Comment j'explore une masse cervicale chez l'enfant

peer reviewedLa découverte d’une masse cervicale chez l’enfant ouvre un champ très vaste de diagnostics possibles allant d’une simple adénopathie d’accompagnement à une manifestation de pathologie tumorale. Il n’est pas rare que les parents consultent le médecin lors de la découverte d’une «boule dans le cou», surtout lorsque celle-ci ne régresse pas après plusieurs semaines. Chez l’enfant, la palpation de ganglions petits et fermes est extrêmement fréquente et banale. L’histoire clinique associée à un examen complet permet le plus souvent de suspecter le caractère bénin ou sérieux de cette masse. Des examens complémentaires peuvent se révéler utiles en cas de doute et dans le cadre d’une recherche étiologique plus précise. Cependant, ils doivent faire l’objet d´une réflexion suivant un arbre décisionnel. L’exploration chez l’enfant reste délicate afin d’exclure une pathologie tumorale. Lorsque le caractère bénin ou banal est adopté, il n’est pas nécessaire alors d´identifier chaque fois l´étiologie, en particulier dans des cas aigus et bilatéraux qui sont souvent bénins et se résolvent spontanément.The discovery of a cervical mass in a child suggests several possible diagnoses ranging from benign conditions to more severe pathologies, even cancer. Parents often worry and consult a physician when such a mass fails to regress after a few weeks. Palpation of small and solid lymph nodes is commonplace and generally trivial in children. A detailed clinical history and a careful examination often allow a distinction to be made between a benign and a serious condition. Additional tests are needed in case of doubt or in the prospect of reaching an precise aetiological diagnosis. These exams should be selected according to a decision algorithm. The investigation remains delicate. When the physician is convinced of the benign nature of the lymphadenopathy, there is no real need to identify the aetiology with the greatest precision, especially in acute cases with bilateral nodes that are commonly benign and spontaneously resolve

Power control strategies and network performance assessment for C+L+S multiband optical transport

Spatial-division multiplexing (SDM) and band-division multiplexing (BDM) have emerged as solutions to expand the capacity of existing C-band wavelength-division multiplexing (WDM) optical systems and to deal with increasing traffic demands. An important difference between these two approaches is that BDM solutions enable data transmission over unused spectral bands of already-deployed optical fibers, whereas SDM solutions require the availability of additional fibers to replicate C-band WDM transmission. On the other hand, to properly design a multiband optical line system (OLS), the following fiber propagation effects have been taken into account in the analysis: (i) stimulated Raman scattering (SRS), which induces considerable power transfer among bands; (ii) frequency dependence of fiber parameters such as attenuation, dispersion, and nonlinear coefficients; and (iii) utilization of optical amplifiers with different doping materials, thus leading to different characteristics, e.g., in terms of noise figures. This work follows a two-step approach: First, we aim at maximizing and flattening the quality of transmission (QoT) when adding L-and rm L +rm S-bands to a traditional WDM OLS where only the C-band is deployed. This is achieved by applying a multiband optimized optical power control for BDM upgrades, which consists of setting a pre-tilt and power offset in the line amplifiers, thus achieving a considerable increase in QoT, both in average value and flatness. Second, the SDM approach is used as a benchmark for the BDM approach by assessing network performance on three network topologies with different geographical footprints. We show that, with optical power properly optimized, BDM may enable an increase in network traffic, slightly less than an SDM upgrade but still comparable, without requiring additional fiber cables

Comparison of Transceiver and C+L Band Upgrades: Network Traffic and Energy Assessment

Being as power-efficient as possible is becoming an issue of increasing importance in optical networks due to the continuous increase of requested capacity resulting from the exponential growth of IP traffic. In this work, we investigate the trade-off between network capacity and energy consumption in optical transport networks when considering (i) three coherent transceiver implementations; (ii) two capacity upgrade strategies, and (iii) uniform and nonuniform traffic distributions. We show that, in Deutsche Telekom (DT) reference network, a nonuniform traffic distribution leads to an increase in network capacity of about 100 Tbps with respect to the uniform case. Interestingly, the nonuniform traffic distribution showed that, in the DT reference network, more traffic could be transmitted with less energy consumption than when considering the uniform traffic distribution. Additionally, it is also shown that C+L systems lead to an only negligible increase in energy consumption while attaining comparable network capacity as adding a second optical fiber and using C-band only for the three considered coherent transceiver implementations. Newer transceivers are found to be very power efficient when compared with older ones. This is a consequence of technological advances enabling to increase capacity via using higher-order modulation formats and baud rates. In the case of the ZR implementation, a compromise between lower power consumption and capacity was reached to address shorter links

As acciones intersectoriales y la estrategia de salud de la familia desde la óptica de gerentes, profesionales y usuarios de la salud en el municipio de João Pessoa, Paraíba, Brasil

Este estudo teve como objetivo investigar a relação entre ações intersetoriais e a Estratégia Saúde da Família segundo a ótica dos gestores, profissionais e usuários na cidade de João Pessoa, Estado da Paraíba. A pesquisa é do tipo qualiquantitativa. A pergunta central do estudo foi: O Programa Saúde da Família (PSF) é uma estratégia política capaz de promover as ações intersetoriais?, tomando como referência o conceito de representações sociais, fundamentando-se nométodo da hermenêutica-dialética, utilizando a triangulação de métodos. Os dados foram coletados por meio da técnica de grupo focal, entrevistas e análise documental. Os dados foram analisados segundo a técnica do Discurso do Sujeito Coletivo (DSC). Os DSC apontam para as potencialidades da Estratégia Saúde da Família (ESF) para promover ações intersetoriais e para a agenda do governo local, que tem sido insuficiente para rearticular os diversos setores executores das políticas públicas. _______________________________________________________________________________________ ABSTRACTThe study’s objective is to investigate the relationship between intersectoral actions and the Family Health Strategy, in the views of managers, professionals and users in the city of João Pessoa, State of Paraíba, in Brazil. The research is of the quanti-qualitative type. The central question of the study was: Is the Family´s Health Program as a political strategy capable of promoting intersectoral actions?, The theoretical reference to addressing this question is Social Representations based on the hermeneutic-dialectic method, using triangulation of methods. Data were collected through the technique of focus group, interviews and document analysis and were analyzed using the Collective Subject Discourse technique. The results indicate the potential of the Family Health Strategy to promote intersectoral actions and for the local government agenda which so far has been insuficient for the re-articulation of the different sectors implementing public politics. _______________________________________________________________________________________ RESUMENEste estudio tuvo por objetivo investigar la relación entre acciones intersectoriales y la Estrategia Salud de la Familia (ESF) según la perspectiva de los gerentes, profesionales u usuarios en la Ciudad de João Pessoa, Estado de Paraíba, Brasil. La investigación es de tipo cuali-cuantitativo. La pregunta central del estudio fue: el Programa Salud de la Familia (PSF) constituye una estrategia política capaz de promover acciones intersectoriales? Fue tomado como referencia el concepto de representaciones sociales, fundamentado en el método de la hermenêutica dialéctica, utilizando la triangulación de métodos. Los datos fueron recolectados por medio de la técnica de Grupo Focal, entrevistas y análisis documental. Los datos fueron analizados según la técnica del Discurso del Sujeto Colectivo (DSC). Los DSC señalan hacia las potencialidades de la ESF para promover acciones intersectoriales y para la agenda del gobierno local, que ha sido insuficiente para rearticular los distintos sectores ejecutores de las políticas públicas

Network Comparison of C+L-band Transparent versus C-band Translucent Upgrade

We investigate the designs for the capacity upgrade for transparent C-and C+L-band and translucent C-band only; and evaluate them in terms of capacity, energy consumption, cost, and link utilization ratio. Two different transceiver (TRX) implementations, namely Flex and Fix are used in transparent C-and C+L-band and translucent C-band network designs. We investigate networking performance enabled by different upgrade strategies on a reference topology by relying on an accurate optical transport model. We show that lighting the L-band by keeping a transparent approach leads to an increase in network capacity of more than two times. Conversely, applying translucent design to the C-band to improve the spectral efficiency by deploying regenerators results in only modest improvements of capacity. Also, C+L-band transparent design allows to reduce the number of transceivers per bit/sec and to consume almost 4 dB less energy than that required with the C-band translucent design

Comparison between bearing, symmetry, and transfer weight measurements in subjects with or without hemiparesis

Avaliação da Simetria e Transferência de Peso (ASTP) foi indicada para se fazer associação entre simetria e atividades funcionais nas hemiparesias, apontando simétricos como mais capacitados. Contudo, tais relações não são claras e divergem com evidências que sugerem assimetrias como estratégias funcionais. Assim, objetivou-se verificar se as medidas subjetivamente determinadas pela ASTP concordam com medidas calculas pela descarga de peso entre os pés. Realizou-se estudo observacional do tipo transversal para amostra de sujeitos com hemiparesia (n=20) pareados por idade e gênero a controles (n=20). Os participantes submeteram-se a procedimentos para obtenção de escore determinado pela ASTP e para cálculo da razão de simetria (RS) na descarga de peso entre os pés obtido por meio de duas balanças digitais. Os resultados obtidos pela ASTP identificaram apenas um sujeito com hemiparesia apresentando simetria, dentre os quatro sujeitos identificados pela RS como simétricos. Ainda, a ASTP não diferenciou assimetrias com sobrecarga para o lado afetado e apresentou correlação significativa somente quando os escores foram analisados com os valores de RS<1(sobrecarga para o lado não afetado). Conclui-se que a ASTP não foi concordante em identificar sujeitos hemiparéticos com descarga de peso compatível com simetria. Ainda, não identificou sobrecargas para o lado afetado que poderia conduzir a análises equivocadas da associação entre simetria e desempenho funcional. _________________________________________________________________________________ ABSTRACTAssessment of symmetry and weight-transfer (ASWT) was indicated to relate symmetry and functional activity in the hemiparesis, pointing as the most qualified symmetrical. However, such relationships are not clear and disagree with evidences suggesting asymmetries as strategies for functional strategies. Then, it was proposed to verify the measurements subjectively determined by ASWT agree with measurements calculated by weight-bearing distribution for each foot. It was applied observational study with transversal design for sample of subjects with hemiparesis (n=20) matched by age and gender with controls (n=20). Participants were included in procedures toobtain scores by ASWT and to calculate symmetry ratio (SR) in the weight-bearing between feet by digital scales. The results obtained by ASWT indicated only one subject with hemiparesis presenting symmetry among four subjects identified as symmetric by SR. Besides, the ASWT did not differ overweight toward the affected side and presented significant correlation only when the scores were analyzed with values of SR<1(overweight toward the non-affected side). It was concluded that the ASWT was not agreementto identify weight-bearing distribution compatible with symmetry. Moreover, it did not identify overweight toward the affected side that could to drive to mistaken analysis of the relationship between symmetries and functional performance

Transparent vs Translucent Multi-Band Optical Networking: Capacity and Energy Analyses

Multi-band optical fiber transmission is generally proposed for capacity upgrades in optical transport networks. To comprehensively assess the potential of multi-band transmission, key metrics such as the potential capacity increase, energy consumption, and the number of required interfaces must be evaluated for different transmission scenarios. We consider progressive spectral exploitation, starting from the C-band only and up to C+L+S+U-band transmission, for both transparent and translucent solutions that exploit optical signal regeneration. By considering accurate state-of-the-art physical layer models, we derive a networking performance metric that enables the comparison of different solutions in terms of capacity allocation and energy consumption. For a translucent network design, different regenerator placement algorithms are compared, with the aim of minimizing energy consumption. The proposed network-wide numerical analysis shows that, for spectral occupations exceeding the C+L-band, translucent solutions can significantly increase network capacity, while leading to a similar energy consumption per transmitted bit as in the transparent design case, but they require the deployment of additional line interfaces. Significantly, these results provide evidence that the transparent exploitation of an additional transmission band produces a capacity increment that is at least comparable to that of a translucent solution based on already-in-use bands. Since this is attained at the expense of fewer line interfaces, it is a key finding suggesting that extending the number of bands supported is a cost-effective approach to scaling the capacity of existing fiber infrastructures

Scalar product according to Klein-Fock-Gordon equation in the context of light cone coordinates / Produto escalar associado a equação de Klein-Fock-Gordon no contexto de coordenadas de cone de luz

The objective of the present work is to didactically analyze, in the context of relativistic quantum mechanics, the algebraic structuring of the dot product between two quantum wavefunctions relative to a spin-0 quantum particle, assuming the light cone coordinates. For that, the linear momentum tensor is used in four dimensions, considering the description of the operational and quantum character of energy and linear momentum in three dimensions, as well as defining a pseudo volumetric probability density from which the product is reached scalar, properly written in terms of light cone coordinates

Influence of grilling pretreatment and optimization of sous vide processing parameters on the physicochemical and microbiological quality of pirarucu fillet

The demand for high-quality food products has promoted the study of techniques for its processing and conservation. The present research aimed to evaluate the influence of grilling pretreatment on the physical characteristics of pirarucu fillets and the heat transfer process by a computational modelling, and to optimize the sous vide process parameters. Before and after the sous vide process, the samples were analysed for microbiological, chemical and physical characteristics. There was no significant difference between the total experimental time of grilling and that obtained by computational modelling. Immersion in brine for 300s in combination with grilling at 200/120s was selected because of its water-holding capacity (%) 79.40±0.31, texture (N) 1.91±0.40 and value of L* 74.44±0.38 in the fillets. Cooking at 60 for 568.8s were the best sous vide parameters obtained, with highest water-holding capacity (%) 93.60, texture (N) 6.24, E* 7.43, and with microbiological loads below 6 log CFU/g and 7 log MPN/g in the final product. Useful information obtained from this study highlighted the brine and grill pretreatment in combination with sous vide proved it is a potential solution for developing pirarucu products even at an industrial scale.The author(s) disclosed receipt of the following financial support for the research, authorship, and/ or publication of this article: The work behind this paper was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior – CAPES, Brazil. Enrique Pino-Herna´ndez thanks to the Organization of American States (OAS – United States) and the Coimbra Group of Brazilian Universities (GCUB) under the scope of Partnerships Program for Education and Training (PAEC) to Latin America and the Caribbean, by the scholarship received for studying a Master program in the Federal University of Para´ (call Brazil, OASGCUB 2013).info:eu-repo/semantics/publishedVersio

Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

AbstractObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate.MethodsThirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen–Taylor functional test and the Buck-Gramcko test.ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen–Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions.ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief