Milk supplementation increases mid-upper arm circumference and haemoglobin level among pregnant women in Kupang, Indonesia: Evidence from a regression discontinuity design

@#Introduction: The high prevalence of chronic energy deficiency (CED) and anaemia among pregnant women in Indonesia is worrying. Nusa Tenggara Timur (NTT) is one of the provinces in Indonesia with the highest prevalence of CED. This study aimed to determine the effect of fortified milk supplementation on changes in mid-upper arm circumference (MUAC) and haemoglobin level among pregnant women. Methods: This quasi-experimental study was conducted in three locations of Community Health Centers in NTT from May to August 2019. Purposive sampling was used to recruit 69 pregnant women who were divided into two groups based on haemoglobin levels; the intervention group consisted of 31 pregnant women with haemoglobin levels below 11 g/dL, and control group consisted of 38 pregnant women with haemoglobin levels above 11 g/dL. Intervention group was provided with fortified milk supplementation, while control group received education about prevention of CED and anaemia. Data were analysed using regression discontinuity design with haemoglobin of 11 g/dL as cut-off. Results: Using regression discontinuity method, we were able to determine the effect of milk supplementation based on haemoglobin levels and confirm the result that milk supplementation significantly increased MUAC by 4.69 cm. Despite no discontinuity found, a positive increase of 0.98 g/dL in haemoglobin level was important to note. Conclusion: Milk supplementation of 300 kcal/day for three months significantly increased MUAC and to some extent, increased haemoglobin level. Thus, it should be considered when planning nutrition programmes to improve the nutritional status of pregnant women.

Screening for Distress and Its Impact on Palliative Care Referral at a General Medical Center: Retrospective Cohort Study

Purpose: Distress screening is mandated by Ministry of Health, Labor and Welfare of Japan, however there is few data available on its effect in actual practice. We examined the impact of distress screening on palliative care referral at Hyogo Prefectural Amagasaki General Medical Center in Japan. Materials and Methods: We implemented distress screening on cancer patients who were given chemotherapy from February 2018. Patients were referred to the palliative care team when the physicians judged the need on the basis of the screening results or when the patients themselves wanted to receive the palliative care service. We examined the number of the patients referred to the palliative care team, then we researched the changes of the number after implementation of the screening, using the regression discontinuity analysis. Results: The distress screening didn’t increase the number of the patients who were referred to the palliative care team: the estimated difference of the number was 3.32 (95% confidence interval: −3.19〜9.82). Conclusion: We implemented distress screening at our hospital but it didn’t increase palliative care referral. Only a few studies have examined how routine screening impacts clinical outcomes. We expect our study helps to research the effectiveness of screening in each healthcare facility.

Study on the influence of Beijing Medical Reform on the hospitalization expenses of medical and surgical patients in a hospital / 中华医院管理杂志

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.

Infidelidades en la era contemporanea / Infidelities in the contemporary era / Infidelidades na era contemporânea

Infidelidades en la pareja inserta en la Cultura Occidental, en el siglo XXI, pensadas como comportamientos complejos y singulares, en cada situación particular. Como una producción vincular, donde confluyen elementos intervinientes de la llamada Lógica del Uno (los aparatos psíquicos de los miembros de la pareja); factores propios de la Lógica del Dos (lo que se produce en el ir siendo sujetos, en el espacio-vacío entre de la pareja, Puget, J. 2014) y las condiciones propias del contexto socio-cultural de los conyugues. La era contemporánea llamada "Modernidad Líquida" por Bauman, Z.2005, la consideramos marcada por la fragilidad de los vínculos. ¿Es posible producirconstruir fidelidad? ¿Lo facilitan estos tiempos de la fluidez, inmediatez, de lo efímero? Revisamos conceptos que nos ayudan a pensarlo: La perspectiva del amor según Alan Badiou, (2011), el tema de la confianza, del deseo, las discontinuidades, entre otros. Viñetas ilustran nuestros planteamientos.

We consider Infidelities in The Contemporary Era's couples, in the XXI century as a complex and singular behavior, in each particular situation. As a linking production (link-relationship production), as a confluence participant elements of the "Logic of the One" (each couple's member psychic system); typical factor of the "Logic of Two" (what is produced in the "between-empty" space: the becoming subjects, the inhabiting and belonging) (Puget, J. 2014) and the social-culture context's couple conditions. We consider The Contemporary Era called "Liquid Modernity" by Bauman Z. 2005, marked by the fragility of human relationship (contaminated by the consumers logic). Is it possible to produce-construct fidelity? This time of fluidity, immediacy, ephemeral does it make it easier? We review concepts looking for thinking ways out to these questions such as Alain Badiou's perspective of love (2011) trust, desire, discontinuity, and others. Clinic illustrive examples are presented.

As infidelidades do casal inserido na cultura ocidental no século XXI, pensadas como comportamentos complexos e singulares, em cada situação particular. Como uma produção de vínculos, na confluência entre elementos da chamada Lógica do UM (o aparelho psíquico dos parceiros); fatores inerentes da Lógica de Dois (que acontece no "andar sendo" sujeitos), entre o espaço-vazio, entre o casal e as condições próprias do contexto sociocultural dos cônjuges. É possível produzir-construir a fidelidade? O que facilitam esses tempos de fluência, do imediatismo, do efêmero? Vamos rever conceitos que nos ajudam a pensar: A perspectiva do amor por Alan Badiou (2011), a questão da confiança, o desejo, descontinuidades, entre outros. Vinhetas ilustrativas da a nossa abordagem.

A study of finite discontinuity-volumetric modulated arc therapy for mid-and distal-Esophageal Carcinoma / 中华放射肿瘤学杂志

Objective To implement the finite discontinuity?volumetric modulated arc therapy ( FD?VMAT) in the Pinnacle planning system, and to investigate its clinical significance. Methods Eight patients with thoracic esophageal cancer in our hospital were enrolled as subjects. FD?VMAT was fulfilled in the Pinnacle planning system using a developed program. FD?VMAT, VMAT, and fixed?field intensity?modulated radiotherapy ( IMRT ) plans were designed for each patient. The conformity index ( CI ) and homogeneity index ( HI) of the planning target volume ( PTV) ,doses to organs at risk,passing rate for plan verification,number of monitor units,and treatment time were used to evaluate the plans. Comparison between different plans was made by paired t test. Results For the PTV,there was no significant difference in CI between FD?VMAT and VAMT ( P=0?186 );FD?VMAT had a significantly worse HI than VMAT ( P=0?001);however,both the CI and HI were significantly improved in FD?VMAT than in IMRT ( P=0?006, 0?002) . Compared with IMRT, FD?VMAT, retaining the advantage of VMAT, had pulmonary V20 and V30 significantly reduced by 19?79% and 20?32%,respectively (P=0?000,0?000).For the pulmonary low?dose regions (≤V5 ) ,FD?VMAT retained the advantage of IMRT and had lower doses than VMAT. Particularly, pulmonary V2 was significantly reduced by 16?79%(P=0?000).The mean lung dose was significantly lower in FD?VMAT than in VMAT or IMRT (P=0?001,0?000).There were no significant differences in D1cc to spinal cord PRV,heart V30,or passing rate for plan verification between the three therapies. The heart V40 and mean heart dose in FD?VMAT were similar to those in VMAT (P=0?175,0?468),but significantly lower than those in IMRT ( P=0?021,0?002) . FD?VMAT had a larger number of monitor units and longer treatment time than VMAT. Compared with IMRT, the number of monitor units and treatment time were reduced by 13?6% and 49?6% in FD?VMAT,respectively. Conclusions Compared with VMAT and IMRT, the application of the developed FD?VMAT in the treatment of thoracic esophageal cancer can further reduce the lung dose while keeping the PTV coverage,protection of the heart and spinal cord,and high efficacy. FD?VMAT is a new therapy available for thoracic esophageal cancer.

Alternatives to Randomized Control Trials: A Review of Three Quasi-experimental Designs for Causal Inference

The Randomized Control Trial (RCT) design is typically seen as the gold standard in psychological research. As it is not always possible to conform to RCT specifications, many studies are conducted in the quasi-experimental framework. Although quasi-experimental designs are considered less preferable to RCTs, with guidance they can produce inferences which are just as valid. In this paper, the authors present 3 quasi-experimental designs which are viable alternatives to RCT designs. These designs are Regression Point Displacement (RPD), Regression Discontinuity (RD), and Propensity Score Matching (PSM). Additionally, the authors outline several notable methodological improvements to use with these designs.

Los diseños de Pruebas Controladas Aleatorizadas (PCA) son típicamente vistas como el mejor diseño en la investigación en psicología. Como tal, no es siempre posible cumplir con las especificaciones de las PCA y por ello muchos estudios son realizados en un marco cuasi experimental. Aunque los diseños cuasi experimentales son considerados menos convenientes que los diseños PCA, con directrices estos pueden producir inferencias igualmente válidas. En este artículo presentamos tres diseños cuasi experimentales que son formas alternativas a los diseños PCA. Estos diseños son Regresión de Punto de Desplazamiento (RPD), Regresión Discontinua (RD), Pareamiento por Puntaje de Propensión (PPP). Adicionalmente, describimos varias mejorías metodológicas para usar con este tipo de diseños.

Reflexões sobre o processo de municipalização das políticas de saúde: a questão da descontinuidade político-administrativa / Reflections on the process of municipalization of healthcare policies: the issue of political and administrative discontinuity / Reflexiones sobre el proceso de municipalización de las políticas de salud: la cuestión de la discontinuidad político-administrativa

A descontinuidade político-administrativa apresenta-se como um fenômeno do sistema político brasileiro, notadamente em âmbito municipal. Com os esforços de descentralização e municipalização definidos pela Constituição de 1988, o processo de implementação das políticas de saúde foi afetado pela descontinuidade, causando prejuízos, entre os quais, atrasos e interrupções nos programas de educação não formal que são importantes para a promoção do empoderamento. A título de proposição para a reflexão, é apresentado um modelo para a realização de levantamentos primários nos municípios. Neste modelo são considerados quatro fatores: eleitoral, técnico, interinstitucional, político-institucional. Esses fatores se referem à organização da política nos níveis da governabilidade e governança. O objetivo deste ensaio é contribuir para o entendimento do fenômeno da descontinuidade político-administrativa verificada nos municípios brasileiros após a implantação do Sistema Único de Saúde (SUS)...

Political and administrative discontinuity is a phenomenon within the Brazilian political system, notably in the municipal sphere. Through the efforts towards decentralization and municipalization that were defined by the 1988 constitution, the process of health policy implementation has been affected by discontinuity. This has causing damage, including delays and interruptions in non-formal education programs that are important for promoting empowerment. As a proposal for reflection, a model for conducting primary surveys in municipalities is presented here. Four factors are considered in this model: electoral, technical, interinstitutional and political-institutional. These factors refer to policy organization at the levels of governability and governance. The objective of this essay was to contribute towards understanding the phenomenon of political and administrative discontinuity observed in Brazilian municipalities since the implementation of the Brazilian Health System (SUS)...

La discontinuidad político-administrativa se presenta como un fenómeno en el sistema político brasileño, principalmente en el ámbito municipal. Con los esfuerzos de descentralización y municipalización definidos por la Constitución de 1988, el proceso de implementación de las políticas de salud fue afectado por la discontinuidad, causando perjuicios, entre ellos atrasos e interrupciones en los programas de educación no formal que son importantes para la promoción del empoderamiento. A título de propuesta para la reflexión, se presenta un modelo para la realización de levantamientos primarios en los municipios. En este modelo se consideran cuatro factores: electoral, técnico, inter-institucional, político institucional. Esos factores se refieren a la organización de la política en los niveles de la gobernabilidad y de la gobernanza. El objetivo de este ensayo es contribuir para el entendimiento del fenómeno de la discontinuidad político-administrativa verificada en los municipios brasileños después de la implantación del Sistema Brasileño de Salud (SUS)...

El efecto del dualismo filosófico en el problema de la ética animal / O efeito do dualismo filosófico no problema da ética animal / The effect of philosophical dualism in the problem of animal ethics

En el plano moral, existe una separación entre el animal y el hombre, expresada filosóficamente en la idea del dualismo ontológico. Una de las consecuencias de esta visión es la justificación que se da en bioética a la experimentación con animales vivos. Sin embargo, dicha separación no guarda relación con el lugar que ocupa el hombre dentro del orden de lo viviente, lo cual abriría el espacio para una reconsideración del estatuto moral de los animales.

In the moral field, there is a separation between animals and human beings, express philosophically in the idea of ontological dualism. One of the consequences of this view is the justification made in bioethics for the experimentation with living animals. Nevertheless, such separation has no relation with the place human beings hold within the living order, which opens a space for the reconsideration of the moral statute of animals.

No plano moral, existe uma separação entre o animal e o homem, expressada filosoficamente na ideia do dualismo ontológico. Uma das consequências desta visão é a justificativa que se dá em bioética à experimentação com animais vivos. No entanto, a dita separação não guarda relação com o lugar que ocupa o homem dentro da ordem do ser vivo, o que abririaespaço para uma reconsideração do estatuto moral dos animais.

Aquatic insect community structure under the influence of small dams in a stream of the Mogi-Guaçu river basin, state of São Paulo / Estrutura da comunidade de insetos aquáticos sob influência de pequenas represas em um ribeirão da bacia do Rio Mogi-Guaçu, Estado de São Paulo

The fragmentation of lotic systems caused by construction of dams has modified many aquatic communities. The objective of this study was to analyse changes in the aquatic insect community structure by discontinuity of habitat created by dams along the Ribeirão das Anhumas, a sub-basin of the Mogi-Guaçu River (state of São Paulo, Brazil). Entomofauna collection was carried out in 10 segments upstream and downstream of five dams along the longitudinal profile of the stream, with a quick sampling method using a D net (mesh 250 mm) with 2 minutes of sampling effort. The insects were sorted and identified to the lowest possible taxonomic level and analysed by the Shannon diversity index, β diversity, richness estimated by rarefaction curves and relative participation of functional feeding groups. The results showed a slight reduction in diversity in the downstream segments, as well as along the longitudinal profile of the stream. However, there were no significant differences in abundance and richness between the upstream and downstream segments, indicating that the dams did not influence these variables. Differences were observed in the functional feeding groups along the longitudinal profile. Predator and gatherer insects were dominant in all segments analysed. The feeding group of shredders was more abundant in the segment DSIII with the participation of Marilia Müller (Odontoceridae – Trichoptera), although we observed a decrease of shredders and scrapers with the decrease of the canopy cover reducing values of β diversity in the continuum of Ribeirão das Anhumas. This result demonstrated the importance of the conservation of the riparian vegetation in order to maintain the integrity of the stream.

A fragmentação de sistemas lóticos causadas pela construção de represas tem causado modificação na estrutura das comunidades aquáticas. O objetivo deste estudo foi analisar as mudanças na estrutura da comunidade de insetos aquáticos decorrentes da descontinuidade de habitat criada por represamentos ao longo do Ribeirão das Anhumas, uma sub-bacia do rio Mogi-Guaçu (Estado de São Paulo, Brasil). A coleta da entomofauna foi realizada em 10 segmentos à montante e à jusante de cinco represas ao longo do perfil longitudinal do ribeirão, pelo método de varredura com rede D (malha 250 mm) e esforço amostral de 2 minutos. Os insetos foram triados e identificados até o menor nível taxonômico possível e os diferentes grupos foram analisados pelo índice de diversidade de Shannon, diversidade β, riqueza estimada pela curva de rarefação e participação relativa dos grupos funcionais de alimentação. Os resultados apontaram ligeira redução na diversidade nos trechos à jusante, bem como ao longo do perfil longitudinal do ribeirão. Todavia, não houve diferenças significativas na abundância e riqueza entre os segmentos à montante e à jusante das represas, indicando que os represamentos não influenciaram nessas variáveis. Os resultados apontaram diferenças nos grupos funcionais de alimentação ao longo do perfil longitudinal. Os insetos predadores e coletores foram os grupos de alimentação predominantes em todos os segmentos analisados. O grupo dos insetos fragmentadores foi mais abudante no segmento DSIII com a participação de Marilia Müller (Odontoceridae- Trichoptera), embora observado um decréscimo de fragmentadores e rapaspadores com a redução da cobertura vegetal, reduzindo os valores dediversidade b no perfil longitudinal do Ribeirão das Anhumas. Os resultados demonstraram a importancia da conservação da vegetação ripária para a manutenção da integridade do ribeirão.

Palavra, ritmo e jogo: fios que dançam no processo de simbolização / Palabra, ritmo y juego: hilos que danzan en el proceso de simbolización / Word, rhythm and game: dancing wires in the process of symbolization

No presente artigo, o autor desenvolve o tema do processo de simbolização no processo de subjetivação da criança, tomando como ponto de referência e análise o papel do polo da presença do outro em sua função simbolizante. Isso implica em conceituar a simbolização a partir de uma perspectiva intersubjetiva. Para isso, também é tentado um diálogo com as contribuições da arte a partir de escritores como J. L. Borges e S. Hustvedt e seu conceito de ritmo e entreidade. Toma-se como um dos pontos fundamentais desenvolver o tema do ritmo a partir de diferentes perspectivas e afirma-se a hipótese do papel da lei materna como princípio organizador do vínculo, em consonância com o papel da lei paterna. Faz-se uma análise mais detalhada do jogo do fort-da e do papel da atenção do terceiro no jogo elaborativo. Também é analisado o caso do menino dos cordões, de Winnicott, para abrir um espaço de reflexão sobre o papel estruturante do jogo e do terceiro na constituição psíquica

In this paper, the author develops the theme of the symbolization process regarding the child subjectivity process, using as a point of reference and analysis, the role of the other’s presence pole in his symbolizing function. This, implies on conceptualizing symbolization from an intersubjective perspective. To do so, it is proposed a dialogue with art contributions from writers such as J. L. Borges and S. Hustvedt and their concept of rhythm and betweenness. One of the key points is to develop the theme of rhythm from different perspectives and to assert a hypothesis of the role of maternal law as the organizing principle of the bond, in consonance with the role of paternal law. A detailed analysis of the fort-da game and of the attention role of the third in the elaborative game will be done. It is also analysed Winnicott’s case of a boy and his strings, in order to open a space for reflection on the role (structural or defective) of the game and of the third in the psychic constitution

En el presente artículo el autor desarrolla el tema del proceso de simbolización en el proceso de subjetivación del niño, tomando como punto de referencia y análisis, el papel del polo de la presencia del otro en su función simbolizante. Esto implica conceptualizar la simbolización desde una perspectiva intersubjetiva, para ello también se intenta un dialogo con los aportes del arte,a partir de escritores como J. L. Borges y S. Hustvedt y su concepto de ritmo y entreidad. Se toman como uno de los puntos fundamentales desarrollar el tema del ritmo desde diferentes perspectivas y se hace hincapié en la hipótesis del papel de la ley materna como principio organizador del vínculo, en consonancia con el papel de la ley paterna. Se realiza un análisis más detallado del juego del fort-da y del papel de la atención del tercero en el juego elaborativo. Y del caso del niño del cordel de Winnicott, para abrir un espacio de reflexión sobre el papel estructurante del juego y del tercero en la constitución psíquica

Causalidade, descontínuo, dor: caminhos da bala perdida e da mega-sena / Causality, discontinuous, pain: the stray bullet paths and the lottery

A lógica formal configura modelos adstritos ao conhecer e ao subjetivar calcados nas concepções de substância, verdade e causalidade linear e contínua. Neste artigo a "mega sena", a "bala perdida" e a dor são entendidas como expressões do descontínuo e do "acaso", bem como, da causalidade não restrita à relação imediata estabelecida entre a intencionalidade do sujeito presentificada na causa e no efeito. O imprevisível e o descontínuo possibilitam problematizar a lógica não causal e o estatuto do denominado efeito, ampliando o trabalho na escuta da dor e na prática terapêutica.

The formal logic configures some connected models when facing and subjecting truth and continuous linear causality based on concepts of substance. Herein the "lottery", the "stray bullet" and the pain are understood as expressions from discontinuity and "chance" linked to a causality that goes further than the immediate relationship established between the intentionality of the subject presented in the cause and effect. The discontinuous and undecided logical allows questioning about the non-casual logical and about the statute of the effect, extending so the listening work concerning the pain and the therapeutic practice.

Evaluation of Bone Resorption Rate after Nonvascularized Iliac Bone Graft for Mandibular Discontinuity Defect

O enigma do acontecimento / The enigma of the event / El enigma del acontecimiento / L'énigme de l'événement

Acontecimento e mudança, duas noções interligadas, que remetem a um enigma: como é que, da continuidade, pode nascer a descontinuidade? A esta questão, a análise do acontecimento - aquilo que de repente irrompe na vida de um grupo ou de um indivíduo, provocando surpresa e confusão - traz certa luz. Evocamos três exemplos de amplidão e de natureza diversas: o chamado caso DSK (Dominique Strauss-Kahn), uma descoberta reveladora das tensões em uma equipe de cuidados e a criação do Estado de Israel, vivida de maneira contraditória pelos palestinos e pelos israelenses. Estes três acontecimentos só fazem sentido e se tornam fonte de mudanças, quando suas repercussões psicológicas e sociais são objeto de trabalho de elaboração por parte das pessoas envolvidas.

Event and change are two interrelated notions referring to an enigma: how can discontinuity be born from continuity? Taking this question into consideration, the analysis of the event - which can be anything that suddenly bursts into a group or an individual life, brings surprise and confusion and sort of a certain light. We can mention three examples of a nature variety: the case so called DSK (Dominique Strauss-Kahn), a discovery revealing the tensions in a team of care and the creation of Israel, which has been in a contradictory ways by the Palestinians and the Israelis. These three events only make sense and become a source of change, when their psychological and social consequences are the subject of an elaboration work by the involved people.

Acontecimiento y cambio, dos nociones interligadas, que remiten a un enigma: ¿cómo es que, de la continuidad, puede nacer la discontinuidad? A esta cuestión, el análisis del acontecimiento - aquello que de repente irrumpe en la vida de un grupo o de un individuo, provocando sorpresa y confusión - trae cierta luz. Evocamos tres ejemplos de amplitud y de naturaleza diversas: el llamado caso DSK (Dominique Strauss-Kahn), un descubrimiento revelador de las tensiones en un equipo de cuidados y la creación del Estado de Israel, vivida de manera contradictoria por los palestinos y por los israelitas. Estos tres acontecimientos solo hacen sentido y se tornan fuente de cambios, cuando sus repercusiones psicológicas y sociales son objeto de trabajo de elaboración por parte de las personas envueltas.

Événement et changement, deux notions liées, qui renvoient toutes deux à une énigme : comment de la continuité peut naître la discontinuité ? A cette question, l’analyse de l’événement, - ce qui fait soudain irruption dans la vie d’un groupe ou d’un individu, provoquant surprise et désarroi - apporte un certain éclairage. Trois exemples d’ampleur et de nature différentes sont évoqués : l’affaire dite DSK, une découverte révélatrice de tensions dans une équipe de soins, la création de l’Etat d’Israël, vécu de façon contradictoire par les palestiniens et les israéliens. Ces trois événements ne prennent sens et ne deviennent source de changement que lorsque leurs répercussions psychologiques et sociales font l’objet d’un travail d’élaboration chez ceux qui y sont impliqués.

A vertigem da descontinuidade: sobre os usos da história na arqueologia de Michel Foucault / The vertigo of discontinuity: on the use of history in Michel Foucault's archeology

Abordam-se os usos da história na arqueologia de Foucault, a fim de precisar suas rupturas com o discurso da história tradicionalista. Analisa-se, inicialmente, a noção de 'arqueologia' e indicam-se os seus propósitos, tomando por base as elucidações do próprio autor. Em seguida, descreve-se a trama de noções ('acontecimento', 'formação discursiva' e 'enunciado') que se encontram enredadas no conceito de 'arquivo', buscando demonstrar a inventividade analítica desse autor para a história, problematizada a partir do paradoxo existente entre 'unidade' e 'dispersão de enunciados'. Finalmente, discute-se a enunciação de mecanismos de controle do discurso, a fim de identificar elementos de transição do trabalho descritivo das formações discursivas realizado na arqueologia do saber, para uma análise de estratégias em jogo tanto nas práticas discursivas quanto nas não-discursivas, presentes na genealogia do poder.

With the goal of identifying ruptures with traditionalist history discourse, this essay offers a reading of the various uses of history in Foucault's archeology. I begin by analyzing and describing the purpose of the notion of archeology, based on Foucault's own elucidations. I then describe the set of notions (event, discursive formation, and enunciation) intertwined within the concept of archive, in an attempt to demonstrate Foucault's analytical inventiveness in his contribution to the field of history, which he approaches from the paradox between unity and dispersion of enunciations. Lastly, I explore the enunciation of mechanisms for controlling discourse, with the aim of identifying elements of transition from descriptive work on discursive formations undertaken in the archeology of knowledge, to an analysis of the interplay of strategies both in discursive as well as non-discursive practices found in the genealogy of power.

Relationship of pure tone audiometry and ossicular discontinuity in chronic suppurative otitis media

Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of 50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)