Utility of signs and symptoms of chronic cough in predicting specific cause in children

Background: Paediatricians rely on cough descriptors to direct them to the level of investigations needed for a child presenting with chronic cough, yet there is a lack of published data to support this approach. A study was undertaken to evaluate ( 1) whether historical cough pointers can predict which children have a specific cause for their cough and ( 2) the usefulness of chest radiography and spirometry as standard investigations in children with chronic cough. Methods: This was a prospective cohort study of children referred to a tertiary hospital with a cough lasting 3 weeks between June 2002 and July 2004. All included children completed a detailed history and examination using a standardised data collection sheet and followed a pathway of investigation until a diagnosis was made. Results: In 100 consecutively recruited children of median age 2.8 years, the best predictor of specific cough observed was a moist cough at the time of consultation with an odds ratio ( OR) of 9.34 (95% CI 3.49 to 25.03). Chest examination or chest radiographic abnormalities were also predictive with OR 3.60 ( 95% CI 1.31 to 9.90) and 3.16 (95% CI 1.32 to 7.62), respectively. The most significant historical pointer for predicting a specific cause of the cough was a parental history of moist cough ( sensitivity 96%, specificity 26%, positive predictive value 74%). Conclusions: The most useful clinical marker in predicting specific cough is the presence of a daily moist cough. Both chest examination and chest radiographic abnormalities are also useful in predicting whether children have a specific cause of their cough.

Cyclic pneumatic soft-tissue compression accelerates the union of distal radial osteomoties in an ovine model

The aim of this randomised, controlled in vivo study in an ovine model was to investigate the effect of cylic pneumatic pressure on fracture healing. We performed a transverse osteotomy of the right radius in 37 sheep. They were randomised to a control group or a treatment group where they received cyclic loading of the osteotomy by the application of a pressure cuff around the muscles of the proximal forelimb. Sheep from both groups were killed at four or six weeks. Radiography, ultrasonography, biomechanical testing and histomorphometry were used to assess the differences between the groups. The area of periosteal callus, peak torsional strength, fracture stiffness, energy absorbed over the first 10° of torsion and histomorphometric analysis all showed that the osteotomies treated with the cyclic pneumatic pressure at four weeks were not significantly different from the control osteotomies at six weeks.

A study of large-bowel volvulus in urban Australia

Background: Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001. Methods: A retrospective chart study was carried out. Results: Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum. Conclusions: Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized.

ANOMALIAS DENTAIS ASSOCIADAS ÀS AGENESIAS

O objetivo deste estudo retrospectivo foi avaliar a prevalência de anomalias de posição (irrupção ectópica de canino superior para palatino, transposição dental, distoangulação de segundos pré-molares inferiores, mesioangulação de segundo molar inferior permanente e infraoclusão de molares decíduos), de número (supranumerários) e de tamanho (microdontias) em pacientes com agenesias de dentes permanentes, comparando-as com as prevalências esperadas para a população em geral, além de testar a hipótese de que pacientes com agenesia de dentes permanentes apresentem uma prevalência aumentada de hipoplasia de esmalte. Para tanto, a amostra deste estudo foi composta por 351 pacientes, com a presença de agenesia de no mínimo um dente permanente, na faixa etária entre 8 e 30 anos e com prontuários clínicos preenchidos. A amostra foi coletada a partir do exame das documentações ortodônticas pertencentes aos arquivos de uma escola de aperfeiçoamento profissional em Ortodontia, de uma clínica radiológica odontológica e de consultórios particulares de ortodontistas. O material de estudo englobou radiografias panorâmicas e periapicais, modelos de gesso, fotografias intra e extraorais e prontuários clínicos devidamente preenchidos. Inicialmente foi analisada a reprodutibilidade das avaliações pela porcentagem de concordância utilizando Kappa, com intervalo de confiança de 95%. O teste de qui-quadrado foi utilizado para comparar as prevalências de agenesias e anomalias na amostra com as prevalências esperadas segundo a literatura científica, considerando o nível de significância de 5%. Analisou-se, ainda, o grau das associações pela razão de chances ( odds ratio ) e o respectivo intervalo de confiança de 95%. A prevalência de agenesias dentais na amostra, excluindo os terceiros molares, foi de 88,6%. Dos 351 pacientes, 128 (36,4%) apresentavam agenesia no arco maxilar, 108 (30,8%) no mandibular e 115 (32,8%) nos dois arcos. Em relação ao hemiarco maxilar esquerdo, 52,4% apresentavam agenesia, no direito 55,0%, no mandibular esquerdo 48,7% e no direito 47,3%. Das anomalias associadas avaliadas, 28,5% microdontia, 28,2% hipoplasia de esmalte, 7,4% apresentavam irrupção ectópica de canino superior por palatino, 6,6% distoangulação, 3,9% transposição de canino/pré-molar superior, 4,3% infraoclusão, 3,7 supranumerário, 3,7% mesioangulação, 0,6% transposição de incisivo/canino inferior, e, quando comparadas com a população em geral, observou que 96,1 vezes mais chance de apresentar mesioangulação do segundo molar inferior; 34,6 vezes mais chance de apresentar distoangulação; 15,9 vezes mais chance de apresentar transposição canino/pré-molar superior; 14,3 vezes mais chance de apresentar transposição de incisivo/canino inferior; 9 vezes mais chance de hipoplasia; a microdontia do incisivo lateral apresentou 8,1 vezes mais chance; 5,2 vezes mais chance de apresentar irrupção ectópica do canino superior por palatino, e, em relação à infraoclusão, apresentando uma menor chance do que a população geral. A partir dos resultados obtidos, verificou-se uma forte associação entre a agenesia de dentes permanentes, correlacionando com outras anomalias dentais importantes. Foi constatado de que pacientes com agenesia de dentes permanentes apresentam uma prevalência aumentada de hipoplasia de esmalte e de que agenesias e outras anomalias associadas apresentam-se interligadas geneticamente entre si.

ANÁLISE CEFALOMÉTRICA LATERAL DE RICKETTS: JOVENS DA REGIÃO NORTE DO BRASIL

Este trabalho teve como objetivo determinar as normas cefalométricas de medidas da análise lateral de RICKETTS 54 de 1981, numa amostra de indivíduos brasileiros, leucodermas, com oclusão normal, sem tratamento ortodôntico prévio, da Região Norte do Brasil e comparar estes valores com os preconizados por RICKETTS54 realizando a projeção destes valores para 18 anos de idade, a fim de tornar possível esta comparação. E determinar a freqüência dos diferentes tipos faciais obtidos pelo índice VERT (quantidade de crescimento vertical), obtido por meio da análise lateral de RICKETTS et al55 de 1982. O material constou de 28 telerradiografias em norma lateral de 15 indivíduos do sexo masculino e 13 do sexo feminino, com idades entre 20 e 26 anos, com média de idade de 22,42 anos. Estes indivíduos foram selecionados na Faculdade de odontologia do CESUPA (Centro Universitário do Pará). O método eleito para os traçados cefalométricos foi o computadorizado (programa Radiocef 2.0). Os resultados permitiram depreender que esta amostra da Região Norte do Brasil quando comparada aos valores normativos preconizados por RICKETTS54 apresentam: Biprotrusão dentária; maxila protruída; padrão braquifacial com tendência para mordida profunda; os molares superiores encontram-se numa posição mais posterior; incisivos inferiores protruídos e vestibularizados; incisivos superiores com inclinação adequada e bem posicionados na base óssea; lábio inferior equilibrado; profundidade facial aumentada; crescimento equilibrado do eixo facial; mandíbula rotacionada no sentido horário, plano palatal com inclinação no sentido horário. Quanto à freqüência dos tipos faciais obtidos pelo índice VERT, do total da amostra estudada 50% dos indivíduos eram braquifaciais, 39,28% dolicofaciais e 10,72% mesofaciais.(AU)

AVALIAÇÃO DA COMPRESSÃO DA IMAGEM DIGITAL DA TELERRADIOGRAFIA LATERAL NA REPRODUTIBILIDADE DA MARCAÇÃO DE PONTOS CEFALOMÉTRICOS

A imagem digital adquirida pelo sistema da placa de fósforo foto ativada é visualizada no monitor do computador em um formato denominado DICOM. Este formato ocupa muito espaço para armazenamento, o que dificulta o arquivamento e transmissão da imagem pela Internet. O objetivo deste estudo foi avaliar a influência da compressão JPEG, nos Fatores de Qualidade 100, 80 e 60 na reprodutibilidade da marcação de pontos cefalométricos em imagens de telerradiografias em norma lateral comparadas com o formato DICOM. A amostra consistiu de 120 imagens de telerradiografias em norma lateral obtidas a partir de 30 indivíduos, dos quais se obteve uma radiografia digital no formato DICOM. Essas imagens foram convertidas para o formato JPEG. Após o cegamento e randomização da amostra, três Ortodontistas calibrados marcaram a localização de 12 pontos cefalométricos em cada imagem utilizando o sistema de coordenadas X e Y. Esse procedimento foi repetido após 1 mês. A reprodutibilidade intra e inter observador foi calculada usando o teste de correlação intraclasse. Para comparação entre os grupos de compressão e DICOM na reprodutibilidade de marcação dos pontos utilizou se a Análise de Variância (ANOVA) a um critério para medidas repetidas. Os resultados mostraram que as marcações dos pontos cefalométricos foram bastante reprodutíveis, exceto para o ponto Órbita na coordenada X. Os diferentes formatos de arquivo mostraram estatisticamente iguais para cada ponto e eixo aferido. As compressões JPEG estudadas das imagens de telerradiografias em norma lateral não tiveram efeito na reprodutibilidade da marcação dos pontos cefalométricos testados.

AVALIAÇÃO DA REPRODUTIBILIDADE DE PONTOS CEFALOMÉTRICOS NAS TELERRADIOGRAFIAS DIGITAIS EM NORMA LATERAL NOS FORMATOS DICOM, TIFF E JPEG

A imagem radiográfica digital adquirida pelo sistema de placa de fósforo foto ativada é normalmente visualizada no monitor do computador no formato DICOM, caracterizado pela alta resolução das imagens. Como este formato ocupa muito espaço para armazenamento, as imagens digitais são submetidas a uma compressão, que otimiza a capacidade de espaço dos computadores e reduz o tempo de transmissão pela Internet. O objetivo desse estudo foi avaliar a influência da compressão TIFF e JPEG na reprodutibilidade intra e interexaminador da marcação de pontos cefalométricos em imagens de telerradiografias em norma lateral comparadas com o formato DICOM. A amostra consistiu de 90 imagens de telerradiografias obtidas a partir de 30 indivíduos, dos quais se obteve uma radiografia digital exibida no formato DICOM. Estas imagens foram convertidas para os formatos JPEG, com Fator de Qualidade 80 e TIFF. Após o cegamento e randomização da amostra, três ortodontistas calibrados marcaram a localização de 15 pontos cefalométricos em cada imagem utilizando o sistema de coordenadas x e y. Os resultados mostraram que as marcações dos pontos cefalométricos apresentaram concordância de reprodutibilidade tanto intra como interexaminador, exceto para os pontos Go, Po, Or, B e Pog . Os diferentes formatos de arquivo mostraram resultados estatisticamente semelhantes para cada ponto e eixo aferido. As compressões JPEG e TIFF estudadas não tiveram efeito, em imagens de telerradiografias em norma lateral, na reprodutibilidade intra e interexaminadores da marcação dos pontos cefalométricos testados.(AU)

Avaliação da influência dos formatos DICOM e JPEG na reprodutibilidade de pontos cefalométricos em Telerradiografia digital em Norma Frontal

A imagem digital no formato DICOM requer grande espaço para armazenamento, dificultando o arquivamento e transmissão da imagem via internet, sendo necessária, muitas vezes, a compressão das imagens por meio de formatos de arquivo como o JPEG. O objetivo neste estudo foi avaliar a influência dos formatos DICOM e JPEG, nos Fatores de Qualidade 100, 80 e 60, na reprodutibilidade intra e interexaminador na marcação de pontos cefalométricos em Telerradiografias digitais em Norma Frontal. A amostra consistiu de 120 imagens digitais de Telerradiografias em Norma Frontal, obtidas de 30 indivíduos. As 30 imagens originais, em formato DICOM, posteriormente, foram convertidas para o formato JPEG, nos Fatores de Qualidade 100, 80 e 60. Após cegar e randomizar a amostra, três ortodontistas calibrados marcaram os 18 pontos cefalométricos em cada imagem utilizando um programa de cefalometria computadorizada, que registra as medidas dos pontos cefalométricos em um sistema de coordenadas cartesianas X e Y. Nos resultados, os testes estatísticos de correlações intraclasses e análise de variância (ANOVA) apresentaram concordância de reprodutibilidade dos pontos cefalométricos em Telerradiografias digitais em Norma Frontal, tanto intra como interexaminador, com exceção dos pontos ZL, ZR, AZ, JR, NC, CN na coordenada Y e A6 na coordenada X, independentemente dos formatos de arquivo. Em conclusão, os formatos de arquivo DICOM e JPEG, nos Fatores de Qualidade 100, 80 e 60, não afetaram a reprodutibilidade intra e interexaminador na marcação dos pontos cefalométricos.(AU)

Gas-metal reactions and porosity in the inert gas arc welding of copper

A study has been made of the effects of welding and material variables on the occurrence of porosity in tungsten inert gas arc welding of copper. The experiments were based on a statistical design and variables included, welding current, welding speed, arc atmosphere composition, inert gas flow rate, weld preparation, and base material. The extent of weld metal porosity was assessed by density measurement and its morphology by X-ray radiography and metallography. In conjunction with this the copper-steam reaction has been investigated under conditions of controlled atmosphere arc melting. The welding experiments have shown that the extent of steam porosity is increased by increased water vapour content of the arc atmosphere, increased oxygen content of the base material and decreased welding speed. The arc melting experiments have shown that the steam reaction occurs in the body of the weld pool and proceeds to an apparent equi1ibrium state appropriate to to its temperature, the hydrogen and oxygen being supplied by the dissociation of water vapour in the arc atmosphere. It has been shown conclusively that nitrogen porosity can occur in the tungsten inert gas arc welding of copper and that this porosity can be eliminated by using filler wires containing small amounts of aluminum and titanium. Since it has been shown to be much more difficult to produce sound butt welds than melt runs it has been concluded that the porosity associated with joint fit up is due to nitrogen entrained into tho arc atmosphere. Clearly atmospheric entrainment would also, to a much lesser extent, involve water vapour. From a practical welding point of view it has thus been postulated that use of a filler wire containing small amounts of aluminum and/or titanium would eliminate both forms of porosity since these elements are both strongJy deoxidising and denitriding.

Poetica de la brevedad en Borges

Although he did not write copious novels, endless essays, or long poems, Jorge Luis Borges is considered one of today's best modern writers. His works have never been more than ten pages long. The purpose of this dissertation is to demonstrate that the willing use of concise expression in Borges's writings is inscribed in a poetic worldview of great implications. This view is based on the synthesis of philosophical, literary, and cultural issues that Borges interprets, discusses, refutes, and re-elaborates with a new conjectural approach. ^ This dissertation is based on a methodological review of all his current scholarly work and on a thorough examination of the four volumes of his Complete Works, edited by Emece, in 2002. His pantheistic vision, the epiphanic moments, and his love/hate relationship with language, conform an aesthetic of resounding silence that enlightens the hidden aspects of his brief masterpieces. ^ Even though Borgesian studies flood the library he once imagined, they have been presented in an isolated manner. This dissertation establishes a link among the various aforementioned aspects as studied by Borges scholars, and demonstrates the powerful influence of Borges's illuminating and precise vision. ^ Paradoxically, the poetry of brevity in Borges's works is filled with allusions to the things that Borges silences, because, from a panoramic pantheism, his words almost reach an epiphanic enlightenment that flashes between preterit and future nothingness. ^ By replacing extension with intensity, and mastering the art of omission, Borges's laborious work reaches power and concentration that only the very greatest talents can achieve. His delicate verbal conciseness provides his readers with a virtually infinite freedom of imagination because it exposes them to the chaotic world of mythical probabilities, where an instant encompasses eternity. ^

Poetica de la brevedad en Borges

Although he did not write copious novels, endless essays, or long poems, Jorge Luis Borges is considered one of today's best modem writers. His works have never been more than ten pages long. The purpose of this dissertation is to demonstrate that the willing use of concise expression in Borges's writings is inscribed in a poetic worldview of great implications. This view is based on the synthesis of philosophical, literary, and cultural issues that Borges interprets, discusses, refutes, and re-elaborates with a new conjectural approach. This dissertation is based on a methodological review of all his current scholarly work and on a thorough examination of the four volumes of his Complete Works, edited by Emece, in 2002. His pantheistic vision, the epiphanic moments, and his love/hate relationship with language, conform an aesthetic of resounding silence that enlightens the hidden aspects of his brief masterpieces. Even though Borgesian studies flood the library he once imagined, they have been presented in an isolated manner. This dissertation establishes a link among the various aforementioned aspects as studied by Borges scholars, and demonstrates the powerful influence of Borges's illuminating and precise vision. Paradoxically, the poetry of brevity in Borges's works is filled with allusions to the things that Borges silences, because, from a panoramic pantheism, his words almost reach an epiphanic enlightenment that flashes between preterit and future nothingness. By replacing extension with intensity, and mastering the art of omission, Borges's laborious work reaches power and concentration that only the very greatest talents can achieve. His delicate verbal conciseness provides his readers with a virtually infinite freedom of imagination because it exposes them to the chaotic world of mythical probabilities, where an instant encompasses etemity.

Late Glacial and Holocene data from sediment cores MD99-2236 and MD99-2256

The Laurentide Ice Sheet (LIS) was a large, dynamic ice sheet in the early Holocene. The glacial events through Hudson Strait leading to its eventual demise are recorded in the well-dated Labrador shelf core, MD99-2236 from the Cartwright Saddle. We develop a detailed history of the timing of ice-sheet discharge events from the Hudson Strait outlet of the LIS during the Holocene using high-resolution detrital carbonate, ice rafted detritus (IRD), d18O, and sediment color data. Eight detrital carbonate peaks (DCPs) associated with IRD peaks and light oxygen isotope events punctuate the MD99-2236 record between 11.5 and 8.0 ka. We use the stratigraphy of the DCPs developed from MD99-2236 to select the appropriate DeltaR to calibrate the ages of recorded glacial events in Hudson Bay and Hudson Strait such that they match the DCPs in MD99-2236. We associate the eight DCPs with H0, Gold Cove advance, Noble Inlet advance, initial retreat of the Hudson Strait ice stream (HSIS) from Hudson Strait, opening of the Tyrrell Sea, and drainage of glacial lakes Agassiz and Ojibway. The opening of Foxe Channel and retreat of glacial ice from Foxe Basin are represented by a shoulder in the carbonate data. DeltaR of 350 years applied to the radiocarbon ages constraining glacial events H0 through the opening of the Tyrell Sea provided the best match with the MD99-2236 DCPs; DeltaR values and ages from the literature are used for the younger events. A very close age match was achieved between the 8.2 ka cold event in the Greenland ice cores, DCP7 (8.15 ka BP), and the drainage of glacial lakes Agassiz and Ojibway. Our stratigraphic comparison between the DCPs in MD99-2236 and the calibrated ages of Hudson Strait/Bay deglacial events shows that the retreat of the HSIS, the opening of the Tyrell Sea, and the catastrophic drainage of glacial lakes Agassiz and Ojibway at 8.2 ka are separate events that have been combined in previous estimates of the timing of the 8.2 ka event from marine records. SW Iceland shelf core MD99-2256 documents freshwater entrainment into the subpolar gyre from the Hudson Strait outlet via the Labrador, North Atlantic, and Irminger currents. The timing of freshwater release from the LIS Hudson Strait outlet in MD99-2236 matches evidence for freshwater forcing and LIS icebergs carrying foreign minerals to the SW Iceland shelf between 11.5 and 8.2 ka. The congruency of these records supports the conclusion of the entrainment of freshwater from the retreat of the LIS through Hudson Strait into the subpolar gyre and provides specific time periods when pulses of LIS freshwater were present to influence climate.

Avaliação das técnicas de soldagem MIG-P CA e MIG-P CC+ aplicadas ao passe de enchimento em liga de alumínio AA5083

For contain beneficial properties, aluminum alloys are gaining more importance in different industrial areas, becoming the subject of study in several academic fields. When related to welding these alloys have some peculiarities that may hinder the union, such as microscopic oxide layer present on the metal surface. The MIG welding process, also known as GMAW, has developed versions that can be effective for welding aluminum. Knowing this, for this paper, two versions of pulsed MIG (CC + and CA) were chosen to evaluate which best suits pass by filling bevel on AA5083 aluminum sheets with 8 and 12 mm thick respectively. Furthermore, two types of wire, ER5087 and ER5183 were evaluated. To evaluate the process and versions of the wires, the high-speed cameras and thermal were used to monitor the metal transfer and the thermal behavior respectively, and the metallographic analysis for macrographic view of the weld beads and non-destructive testing by radiography for observation of possible discontinuities. It was found that the technique of MIG-P CA showed better results ahead of another technique both welding conditions imposed. When connected to the wires, they showed similar results, with uniform cords and seamless

Entre salinas e maledicências: uma leitura do romance Macau e sua aplicabilidade ao ensino de literatura

The objective of this research is to present a reading of the novel Macau (1934), authoring of Aurélio Pinheiro, situated in the context of Brazilian literature produced in the 30s of the last century and analyze the settings of language that reveal individual and social conflicts related to tensions arising of the modernization of a city in the interior of Rio Grande do Norte, in view of the applicability of this knowledge in the educational context. The discussions on the teaching of literature led to an internship experience in the higher education, with the guiding literary reading of the novel Macau. In this sense, this research, bibliographic, analytical and empirical, is in discussions between literature and education that allow us, in addition to a critical reading about Macau romance, a look both in basic education and in teacher training, which justifies linking this thesis in the research line “Reading of the literary text and teaching”. The objectives were met from literary readings of the text, brief study of the author, analysis of the tensions expressed by language, literature defense as a universal right, panoramic review of research on the teaching of literature, reading official documents governing the Brazilian education, discussion of teacher training, training in higher education with application of a didactic sequence, receipt of that novel by teachers in training directed to the applicability in basic education. For this, the research was the theoretical framework primarily the studies of Antonio Candido (1976; 1995), Luís Bueno (2006), Walter Benjamin (1985), Mikhail Bakhtin (2010), Hans Robert Jauss (1994), Theodor Adorno (2006), Antoine Compagnon (2009), and Rildo Cosson (2009).