Air abrasion before and/or after zirconia sintering: surface characterization, flexural strength, and resin cement bond strength.

The purpose of this in vitro study was to evaluate the effect of air-abrasion/zirconia sintering order on the yttria partially stabilized tetragonal zirconia polycrystal (Y-TZP) surface characterization (roughness, morphology, and phase transformation), flexural strength (FS), and shear bond strength (SBS) to a resin cement. Y-TZP specimens were air abraded with 50-µm Al2O3 particles after (AS), before (BS), or before and after zirconia sintering (BAS). For roughness (Ra), 30 block specimens (12×12×3.0 mm; n=10) had their surfaces analyzed by a profilometer. Next, on the air-abraded surfaces of these specimens, composite resin discs (n=30) were bonded with RelyX ARC. The bonded specimens were stored for 24 hours in distilled water at 37°C before shear testing. Failure mode was determined with a stereomicroscope (20×). The surface morphology (n=2) was evaluated by SEM (500×). For the four-point flexural strength test (EMIC DL2000), 39 bar-shaped specimens (20×4.0×1.2 mm; n=13) were air abraded according to the three conditions proposed, and an additional group (nonabraded) was evaluated (n=13). The quantitative analysis of phase transformation (n=1) was completed with Rietveld refinement with X-ray diffraction data. Ra (µm) and SBS (MPa) data were analyzed by one-way analysis of variance (ANOVA) and the Tukey test (α=0.05). Pearson correlation analysis was used to determine if there was a correlation between roughness and SBS. For FS (MPa) data, one-way ANOVA and the Dunnett C-test (α=0.05) were used. The air-abrasion/zirconia sintering order influenced significantly (p<0.001) Ra, SBS, and FS. The BS and AS groups presented the highest (1.3 µm) and the lowest (0.7 µm) Ra. The highest SBS (7.0 MPa) was exhibited by the BAS group, followed by the AS group (5.4 MPa) and finally by the BS group (2.6 MPa). All groups presented 100% adhesive failure. A weak correlation (r=-0.45, p<0.05) was found between roughness and SBS. The air-abrasion/zirconia sintering order provided differences in the surface morphology. The nonabraded (926.8 MPa) and BS (816.3 MPa) groups exhibited statistically similar FS values but lower values than the AS (1249.1 MPa) and BAS (1181.4 MPa) groups, with no significant difference between them. The nonabraded, AS, BS, and BAS groups exhibited, respectively, percentages of monoclinic phase of 0.0 wt%, 12.2 wt%, 0.0 wt%, and 8.6 wt%. The rougher surface provided by the air-abrasion before zirconia sintering may have impaired the bonding with the resin cement. The morphological patterns were consistent with the surface roughness. Considering the short-term SBS and FS, the BAS group exhibited the best performance. Air abrasion, regardless of its performance order, provides tetragonal to monoclinic transformation, while sintering tends to zero the monoclinic phase content.

Ergonomics, design universal and fashion.

People who lie beyond the "standard" model of users often come up against barriers when using fashion products, especially clothing, the design of which ought to give special attention to comfort, security and well-being. The principles of universal design seek to extend the design process for products manufactured in bulk so as to include people who, because of their personal characteristics or physical conditions, are at an extreme end of some dimension of performance, whether this is to do with sight, hearing, reach or manipulation. Ergonomics, a discipline anchored on scientific data, regards human beings as the central focus of its operations and, consequently, offers various forms of support to applying universal design in product development. In this context, this paper sets out a reflection on applying the seven principles of universal design to fashion products and clothing with a view to targeting such principles as recommendations that will guide the early stages of developing these products, and establish strategies for market expansion, thereby increasing the volume of production and reducing prices.

Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection.

OBJECTIVE: To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency. MATERIALS AND METHODS: Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment. RESULTS: It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46% in GI and 40.7% in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant. CONCLUSIONS: It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patient's procedure, with little side effects.

Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection

OBJECTIVE: To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency MATERIALS AND METHODS: Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment RESULTS: It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46 percent in GI and 40.7 percent in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant CONCLUSIONS: It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patient's procedure, with little side effects.

Identifying barriers to hypertension guideline adherence using clinician feedback at the point of care.

Factors contributing to low adherence to clinical guidelines by clinicians are not well understood. The user interface of ATHENA-HTN, a guideline-based decision support system (DSS) for hypertension, presents a novel opportunity to collect clinician feedback on recommendations displayed at the point of care. We analyzed feedback from 46 clinicians who received ATHENA advisories as part of a 15-month randomized trial to identify potential reasons clinicians may not intensify hypertension therapy when it is recommended. Among the 368 visits for which feedback was provided, clinicians commonly reported they did not follow recommendations because: recorded blood pressure was not representative of the patient's typical blood pressure; hypertension was not a clinical priority for the visit; or patients were nonadherent to medications. For many visits, current quality-assurance algorithms may incorrectly identify clinically appropriate decisions as guideline nonadherent due to incomplete capture of relevant information. We present recommendations for how automated DSSs may help identify "apparent" barriers and better target decision support.

Offline testing of the ATHENA Hypertension decision support system knowledge base to improve the accuracy of recommendations.

ATHENA-HTN is a clinical decision support system (CDSS) that delivers guideline-based patient-specific recommendations about hypertension management at the time of clinical decision-making. The ATHENA-HTN knowledge is stored in a knowledge-base (KB). Changes in best-practice recommendations require updates to the KB. We describe a method of offline testing to evaluate the accuracy of recommendations generated from the KB. A physician reviewed 100 test cases and made drug recommendations based on guidelines and the "Rules" (descriptions of encoded knowledge). These drug recommendations were compared to those generated by ATHENA-HTN. Nineteen drug-recommendation discrepancies were identified: ATHENA-HTN was more complete in generating recommendations (15); ambiguities in the Rules misled the physician (3); and content in the Rules was not encoded (1). Three new boundaries were identified. Three updates were made to the KB based on the results. The offline testing method was successful in identifying areas for KB improvement and led to improved accuracy of guideline-based recommendations.

Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension.

Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intention of the guideline and different ways providers attempt to satisfy the guideline. During our work with a guideline-based decision support system for hypertension, ATHENA DSS, we document a number of subtle deviations from the strict hypertension guideline recommendations that ultimately demonstrate provider adherence. We believe that understanding these complexities is crucial to any valid evaluation of provider adherence. We also describe the development of an advisory evaluation engine that automates the interpretation of clinician adherence with the DSS on multiple levels, facilitating the high volume of complex data analysis that is created in a clinical trial of a guideline-based DSS.

Building an explanation function for a hypertension decision-support system.

ATHENA DSS is a decision-support system that provides recommendations for managing hypertension in primary care. ATHENA DSS is built on a component-based architecture called EON. User acceptance of a system like this one depends partly on how well the system explains its reasoning and justifies its conclusions. We addressed this issue by adapting WOZ, a declarative explanation framework, to build an explanation function for ATHENA DSS. ATHENA DSS is built based on a component-based architecture called EON. The explanation function obtains its information by tapping into EON's components, as well as into other relevant sources such as the guideline document and medical literature. It uses an argument model to identify the pieces of information that constitute an explanation, and employs a set of visual clients to display that explanation. By incorporating varied information sources, by mirroring naturally occurring medical arguments and by utilizing graphic visualizations, ATHENA DSS's explanation function generates rich, evidence-based explanations.

Integration of textual guideline documents with formal guideline knowledge bases.

Numerous approaches have been proposed to integrate the text of guideline documents with guideline-based care systems. Current approaches range from serving marked up guideline text documents to generating advisories using complex guideline knowledge bases. These approaches have integration problems mainly because they tend to rigidly link the knowledge base with text. We are developing a bridge approach that uses an information retrieval technology. The new approach facilitates a versatile decision-support system by using flexible links between the formal structures of the knowledge base and the natural language style of the guideline text.

HA95 is a protein of the chromatin and nuclear matrix regulating nuclear envelope dynamics.

We report a role for HA95, a nuclear protein with high homology to the nuclear A-kinase anchoring protein AKAP95, in the regulation of nuclear envelope-chromatin interactions. Biochemical and photobleaching data indicate that HA95 is tightly associated with chromatin and the nuclear matrix/lamina network in interphase, and bound to chromatin at mitosis. HA95 resides in a complex together with lamin B receptor (LBR), lamina-associated polypeptide (LAP)2 and emerin, integral proteins of the inner nuclear membrane. Cross-linking experiments, however, illustrate a tight association of HA95 with LBR and LAP2 only. Intra-nuclear blocking of HA95 with anti-HA95 antibodies abolishes nuclear breakdown in a mitotic HeLa cell extract. The antibodies inhibit nuclear membrane breakdown and chromatin condensation - the latter independently of nuclear membranes. However, lamina disassembly is not affected, as judged by immunological analyses of A/C- and B-type lamins. In contrast, immunoblocking of HA95 bound to condensed chromosomes does not impair chromatin decondensation, nuclear membrane reassembly or lamina reformation. Our results argue for a role for HA95 in anchoring nuclear membranes and lamins to chromatin in interphase, and in releasing membranes from chromatin at mitosis. The data also suggest that HA95 is not involved in initial binding of membranes to chromatin upon nuclear reassembly. We propose that HA95 is a central platform at the chromatin/nuclear matrix interface implicated in regulating nuclear envelope-chromatin interactions during the cell cycle.

Recruitment of protein phosphatase 1 to the nuclear envelope by A-kinase anchoring protein AKAP149 is a prerequisite for nuclear lamina assembly.

Subcellular targeting of cAMP-dependent protein kinase (protein kinase A [PKA]) and of type 1 protein phosphatase (PP1) is believed to enhance the specificity of these enzymes. We report that in addition to anchoring PKA, A-kinase anchoring protein AKAP149 recruits PP1 at the nuclear envelope (NE) upon somatic nuclear reformation in vitro, and that PP1 targeting to the NE is a prerequisite for assembly of B-type lamins. AKAP149 is an integral membrane protein of the endoplasmic reticulum/NE network. The PP1-binding domain of AKAP149 was identified as K(153)GVLF(157). PP1 binds immobilized AKAP149 in vitro and coprecipitates with AKAP149 from purified NE extracts. Affinity isolation of PP1 from solubilized NEs copurifies AKAP149. Upon reassembly of somatic nuclei in interphase extract, PP1 is targeted to the NE. Targeting is inhibited by a peptide containing the PP1-binding domain of AKAP149, abolished in nuclei assembled with membranes immunodepleted of AKAP149, and restored after reincorporation of AKAP149 into nuclear membranes. B-type lamins do not assemble into a lamina when NE targeting of PP1 is abolished, and is rescued upon recruitment of PP1 to the NE. We propose that kinase and phosphatase anchoring at the NE by AKAP149 plays in a role in modulating nuclear reassembly at the end of mitosis.

An international perspective on the treatment of pediatric shock: the Brazilian experience.

Shock in the pediatric population has many preventable causes. Treatment of children in shock will depend on access to health services, training of health personnel, availability of diagnostic procedures, monitoring, and therapeutic measures. Countries will differ among themselves and within themselves in the care provided to children developing shock. In Brazil, the majority of children are cared for in public hospitals, which often lack resources for basic care. Many children in shock do not even reach healthcare services. Investment in training healthcare personnel in a simplified and systematic approach to shock and access to equipped health services are basic to improved outcomes in the treatment of pediatric shock. The Brazilian experience in the treatment of children in shock outside hospital facilities, in the emergency department, and in the ICU is described.

The female street children of Rio de Janeiro: a qualitative study of their backgrounds.

A study of female street children using qualitative methodology revealed a family background of poverty, neglect, and violence as key factors in girls taking to the streets. Lack of any form of services, either social or medical, which could provide a safety net around dysfunctioning families was striking. The role of Maternal and Child Health Services in addressing the problem of street children is discussed.

Evaluation of a Rapid Impedimetric Method for Determining the Keeping Quality of Milk.

Shelf-life of 151 pasteurized milk samples was recorded and correlation coefficients calculated using various microbiological factors: standard plate count (SPC), psychrotrophic plate count (PPC), coliform count (CC), and the impedance response detection time (DT) with incubation at both 21 and 32°C. These data were obtained for milk samples on the day of pasteurization as well as 4 and 8 d thereafter. Various treatments (media, dilution factors, temperature and sample volume) were compared. Of the SPC, PPC, CC and DT taken on the day of pasteurization, only the DT achieved a significant correlation with shelf-life. A correlation coefficient of 0.55 was obtained for one treatment applied to 61 samples and correlation coefficients of 0.28 to 0.32 were obtained for several other treatments applied to the entire 151 samples. Values as large as these could occur by chance in uncorrelated data with p<0.0005. Thus, of the total 61 samples, 80% were correctly classified by the impedance detection time test. It is concluded that for prediction of shelf-life on the day of pasteurization, the impedance method is superior to the SPC and the PPC. In addition, the impedance method is more rapid, i.e., 14 h vs.2 d for the SPC and 10 d for the PPC.

Evaluation of a rapid method for the quantitative estimation of coliforms in meat by impedimetric procedures.

A 24-h instrumental procedure is described for the quantitative estimation of coliforms in ground meat. The method is simple and rapid, and it requires but a single sample dilution and four replicates. The data are recorded automatically and can be used to estimate coliforms in the range of 100 to 10,000 organisms per g. The procedure is an impedance detection time (IDT) method using a new medium, tested against 131 stock cultures, that markedly enhances the impedance response of gram-negative organisms, and it is selective for coliforms. Seventy samples of ground beef were analyzed for coliforms by the IDT method and the conventional three-dilution, two-step most-probable-number test tube procedure. Seventy-nine percent of the impedimetric estimates fell within the 95% confidence limits of the most-probable-number values. This corresponds to the criteria used to evaluate other coliform tests, with the added advantage of a single dilution and more rapid results.