Relação entre os atributos de qualidade de um serviço de reabilitação ambulatorial e os padrões do modelo de acreditação Joint Commission on Accreditation of Healthcare Organizations : a visão do cliente

Mostra evidências de relação entre os atributos de qualidade de um serviço de realibilitação ambulatorial sob a percepção do cliente e os padrões do modelo internacional de acreditação de serviço de saúde.

Joint dynamic probabilistic constraints with projected linear decision rules

We consider multistage stochastic linear optimization problems combining joint dynamic probabilistic constraints with hard constraints. We develop a method for projecting decision rules onto hard constraints of wait-and-see type. We establish the relation between the original (in nite dimensional) problem and approximating problems working with projections from di erent subclasses of decision policies. Considering the subclass of linear decision rules and a generalized linear model for the underlying stochastic process with noises that are Gaussian or truncated Gaussian, we show that the value and gradient of the objective and constraint functions of the approximating problems can be computed analytically.

Construção e validação de instrumento simplificado para diagnóstico de disfunção temporomandibular em pacientes adultos

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde

Role of the oblique ligament in the integrity of the medial collateral ligament of the canine elbow joint

Foram estudados o arranjo e o diâmetro médio das fibrilas colágenas do ligamento colateral medial da articulação do cotovelo do cão, isolado ou associado ao ligamento oblíquo e tracionado até a ruptura. Dezoito articulações foram divididas em três grupos. O primeiro grupo teve o ligamento colateral medial coletado, mas não tracionado; o segundo grupo teve o ligamento colateral medial tracionado isoladamente; o terceiro grupo teve os ligamentos colateral medial e oblíquo tracionados associadamente. O ligamento colateral medial não submetido ao ensaio de tração apresentou um padrão ondulado das fibras colágenas, o qual não foi totalmente destruído quando foi tracionado, associado ao ligamento oblíquo, e perdeu totalmente o padrão reticular das fibras colágenas quando testado isoladamente. Quando o ligamento colateral medial foi submetido à tensão isoladamente, o diâmetro médio das fibrilas colágenas aumentou em relação ao grupo não submetido à tensão. Associado ao ligamento oblíquo, o diâmetro médio das fibrilas colágenas foi o maior na região de inserção e o menor na região média, em relação aos outros grupos. Concluiu-se que o ligamento oblíquo pode favorecer a integridade da região de inserção do ligamento colateral medial, aumentando a eficácia de sua reconstrução após a lesão.

Study on the bone mineral density of broiler suffering femoral joint degenerative lesions

An experiment was carried out with male and females broilers of two different commercial breeds to evaluate bone mineral density of the right femur head. A number of 600 one-day-old broilers were raised in an experimental poultry house up to 42 days of age at the School of Veterinary Medicine and Animal Science of UNESP, Botucatu, Brazil. After slaughter, three males and three females in each breed in each of the established gross scores were selected. Their femora heads were submitted to gross examination, and subsequently the thighs were submitted to the Veterinary Hospital for radiographic analysis. Femora were also submitted to bone resistance, Seedor index, and dry matter content analyses. All these bone quality characteristics were different between males and females, independent of breed. Breeds presented similar behavior. It was possible to establish correlations between bone quality parameters, and confidence intervals for bone mineral density values, correlating them to femoral degeneration score, which allows characterizing femoral head lesions by radiographic optical densitometry.

Modeling and Experimental Aspects of Self-healing Bolted Joint through Shape Memory Alloy Actuators

Bolted joints are a form of mechanical coupling largely used in machinery due to their reliability and low cost. Failure of bolted joints can lead to catastrophic events, such as leaking, train derailments, aircraft crashes, etc. Most of these failures occur due to the reduction of the pre-load, induced by mechanical vibration or human errors in the assembly or maintenance process. This article investigates the application of shape memory alloy (SMA) washers as an actuator to increase the pre-load on loosened bolted joints. The application of SMA washer follows a structural health monitoring procedure to identify a damage (reduction in pre-load) occurrence. In this article, a thermo-mechanical model is presented to predict the final pre-load achieved using this kind of actuator, based on the heat input and SMA washer dimension. This model extends and improves on the previous model of Ghorashi and Inman [2004, "Shape Memory Alloy in Tension and Compression and its Application as Clamping Force Actuator in a Bolted Joint: Part 2 - Modeling," J. Intell. Mater. Syst. Struct., 15:589-600], by eliminating the pre-load term related to nut turning making the system more practical. This complete model is a powerful but complex tool to be used by designers. A novel modeling approach for self-healing bolted joints based on curve fitting of experimental data is presented. The article concludes with an experimental application that leads to a change in joint assembly to increase the system reliability, by removing the ceramic washer component. Further research topics are also suggested.

Radiographic measurement of tibial joint angles in sheep

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Radiographic Abnormalities in Barrel Racing Horses with Lameness Referable to the Metacarpophalangeal Joint

Barrel racing is one of the most popular uses of the American Quarter horse in North and South America. Although injury to the metacarpophalangeal joint frequently occurs in this sport, there is limited information describing the nature of these injuries. The aim of this study was to determine the most common radiographic abnormalities in barrel racing horses with lameness referable to the metacarpophalangeal joint. lameness examinations were performed on 63 barrel racing horses. Those found to be lame were subjected to radiographic examination. Lameness at trot was scored on a scale of 0-5 (0 = sound; 5 = inability to move). Data were analyzed using descriptive statistical analysis. of horses examined, 30 (47.6%) were lame with scores ranging from 1 to 4. Half of the lame horses (15 of 30) had grade 2 lameness of the right forelimb. Abnormal radiographic findings were more often present on the left forelimb and included signs of sesamoiditis (70%), villonodular synovitis (56.6%), osteoarthritis (36.6%), osteochondritis dissecans (13.3%), capsulitis (13.3%), and soft-tissue swelling (6.6%). Radiographic abnormalities indicated that sesamoiditis, villonodular synovitis, and osteoarthritis may be associated to mild-to-moderate lameness in barrel racing horses. Complementary sonographic evaluation is recommended to better characterize soft-tissue abnormalities. (C) 2012 Elsevier B.V. All rights reserved.

Preload Evaluation of Different Screws in External Hexagon Joint

Purpose: This study compared the maintenance of tightening torque in different retention screw types of implant-supported crowns.Materials and Methods: Twelve metallic crowns in UCLA abutments cast with cobalt-chromium alloy were attached to external hexagon osseointegrated implants with different retention screws: group A: titanium alloy retention screw; group B: gold alloy retention screw with gold coating; group C: titanium alloy retention screw with diamond-like carbon film coating; and group D: titanium alloy retention screw with aluminum titanium nitride coating. Three detorque measurements were obtained after torque insertion in each replica. Data were evaluated by analysis of variance (ANOVA), Tukey's test (P < 0.05), and t test (P < 0.05).Results: Detorque value reduced in all groups (P < 0.05). Group A retained the highest percentage of torque in comparison with the other groups (P < 0.05). Groups B and D retained the lowest percentage of torque without statistically significant difference between them (P < 0.05).Conclusions: All screw types exhibited reduction in the detorque value. The titanium screw maintained the highest percentage of torque whereas the gold-coated screw and the titanium screw with aluminum titanium nitride coating retained the lowest percentage. (Implant Dent 2012;21:46-50)

Effect of Vertical Misfit on Screw Joint Stability of Implant-Supported Crowns

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part IV - Soft tissue response

The purpose of this Study was to evaluate Soft tissue response to rnaxillo-mandibular counter-clockwise rotation, with TMJ reconstruction and mandibular advancement using TMJ Concepts (R) total joint prostheses, and maxillary osteotomies in 44 females. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one Surgeon (Wolford). Eighteen patients had genioplasties with either porous block hydroxyapatite or hard tissue replacement implants (Group 2) 26 had no genioplasty (Group 1). Surgically, the maxilla moved forward and upward by counter-clockwise maxillo-mandibular rotation with greater horizontal movement in Group 2. Vertically, both groups showed diversity of maxillo-mandibular mean movement. Group I showed a consistent 1:0.97 ratio of hard to soft tissue advancement at pogonion; Group 2 results were less consistent, with ratios between 1:0.84 and 1:1.02. Horizontal changes in upper lip morphology after maxillary advancement/impaction, VY closure, and alar base cinch sutures showed greater movement in both groups, than observed in hard tissue. Counter-clockwise rotation of the maxillo-mandibular complex using TMJ Concepts total joint prostheses resulted in similar soft tissue response as previously reported for traditional maxillo-mandibular advancement without counter-clockwise rotation of the occlusal plane. The association of chin implants, in the present sample, showed higher variability of soft tissue response.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part II - Airway changes and stability

The purpose of this study was to evaluate the anatomical changes and stability of the oropharyngeal airway and head Posture following TMJ reconstruction and mandibular advancement with TMJ Concepts custom-made total joint prostheses and maxillary osteotomies with counter-clockwise rotation of the maxillo-mandibular complex. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). The lateral cephalograms of 47 patients were analyzed to determine surgical and post-surgical changes of the oropharyngeal airway, hyoid bone and head posture. Surgery increased the narrowest retroglossal airway space 4.9 mm. Head Posture showed flexure immediately after surgery (-5.6 +/- 6.7 degrees) and extension long-term post surgery (1.8 +/- 6.7 degrees); cervical curvature showed no significant change. Surgery increased the distances between the third cervical vertebrae and the menton 11.7 +/- 9.1 mm and the third cervical vertebrae and hyoid 3.2 +/- 3.9 mm, and remained stable. The distance from the hyoid to the mandibular plane decreased during surgery (-3.8 +/- 5.8 mm) and after surgery (-2.5 +/- 5.2 mm), Maxillo-mandibular advancement with counter-clockwise rotation and TMJ reconstruction with total joint prostheses produced immediate increase in oropharyngeal airway dimension, which was influenced by long-term changes in head posture but remained stable over the follow-up period.