Clinical management and subsequent healing of teeth with horizontal root fractures

Horizontal root fractures are uncommon, mainly occurring on the cervical and middle third of the root of permanent upper incisors. The diagnosis is essentially radiographic and requires different healing patterns, depending on some pre- and postinjury factors. The aim of this article was to report the clinical management and different healing types in three cases of horizontal root fractures on permanent dentition. In case 1, the pulp tissue was vital and no treatment was necessary. In case 2, a root canal treatment of the cervical fragment was necessary and in case 3, pulpal necrosis was verified and an apical surgery was performed.

Improving pain management by nurses: A pilot peer intervention program

Significant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self-efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia. The pilot study of this program utilized a quasi-experimental pre-post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self-efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.

Productivity growth in pre-1990 Mongolian agriculture: Spiralling disaster or emerging success?

The reasons for the spectacular collapse of so many centrally-planned economies are a source of ongoing debate. In this paper, we use detailed farm-level data to measure total factor productivity (TFP) changes in Mongolian grain and potato farming during the 14-year period immediately preceding the 1990 economic reforms. We measure TFP growth using stochastic frontier analysis (SFA) and data envelopment analysis (DEA) methods. Our results indicate quite poor overall performance, with an average annual TFP change of - 1.7% in grain and 0.8% in potatoes, over the 14-year period. However, the pattern of TFP growth changed substantially during this period, with TFP growth exceeding 7% per year in the latter half of this period. This suggests that the new policies of improved education, greater management autonomy, and improved incentives, which were introduced in final two planning periods in the 1980s, were beginning to have a significant influence upon the performance of Mongolian crop farming. Crown Copyright (C) 2002 Published by Elsevier Science B.V. All rights reserved.

Hydrofluoric acid pre-treatment for improving 13C CPMAS NMR spectral quality of forest soils in south-east Queensland, Australia

Hydrofluoric acid (HF) was used to pre-treat forest soils of south-east Queensland for assessing the effectiveness of iron (Fe) removal, carbon (C) composition using C-13 cross-polarisation (CP) with magic-angle-spinning (MAS) nuclear magnetic resonance (NMR) before and after the HF pre-treatment, and the improvement of C-13 CPMAS NMR spectra. Soil samples were collected from 4 experimental sites of different soil types, harvest residue management or prescribed burning, and tree species. More than 86% of Fe was in all soil types removed by the HF treatment. The C-13 NMR spectral quality was improved with increased resolution, especially in the alkyl C and O-alkyl C regions, and reduced NMR run-time (1-5 h per sample compared with >20 h per sample without the pre-treatment). The C composition appeared to alter slightly after the pre-treatment, but this might be largely due to improved spectrometer conditions and increased resolution leading to more accurate NMR spectral integration. Organic C recovery after HF pre-treatment varied with soil types and forest management, and soluble soil organic matter (SOM) could be lost during the pre-treatment. The Fourier Transform-Infrared (FT-IR) spectra of HF extracts indicated the preferential removal of carboxylic C groups during the pre-treatment, but this could also be due to adsorbed water on the mineral matter. The NMR spectra revealed some changes in C composition and quality due to residue management and decomposition. Overall, the HF treatment was a useful pre-treatment for obtaining semi-quantitative C-13 CPMAS NMR spectra of subtropical Australian forest soils.

Diagnosis and management of unusual dental abscesses in children

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses,. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities Which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.

Controle estatístico de processo aplicado no monitoramento da absorção de água por carcaças de frango durante a etapa de pré-resfriamento

A absorção de água por carcaças de frango na etapa de pré-resfriamento da linha abate representa uma característica de qualidade importante relacionada ao rendimento do produto final. Uma forma de manter o padrão de qualidade de um produto é garantir que as etapas do processo sejam estáveis e replicáveis. Ao empregar o Controle Estatístico de Processo (CEP) é possível obter estabilidade e melhorias nos processos, por meio da redução da variabilidade. Neste contexto, o objetivo deste trabalho foi a aplicação de gráficos de controle, análise de correlação, estatística descritiva, testes de hipóteses e regressão linear múltipla na linha de abate de um abatedouro-frigorífico de aves para monitorar a variabilidade da absorção de água pelas carcaças de frango após a etapa de pré-resfriamento. Como resultado, verificou-se que o teor de absorção de água das carcaças de frango apresentou elevada variabilidade, sendo que 10% (8/80) das carcaças apresentaram absorção de água superior ao limite de 8% definido pela legislação brasileira. Do total de 16 variáveis de entrada analisadas, as mais impactantes no teor de absorção de água foram o “tempo de retenção da carcaça no pré-chiller” e o “tempo de espera da carcaça após a etapa de gotejamento”. Entretanto, o modelo de regressão obtido apresentou baixa correlação (R²=0,16) que foi associada à elevada variabilidade da variável-resposta. Os resultados da estatística descritiva demonstraram que as variáveis de entrada também apresentaram elevada variabilidade, com coeficiente de variação entre 7,95 e 63,5%. Verificou-se, pela análise dos gráficos de controle de medida individual e da amplitude móvel, que 15 das 16 variáveis de entrada se apresentaram fora de controle estatístico assim como a variável-resposta. Baseado no fluxograma e na descrição das etapas da linha de abate, previamente realizados, atribuiu-se à falta de padronização na condução das etapas e de procedimentos para o controle de qualidade das operações na linha de abate como fatores relevantes que poderiam estar associados à presença de causas especiais no processo. Concluiu-se que para reduzir a elevada variabilidade das variáveis e eliminar as causas especiais presentes são necessários ajustes operacionais para, dessa forma, obter um processo mais estável e mais uniforme garantindo o padrão de qualidade das carcaças de frango em relação ao teor de absorção de água.

Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women

OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The significance level was set at p<0.05. RESULTS: The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.07; 95% CI: 1.06;1.08), time since menopause (OR=2.16; 95% CI: 1.49;3.14), previous fracture (OR=2.62; 95% CI: 2.08;3.29) and current smoking (OR=1.45; 95% CI: 1.13;1.85). BMI (OR=0.88; 95% CI: 0.86;0.89), regular physical activity (OR=0.78; 95% CI: 0.65;0.94) and hormone replacement therapy (OR=0.43; 95% CI: 0.33;0.56) had a protective effect on bone mass. Risk factors significantly associated with osteoporotic fractures were age (OR=1.05; 95% CI: 1.04;1.06), time since menopause (OR=4.12; 95% CI: 1.79;9.48), familial history of hip fracture (OR=3.59; 95% CI: 2.88;4.47) and low BMD (OR=2.28; 95% CI: 1.85;2.82). CONCLUSIONS: Advanced age, menopause, low-trauma fracture and current smoking are major risk factors associated with low BMD and osteoporotic fracture. The clinical use of these parameters to identify women at higher risk for fractures might be a reasonable strategy to improve the management of osteoporosis.

Replication management in reliable real-time systems

Building reliable real-time applications on top of commercial off-the-shelf (COTS) components is not a straightforward task. Thus, it is essential to provide a simple and transparent programming model, in order to abstract programmers from the low-level implementation details of distribution and replication. However, the recent trend for incorporating pre-emptive multitasking applications in reliable real-time systems inherently increases its complexity. It is therefore important to provide a transparent programming model, enabling pre-emptive multitasking applications to be implemented without resorting to simultaneously dealing with both system requirements and distribution and replication issues. The distributed embedded architecture using COTS components (DEAR-COTS) architecture has been previously proposed as an architecture to support real-time and reliable distributed computer-controlled systems (DCCS) using COTS components. Within the DEAR-COTS architecture, the hard real-time subsystem provides a framework for the development of reliable real-time applications, which are the core of DCCS applications. This paper presents the proposed framework, and demonstrates how it can be used to support the transparent replication of software components.

Integrated Management of IaaS Resources

This paper proposes and reports the development of an open source solution for the integrated management of Infrastructure as a Service (IaaS) cloud computing resources, through the use of a common API taxonomy, to incorporate open source and proprietary platforms. This research included two surveys on open source IaaS platforms (OpenNebula, OpenStack and CloudStack) and a proprietary platform (Parallels Automation for Cloud Infrastructure - PACI) as well as on IaaS abstraction solutions (jClouds, Libcloud and Deltacloud), followed by a thorough comparison to determine the best approach. The adopted implementation reuses the Apache Deltacloud open source abstraction framework, which relies on the development of software driver modules to interface with different IaaS platforms, and involved the development of a new Deltacloud driver for PACI. The resulting interoperable solution successfully incorporates OpenNebula, OpenStack (reuses pre-existing drivers) and PACI (includes the developed Deltacloud PACI driver) nodes and provides a Web dashboard and a Representational State Transfer (REST) interface library. The results of the exchanged data payload and time response tests performed are presented and discussed. The conclusions show that open source abstraction tools like Deltacloud allow the modular and integrated management of IaaS platforms (open source and proprietary), introduce relevant time and negligible data overheads and, as a result, can be adopted by Small and Medium-sized Enterprise (SME) cloud providers to circumvent the vendor lock-in problem whenever service response time is not critical.

Integrated Management of Cloud Computing Resources

Lunacloud is a cloud service provider with offices in Portugal, Spain, France and UK that focus on delivering reliable, elastic and low cost cloud Infrastructure as a Service (IaaS) solutions. The company currently relies on a proprietary IaaS platform - the Parallels Automation for Cloud Infrastructure (PACI) - and wishes to expand and integrate other IaaS solutions seamlessly, namely open source solutions. This is the challenge addressed in this thesis. This proposal, which was fostered by Eurocloud Portugal Association, contributes to the promotion of interoperability and standardisation in Cloud Computing. The goal is to investigate, propose and develop an interoperable open source solution with standard interfaces for the integrated management of IaaS Cloud Computing resources based on new as well as existing abstraction libraries or frameworks. The solution should provide bothWeb and application programming interfaces. The research conducted consisted of two surveys covering existing open source IaaS platforms and PACI (features and API) and open source IaaS abstraction solutions. The first study was focussed on the characteristics of most popular open source IaaS platforms, namely OpenNebula, OpenStack, CloudStack and Eucalyptus, as well as PACI and included a thorough inventory of the provided Application Programming Interfaces (API), i.e., offered operations, followed by a comparison of these platforms in order to establish their similarities and dissimilarities. The second study on existing open source interoperability solutions included the analysis of existing abstraction libraries and frameworks and their comparison. The approach proposed and adopted, which was supported on the conclusions of the carried surveys, reuses an existing open source abstraction solution – the Apache Deltacloud framework. Deltacloud relies on the development of software driver modules to interface with different IaaS platforms, officially provides and supports drivers to sixteen IaaS platform, including OpenNebula and OpenStack, and allows the development of new provider drivers. The latter functionality was used to develop a new Deltacloud driver for PACI. Furthermore, Deltacloud provides a Web dashboard and REpresentational State Transfer (REST) API interfaces. To evaluate the adopted solution, a test bed integrating OpenNebula, Open- Stack and PACI nodes was assembled and deployed. The tests conducted involved time elapsed and data payload measurements via the Deltacloud framework as well as via the pre-existing IaaS platform API. The Deltacloud framework behaved as expected, i.e., introduced additional delays, but no substantial overheads. Both the Web and the REST interfaces were tested and showed identical measurements. The developed interoperable solution for the seamless integration and provision of IaaS resources from PACI, OpenNebula and OpenStack IaaS platforms fulfils the specified requirements, i.e., provides Lunacloud with the ability to expand the range of adopted IaaS platforms and offers a Web dashboard and REST API for the integrated management. The contributions of this work include the surveys and comparisons made, the selection of the abstraction framework and, last, but not the least, the PACI driver developed.

The influence of pre-departure training on expatriate adjustment: an empirical investigation with portuguese international assignees

This chapter examines the cross-cultural influence of training on the adjustment of international assignees. We focus on the pre-departure training (PDT) before an international assignment. It is an important topic because in the globalized world of today more and more expatriations are needed. The absence of PDT may generate the failure of the expatriation experience. Companies may neglect PDT due to cost reduction practices and ignorance of the need for it. Data were collected through semi-structured interviews to 42 Portuguese international assignees and 18 organizational representatives from nine Portuguese companies. The results suggest that companies should develop PDT programs, particularly when the cultural distance to the host country is bigger and when there is no previous experience of expatriation to that country in the company. The study is original because it details in depth the methods of PDT, its problems, and consequences. Some limitations linked to the research design and detailed in the conclusion should be overcome in future studies.

Indexing and active fund management: International evidence

Author's pre-print

Management consulting labs- Portugal Telecom

The purpose of this work project was to analyze and evaluate the potential impact of a technological innovation in the telecommunications sector, across a wide range of business areas. A cost-benefit and competitive analysis for each pre-selected business area was conducted, as well as national and international benchmarks. As a result of the analysis, a list of prioritized business areas, presenting more immediate opportunities for Portugal Telecom, was created and implications for go-to-market strategies were inferred from the conclusions reached. In addition, a final recommendation that redefined the company’s positioning strategy was made

Is PaCO2 management optimal under controlled mechanical ventilation (CMV) during neuro-resuscitation?

INTRODUCTION. Both hypocapnia and hypercapnia can be deleterious to brain injured patients. Strict PaCO2 control is difficult to achieve because of patient's instability and unpredictable effects of ventilator settings changes. OBJECTIVE. The aim of this study was to evaluate our ability to comply with a protocol of controlled mechanical ventilation (CMV) aiming at a PaCO2 between 35 and 40 mmHg in patients requiring neuro-resuscitation. METHODS. Retrospective analysis of consecutive patients (2005-2011) requiring intracranial pressure (ICP) monitoring for traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), intracranial haemorrhage (ICH) or ischemic stroke (IS). Demographic data, GCS, SAPS II, hospital mortality, PaCO2 and ICP values were recorded. During CMV in the first 48 h after admission, we analyzed the time spent within the PaCO2 target in relation to the presence or absence of intracranial hypertension (ICP[20 mmHg, by periods of 30 min) (Table 1). We also compared the fraction of time (determined by linear interpolation) spent with normal, low or high PaCO2 in hospital survivors and non-survivors (Wilcoxon, Bonferroni correction, p\0.05) (Table 2). PaCO2 samples collected during and after apnoea tests were excluded. Results given as median [IQR]. RESULTS. 436 patients were included (TBI: 51.2 %, SAH: 20.6 %, ICH: 23.2 %, IS: 5.0 %), age: 54 [39-64], SAPS II score: 52 [41-62], GCS: 5 [3-8]. 8744 PaCO2 samples were collected during 150611 h of CMV. CONCLUSIONS. Despite a high number of PaCO2 samples collected (in average one sample every 107 min), our results show that patients undergoing CMV for neuro- resuscitation spent less than half of the time within the pre-defined PaCO2 range. During documented intracranial hypertension, hypercapnia was observed in 17.4 % of the time. Since non-survivors spent more time with hypocapnia, further analysis is required to determine whether hypocapnia was detrimental per se, or merely reflects increased severity of brain insult.

Is (1→3)-β-D-glucan the missing link from bedside assessment to pre-emptive therapy of invasive candidiasis?

ABSTRACT: Invasive candidiasis is a frequent life-threatening complication in critically ill patients. Early diagnosis followed by prompt treatment aimed at improving outcome by minimizing unnecessary antifungal use remains a major challenge in the ICU setting. Timely patient selection thus plays a key role for clinically efficient and cost-effective management. Approaches combining clinical risk factors and Candida colonization data have improved our ability to identify such patients early. While the negative predictive value of scores and predicting rules is up to 95 to 99%, the positive predictive value is much lower, ranging between 10 and 60%. Accordingly, if a positive score or rule is used to guide the start of antifungal therapy, many patients may be treated unnecessarily. Candida biomarkers display higher positive predictive values; however, they lack sensitivity and are thus not able to identify all cases of invasive candidiasis. The (1→3)-β-D-glucan (BG) assay, a panfungal antigen test, is recommended as a complementary tool for the diagnosis of invasive mycoses in high-risk hemato-oncological patients. Its role in the more heterogeneous ICU population remains to be defined. More efficient clinical selection strategies combined with performant laboratory tools are needed in order to treat the right patients at the right time by keeping costs of screening and therapy as low as possible. The new approach proposed by Posteraro and colleagues in the previous issue of Critical Care meets these requirements. A single positive BG value in medical patients admitted to the ICU with sepsis and expected to stay for more than 5 days preceded the documentation of candidemia by 1 to 3 days with an unprecedented diagnostic accuracy. Applying this one-point fungal screening on a selected subset of ICU patients with an estimated 15 to 20% risk of developing candidemia is an appealing and potentially cost-effective approach. If confirmed by multicenter investigations, and extended to surgical patients at high risk of invasive candidiasis after abdominal surgery, this Bayesian-based risk stratification approach aimed at maximizing clinical efficiency by minimizing health care resource utilization may substantially simplify the management of critically ill patients at risk of invasive candidiasis.