Diagnostic algorithm for a validated displacement grading of pediatric supracondylar fractures.

Background: The first AO comprehensive pediatric long bone fracture classification system has been established following a structured path of development and validation with experienced pediatric surgeons. Methods: A follow-up series of agreement studies was applied to specify and evaluate a grading system for displacement of pediatric supracondylar fractures. An iterative process comprising an international group of 5 experienced pediatric surgeons (Phase 1) followed by a pragmatic multicenter agreement study involving 26 raters (Phase 2) was used. The last evaluations were conducted on a consecutive collection of 154 supracondylar fractures documented by standard anteroposterior and lateral radiographs. Results: Fractures were classified according to 1 of 4 grades: I = incomplete fracture with no or minimal displacement; II = Incomplete fracture with continuity of the posterior (extension fracture) or anterior cortex (flexion fracture); III = lack of bone continuity (broken cortex), but still some contact between the fracture planes; IV = complete fracture with no bone continuity (broken cortex), and no contact between the fracture planes. A diagnostic algorithm to support the practical application of the grading system in a clinical setting, as well as an aid using a circle placed over the capitellum was proposed. The overall kappa coefficients were 0.68 and 0.61 in the Phase 1 and Phase 2 studies, respectively. In the Phase 1 study, fracture grades I, II, III, and IV were classified with median accuracies of 91%, 82%, 83%, and 99.5%, respectively. Similar median accuracies of 86% (Grade I), 73% (Grade II), 83%(Grade III), and 92% were reported for the Phase 2 study. Reliability was high in distinguishing complete, unstable fractures from stable injuries [ie, kappa coefficients of 0.84 (Phase 1) and 0.83 (Phase 2) were calculated]; in Phase 2, surgeons' accuracies in classifying complete fractures were all above 85%. Conclusions: With clear and unambiguous definition, this new grading system for supracondylar fracture displacement has proved to be sufficiently reliable and accurate when applied by pediatric surgeons in the framework of clinical routine as well as research.

Time-Dependent Specificity of Immunopathologic (C4d-CD68) and Histologic Criteria of Antibody-Mediated Rejection for Donor-Specific Antibodies and Allograft Dysfunction in Heart Transplantation.

BACKGROUND: In heart transplantation, antibody-mediated rejection (AMR) is diagnosed and graded on the basis of immunopathologic (C4d-CD68) and histopathologic criteria found on endomyocardial biopsies (EMB). Because some pathologic AMR (pAMR) grades may be associated with clinical AMR, and because humoral responses may be affected by the intensity of immunosuppression during the first posttransplantation year, we investigated the incidence and positive predictive values (PPV) of C4d-CD68 and pAMR grades for clinical AMR as a function of time. METHODS: All 564 EMB from 40 adult heart recipients were graded for pAMR during the first posttransplantation year. Clinical AMR was diagnosed by simultaneous occurrence of pAMR on EMB, donor specific antibodies and allograft dysfunction. RESULTS: One patient demonstrated clinical AMR at postoperative day 7 and one at 6 months (1-year incidence 5%). C4d-CD68 was found on 4,7% EMB with a "decrescendo" pattern over time (7% during the first 4 months vs. 1.2% during the last 8 months; P < 0.05). Histopathologic criteria of AMR occurred on 10.3% EMB with no particular time pattern. Only the infrequent (1.4%) pAMR2 grade (simultaneous histopathologic and immunopathologic markers) was predictive for clinical AMR, particularly after the initial postoperative period (first 4 months and last 8 months PPV = 33%-100%; P < 0.05). CONCLUSION: In the first posttransplantation year, AMR immunopathologic and histopathologic markers were relatively frequent, but only their simultaneous occurrence (pAMR2) was predictive of clinical AMR. Furthermore, posttransplantation time may modulate the occurrence of C4d-CD68 on EMB and thus the incidence of pAMR2 and its relevance to the diagnosis of clinical AMR.

Uso de imagens de satélite na discriminação de solos desenvolvidos de basalto e arenito na região de Paraguaçu Paulista

O objetivo deste trabalho foi avaliar o potencial de discriminação de solos, mediante informações espectrais obtidas por sensor remoto em satélite. Os solos apresentaram variações na forma da curva espectral e intensidades de reflectância. Os Nitossolos apresentaram baixa intensidade de reflectância e os Neossolos, bastante alta. Os Latossolos Vermelhos, com diferentes texturas, apresentaram aumento na intensidade de reflectância, na seqüência dos mais argilosos para os mais arenosos. Solos eutróficos apresentaram maiores intensidades de reflectância que os álicos. A análise discriminante indicou um erro geral de 0,028%. As amostras confundidas geralmente ocorreram entre os solos com características semelhantes. A metodologia empregada na coleta de dados espectrais de satélites mostrou-se eficiente, tornando possível discriminar os solos da região estudada e, assim, agilizar a confecção de mapas de solos.

2014 Iowa Youth Survey State of Iowa Results, March 2015

From September 29, 2014 through November 7, 2014, the Iowa Department of Public Health (IDPH) collaborated with schools in Iowa to conduct the 2014 Iowa Youth Survey (IYS). The 2014 IYS is the fifteenth in a series of surveys that have been completed every two or 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.

Mapeamento da condutividade elétrica e relação com a argila de Latossolo sob plantio direto

O objetivo deste trabalho foi mapear e avaliar a variabilidade espacial da condutividade elétrica do solo (CE), obtida por meio de sensor de contato de campo, num Latossolo Vermelho distroférrico, sob plantio direto de grãos, e relacionar a CE com os teores de argila medidos pelo método do densímetro, em amostras georreferenciadas de solo. As amostras foram coletadas numa área de 13 ha, por meio de uma grade de 40x40 m e de grades de 20x20 m, 10x10 m e 5x5 m. A continuidade espacial da CE e do teor de argila foi modelada com o uso de semivariogramas. A CE variou de 1,9 a 13,7 mS m-1, com valor médio de 5,2 mS m-1 e coeficiente de variação de 48%. O mapa interpolado mostrou tendência de aumento da CE com o aumento dos teores de argila. Os coeficientes de determinação foram de 0,78 e 0,77 entre CE e teor de argila, camadas 0-5 e 5-10 cm, respectivamente. O mapa da CE reflete suficientemente a variação espacial dos teores de argila para uso na delimitação de zonas de manejo.

Parental monitoring: an easy way to decrease adolescent substance use?

Objective: To examine whether the level of parental monitoring is associated with substance use among Swiss adolescents, and to assess whether this effect remains when these adolescents have consuming peers. Methods: Nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs (ESPAD) survey, which included 7611 adolescents issued from public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Results: Most adolescents had a high level of parental monitoring and that was associated with younger age, being female, high socioeconomic status, intact family structure and a satisfactory relationship with mother, father and peers. Globally, substance use decreased as parental monitoring increased and high parental monitoring decreased having consuming peers. Results remained essentially the same when consuming peers were added in the analysis. Conclusions: Parental monitoring has positive effects on adolescent substance use with a reduction of consumption and a lower association with consuming peers, which seems to protect adolescents against their potential negative influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not are simple ways to limit the negative influence of consuming peers on adolescent substance use.

Curb Removal Study, HR-76, Progress Report, 1962

Pavements constructed in Iowa during the period of the 1920's through the late 1940's were built with an integral curb. The purpose of the curb was to control drainage of water from the pavement surface in areas where runoff took place at a very rapid rate. It is for this reason that curbing is found on pavements constructed during this period. The curbing led the water flowing on the pavement surface to drainage outlets; this helped reduce erosion along the edge of the slab. The curbs have satisfactorily performed the job for which they were intended. The advent of bigger and faster vehicles has created a demand for changes in the design of pavements. Current designs provide wider driving surfaces with reduced grades which can better accommodate the wider cars and trucks. By present day design standards the narrow highways are inadequate and are being replaced or improved. The normal improvement procedure is to widen to 24 feet by providing additional driving surface at each edge of the pavement. Curbing is removed from the pavement so that the surface of the widening can be placed at the same level as that of the slab.

Desempenho de tratores agrícolas em tração

O objetivo deste trabalho foi avaliar o desempenho de tratores agrícolas e implementos em trabalhos de tração. Procurou-se estabelecer e validar modelos de previsão relativos ao esforço de tração requerido pela grade de discos offset de arrasto e relativos ao consumo de combustível do trator. É descrito o sistema de aquisição de dados desenvolvido para utilização em ensaios de campo, em condições reais de trabalho. Os parâmetros medidos foram: o regime do motor, a velocidade teórica e a velocidade real de avanço, o consumo horário de combustível e a força de tração na barra. Também foram realizados testes dos tratores com um freio dinamométrico ligado à tomada de potência. Os resultados de um projeto de pesquisa de três anos foram usados para estabelecer uma equação de previsão do esforço requerido por grades de discos offset, válida para mobilização primária de solos secos, de textura franca. Nas mesmas condições, os resultados validam a relação linear entre a força de tração por unidade de largura de trabalho do implemento e o consumo de combustível por hectare, indicador do dimensionamento do conjunto trator-implemento. Os dados obtidos também evidenciam as vantagens de se selecionarem marchas altas e baixa rotação do motor.

Prognostic factors and role of adjuvant therapies in the management of parasagittal meningiomas

L'objectif du présent travail de thèse est d'analyser rétrospectivement la série de méningiomes parasagittaux traités au CHUV, soit par traitements simples ou combinés (chirurgie et / ou radiochirurgie et radiothérapie fractionnée), afin de déterminer les facteurs qui influencent leur pronostic. Méthode: Entre Janvier 1999 et mai 2007, 37 méningiomes parasagittaux ont été traités dans notre centre. Nous avons analysé de manière rétrospective les différents paramètres du traitement de ces méningiomes ainsi que leur emplacement le long du sinus sagittal supérieur, leur volume, leur grade histologique et le degré de résection ainsi que le sexe et l'âge du patient afin de comprendre les facteurs qui influencent leur histoire naturelle. Résultats: Le suivi médian était de 6,7 ans (2,4 -12 ans). Les grades histologiques et le degré de résection tumorale (Simpson) étaient répartis uniformément le long du sinus sagittal supérieur. Le taux actuariel de contrôle global des tumeurs était de 65,9%. L'analyse de régression montre que le grade tumoral et le degré de résection sont deux facteurs extrêmement importants pour déterminer le contrôle tumoral (p <0,002 et ρ <0,008). La localisation le long du sinus sagittal supérieur a montré une baisse du taux de contrôle dans le tiers postérieur (p <0,002). Le sexe, l'âge et le volume de la tumeur n'étaient quand à eux pas des facteurs significatifs. Par ailleurs, et de façon inattendue, dans notre série, la proportion du traitement adjuvant a été beaucoup plus élevée que dans les séries décrites jusqu'à maintenant (39% vs 7%) mais avec un taux de contrôle similaire et diminution de la morbidité et la mortalité. Conclusions: Dans notre série, le grade histologique et le degré de résection tumorale (Simpson) sont des facteurs indépendants de récidive et de contrôle tumoral. Fait intéressant, l'emplacement dans le tiers postérieur du sinus sagittal supérieur semble être un autre facteur indépendant de récidive. Afin d'éviter les morbidités importantes liées à la chirurgie nous préconisons une utilisation précoce de traitements adjuvants pour les tumeurs grade histologique élevé et pour les tumeurs situées dans la partie postérieure du sinus sagittal supérieur

Pressão de insuflagem dos pneus no desempenho do conjunto trator-grade de discos

O objetivo deste trabalho foi avaliar o efeito da pressão de insuflagem dos pneus nos parâmetros de desempenho do conjunto trator-grade de discos. As pressões avaliadas foram: 100 kPa nos pneus da frente e 70 kPa nos pneus atrás; 140 kPa nos quatro pneus; 190 kPa nos quatro pneus. Os testes de um trator com grades de discos foram desenvolvidos em condições de campo, em solos de textura franca, mobilizados e secos. Os parâmetros de avaliação foram: o patinamento, a velocidade, a capacidade de trabalho, a eficiência energética global e o consumo de combustível por hectare. Entre as situações de pressão de insuflagem dos pneus indicadas pelo fabricante do trator e a pressão de insuflagem indicada pelo fabricante dos pneus, não se verificam diferenças significativas, tanto na capacidade de trabalho como no consumo de combustível por hectare. A utilização de elevadas pressões de insuflagem dos pneus conduz a uma redução da ordem de 3 a 5% na capacidade de trabalho e um aumento significativo entre 10 e 25% do consumo de combustível por hectare, mesmo em condições de boa aderência dos pneus, refletidas no intervalo de 7 a 15% de patinamento registrados.

2010 Iowa Youth Survey State of Iowa Results, June 2011

The Iowa Department of Public Health (IDPH) collaborated with schools in Iowa to conduct the 2014 Iowa Youth Survey (IYS). In a series of surveys that have been completed every two or 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.

Automatic quality assessment in structural brain magnetic resonance imaging

MRI has evolved into an important diagnostic technique in medical imaging. However, reliability of the derived diagnosis can be degraded by artifacts, which challenge both radiologists and automatic computer-aided diagnosis. This work proposes a fully-automatic method for measuring image quality of three-dimensional (3D) structural MRI. Quality measures are derived by analyzing the air background of magnitude images and are capable of detecting image degradation from several sources, including bulk motion, residual magnetization from incomplete spoiling, blurring, and ghosting. The method has been validated on 749 3D T(1)-weighted 1.5T and 3T head scans acquired at 36 Alzheimer's Disease Neuroimaging Initiative (ADNI) study sites operating with various software and hardware combinations. Results are compared against qualitative grades assigned by the ADNI quality control center (taken as the reference standard). The derived quality indices are independent of the MRI system used and agree with the reference standard quality ratings with high sensitivity and specificity (>85%). The proposed procedures for quality assessment could be of great value for both research and routine clinical imaging. It could greatly improve workflow through its ability to rule out the need for a repeat scan while the patient is still in the magnet bore.

Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, CRP, and blood leukocytes

Background: Thus far, the correlation of noninvasive markers with endoscopic activity in ulcerative colitis (UC) according to the modified Baron Index is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin (FC), C-reactive protein (CRP), blood leukocytes, and the Lichtiger Index (clinical score). Methods: UC patients undergoing complete colonoscopy were prospectively enrolled and scored clinically and endoscopically in an independent fashion. Fecal and blood samples were analyzed in UC patients and controls. Results: We enrolled 228 UC patients and 52 controls. Endoscopic disease activity correlated best with FC (Spearman's rank correlation coefficient r = 0.821), followed by the Lichtiger Index (r = 0.682), CRP (r = 0.556), and leukocytes (r = 0.401). FC was the only marker discriminating between different grades of endoscopic activity (grade 0, 20}11 mg/g; grade 1, 44}34 mg/g; grade 2, 111}74 mg/g; grade 3, 330}332 mg/g; grade 4, 659}319 mg/g; P = 0.0018 for discriminating grade 0 vs. 1 and P < 0.001 for discriminating all other grades). FC had the highest overall accuracy (91%) to detect endoscopically active disease (modified Baron Index _2), followed by the Lichtiger Index of _4 (77%), CRP larger than 5 mg/L (69%) and blood leukocytosis (58%). Conclusions: FC better correlated with the endoscopic disease activity than clinical activity, CRP, and blood leukocytes. The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients.

Qualidade de queijo minas frescal preparado com leite com diferentes quantidades de células somáticas

The objective of this work was to evaluate the effects of using bulk milk with different somatic cell counts (SCC) on the quality of minas frescal cheese. A randomized complete block design was used, with 3x5 factorial treatments, with three SCC levels (low, 125,000 cells mL-1; intermediate, 437,000 cells mL-1; and high, 1,053,000 cells mL-1) and five storage durations. Cheese was vacuum-packed in plastic bags and analyzed after 2, 9, 16, 23 and 30 days of storage at 4ºC. Somatic cell counts did not affect dry matter, fat, ash content, pH, free fatty acid concentrations and sensory parameters of minas frescal cheese. However, SCC in milk increased losses of protein in whey and decreased the cheese protein content. These changes did not affect the moisture-adjusted cheese yield and proteolysis during 30 days of storage. An interaction effect between SCC and time of storage was observed for firmness and sensory grades of cheeses. Results indicated that raw milk used to produce minas frescal cheese should not contain high SCC, in order to avoid lower acceptance of the product after 30 days of storage.

Association between growth and blood pressure during the life course in children and adolescents

Background: Little is known on the relative importance of growth at different periods between birth and adolescence on blood pressure (BP). Objective: To assess the association between birth weight, change in body weight (growth) and BP across the entire span of childhood and adolescence. Methods: School-based surveys were conducted annually between 1998 and 2006 among all children in four school grades (kindergarten, 4th, 7th, and 10th year of compulsory school) in the Seychelles, Indian Ocean. Height and weight and BP were measured. Three cohorts of children examined twice were analyzed: 1606 children surveyed at age 5.5 and 9.1, 2557 at age 9.2 and 12.5, and 2065 at age 12.5 and 15.5, respectively. Weights at birth and at one year were extracted from medical files. Weights were expressed as Z-scores and growth was defined as a change in weight Z-scores (corresponding to weight centile crossing). The association between BP (at age 5.5, 9.2, 12.5, and 15.5) and weight at different times was assessed by linear regression. Using results of regression models of BP on all successive weights, life course plots were drawn by plotting regression coefficients against age at which weight was measured. The figure shows a life course plot of systolic BP in boys aged 15.5. Results: Without adjustment for current weight (at the time of BP measurement), birth weight was not associated with current BP, irrespective of age, excepted for girls at age 15.5 for whom a modest positive association was found. When adjusted for current weight, birth weight was negatively and modestly associated with current BP. BP was strongly associated with current weight, irrespective of age. Life course plots showed that BP was strongly associated with growth during the few preceding years but not with growth during earlier years, except for growth during the first year of life which tended to be associated with systolic BP. Conclusions: Our findings suggest that BP during childhood and adolescence is mainly determined by current body weight and recent growth.