of respondents who would proceed to surgery for a given DSCA or morphological grade. Substantial agreement among the respondents was observed, with severe or extreme stenosis as defined by the morphological grade leading to surgery. This decision was not dependent on the number of years in practice, medical density or specialty. Disclosing the DSCA did not alter operative decision-making. In all, 40 respondents (29%) had prior knowledge of the morphological grading system, but their responses showed no difference from those who had not. This study suggests that the participants were less influenced by DSCA than by the morphological appearance of the dural sac. Classifying lumbar spinal stenosis according to morphology rather than surface measurements appears to be consistent with current clinical practice.

The importance of relative performance feedback information: Evidence from a natural experiment using high school students

We study the effect of providing relative performance feedback information onperformance, when individuals are rewarded according to their absolute performance. Anatural experiment that took place in a high school offers an unusual opportunity to testthis effect in a real-effort setting. For one year only, students received information thatallowed them to know whether they were performing above (below) the class average aswell as the distance from this average. We exploit a rich panel data set and find that theprovision of this information led to an increase of 5% in students grades. Moreover, theeffect was significant for the whole distribution. However, once the information wasremoved, the effect disappeared. To rule out the concern that the effect may beartificially driven by teachers within the school, we verify our results using nationallevel exams (externally graded) for the same students, and the effect remains.

When performance-approach goals predict academic achievement and when they do not: A social value approach

Research on achievement goal promotion at University has shown that performance-approach goals are perceived as a means to succeed at University (high social utility) but are not appreciated (low social desirability). We argue that such a paradox could explain why research has detected that performance-approach goals consistently predict academic grades. First-year psychology students answered a performance-approach goal scale with standard, social desirability and social utility instructions. Participants' grades were recorded at the end of the semester. Results showed that the relationship between performance-approach goals and grades was inhibited by the increase of these goals' social desirability and facilitated by the increase of their social utility, revealing that the predictive validity of performance-approach goals depend on social value.

Rearing method of Oryzaephilus surinamensis (L.) (Coleoptera, Silvanidae) on various wheat grain granulometry

Oryzaephilus surinamensis is one of most common insect pest of grains and a variety of stored products, and has been found in high numbers in almost all storage facilities. However, laboratory mass rearing of this insect for bioassays is not a simple task, mainly because of its feeding behavior, small size, and high mobility. Thus, the aim of this work was to develop a simple and efficient laboratory rearing method for O. surinamensis, using wheat kernels milled into different granulometry to obtain large number and standardized population at different life stages for bioassays. The adults were collected from storage grain facilities in the southern region of Brazil and 100 specimens were placed inside glass jars with wheat kernels milled at different grades and kept at 25±0.5ºC and 65±5% relative humidity. The insects were allowed to copulate and lay eggs for 10 days and then removed. The number of eggs, larvae, and pupae was counted at five-day intervals; longevity of the second generation adults was evaluated. The kernels milled at grade 20 were the best medium for offspring production: 89% of eggs by the 5th day; 30.5% larvae by the 10th day; 43% pupae by the 30th day and 63.4% adults at the 46th day. The adults survived up to 450 days. Culturing O. surinamensis under the described conditions, transferring the parental adults by the 10th day after infestation and replacing the media when population builds up will produce enough insects of each stage for various laboratory bioassays.

English as a world language: its role as a lingua francaa sociolinguistic profile of students of secondary schools in Santiago Island, in the Archipelago of Cape Verde

Esta tese centra-se em aspectos relevantes do inglês como uma língua universal, no actual contexto globalizado e examina possíveis mudanças relacionadas com o seu uso, em especial no continente africano, particularmente no caso de Cabo Verde, no sentido de ponderar eventuais alternativas nas pedagogias linguísticas no ensino desta língua que impliquem uma adaptação à realidade contemporânea. Uma vez que, nos nossos tempos, o inglês é a língua de eleição para a comunicação intercultural entre povos com várias experiências culturais e linguísticas, o conhecimento deste idioma torna-se, a cada dia que passa, impreterível e indispensável, na interacção intercultural. Em África, as funções desempenhadas pelo inglês são complexas; além da língua inglesa ser usada para comunicação entre etnias, com o estatuto de língua franca, também tem o papel de preservar a identidade nacional e de estabelecer a unidade entre os povos da mesma nação. Por conseguinte, é de considerar talvez ainda com mais pertinência, a adopção de uma nova filosofia de pedagogia de ensino que permita dotar os seus cidadãos de capacidades que lhes possibilitem comunicar de forma inteligível com povos de outras culturas e línguas. O primeiro capítulo aborda aspectos teóricos relacionados com a expansão, comunicação e mudança associadas à língua inglesa e suas implicações no ensino em países onde esta não é língua nativa (L1). O segundo capítulo reflecte, em primeiro lugar, sobre a situação linguística em África e as línguas francas predominantes no continente, incluindo a língua inglesa. Considera também questões relacionadas com o multilinguismo e a identidade, bem como assuntos relacionados com as implicações da diversidade linguística para a educação dos povos africanos.

Violência Urbana: Estudo de Caso do Bairro de Tira Chapéu.

Nos últimos anos a criminalidade tem fustigado o Bairro Tira Chapéu, nomeadamente a delinquência. Os sinais desta insegurança estão omnipresentes e não deixam de chocar o observador, depara-se com imoveis cercados de grades e postos de guarda. Neste contexto, este trabalho tem como objetivo, avaliar a violência urbana, com mais incidência no Bairro Tira Chapéu. Para isso, realizou-se um estudo a partir das técnicas estatísticas de amostragem e análise descritiva, seguidamente foi realizada a critica dos resultados obtidos. Entre os principais resultados verifica-se que a maior parte dos moradores do Bairro Tira Chapéu já sofreu e/ou presenciou pelo menos um delito. Em relação a falta de iluminação pública, falta de policiamento e a falta de emprego, os residentes acreditam que sejam fatores de alta influência para o aumento da criminalidade. Além disso, a maioria dos delitos sofridos por moradores do Bairro Tira Chapéu ocorrera no próprio Bairro, sendo em sua maioria vítimas de roubo, confirmando a hipótese inicial deste trabalho. Finalmente, a partir dos resultados pôde-se verificar que a delinquência urbana neste Bairro é um fenómeno que aflige todos os seus moradores.

Monitoring the university admissions process in Spain

The examinations taken by high-school graduates in Spain and the role ofthe examination in the university admissions process are described. Thefollowing issues arising in the assessment of the process are discussed:reliability of grading, comparability of the grades and scores(equating),maintenance of standards, and compilation and use of the grading process,and their integration in the operational grading are proposed. Variousschemes for score adjustment are reviewed and feasibility of theirimplementation discussed. The advantages of pretesting of items and ofempirical checks of experts' judgements are pointed out. The paperconcludes with an outline of a planned reorganisation of the highereducation in Spain, and with a call for a comprehensive programme ofempirical research concurrent with the operation of the examination andscoring system.

Tratamento de Águas Residuais Estação de Tratamento de Palmarejo

Com este trabalho pretende-se fazer um estudo da estação de tratamento do Palmarejo na cidade da Praia, desde a entrada do afluente na estação até estar em condições de ser reutilizada. O tratamento de água residual surgiu como forma de dar um destino ao resíduo poluente que é o esgoto produzido em nossas casas, sem agredir o meio ambiente natural e resolver alguns problemas do saneamento do meio. Neste trabalho apresentamos as etapas de tratamento da linha líquida do esgoto, bem como o funcionamento de cada órgão do sistema, a comparação dos resultados esperados com os obtidos após o funcionamento da estação. Dimensionamento de uma conduta de transporte de água residual para o Empreendimento turístico da Golfe Resort. Encontrar o custo por cada metro cúbico de água tratado e estudar a possibilidade de sua reutilização. Palavras-chave: Efluente, Água Residual, Lamas Activadas, Desinfecção.

Direct magnetic resonance arthrography of the knee: utility of axial traction.

The purpose of this study was to determine the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography examination of the knee in terms of joint space width and amount of contrast material between the cartilage surfaces. Direct knee MR arthrography was performed in 11 patients on a 3-T MR imaging unit using a T1-weighted isotropic gradient echo sequence in a coronal plane with and without axial traction of 15 kg. Joint space widths were measured at the level of the medial and the lateral femorotibial joint with and without traction. The amount of contrast material in the medial and lateral femorotibial joint was assessed independently by two musculoskeletal radiologists in a semiquantitative manner using three grades ('absence of surface visualization, 'partial surface visualization or 'complete surface visualization'). With traction, joint space width increased significantly at the lateral femorotibial compartment (mean = 0.55 mm, p = 0.0105) and at the medial femorotibial compartment (mean = 0.4 mm, p = 0.0124). There was a trend towards an increased amount of contrast material in the femorotibial compartment with axial traction. Direct MR arthrography of the knee with axial traction showed a slight and significant increase of the width of the femorotibial compartment with a trend towards more contrast material between the articular cartilage surfaces.

Home care: a safe and attractive alternative to inpatient administration of intensive chemotherapies.

OBJECTIVE: The objective of this study was to evaluate feasibility, safety, perception, and costs of home care for the administration of intensive chemotherapies. METHODS: Patients receiving sequential chemotherapy in an inpatient setting, living within 30 km of the hospital, and having a relative to care for them were offered home care treatment. Chemotherapy was administered by a portable, programmable pump via an implantable catheter. The main endpoints were safety, patient's quality of life [Functional Living Index-Cancer (FLIC)], satisfaction of patients and relatives, and costs. RESULTS: Two hundred days of home care were analysed, representing a total of 46 treatment cycles of intensive chemotherapy in 17 patients. Two cycles were complicated by technical problems that required hospitalisation for a total of 5 days. Three major medical complications (heart failure, angina pectoris, and major allergic reaction) could be managed at home. Grades 1 and 2 nausea and vomiting occurring in 36% of patients could be treated at home. FLIC scores remained constant throughout the study. All patients rated home care as very satisfactory or satisfactory. Patient benefits of home care included increased comfort and freedom. Relatives acknowledged better tolerance and less asthenia of the patient. Home care resulted in a 53% cost benefit compared to hospital treatment (420 ± 120/day vs. 896 ± 165/day). CONCLUSION: Administration of intensive chemotherapy regimens at home was feasible and safe. Quality of life was not affected; satisfaction of patients and relatives was very high. A psychosocial benefit was observed for patients and relatives. Furthermore, a cost-benefit of home care compared to hospital treatment was demonstrated.

La zonación estructural del hercínico del Pirineo Central en el anticlinorio de la Pallaresa

The Pyrenees are an alpine chain with hercynian basement rocks that outcrop in a large area called the Axial Zone. These rocks have been involved in the alpine deformation events although their main structural features resulted from the Hercynian orogeny. A relevant characteristic of the Hercynian basement is a change in structural style in depth which has been commonly studied and interpreted in the Pallaresa Anticlinorium, in the Central Pyrenees. This anticlinorium is a complex hercynian structural unit whose southern part belongs to the suprastructure whereas the northern part corresponds mostly to a transition zone between the infrastructure and the suprastructure. Rocks of the suprastructure show a steeply dipping slaty cleavage as the dominant structure, which is overprinting folds and thrusts rarely going with pervasive deformation. The transition zone results from a slaty cleavage, very often close to the bedding, overprinted by one or two steep crenulation cleavages. A gradual boundary exists between both structural levels and it can be observed that the deformation developing slaty cleavage in the suprastructure grades to a crenulation foliation in the transition zone. The gradual character of that boundary, as seen in the northern end of the transition zone, suggests that the southern sharp boundary is not original. That boundary is interpreted as a northward dipping inverse fault, possibly with Alpine age. That fault causes a relative uplift of the rocks of the transition zone and gives this sharp boundary with the suprastructural levels. It provokes the asymmetry in the Pallaresa anticlinorium

Incidence et pronostic des métastases ganglionnaires dans les sarcomes des membres

Introduction : Bien que rares chez l'adulte, les sarcomes des tissus mous restent une maladie au pronostic très sombre. En effet, leur survie globale à 5 ans est de 50 % chez la femme et de 41 % chez l'homme. De plus, ils sont particulièrement difficiles à traiter, en raison de leur agressivité, de leur résistance face aux chimiothérapies et à la radiothérapie et d'autre part leur localisation conduit souvent à des opérations mutilantes. Pour les sarcomes des membres, il existe une opération appelée perfusion isolée du membre (ILP). Cela consiste à réaliser une chimiothérapie par voie intra-artérielle, en isolant le membre qui est perfusé par une solution Melphalan et de Tumor Necrosis Factor α à l'aide d'une circulation extra-corporelle pour son oxygénation. Ce type de traitement est à visée palliative, évitant une amputation du membre atteint. Pour accéder aux vaisseaux permettant la canulation de la pompe, un curage ganglionnaire est généralement effectué. Patients et méthode : Pour cette étude rétrospective, nous avons analysé la base de données des 278 ILP réalisées au Centre Hospitalier Universitaire Vaudois (CHUV) à Lausanne depuis mai 1988. Nous avons extrait et analysé de cette étude rétrospective 57 ILP réalisées pour des sarcomes. L'étude porte sur 52 patients traités entre le 19 février 1992 et le 14 décembre 2011, après avoir exclu les patients n'ayant pas bénéficié d'un curage ganglionnaire et la seconde ILP pour 4 patients qui en ont eu 2. Pour chacun de ces patients, les protocoles opératoires, les rapports d'examens radiologiques ainsi que les rapports de pathologies ont été revus et analysés. Nous avons également effectué une revue de la littérature sur PubMed. Résultats : Il y avait 28 hommes (53.8%) et 24 femmes (46.2 %). L'âge moyen au moment de l'ILP était de 56,7 ans (écart-type 16,8). Seul 3 patients sur les 52 avaient des métastases à distance au moment du diagnostic. Le curage ganglionnaire radical a montré que 13 patients (25 %) avaient une atteinte des ganglions lymphatiques (N+). Parmi les types histologiques qui ont présenté au moins une métastase ganglionnaire, on retrouve 2 léomyosarcomes, 2 sarcomes indifférenciés (anciennement MFH), 3 sarcomes épithélioïdes, 4 angiosarcomes et 2 synoviosarcomes. Pour les patients N0, la survie globale moyenne estimée par la méthode de Kaplan et Meier a été de 95,98 mois (CI 95% 66,72-125,23 mois). Pour les patients N1 la survie globale moyenne a chuté à 28,72 mois (CI 95% 6,48-50,97). Le test du Log Rank donne un Chi2 de 9,659 (P=0,002). La moyenne de survie sans maladie a été de 38,03 mois pour le groupe (N0) et de 10,87 mois pour le groupe N1, (CI 95 % 25,75-50,3 et 1,87-19,88 respectivement) et une valeur de P= 0.006. Nous n'avons pas mis en évidence de différence de survie statistiquement significative (P=0.946) entre les types ou les grades histologiques, en raison de la taille du collectif. Conclusion : Bien que rares, les métastases ganglionnaires des sarcomes des membres ont un impact négatif sur la survie à long terme du patient. Les résultats obtenus montrent qu'un curage peut participer au traitement régional et confirme la nécessité de pratiquer systématiquement une lymphadénectomie radicale en vue d'offrir les meilleures chances de survie au patient. Il faudrait donc se poser la question si la présence de métastases ganglionnaires ne devrait pas modifier la prise en charge pour tendre vers un traitement plus agressif chez de tels patients. Ce qui n'est pas le cas à l'heure actuelle.

Influência do relevo e erosão na variabilidade espacial de um Latossolo em Jaboticabal (SP)

Com o objetivo de avaliar as relações entre formas de paisagem e erosão em um Latossolo Vermelho eutroférrico (LVef) por meio de técnicas geoestatísticas na Fazenda Santa Isabel, município de Jaboticabal (SP), identificaram-se modelos de paisagem côncavo e linear. Coletaram-se amostras de solo em ambas as formas de paisagem em uma malha regular espaçada de 50 x 50 m em sete transeções na profundidade de 0,00-0,20 m, totalizando 412 pontos em 93 ha. Determinou-se a erodibilidade dos solos pelo método indireto, granulometria, bem como o carbono orgânico para cada ponto da malha, sendo esses valores usados na estimativa do potencial natural de erosão (pne). Os dados obtidos das propriedades de solo, erodibilidade e potencial natural de erosão foram analisados por meio de estatística descritiva e geoestatística com a modelagem de semivariogramas, sendo este utilizado para a confecção de mapas de krigagem. Segundo os resultados, as propriedades do solo e do pne apresentaram maior variabilidade espacial na pedoforma côncava, apesar de esta forma de paisagem apresentar menores perdas de solo por erosão e menor variabilidade espacial da erodibilidade. Deste modo, conclui-se que a erosão não adicionou variabilidade espacial para as propriedades do solo na mesma magnitude do relevo.

Lateral condyle fracture of the humerus in children treated with bioabsorbable materials

Les fractures du condyle externe de l'enfant sont un traumatisme relativement fréquent qui survient le plus souvent chez l'enfant entre 5 et 15 ans. Elles sont classées en 3 grades : le grade 1 sans déplacement qui peuvent être traitées conservativement et les grades 2 (déplacées) et 3 (disloquées) qui nécessitent une prise en charge chirurgicale par réduction ouverte et embrochage. Le traitement traditionnel de ces fractures consistent en la mise en place de broches/vis métalliques qui doivent être retirées quelques semaines plus tard lors d'une seconde intervention. Depuis les années 90, des matériaux bio-résorbables à base d'acide polyglycoliques sont apparus en chirurgie orthopédique et traumatologique. En raison de la survenue de complications telles que réactions inflammatoires, formation de séromes ou ostéolyse, l'utilisation du matériel conventionnel a été préférée. Cependant, depuis quelques années, de nouveaux matériaux en acide polylactique sont apparus sur le marché. La période de résorption étant beaucoup plus lente, ces matériaux induisent des réactions beaucoup plus faibles, sans conséquences cliniques relevées jusqu'à présent. Chez l'adulte, de récentes études ont prouvés l'efficacité et l'absence d'effets secondaires liés à ces matériaux. Par contre, chez l'enfant, peu d'études à moyen terme ont été réalisées et l'impact sur l'os en croissance est peu connu, même si pour l'heure aucune conséquence clinique n'a été relevée. Dans le cadre de notre étude, nous avons comparé 2 groupes d'enfants traités pour des fractures du condyle externe du coude. Le premier groupe traité par du matériel conventionnel et le second par matériel résorbable. Les enfants ont tous étés suivis de manière très étroite durant la première année et la récupération clinique est similaire pour les 2 groupes. A 4 ans du traumatisme, les résultats fonctionnels sont identiques pour les 2 groupes et aucune complication liée au matériel résorbable n'a été mise en évidence. Par ailleurs, à 1 et 4 ans, les clichés radiologiques montrent l'absence de lésions liées au matériel résorbable. En conclusion, dans le cadre de notre travail nous avons pu montrer l'efficacité des matériaux résorbables dans la prise en charge des fractures du condyle externe du coude chez l'enfant. Ces matériaux permettent d'optimiser la prise en charge de ce type de fracture en prévenant un risque opératoire et anesthésique liés à une seconde intervention nécessaire au retrait du matériel d'ostéosynthèse conventionnel. Par ailleurs le coût lié à la prise en charge globale de ce type de fracture est moindre lors de l'utilisation de matériel résorbable.

2008 Iowa Youth Survey State of Iowa Results, Revised June 2009

In September and October of 2008, the Iowa Department of Public Health (IDPH) collaborated with schools in Iowa to conduct the 2008 Iowa Youth Survey (IYS). The 2008 IYS is the twelfth in a series of surveys that have been completed every three years since 1975. The survey is conducted with students in grades 6, 8, and 11 attending Iowa public and private schools. The IYS includes questions about students’ behaviors, attitudes, and beliefs, as well as their perceptions of peer, family, school, neighborhood, and community environments.