Sensibilização ao látex em pacientes com mielomeningocele na urologia do HC-FMUSP: prevalência e fatores associados

INTRODUÇÃO: A alergia ao látex é um importante problema de saúde pública, especialmente em grupos de risco que têm contato frequente com este potente alérgeno. Este estudo estimou a prevalência e os fatores de risco para sensibilização ao látex em pacientes com mielomeningocele (MMC) submetidos a procedimentos cirúrgicos urológicos no HC-FMUSP. MÉTODOS: Foram selecionados pacientes com MMC submetidos a pelo menos uma cirurgia urológica, entre 2009 e 2014.Todos foram entrevistados e seus prontuários revisados. Uma amostra de sangue permitiu que a IgE específica ao látex, a K82, e seus recombinantes fossem investigados pelo método lmmunoCAP100 (kUa/L -1). A associação entre a exposição e o desfecho foi avaliada por meio de regressão logística de Poisson, Quiquadrado ou o teste exato de Fischer, para variáveis categóricas. O teste t de Student foi utilizado para comparar variáveis contínuas (nível de significância de 5%). Foram calculados a razão de prevalência (RP) e o intervalo de confiança de 95%. RESULTADOS: Foram identificados Duzentos e doze pacientes (51% do sexo masculino, 20,4 ± 6,4 anos de idade), 68 foram submetidos a pelo menos um procedimento urológico e 51 aceitaram participar (87,9%). Vinte e nove pacientes foram considerados não-sensibilizados (IgE específica para o látex :: a 0,7 kUa/L) e 22 sensibilizados ao látex com IgE > 0,7 kUa/L. Quando comparados os dois grupos, o sensibilizado apresentou um número de procedimentos cirúrgicos maior (11,6 ± 5,9 vs 7,2 ± 5,6) e dentre eles 48,3% apresentaram alguma alergia anterior contra 27,6% no grupo não sensibilizado. A sensibilização ao látex foi independentemente associada com alergia a produtos de látex (p = 0,014) e com o número de cirurgias anteriores (p = 0,032). A alergia ao látex tinha uma razão de prevalência de 2,87 (95% Cl: 1,24 a 6,65) ajustado para o número de cirurgias. Para cada procedimento cirúrgico, ajustado à alergia a produtos que contém látex, aumentou o risco para sensibilização em 4% (PR = 1,04; 95% CI: 1,00-1,09). CONCLUSÕES: A história de alergia ao látex e o número de cirurgias foram fatores de risco independentes para sensibilização ao látex

Validation of the Item-Attribute Matrix in TIMSS-Mathematics Using Multiple Regression and the LSDM

The purposes of this study were (1) to validate of the item-attribute matrix using two levels of attributes (Level 1 attributes and Level 2 sub-attributes), and (2) through retrofitting the diagnostic models to the mathematics test of the Trends in International Mathematics and Science Study (TIMSS), to evaluate the construct validity of TIMSS mathematics assessment by comparing the results of two assessment booklets. Item data were extracted from Booklets 2 and 3 for the 8th grade in TIMSS 2007, which included a total of 49 mathematics items and every student's response to every item. The study developed three categories of attributes at two levels: content, cognitive process (TIMSS or new), and comprehensive cognitive process (or IT) based on the TIMSS assessment framework, cognitive procedures, and item type. At level one, there were 4 content attributes (number, algebra, geometry, and data and chance), 3 TIMSS process attributes (knowing, applying, and reasoning), and 4 new process attributes (identifying, computing, judging, and reasoning). At level two, the level 1 attributes were further divided into 32 sub-attributes. There was only one level of IT attributes (multiple steps/responses, complexity, and constructed-response). Twelve Q-matrices (4 originally specified, 4 random, and 4 revised) were investigated with eleven Q-matrix models (QM1 ~ QM11) using multiple regression and the least squares distance method (LSDM). Comprehensive analyses indicated that the proposed Q-matrices explained most of the variance in item difficulty (i.e., 64% to 81%). The cognitive process attributes contributed to the item difficulties more than the content attributes, and the IT attributes contributed much more than both the content and process attributes. The new retrofitted process attributes explained the items better than the TIMSS process attributes. Results generated from the level 1 attributes and the level 2 attributes were consistent. Most attributes could be used to recover students' performance, but some attributes' probabilities showed unreasonable patterns. The analysis approaches could not demonstrate if the same construct validity was supported across booklets. The proposed attributes and Q-matrices explained the items of Booklet 2 better than the items of Booklet 3. The specified Q-matrices explained the items better than the random Q-matrices.

Mathematical programming model for heat exchanger design through optimization of partial objectives

Mathematical programming can be used for the optimal design of shell-and-tube heat exchangers (STHEs). This paper proposes a mixed integer non-linear programming (MINLP) model for the design of STHEs, following rigorously the standards of the Tubular Exchanger Manufacturers Association (TEMA). Bell–Delaware Method is used for the shell-side calculations. This approach produces a large and non-convex model that cannot be solved to global optimality with the current state of the art solvers. Notwithstanding, it is proposed to perform a sequential optimization approach of partial objective targets through the division of the problem into sets of related equations that are easier to solve. For each one of these problems a heuristic objective function is selected based on the physical behavior of the problem. The global optimal solution of the original problem cannot be ensured even in the case in which each of the sub-problems is solved to global optimality, but at least a very good solution is always guaranteed. Three cases extracted from the literature were studied. The results showed that in all cases the values obtained using the proposed MINLP model containing multiple objective functions improved the values presented in the literature.

An improved procedure for obtaining and maintaining well characterized partial water saturation states on concrete samples to be used for mass transport tests

A conditioning procedure is proposed allowing to install into the concrete specimens any selected value of water saturation degree with homogeneous moisture distribution. This is achieved within the least time and the minimum alteration of the concrete specimens. The protocol has the following steps: obtaining basic drying data at 50 °C (water absorption capacity and drying curves); unidirectional drying of the specimens at 50 °C until reaching the target saturation degree values; redistribution phase in closed containers at 50 °C (with measurement of the quasi-equilibrium relative humidities); storage into controlled environment chambers until and during mass transport tests, if necessary. A water transport model is used to derive transport parameters of the tested materials from the drying data, i.e., relative permeabilities and apparent water diffusion coefficients. The model also allows calculating moisture profiles during isothermal drying and redistribution phases, thus allowing optimization of the redistribution times for obtaining homogeneous moisture distributions.

LOGITCPRPLOT: Stata module to graph component-plus-residual plot for logistic regression

logitcprplot can be used after logistic regression for graphing a component-plus-residual plot (a.k.a. partial residual plot) for a given predictor, including a lowess, local polynomial, restricted cubic spline, fractional polynomial, penalized spline, regression spline, running line, or adaptive variable span running line smooth

Anaemia and vitamin A deficiency in poor urban pregnant women of Bangladesh

This cross-sectional study investigated the prevalence of anaemia and vitamin A deficiency (VAD) among pregnant women in a poor urban population of Bangladesh. It also examined the association of various socio-economic and dietary factors with anaemia and vitamin A status. A maternal and child health clinic in Dhaka city, Bangladesh was used to obtain the sample. Three hundred and eighty three pregnant women, aged 20-30 years, of 20-30 weeks gestation were randomly selected from women on their first presentation for antenatal care. Socio-economic, pregnancy related information, usual dietary pattern, and anthropometric data were collected. Blood haemoglobin and serum retinol (vitamin A) concentrations were determined. About 40% of the pregnant women were anaemic (haemoglobin <11.0 g/dl) and 45% had low serum vitamin A levels (<30 mug/dl); with 8.6% having sub-clinical VAD (serum retinol <20 μg/dl). The women with low serum vitamin A levels had 1.8 times greater risk of being anaemic than did the women with normal vitamin A status. Food frequency data revealed that a large proportion of these women did not consume egg (49%), milk (25%), meat (31%), liver (83%), large fish (32%), small fish (39%) and sweet pumpkin (52%) at all; while about 25% of the women reported consuming dark green leafy vegetables (DGLV) and 64% reported an intake of fruit at least four servings a week. The pregnant women who were either illiterate or received only informal education (up to grade ten) had significantly lower haemoglobin and serum vitamin A levels compared to those who completed at least a secondary school certificate. The women whose husbands were illiterate or received only informal education had significantly (P=0.01) lower serum vitamin A levels than those whose husbands had received at least a secondary school certificate. The women who came from families with a per-capita income below the poverty line had significantly lower haemoglobin and serum vitamin A levels compared to those who came from families with a per-capita income above the poverty line. The women who consumed three servings or less of DGLV and fruit per week had significantly lower haemoglobin and serum vitamin A levels than those who consumed four or more servings a week. The women who never consumed large fish had significantly lower haemoglobin compared to those who reported at least one serving a week. Furthermore, the women who never consumed sweet pumpkin had significantly lower serum vitamin A than the women who ate at least one serving a week. By multiple regression analysis, intake of meat, DGLV and fruit, and serum vitamin A levels were found to have a significant independent relationship with haemoglobin. The overall F-ratio (9.9) was highly significant (P=0.000), the adjusted R-square was 0.086 (multiple R=0.309). Multiple regression analysis for serum vitamin A also revealed a significant independent relationship with per capita income, haemoglobin levels, intakes of DGLV and sweet pumpkin. The overall F-ratio (10.2) was highly significant (P=0.000), the adjusted R-square was 0.10 (multiple R=0.312). In conclusion, anaemia and vitamin A deficiency were highly prevalent among poor urban pregnant women in Bangladesh. Various socio-economic and dietary factors may influence the anaemia and vitamin A status of these women. The present study emphasizes the need for a comprehensive intervention strategy, which include both nutritional and environmental factors, to improve the nutritional status of this population.

Forecasting with serially correlated regression models

In this article we investigate the asymptotic and finite-sample properties of predictors of regression models with autocorrelated errors. We prove new theorems associated with the predictive efficiency of generalized least squares (GLS) and incorrectly structured GLS predictors. We also establish the form associated with their predictive mean squared errors as well as the magnitude of these errors relative to each other and to those generated from the ordinary least squares (OLS) predictor. A large simulation study is used to evaluate the finite-sample performance of forecasts generated from models using different corrections for the serial correlation.

Treatment of partial-thickness burns: A prospective, randomized trial using Transcyte (TM)

Background: The purpose of the present study was to compare the effectiveness of three burns dressings (TransCyte, a bio-engineered skin substitute; Biobrane; and Silvazine cream (silver sulphadiazine and 0.2% chlorhexidine)), in treating children with partial-thickness burns. The primary objective was to determine the days until greater than or equal to90% re-epithelialization. The secondary objectives were to evaluate the number of wounds requiring autografting and the number of dressing changes/local wound care required. Methods: Study wounds were identified on each patient and the patients were randomized to receive TransCyte or Biobrane or Silvazine. Assessment of study wound closure began at 2 days after treatment and continued at least every other day thereafter until the wounds re-epithelialized or were autografted. A laser Doppler imaging system was used as an adjunct to assessing the depth of the burn. Results: Thirty-three patients with 58 wound sites enrolled in the study (TransCyte, n = 20, Biobrane, n = 17; Silvazine, n = 21). Mean time to re-epithelialization was 7.5 days for TransCyte, 9.5 days for Biobrane, and 11.2 days for Silvazine. The number of wounds requiring autografting were 5/21 (24%) for Silvazine, 3/17 (17%) for Biobrane, and 1/20 (5%) for TransCyte. Conclusions: When used in partial-thickness burns in children, TransCyte promotes fastest re-epithelialization and required less overall dressings then Biobrane or Silvazine. Patients who received Silvazine or Biobrane require more autografting than those treated with TransCyte.

Embedding a restricted class of partial K-4-designs

Given a partial K-4-design (X, P), if x is an element of X is a vertex which occurs in exactly one block of P, then call x a free vertex. In this paper, a technique is described for obtaining a cubic embedding of any partial K-4-design with the property that every block in the partial design contains at least two free vertices.

Enhanced detection-guided NLMS estimation of sparse FIR-modeled signal channels

In various signal-channel-estimation problems, the channel being estimated may be well approximated by a discrete finite impulse response (FIR) model with sparsely separated active or nonzero taps. A common approach to estimating such channels involves a discrete normalized least-mean-square (NLMS) adaptive FIR filter, every tap of which is adapted at each sample interval. Such an approach suffers from slow convergence rates and poor tracking when the required FIR filter is "long." Recently, NLMS-based algorithms have been proposed that employ least-squares-based structural detection techniques to exploit possible sparse channel structure and subsequently provide improved estimation performance. However, these algorithms perform poorly when there is a large dynamic range amongst the active taps. In this paper, we propose two modifications to the previous algorithms, which essentially remove this limitation. The modifications also significantly improve the applicability of the detection technique to structurally time varying channels. Importantly, for sparse channels, the computational cost of the newly proposed detection-guided NLMS estimator is only marginally greater than that of the standard NLMS estimator. Simulations demonstrate the favourable performance of the newly proposed algorithm. © 2006 IEEE.

Effect of sample geometry on regression rate of the melting interface for carbon steel burned in oxygen

Promoted-ignition testing on carbon steel rods of varying cross-sectional area and shape was performed in high pressure oxygen to assess the effect of sample geometry on the regression rate of the melting interface. Cylindrical and rectangular geometries and three different cross sections were tested and the regression rates of the cylinders were compared to the regression rates of the rectangular samples at test pressures around 6.9 MPa. Tests were recorded and video analysis used to determine the regression rate of the melting interface by a new method based on a drop cycle which was found to provide a good basis for statistical analysis and provide excellent agreement to the standard averaging methods used. Both geometries tested showed the typical trend of decreasing regression rate of the melting interface with increasing cross-sectional area; however, it was shown that the effect of geometry is more significant as the sample's cross sections become larger. Discussion is provided regarding the use of 3.2-mm square rods rather than 3.2-mm cylindrical rods within the standard ASTM test and any effect this may have on the observed regression rate of the melting interface.

A survey of regular ecstasy users' knowledge and practices around determining pill content and purity: Implications for policy and practice.

Objective: To examine the methods used by a sample of regular ecstasy users to determine the content and purity of ecstasy pills, their knowledge of the limitations of available pill testing methods, and how pill test results would influence their drug use behaviour. Method: Data were collected from regular ecstasy users (n = 810) recruited from all eight capital cities of Australia. Data were analysed using multiple logistic regression and chi-square (chi(2)) tests of association. Open-ended responses were coded for themes. Results: The majority of the sample(84%) reported attempting to find out the content and purity of ecstasy at least some of the time, most commonly asking friends or dealers. Less than one quarter (22%) reported personal use of testing kits. There was a moderate level of awareness of the limitations of testing kits among those who reported having used them. Over half (57%) of those reporting personal use of testing kits reported that they would not take a pill if test results indicated that it contained ketamine and over three quarters (76%) reported that they would not take an "unknown" pill (producing no reaction in a reagent test). Finally, a considerable majority (63%) expressed interest in pill testing should it be more widely available. Conclusions: The majority of regular ecstasy users sampled in this Australian study report previous attempts to determine the content and purity of pills sold as ecstasy. Although only a small proportion have used testing kits, many report that they would do so if they were more widely available. The results of pill tests may influence drug use if they indicate that pills contain substances which ecstasy users do not want to ingest or are of unknown content. More detailed research examining ways in which pill testing may influence drug use is required to inform evidence-based policy. (c) 2006 Elsevier B.V. All rights reserved.

The use of correlation and regression methods in optometry

Correlation and regression are two of the statistical procedures most widely used by optometrists. However, these tests are often misused or interpreted incorrectly, leading to erroneous conclusions from clinical experiments. This review examines the major statistical tests concerned with correlation and regression that are most likely to arise in clinical investigations in optometry. First, the use, interpretation and limitations of Pearson's product moment correlation coefficient are described. Second, the least squares method of fitting a linear regression to data and for testing how well a regression line fits the data are described. Third, the problems of using linear regression methods in observational studies, if there are errors associated in measuring the independent variable and for predicting a new value of Y for a given X, are discussed. Finally, methods for testing whether a non-linear relationship provides a better fit to the data and for comparing two or more regression lines are considered.

Data analysis methods in optometry Part 7: multiple linear regression

Multiple regression analysis is a complex statistical method with many potential uses. It has also become one of the most abused of all statistical procedures since anyone with a data base and suitable software can carry it out. An investigator should always have a clear hypothesis in mind before carrying out such a procedure and knowledge of the limitations of each aspect of the analysis. In addition, multiple regression is probably best used in an exploratory context, identifying variables that might profitably be examined by more detailed studies. Where there are many variables potentially influencing Y, they are likely to be intercorrelated and to account for relatively small amounts of the variance. Any analysis in which R squared is less than 50% should be suspect as probably not indicating the presence of significant variables. A further problem relates to sample size. It is often stated that the number of subjects or patients must be at least 5-10 times the number of variables included in the study.5 This advice should be taken only as a rough guide but it does indicate that the variables included should be selected with great care as inclusion of an obviously unimportant variable may have a significant impact on the sample size required.

Extended surface fluidized bed heat transfer

Experirnental data and theoretical calculation on the heat transfer performance of extended surface submerged: in shallow air fluidized beds ~ less than 150 mm, are presented. Energy t;ransferrence from the bed material was effected by water cooled tubes passing through the fins. The extended surface tested was either manufactured from square or radial copper fins silver soldered to a circular basic tube or commercially supplied, being of the crimped or extruded helical fin type. Performances are compared, for a wide range of geometric variables, bed configurations and fluidized materials, with plain and oval tubes operating under similar experimental conditions. A statistical analysis of all results, using a regression technique, has shown the relative importance of each significant variable. The bed to surface heat transfer coefficients are higher than those reported in earlier published work using finned tubes in much deeper beds and the heat transfer to the whole of the extended surface is at least as good as that previously reported for un-finned tubes. The improved performance is attributed partly to the absence of large bubbles in shallow beds and it is suggested that the improved circulation of the solids when constrained in the narrow passages between adjacent fins may be a contributory factor. Flow visualisation studies between a perspex extended surface and a fluidized bed using air at ambient temperatures, have demonstrated the effect of too small a fin spacing. Fin material and the bonding to the basic tube are more important in the optimisation of performance than in conventional convective applications because of the very much larger heat fluxes involved. A theoretical model of heat flow for a radial fin surface, provides data concerning the maximum heat transfer and minimum metal required to fulfil a given heat exchange duty. Results plotted in a series of charts aim at assisting the designer of shalJow fluidized beds.