Informatização do consultório odontológico

Dental software allow for a practical management of clinical and administrative tasks of the dental office. The aim of this study was to correlate different software (ProDent, Is-Odonto, ExDental, DentalPro, Dental Office, Dental Clinic, Dentalis, EasyDental), through research in specialized sites on the internet, enumerating their advantages and disadvantages. Due to the variety of software in the market, the dentist should be aware of some aspects such as: friendliness of use, presence of a calendar base and administrative controls, storage of treatments and images, broader coverage of the dentist competency, direct contact with software developers, and the pertinent ethical issues.

Utilização de dados fornecidos por satélites para determinação de riscos ambientais

Pós-graduação em Engenharia Mecânica - FEG

Fire History at the Eastern Great Plains Margin, Missouri River Loess Hills

The purpose of this paper is to provide quantitative fire history information for a geographically unique region, the Loess Hills of northwest Missouri. We sampled 33 bur oak (Quercus macrocarpa Michx.), chinkapin oak (Q. muehlenbergii Engelm.), and black oak (Q. velutina Lam.) trees from the Brickyard Hill Conservation Area in northwest Missouri. The period of tree-ring record ranged in calendar years from 1671 to 2004 and fire-scar dates (n = 97) ranged from 1672 to 1980. Fire intervals for individual trees ranged from 1 to 87 years. The mean fire interval was 6.6 years for the pre-Euro-American settlement period (1672-1820), and 5.2 years for the entire record (1672-1980). A period of more frequent fire (mean fire interval = 1.6 for 1825 to 1850) coincided with Euro-American settlement of the area. The average percentage of trees scarred at the site was 16.8%, or about 1 in 7 trees sampled per fire. No significant relationship between fire years and drought conditions was found; however, events prior to 1820 may have been associated with wet to dry mode transitions.

High Resolution Paleoceanography of the Guaymas Basin, Gulf of California, During the Past 15 000 Years

Deep Sea Drilling Project Site 480 (27°54.10’N, 111°39.34’W; 655 m water depth) contains a high resolution record of paleoceanographic change of the past 15 000 years for the Guaymas Basin, a region of very high diatom productivity within the central Gulf of California. Analyses of diatoms and silicoflagellates were completed on samples spaced every 40-50 yr, whereas ICP-AES geochemical analyses were completed on alternate samples (sample spacing 80-100 yr). The Bolling-Allerod interval (14.6-12.9 ka) (note, ka refers to 1000 calendar years BP throughout this report) is characterized by an increase in biogenic silica and a decline in calcium carbonate relative to surrounding intervals, suggesting conditions somewhat similar to those of today. The Younger Dryas event (12.9-11.6 ka) is marked by a major drop in biogenic silica and an increase in calcium carbonate. Increasing relative percentage contributions of Azpeitia nodulifera and Dictyocha perlaevis (a tropical diatom and silicoflagellate, respectively) and reduced numbers of the silicoflagellate Octactis pulchra are supportive of reduced upwelling of nutrient-rich waters. Between 10.6 and 10.0 ka, calcium carbonate and A. nodulifera abruptly decline at DSDP 480, while Roperia tesselata, a diatom indicative of winter upwelling in the modern-day Gulf, increases sharply in numbers. A nearly coincident increase in the silicoflagellate Dictyocha stapedia suggests that waters above DSDP 480 were more similar to the cooler and slightly more saline waters of the northern Gulf during much of the early and middle parts of the Holocene (~10 to 3.2 ka). At about 6.2 ka a stepwise increase in biogenic silica and the reappearance of the tropical diatom A. nodulifera marks a major change in oceanographic conditions in the Gulf. A winter shift to more northwesterly winds may have occurred at this time along with the onset of periodic northward excursions (El Nino-driven?) of the North Equatorial Countercurrent during the summer. Beginning between 2.8 and 2.4 ka, the amplitude of biogenic silica and wt% Fe, Al, and Ti (proxies of terrigenous input) increase, possibly reflecting intensification of ENSO cycles and the establishment of modern oceanographic conditions in the Gulf. Increased numbers of O. pulchra after 2.8 ka suggest enhanced spring upwelling.

Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department

Introduction C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality. Objective To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED. Methods Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010. Results From 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests. Discussion Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.

Formazione e Competenze Professionali: una ricerca empirica sui Cassaintegrati in deroga della regione Emilia Romagna

The general theme of the present inquiry concerns the role of training and continuous updating of knowledge and skills in relation to the concept of employability and social vulnerability. The empirical research has affected the entire calendar year 2010, namely from 13 February 2010 to December 31, 2010: data refer to a very specific context or to the course funded by the Emilia Romagna region and targeted to employees in cassintegrazione notwithstanding domiciled in the region. The investigations were performed in a vocational training scheme accredited by the Emilia Romagna for the provision of publicly funded training courses. The quantitative data collected are limited to the region and distributed in all the provinces of Emilia Romagna; It addressed the issue of the role of continuing education throughout life and the importance of updating knowledge and skills, such as privileged instruments to address the instability of the labor market and what strategy to reduce the risk unemployment. Based on the different strategies that the employee puts in place during their professional careers, we introduce two concepts that are more common in the so-called knowledge society, namely the concept of social vulnerability and employability. In modern organizations becomes relevant knowledge they bring workers and the relationships that develop between people and allowing exponentially and disseminate such knowledge and skills. The knowledge thus becomes the first productive force, defined by Davenport and Prusak (1998) as "fluid combination of experience, values, contextual information and specialist knowledge that provides a framework for the evaluation and assimilation of new experience and new information ". Learning at work is a by stable explicit and conscious, and even enjoyable for everyone, especially outside of a training intervention. It then goes on to address the specific issue of training, under the current labor market increasingly deconstructed.

Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: a prospective cohort study

Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment. Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men.

Infantile spasms: does season influence onset and long-term outcome?

To study whether onset of infantile spasms manifests seasonal variation, as previously reported, and whether any such seasonality is associated with treatment response and long-term outcome, data for 57 patients were retrospectively reviewed. The data were collected from hospital files and through a mail survey of children with infantile spasms born from 1980 to 2002 and monitored at the University Children's Hospital of Berne, Switzerland. The mean age at time of onset of infantile spasms was 7 months (range, 0.75-40), at diagnosis 8 months (range, 1-42) and at follow-up 11.3 years (range, 1-23 years). In 77% of participants, the etiology of infantile spasms was known (symptomatic); in the remaining 23% it was not known (nonsymptomatic). In contrast to previous findings, onset of infantile spasms was not associated with calendar month, photoperiod, or global solar radiation. Long-term prognosis was poor: 4 of the 57 (7%) children died; 49 (86%) had cognitive impairment and 40 (70%) had physical impairment; 31 (54%) had cerebral palsy, 37 had (65%) persistent seizures, and 9 (16%) had Lennox-Gastaut syndrome. Symptomatic infantile spasms were associated with worse cognitive outcome (P < 0.001), but treatment modality and overall duration of infantile spasms were not. There was no association of calendar month or photoperiod at onset with cognitive outcome or treatment response.

Pesiqta Rabbati: a text-linguistic and form-analytical analysis of the rabbinic homily

Pesiqta Rabbati is a unique homiletic midrash that follows the liturgical calendar in its presentation of homilies for festivals and special Sabbaths. This article attempts to utilize Pesiqta Rabbati in order to present a global theory of the literary production of rabbinic/homiletic literature. In respect to Pesiqta Rabbati it explores such areas as dating, textual witnesses, integrative apocalyptic meta-narrative, describing and mapping the structure of the text, internal and external constraints that impacted upon the text, text linguistic analysis, form-analysis: problems in the texts and linguistic gap-filling, transmission of text, strict formalization of a homiletic unit, deconstructing and reconstructing homiletic midrashim based upon form-analytic units of the homily, Neusner’s documentary hypothesis, surface structures of the homiletic unit, and textual variants. The suggested methodology may assist scholars in their production of editions of midrashic works by eliminating superfluous material and in their decoding and defining of ancient texts.

The Little Metropolis: Religion, Politics, & Spolia

There have been numerous councils throughout the Catholic Church?s history. From the First Council of Nicaea in 325 CE to Vatican II in 1962, only a few centuries have passed without any major church doctrinal change. Following hand in hand with changes in doctrine came the bifurcation of the Christian Church into the Roman CatholicChurch and the Orthodox Church. The first split came in 325 CE with Arianism. Arius of Alexandria and his followers did not agree with the Catholic Church?s viewpoint that the son, Jesus, should be on equal footing with the Father and the Holy Spirit. Constantine the Great brought the Arianism debate to the First Council of Nicaea,which declared Arianism a heretical religion. The following Catholic council?s decisions separated the two Churches even more, eventually creating the formal separation of the Church during the East-West Schism in the middle of the 11th century. Although the twoChurches constantly tried to unite, the Churches hit speed bumps along the way. Eventually, the 1274 Second Council of Lyons officially united the two Churches, even if only for an ephemeral time. At first glance, it might not seem that much resulted from the 1274 Second Council of Lyons. Almost immediately after the council?s ruling, the two Churches split again. Little is known as to why the 1274 Second Council of Lyons ultimately failed in its unification attempt. In this thesis, I will examine the churches of the Little Metropolis at Athens, Merbaka in the Argolid, and Agioi Theodoroi in Athens. In detailing the architectural features of these buildings, I will reconstruct the church building program in association with the 1274 Second Council of Lyons. I will also compare these churchesusing historical sources to keep the sociological, religious, political, and historical context accurate.

Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa

We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.

Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians

OBJECTIVES: Smoking is the most prevalent modifiable risk factor for cardiovascular diseases among HIV-positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling. METHODS: The Swiss HIV Cohort Study (SHCS) is a multicentre prospective observational database. Our single-centre intervention at the Zurich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians' checklist for semi-annual documentation of their counselling. Smoking status was then compared between participants at the Zurich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse. RESULTS: Between April 2000 and December 2010, 11 056 SHCS participants had 121 238 semi-annual visits and 64 118 person-years of follow-up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.07-1.42; P = 0.004] and had fewer relapses (OR 0.75; 95% CI 0.61-0.92; P = 0.007) than participants at other SHCS institutions. The effect of the intervention was stronger than the calendar time effect (OR 1.19 vs. 1.04 per year, respectively). Middle-aged participants, injecting drug users, and participants with psychiatric problems or with higher alcohol consumption were less likely to stop smoking, whereas persons with a prior cardiovascular event were more likely to stop smoking. CONCLUSIONS: An institution-wide training programme for HIV care physicians in smoking cessation counselling led to increased smoking cessation and fewer relapses.

A Comparative Chronology of the History of Eastern Europe and the Climate

Two main areas were examined in this project: * The detailed climatic history of the second part of the Holocene (approximately the last 5500 calendar years) for the Zapadnodvinskaya lowland, making it possible to reconstruct general climatic changes in eastern Europe (taking other palynological, dendrochronological, historical and instrumental data into account). * The most important historical events for the period of the 9th-17th centuries that had an impact on Russian history. The comparative chronology of the main climatic changes and events of Russian social history showed that as local climatic conditions became worse (i.e. falling average annual temperature or precipitation rate) the density of significant events in society rose. This suggests that climatic deterioration is both a stimulus and an outstanding factor in social development.

HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis

BACKGROUND: Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis. METHODS: We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression. RESULTS: The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51). INTERPRETATION: Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

Detection of Progressive Deterioration in Early Onset Schizophrenia with a New Statistical Method

Much controversy exists over whether the course of schizophrenia, as defined by the lengths of repeated community tenures, is progressively ameliorating or deteriorating. This article employs a new statistical method proposed by Wang and Chen (2000) to analyze the Denmark registry data in Eaton, et al (1992). The new statistical method correctly handles the bias caused by induced informative censoring, which is an interaction of the heterogeneity of schizophrenia patients and long-term follow-up. The analysis shows a progressive deterioration pattern in terms of community tenures for the full registry cohort, rather than a progressive amelioration pattern as reported for a selected sub-cohort in Eaton, et al (1992). When adjusted for the long-term chronicity of calendar time, no significant progressive pattern was found for the full cohort.