Patient Education and Self-Care for the Management of Jaw Pain upon Awakening: A Randomized Controlled Clinical Trial Comparing the Effectiveness of Adding Pharmacologic Treatment with Cyclobenzaprine or Tizanidine

Aims: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. Methods: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. Results: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. Conclusion: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.

The De-Totalization of History in Tim O'Brien's The Things They Carried

This paper aims at discussing how Tim O’Brien, a veteran of the Vietnam War, reviews the American involvement in the conflict in his novel The Things They Carried (1990). The author shows the perspective of the soldiers in the stories and, therefore, presents other possibilities to analyze that historical fact. The interplay of fiction and truth is essential for O’Brien to reach the objective of reevaluating official history in order to make the readers rethink the past.

Ecology of the Skink, Mabuya arajara Reboucas-Spieker, 1981, in the Araripe Plateau, Northeastern Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Recomendações para prevenção clínica: aspectos relevantes em idosos

The American Academy of Family Physicians (AAFP) released a summary of the “Recommendations for Clinical Preventive Services”. It is a publication based on “Recommendations for Clinical Preventive Services” published by the United States Preventive Services Task Force (USPSTF). These recommendations are provided only as an aid to physicians in making clinical decisions about the care of their patients. They reflect the clinic references existing at the time of publication. But its only should be used with the clear understanding that continued research may result in new knowledge and consequently there is a need for updates. Some recommendations of the USPSTF are important in clinical practice with the elderly.

“PROVINCIALISM, PICKING SIDES AND BIAS: EFFECTS OF GEOGRAPHY ON MEDIA COVERAGE OF CRYSTAL BRIDGES MUSEUM OF AMERICAN ART, 2005-10.”

The development of Crystal Bridges Museum of American Art in Bentonville, Arkansas, by Wal-Mart heiress Alice Walton has prompted diverse coverage from print and online media. This investigation looked at trends in news stories and commentary from 2005-10 to show how the location of a medium affected coverage. Through the author’s own observations and interviews with journalists and other interested parties, several trends emerged. Media outlets outside Arkansas portrayed the museum as trying to plunder the cultural heritage of local communities and relied partly on the museum’s association with Wal-Mart and stereotypes of Arkansas to frame coverage. Arkansas media, faced with limited cooperation from the museum’s public relations apparatus, typically played a cheerleader role, at times overemphasizing the importance of the collection in the art world and showcasing few critical voices in stories about acquisitions and other areas of the museum’s development.

The Probe, Issue 223 – July/August 2002

• Suburban Invasion! By Wildlife? -- Michelle L. Shuey, Southwest Texas State University • What are the health risks of consuming meat from deer or elk infected with Chronic Wasting Disease ? • The 68th North American Wildlife and Natural Resources Conference is set for March 26-30, 2003, in Winston-Salem, North Carolina • Book Review: Living in the Shadows: How to Help the Stray Cat in Your Life (Without Adding to the Problem) by Ann K. Fisher.--“I was impressed with her chapter on taming feral cats. It would certainly take a dedicated soul to put that much work into taming a cat.” • Goose School: the first National Goose Management Training Academy in Indianapolis, Indiana (June 8 & 9, 2002) -- Larry Sullivan • The California Contractors State License Board, (CSLB), recently approved a new sub-classification in its Non-Specialty Contractors License category. The new license is listed as C-61/D-64 "Animal Damage and Bird Control". • Los Angeles animal control recently approved increased efforts to control coyotes in residential areas by using traditional deterrent programs. • Identifying Predator Kills: Texas A&M has a website with some excellent photos to help identify predator kills of livestock. See http://texnat.tamu.edu/ranchref/predator/p-gen.htm • History of Wolf Attacks in Europe and Asia -- Barton Stam, Utah State University

Do extrafloral nectaries present a defensive role against herbivores in two species of the family Bignoniaceae in a Neotropical savannas?

Despite the general belief that the interaction between extrafloral nectaries (EFNs) and ants is mutualistic, the defensive function of EFNs has been poorly documented in South American savannas. In this article, we evaluate the potential impact of EFNs (benefits and costs) on two species of plants from the dry areas of Central Brazil, Anemopaegma album and Anemopaegma scabriusculum (Bignoniaceae). In particular, we characterize the composition of substances secreted by the EFNs, test whether EFNs attract ants, and whether ants actually present a defensive role, leading to reduced herbivory and increased plant fitness. Histochemical analyses indicated that EFNs from both species of Anemopaegma secrete an exudate that is composed of sugars, and potentially lipids and proteins. Furthermore, EFNs from both species were shown to present a significant role in ant attraction. However, contrary to common expectations, ants were not found to protect plants against herbivore attack. No effect was found between ant visitation and flower or fruit production in A. album, while the presence of ants led to a significant decrease in flower production in A. scabriusculum. These results suggest that EFNs might present a similar cost and benefit in A. album, and a higher cost than benefit in A. scabriusculum. Since the ancestor of Anemopaegma occupied humid forests and already presented EFNs that were maintained in subsequent lineages that occupied savannas, we suggest that phylogenetic inertia might explain the presence of EFNs in the species of Anemopaegma in which EFNs lack a defensive function.

Multiple Radial Midpupil Lid Distances: A Simple Method for Lid Contour Analysis

Purpose: To describe a new computerized method for the analysis of lid contour based on the measurement of multiple radial midpupil lid distances. Design: Evaluation of diagnostic technology. Participants and Controls: Monocular palpebral fissure images of 35 patients with Graves' upper eyelid retraction and of 30 normal subjects. Methods: Custom software was used to measure the conventional midpupil upper lid distance (MPLD) and 12 oblique MPLDs on each 15 degrees across the temporal (105 degrees, 120 degrees, 135 degrees, 150 degrees, 165 degrees, and 180 degrees) and nasal (75 degrees, 60 degrees, 45 degrees, 30 degrees, 15 degrees, and 0 degrees) sectors of the lid fissure. Main Outcome Measures: Mean, standard deviation, 5th and 95th percentiles of the oblique MPLDs obtained for patients and controls. Temporal/nasal MPLD ratios of the same angles with respect to the midline. Results: The MPLDs increased from the vertical midline in both nasal and temporal sectors of the fissure. In the control group the differences between the mean central MPLD (90 degrees) and those up to 30 degrees in the nasal (75 degrees and 60 degrees) and temporal sectors (105 degrees and 120 degrees) were not significant. For greater eccentricities, all temporal and nasal mean MPLDs increased significantly. When the MPLDs of the same angles were compared between groups, the mean values of the Graves' patients differed from control at all angles (F = 4192; P<0.0001). The greatest temporal/nasal asymmetry occurred 60 degrees from the vertical midline. Conclusions: The measurement of radial MPLD is a simple and effective way to characterize lid contour abnormalities. In patients with Graves' upper eyelid retraction, the method demonstrated that the maximum amplitude of the lateral lid flare sign occurred at 60 degrees from the vertical midline. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012; 119: 625-628 (C) 2012 by the American Academy of Ophthalmology.

A hearing report from Brazil

The past several decades, the need for hearing health services is still great, especially in the northeast, the Amazonian, and the southern regions Brazil, officially Federative Republic of Brazil, is the largest Portuguese-speaking country, and the fifth largest country in the world by population and by land. The vast land not only brings rich natural resources but also large varieties of exotic vegetation and wildlife. One hundred and ninety-three million inhabitants live in five geographical regions with diverse cultural practices influenced by immigrants from Italy, Spain, Japan, Germany, and other countries. Brazilian people generally are warm-hearted, very welcoming, and resilient. They are optimistic and creative despite having encountered many economic downturns and political challenges throughout history. A bachelor's degree is the entry level for the profession. As only 19 percent of the population aged 18–24 years have access to higher education, the competition for admissions is fierce, especially in government institutions. High school students need to pass tests of general knowledge in a national examination and a university-specific examination. Government educational institutions offer good education without charging tuition. The majority of scientific papers are also produced by scholars working in government institutions. Private institutions are generally ranked lower in academic rigor (Behlau and Gasparini, 2006), except for a few top-ranking institutions. The fields of speech-language pathology and audiology are marked by rapid changes in recent years. Currently, there are 104 undergraduate programs recognized by the Ministry of Education and distributed in all but three federal states of Brazil.

Mast cells act as phagocytes against the periodontopathogen Aggregatibacter Actinomycetemcomitans

Background: Evidence to date shows that mast cells play a critical role in immune defenses against infectious agents, but there have been no reports about involvement of these cells in eliminating periodontopathogens. In this study, the phagocytic ability of mast cells against Aggregatibacter actinomycetemcomitans compared with macrophages is evaluated. Methods: In vitro phagocytic assays were conducted using murine mast cells and macrophages, incubated with A. actinomycetemcomitans, either opsonized or not, with different bacterial load ratios. After 1 hour, cells were stained with acridine orange and assessed by confocal laser-scanning electronmicroscopy. Results: Phagocytic ability of murine mast cells against A. actinomycetemcomitans was confirmed. In addition, the percentage of mast cells with internalized bacteria was higher in the absence of opsonization than in the presence of opsonization. Both cell types showed significant phagocytic activity against A. actinomycetemcomitans. However, the percentage of mast cells with non-opsonized bacteria was higher than that of macrophages with opsonized bacteria in one of the ratios (1:10). Conclusions: This is the first report about the participation of murine mast cells as phagocytes against A. actinomycetemcomitans, mainly in the absence of opsonization with human serum. Our results may indicate that mast cells act as professional phagocytes in the pathogenesis of biofilmassociated periodontal disease

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

Antibiotics are used extensively in the treatment of various infections. Consequently, they can be considered among the most important agents involved in adverse reactions to drugs, including both allergic and non-allergic drug hypersensitivity [J Allergy Clin Immunol 113:832–836, 2004]. Most studies published to date deal mainly with reactions to the beta-lactam group, and information on hypersensitivity to each of the other antimicrobial agents is scarce. The present document has been produced by the Special Committee on Drug Allergy of the World Allergy Organization to present the most relevant information on the incidence, clinical manifestations, diagnosis, possible mechanisms, and management of hypersensitivity reactions to non beta-lactam antimicrobials for use by practitioners worldwide.

Lagrangian transport evaluation of atmospheric chemistry in the Mediterranean region

Global observations of the chemical composition of the atmosphere are essential for understanding and studying the present and future state of the earth's atmosphere. However, by analyzing field experiments the consideration of the atmospheric motion is indispensable, because transport enables different chemical species, with different local natural and anthropogenic sources, to interact chemically and so consequently influences the chemical composition of the atmosphere. The distance over which that transport occurs is highly dependent upon meteorological conditions (e.g., wind speed, precipitation) and the properties of chemical species itself (e.g., solubility, reactivity). This interaction between chemistry and dynamics makes the study of atmospheric chemistry both difficult and challenging, and also demonstrates the relevance of including the atmospheric motions in that context. In this doctoral thesis the large-scale transport of air over the eastern Mediterranean region during summer 2001, with a focus on August during the Mediterranean Intensive Oxidant Study (MINOS) measurement campaign, was investigated from a lagrangian perspective. Analysis of back trajectories demonstrated transport of polluted air masses from western and eastern Europe in the boundary layer, from the North Atlantic/North American area in the middle end upper troposphere and additionally from South Asia in the upper troposphere towards the eastern Mediterranean. Investigation of air mass transport near the tropopause indicated enhanced cross-tropopause transport relative to the surrounding area over the eastern Mediterranean region in summer. A large band of air mass transport across the dynamical tropopause develops in June, and is shifted toward higher latitudes in July and August. This shifting is associated with the development and the intensification of the Arabian and South Asian upper-level anticyclones and consequential with areas of maximum clear-air turbulence, hypothesizing quasi-permanent areas with turbulent mixing of tropospheric and stratospheric air during summer over the eastern Mediterranean as a result of large-scale synoptic circulation. In context with the latex knowledge about the transport of polluted air masses towards the Mediterranean and with increasing emissions, especially in developing countries like India, this likely gains in importance.

(De)colonization through topophilia: Marjorie Kinnan Rawlings’s life and work in Florida

(De)colonization Through Topophilia: Marjorie Kinnan Rawlings’s Life and Work in Florida attempts to reveal the author’s intimate connection to and mental growth through her place, namely the Cross Creek environs, and its subsequent effect on her writing. In 1928, Marjorie Kinnan Rawlings and her first husband Charles Rawlings came to Cross Creek, Florida. They bought the shabby farmhouse on Cross Creek Road, trying to be both, writers and farmers. However, while Charles Rawlings was unable to write in the backwoods of the Florida Interior, Rawlings found her literary voice and entered a symbiotic, reciprocal relationship with the natural world of the Cracker frontier. Her biographical preconditions – a childhood spent in the rural area of Rock Creek, outside of Washington D. C. - and a father who had instilled in her a sense of place or topophilia, enabled her to overcome severe marriage tensions and the hostile climate women writers faced during the Depression era. Nature as a helping ally and as an “undomesticated”(1) space/place is a recurrent motif throughout most of Rawlings’s Florida literature. At a time when writing the American landscape/documentary and the extraction of the self from texts was the prevalent literary genre, Marjorie Kinnan Rawlings inscribed herself into her texts. However, she knew that the American public was not yet ready for a ‘feminist revolt’, but was receptive of the longtime ‘inaudible’ voices from America’s regions, especially with regard to urban poverty and a homeward yearning during the Depression years. Fusing with the dynamic eco-consciousness of her Cracker friends and neighbors, Rawlings wrote in the literary category of regionalism enabling her to pursue three of her major aims: an individuated self, a self that assimilated with the ‘master narratives’ of her time and the recognition of the Florida Cracker and Scrub region. The first part of this dissertation briefly introduces the largely unknown and underestimated writer Marjorie Kinnan Rawlings, providing background information on her younger years, the relationship toward her family and other influential persons in her life. Furthermore, it takes a closer look at the literary category of regionalism and Rawlings’s use of ‘place’ in her writings. The second part is concerned with the ‘region’ itself, the state of Florida. It focuses on the natural peculiarities of the state’s Interior, the scrub and hammock land around her Cracker hamlet as well as the unique culture of the Florida Cracker. Part IV is concerned with the analysis of her four Florida books. The author is still widely related to the ever-popular novel The Yearling (1938). South Moon Under (1933) and Golden Apples (1935), her first two novels, have not been frequently republished and have subsequently fallen into oblivion. Cross Creek (1942), Rawlings’s last Florida book, however, has recently gained renewed popularity through its use in classes on nature writers and the non-fiction essay but it requires and is here re-evaluated as the author’s (relational) autobiography. The analysis through place is brought to completion in this work and seems to intentionally close the circle of Rawlings’s Florida writings. It exemplifies once more that detachment from place is impossible for Rawlings and that the intermingling of life and place in literature, is essential for the (re)creation of her identity. Cross Creek is therefore not only one of Rawlings’s greatest achievements; it is more importantly the key to understanding the author’s self and her fiction. Through the ‘natural’ interrelationship of place and self and by looking “mutually outward and inward,”(2) Marjorie Kinnan Rawlings finds her literary voice, a home and ‘a room of her own’ in which to write and come to consciousness. Her Florida literature is not only product but also medium and process in her assessment of her identity and self. _____________ (1) Alaimo, Stacy. Undomesticated Ground: Recasting Nature as Feminist Space (Ithaca: Cornell UP, 2000) 23. (2) Libby, Brooke. “Nature Writing as Refuge: Autobiography in the Natural World” Reading Under the Sign of Nature. New Essays in Ecocriticism. Ed. John Tallmadge and Henry Harrington. (Salt Lake City: The U of Utah P, 2000) 200.

Ex occulto carpere agmen: la guerriglia antiromana in Britannia e in Giudea

Scopo di questo lavoro è quello di analizzare le componenti tattiche, strategiche e sociali della guerriglia antiromana in Britannia e in Giudea, in un periodo che va dal I secolo a. C. al III secolo d. C., con l'obiettivo di mettere in luce la differente efficacia delle tattiche non ortodosse rispetto a quelle convenzionali; e di analizzare le risposte teoriche ed empiriche concepite dai Romani per affrontare questa forma di lotta. La tesi è stata articolata nel modo seguente: una prima parte analizza gli aspetti tattici, strategici e sociali della guerriglia e della controguerriglia, anche attraverso il metodo comparativo, mettendo cioè a confronto alcuni dei principali testi sulla guerra non convenzionale redatti in epoche e contesti diversi, dai quali si è cercato di delle costanti potenzialmente applicabili a qualsiasi periodo storico e a qualsiasi area geografica. Nella seconda parte si cerca di applicare tali costanti alla realtà storico – sociale dell'impero romano. Particolare attenzione è stata riservata al rapporto tra la mentalità romana, basata sul concetto di bellum iustum, e le tattiche non ortodosse. La terza e la quarta parte analizzano la resistenza antiromana in Britannia e in Giudea, mettendone in luce tutti gli aspetti, in particolare quelli legati alla guerriglia rurale, a quella urbana, al terrorismo, all'evoluzione della guerriglia da guerra per bande a guerra convenzionale e alla controguerriglia. La scelta di queste due province non è casuale. In province così lontane e diverse tra loro, Roma inviò spesso gli stessi generali esperti di controguerriglia. Questo particolare permette di notare la presenza, a Roma, di una grand strategy che, consapevole del fenomeno della guerriglia, ne affidò la repressione agli stessi generali, specialisti della controguerriglia, non esitando a spostarli, in caso di necessità, da un capo all'altro dell'impero.