Ontological indistinguishability as a central tenet of quantum theory.

Quantum indistinguishability directly relates to the philosophical debate on the notions of identity and individuality. They are crucial for our understanding of multipartite quantum systems. Furthermore, the correct interpretation of this feature of quantum theory has implications that transcend fundamental science and philosophy, given that quantum indistinguishability is a resource in quantum information theory. Most of the conceptual analysis of quantum indistinguishability is restricted to studying the permutational invariance of quantum states, the concomitant quantum statistics and their entanglement. Here, we analyse the role of indistinguishability and non-individuality in other areas of quantum theory. We start by analysing how a very peculiar use of indistinguishability underlies Feynman's rules for summing amplitudes in interference phenomena. Next, we study how quantum indistinguishability is underestimated in several topics of debate in the quantum physics literature, such as the Einstein-Podolsky-Rosen argument, Bell's inequalities and the Bell-Kochen-Specker theorem. Finally, we argue that an ontology of truly indistinguishable entities can serve as a basis for a quantum ontology that can give interesting answers to the interpretational problems of quantum mechanics. We claim that, in addition to superposition, contextuality and entanglement, indistinguishability (understood in a robust ontological sense) is one of the central features of quantum physics. This article is part of the theme issue 'Identity, individuality and indistinguishability in physics and mathematics'.

Severity of precapillary pulmonary hypertension: Predictive factor.

BACKGROUND AND OBJECTIVES: Patients with pulmonary arterial hypertension (PAH) require risk assessments for prognosis and appropriate therapy. These assessments need to be improved by incorporating clinical and laboratory data such as the analysis of the right ventricle. We aim to establish echocardiographic morphometric data of the right ventricle and its relationship with the left ventricle, to estimate the hemodynamic severity of precapillary pulmonary hypertension (PHprecapillary). METHODS: This cohort, prospective, observational, and cross-sectional study included 41 consecutive patients with PHprecapillary using echocardiographic study and cardiac catheterization. RESULTS: Patients' mean age was 44.0±16.4 years, and 37 were women (90.2%). Idiopathic PAH was diagnosed in 18 patients (43.9%). The World Health Organization/New York Association functional class was III or IV in 31 patients (75.6%). The ratio of the right to left ventricles (RV/LV) echocardiographic diastolic diameters was associated with pulmonary arterial pressures in cardiac catheterization, with the best cutoff per receiver operating characteristic curve being 0.8 for systolic pressure (sensitivity 90.0%, specificity 78.3%, area under the curve [AUC] 0.882) and mean pressure (sensitivity 60.0%, specificity 95.7%, AUC 0.823). Spearman's correlation (R) of RV/LV echocardiographic ratio and the hemodynamic variables was significant for systolic pressure (R = 0.7015, p < 0.0001), mean pressure (R = 0.6332, p < 0.0001), transpulmonary pressure gradient (R = 0.6524, p < 0.0001), pulmonary vascular resistance (R = 0.6076, p = 0.0021), and pulmonary vascular resistance index (R = 0.6229, p = 0.0014). CONCLUSION: The ratio of RV/LV echocardiographic diastolic diameters contribute to the estimates the hemodynamic severity of precapillary pulmonary hypertension. The best cutoff for this assessment was RV/LV of 0.8.

Construct validity and reliability of the Brazilian version of the Falls Efficacy Scale in patients with COPD.

INTRODUCTION AND OBJECTIVE: The Brazilian version of Falls Efficacy Scale (FES-BR) used to assess the fear of falling, has not yet been validated in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of the present study was to investigate the construct validity and reliability of the (FES-BR) in patients with COPD. METHODS: A cross-sectional study involving subjects with COPD, aged between 48 and 83 years. Data were collected by two independent and blind assessors. Construct validity was assessed using the Spearman's rank correlation coefficient between FES-BR and Berg Balance Scale, Downton fall risk index, Timed Up and Go Test (TUG), hand-grip strength (HGS), Five Times Sit to Stand Test (FTSST) and 6-Minute Walk Test (6MWT). Reliability was measured by the Cronbach's alpha coefficient, Intraclass Correlation Coefficient (ICC), and Bland-Altman plot. RESULTS: The study included 60 subjects aged 68.3 ±â€¯9.9 years and FEV1 56.0 ±â€¯19.3. The correlations were significantly strong between FES-BR and the Berg Balance Scale (r = -0.66), TUG (r = 0.64), HGS (r = 0.61) and FTSST (r = 0.62); and moderate between FES-BR and the Downton fall risk index (r = 0.38) and the 6MWT (r = -0.48). All correlations had p < 0.001. Intra-rater [ICC = 0.94, (95% CI = 0.91-0.96)] and inter-rater [0.97, (95% CI = 0.97-0.98)] reliability were considered excellent. CONCLUSIONS: The Brazilian version of FES was valid and reliable in assess fear of falling in subjects with COPD.

The effects of dehydroepiandrosterone on sexual function: a systematic review.

OBJECTIVE: Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on people's quality of life, this systematic review was undertaken with the objective of evaluating the effect of DHEA use on aspects of sexual function. METHOD: An electronic search was conducted in the databases of PubMed, ISI Web of Science and Virtual Health Library (VHL) combining the terms 'DHEA treatment' and 'DHEA use' with terms such as 'sexual dysfunction', 'sexual frequency' and 'libido'. No limits on time and language were imposed. Clinical studies were considered eligible where individuals for any reason made use of DHEA and if they had any aspect of sexual function assessed. Preclinical studies and systematic reviews were considered ineligible. RESULTS: The search identified 183 references and 38 were considered eligible. DHEA improved aspects such as sexual interest, lubrication, pain, arousal, orgasm and sexual frequency. Its effect was better in populations with sexual dysfunction, especially in perimenopausal and postmenopausal women. CONCLUSION: Considering the studies currently published, DHEA is effective in improving several aspects of sexual function, but this effect did not reach all the populations studied.

In vitro evaluation of Midwest Caries ID: a novel light-emitting diode for caries detection.

INTRODUCTION: Traditional detection techniques have limits in diagnosing occlusal caries. Thus, more accurate methods are needed. This study evaluates the ability of the Midwest Caries ID (Midwest) to detect caries. METHODS: Two hundred sixty-four extracted, nonrestored premolars and molars were cleaned and stored in 0.2% sodium azide. Teeth were divided into three groups of 88. One examination site on each occlusal surface was chosen. Each site was inspected by a calibrated examiner via visual, Midwest, and histologic exams. First, a visual exam was performed following the International Caries Detection and Assessment guidelines. Next, the same site was inspected using the Midwest device. Finally, the tooth was sectioned mesiodistally through the site. The half with greater caries progression was visualized under a stereomicroscope (64×). Histologic appearance was scored based on the Downer system. Data were analyzed using Kendall tau-b, partial correlation coefficients, and the receiver operating characteristics curve. RESULTS: Overall, the Midwest scoring assessment correlated with histologic assessments (tau = 0.32; p<0.0001), but the visual exam had a stronger correlation (tau = 0.53; p<0.0001) with the histologic exam. The sensitivity and specificity of the Midwest was also reported at 0.56 and 0.84, compared with 0.92 and 0.43, respectively, for the visual exam. CONCLUSIONS: Midwest Caries ID is a novel caries detection device that has limitations and should not be used as the sole means to detect occlusal caries.

Effect of silver diamine fluoride on microtensile bond strength to dentin.

The aim of this in vitro study was to investigate the effect of the cariostatic and preventive agent silver diamine fluoride (SDF) on the microtensile bond strength of resin composite to dentin. Forty-two caries-free, extracted molars were flattened occlusally and apically using a diamond saw, and the exposed occlusal dentin was polished with a series of silicon carbide papers, all under water irrigation. The teeth were then randomly divided into six groups of seven teeth each that were treated as follows: 1) Peak SE self-etch bonding agent; 2) 12% SDF + Peak SE; 3) 38% SDF + Peak SE; 4) Peak LC etch-and-rinse bonding agent; 5) 12% SDF + Peak LC; and 6) 38% SDF + Peak LC. Four-millimeter buildups of Amelogen Plus were incrementally placed on all teeth; after a 24-hour storage period in distilled water, the specimens were sectioned perpendicular to the adhesive interface to produce beams of cross-sectional surface area measuring approximately 1 mm(2). The beams were placed on a microtensile testing machine, which utilized a single-speed pump motor and force gauge at 20 kgf × 0.01 second to record maximum tensile force before failure occurred. Two-way analysis of variance and post hoc Tukey tests were performed to compare the effects of the SDF on microtensile bond strength, with statistical significance set at α = 0.05. None of the experimental groups treated with different concentrations of SDF showed a significant difference in bond strength compared to the control groups, and there was no significant difference in bond strength between self-etch and etch-and-rinse groups. However, the effect of SDF on self-etch bonded teeth compared to etch-and-rinse bonded teeth was statistically significant (p=0.0363), specifically at the 12% concentration. SDF does not adversely affect the bond strength of resin composite to noncarious dentin.

Effect of bur type and conditioning on the surface and interface of dentine.

The purpose of this in vitro study was to evaluate the surface and resin-dentine interface characteristics of permanent tooth dentine cut with diamond or carbide burs and treated with phosphoric acid (PA) or an acidic conditioner. Labial surfaces of permanent incisors were prepared into dentine with high-speed carbide or diamond burs and divided into two halves. Phosphoric acid 36% was applied on one half and non-rinse conditioner (NRC) was applied on the other half. Ten randomly selected scanning electron microscopy (SEM) fields from each specimen (n = 15) were evaluated. Occlusal surfaces of third molars were divided in two halves for evaluation of the resin-dentine interface. The halves were randomly assigned to one of each conditioner and restored with Prime & Bond NT/Spectrum. Ten specimens were analysed by SEM to evaluate hybrid layer formation and interfacial seal. We observed that surfaces prepared with carbide bur presented less residual smear plugs (P < 0.05) than surfaces prepared with diamond burs. Surfaces conditioned with NRC, which is a smear layer modifier, presented more residual smear plugs than surfaces conditioned with PA (P < 0.05). Treatment with PA resulted in more sealed interfaces than specimens treated with NRC. Within the limitations of this study the results showed that carbide burs leave a surface that is more conducive to bonding than diamond burs.

[Applicability of the Torrington and Henderson scale]. / Aplicabilidade da escala de Torrington e Henderson.

PURPOSE: To validate the Torrington & Henderson preoperative risk assessment program in the population of surgical patients in an university hospital (Hospital São Paulo, UNIFESP, São Paulo, Brasil). MATERIAL AND METHODS: We evaluated 1162 patients who underwent to major thoracic, upper and under abdominal surgery using the Torrington & Henderson program. The patients were classified in low (785), moderate (317) and high risk (60). All patients were accompanied daily during the postoperative period by the same medical team which assessed the preoperative period, until discharged or died. RESULTS: The postoperative pulmonary complications were present in 6.1%, 23.3% and 35.0% in the low, moderate and high risk respectively. The relative risk to develop postoperative pulmonary complications was 3.8 higher in the patients with moderate risk and 5.7 higher in the patients with high risk. The mortality rate due to pulmonary complications was 1.7%, 6.3% and 11.7% respectively in the patients with low, moderate and high risk. The relative risk to the death was 3.7 higher in the patients with moderate risk and 6.9 in the high risk. CONCLUSION: We concluded that the Torrington & Henderson preoperative risk assessment program can identify in our population patients who will develop postoperative pulmonary complications.

[(Mis)information on drugs: the double standard practiced by pharmaceutical companies]. / A (des)informação sobre medicamentos: o duplo padrão de conduta das empresas farmacêuticas.

Different factors have been identified as influencing drug prescribers. Some studies emphasize the role played by sources of information available to physicians. Reports have been published on the influence of marketing strategies on these health professionals. Such strategies include advertisements in medical journals, sales representatives, free samples, leaflets, distribution of gifts and prizes, etc. The research reported here aimed to identify information provided by a commonly used Brazilian prescription handbook, the Dicionário de Especialidades Farmacêuticas (DEF), in relation to the 44 most frequently sold pharmaceutical products in Brazil, using as parameters the WHO guidelines for information to be included in informative materials offered to physicians. The information was then compared to that included in the PDR (Physicians' Desk Reference) and USP-DI (Drug Information for the Health Care Professional) used by prescribers in the United States. The results showed lack of data in the Brazilian publication (contraindications, side effects, drug interaction), suggesting lack of reliability in prescription quality and thus in the ultimate utilization of drugs.

Aplicabilidade da escala de Torrington e Henderson / Applicability of the Torrington and Henderson scale

OBJETIVO: Validar a escala de Torrington e Henderson na estratificação do risco cirúrgico da nossa população, fornecendo a quantificação do mesmo. Tipo de estudo: coorte prospectivo longitudinal. Duração do estudo: 30 meses. MÉTODOS: Foram avaliados 1162 pacientes no pré-operatório de cirurgia geral eletiva no Ambulatório de Risco Cirúrgico da Disciplina de Pneumologia da EPM/Unifesp. De acordo com a escala de Torrington e Henderson os pacientes foram classificados no período pré-operatório em portadores de baixo (n=785), moderado (n=317) e alto risco (n=60) para a ocorrência de complicações pulmonares e óbito, no período pós-operatório. No pós-operatório realizou-se avaliação clínica diária dos mesmos até alta hospitalar ou óbito verificando-se a ocorrência das seguintes complicações pulmonares neste período: infecção respiratória aguda (pneumonia ou traqueobronquite),atelectasia, insuficiência respiratória aguda, entubação orotraqueal ou ventilação mecânica por mais de 48 horas e broncoespasmo. RESULTADOS: Complicações pulmonares no pós-operatório ocorreram em 6,1 por cento dos pacientes de baixo risco, 23,3 por cento nos de moderado e 35 por cento nos de alto risco (p < 0,05). O risco relativo de ocorrer complicações pulmonares foi de 3,8 vezes para os pacientes de moderado risco e de 5,7 vezes para os de alto risco em relação aos de baixo risco. A incidência de óbito de causa pulmonar no pós-operatório foi, respectivamente, de 1,7 por cento , 6,3 e 11,7 por cento entre os pacientes de baixo, moderado e de alto risco (p < 0,001). O risco relativo de óbito pulmonar foi de 3,7 vezes para os pacientes de moderado risco e de 6,9 vezes para aqueles de alto risco em relação aos de baixo risco. CONCLUSÃO: A escala de Torrington e Henderson é útil na estratificação do risco cirúrgico nesta população estudada.

One more case of the double standard: discrepancies between drug information provided to Brazilian and American physicians.

Several factors have been identified as exerting influences upon the physician prescribing behaviour. Some studies on this issue emphasize the role played by the sources of information available to physicians. A number of reports have been published on the influence of marketing strategies upon these professionals. Such strategies include advertisements in medical journals, detail-men, free samples, distribution of folders, leaflets and gifts, as well as support to congresses and symposia. The impact of the 'special' relationships that manufacturers cultivate with health authorities and physicians and considered opinion-makers should also not be underestimated. This study aimed to evaluate the quality of information provided by a widely-used Brazilian prescribing guide, the Dicionário de Especialidades Farmacêuticas(DEF) on the 44 best-selling pharmaceutical products in Brazil. WHO criteria for drug information were used as parameters of which information is of such outstanding importance that it should be included in any informative material offered to physicians. The information in the DEF was compared with that available for the same products in the PDR (Physicians' Desk Reference) and USP-DI (Drug Information for the Health Care Professional) used by prescribers in USA. Results show the absence of important data from the Brazilian manual, including contraindications, adverse effects and drug interactions. These findings suggest that poor quality information may potentially contribute to the irrational use of drugs. Copyright (c) 2000 John Wiley & Sons, Ltd.

La publicidad de los medicamentos: riesgo o beneficio? / Publicity of medicaments: risks or benefits

Ya esta suficientemente comprobada la importancia del rol asignado al medico en el consumo de los medicamentos. A partir de su condicion de intermediario de la adquisicion y dispensacion de medicamentos, el prescriptor es la gran diana de las actividades promocionales de los productores, orientadas hacia la optimizacion de las ganancias aunque bajo el disfraz del proposito de educar y/o informar. Diferentes estudios evidenciaron el lugar destacado ocupado por las fuentes comerciales sobre la prescripcion. La presente revision enfatiza dos de estas fuentes - los anuncios en revistas y el visitador medico - concluyendo a partir de multiples estudios que los primeros en gneral preentan informaciones sesgadas o incompletas mientras que el segundo cumple el papel de mero agente de ventas. Se presenan igualmente las fuentes profesionales de informacion y los alcances y limites de dos de ellas: las guias farmacologicas y los boletines terapeuticos

[Advertising of drugs: risk or benefits?]. / La publicidad de los medicamentos: riesgo o beneficio?

It is obvious how important is the role of the physicians on drugs consumption. On account of their intermediary in the procurement and consumption of medicines, the prescriber is the main focus of manufacturers' promotional activities aiming at increasing sales and profits although these activities often are disguised as a means of education or information. Many reports have been issued emphasizing the influence of commercial sources upon the prescription. This text reviews two of them -advertisements in medical journals and the representatives- arriving to the conclusion that first ones display informations that are biased and incomplete while the representative in fact acts as a sales agent. The professional sources of information for prescribers are also described being evaluated how far-reaching the sources referred can be.

Xadrez, ansiedade e coronariopatia / Chess, anxiety and coronary disease

O registro eletrocardiografico continuo pelo sistema Holter de 16 enxadristas em 44 competicoes foi realizado com o objetivo de detectar arritmias, variacoes de frequencia cardiaca (FC) e alteracoes morfologicas. Foram considerados o grupo 1(8) de competicoes convencionais (2 1/2 x 2 1/2 h), grupo II (6) de competicoes "relampago" (5 x 5 minutos) e o grupo II (4) de competicoes convencionais com administracao previa de um beta-bloqueador oral.A FC elevou-se em todos, variando este aumento de 15,05 a 97,14% e a elevacao coincidiu com dificuldades encontradas durante a competicao. Arritmias foram registradas em 4/16 (25%), porem nao significativas.Dois (12,5%) apresentaram alteracoes isquemicas que, em um deles, se reproduziram durante teste ergometrico posteriormente realizado

Estrategias mercadologicas da industria farmaceutica e o consumo de medicamentos. / Marketing strategies of the pharmaceutical industry and the consumption of drugs

Dentro do processo de ampliacao crescente do ambito de intervencao da Medicina (a chamada "medicalizacao"), o uso abusivo de medicamentos industrializados assume papel de destaque. Entre as diversas praticas mercadologicas de que a Industria Farmaceutica se vale para incrementar os seus lucros - via estimulo ao consumo - sobressai-se a propaganda, particularmente junto ao medico. A despeito da automedicacao, dependente, por sua vez, em grande parte, da influencia inclusive "legitimadora" do medico, e sobre esse profissional que recai, direta ou indiretamente, atraves da prescricao medicamentosa, a responsabilidade por acao significativa do consumo.Propoe-se, com base em diversos estudos ja realizados, a analise critica do papel da propaganda, com enfase no papel do propagandista de laboratorio e na sua eficacia como instrumento preferencial de que lancam mao os produtores de medicamentos para influenciar os habitos de prescricao dos medicos, dirigindo-os prioritariamente a satisfacao dos interesses dos produtores, em detrimento daqueles dos consumidores