Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system: outcomes and pitfalls in relation to bone mineral density

The purpose of this study is to compare the results of 2 techniques, tension band wiring (TBW) and fixation with screws, in olecranon fractures in children affected with osteogenesis imperfecta (OI) type I. Between 2010 and 2014, 21 olecranon fractures in 18 children with OI (average age: 12 years old) were treated surgically. Ten patients were treated with the screw fixation and 11 with TBW. A total of 65% of olecranon fractures occurred as a result of a spontaneous avulsion of the olecranon during the contraction of the triceps muscle. The average follow-up was 36 months. Among the children treated with 1 screw, 5 patients needed a surgical revision with TBW due to a mobilization of the screw. In this group, the satisfactory results were 50%. In patients treated with TBW, the satisfactory results were 100% of the cases. The average Z-score, the last one recorded in the patients before the trauma, was -2.53 in patients treated with screw fixation and -2.04 in those treated with TBW. TBW represents the safest surgical treatment for patients suffering from OI type I, as it helps to prevent the rigidity of the elbow through an earlier recovery of the range of motion, and there was no loosening of the implant. In analyzing the average Z-score before any fracture, the fixation with screws has an increased risk of failure in combination with low bone mineral density

Choice of three different intramedullary nails in the treatment of trochanteric fractures: outcome, analysis and consideration in midterm

paragone di 3 differenti impianti per frattura pertrocanterica femoreThe purpose of this study is to compare the results obtained using three different systems of osteosynthesis, developed for the surgical treatment of fractures of the trochanteric region of the femur, based on the principle intramedullary nailing: the Gamma nail, the Affixus nail and the ZNN nail. This is a retrospective study: 72 trochanteric fractures treated with the Gamma nail, 68 treated with the Affixus nail and 69 treated with the ZNN nail, between the years 2012 and 2014, with the prerequisite of a minimum follow-up of 18 months. The fractures were classified according to the AO system; the most commonly reported subtype was the A2 fracture. Clinical and radiographic examinations were performed, both at hospital admission and post-operatively, at 1, 3, 6, 12 and 18 months. Of the 209 patients, 171 were women and 38 were men. The average age was 83.12 years old. All three systems guaranteed an early mobilization and ambulation in most of the patients. There were no significant differences in the use of the three nails in terms of recovery of previous functional capacity, or in terms of the time required for the fracture to heal. There were no advantages encountered with the use of one intramedullary nail over another and, in particular, when observing the complications and patient outcome, there were no statistically significant differences detected

exploring the use of operational interventions in water distribution systems to reduce the formation of tthms

Abstract Trihalomethanes (TTHMs) are water disinfection by-products whose consumption via drinking water may eventually be harmful for human health, as they could have carcinogenic effects, also for the exposure to them via non-ingestion routes [1] . In the present work the possibility to reduce the vulnerability of the population exposed to TTHMs by the optimal operational interventions in water distribution systems is explored. The proposed approach is formulated as a multi-objective optimization problem with two objective functions, the number of the operations and the maximum TTHMs concentration that occurs at each node in the network during time, both to minimize. The feasible operational actions concern opening/closing valves and hydrants and turning pumping stations for a fixed time. The AMGA 2 optimizer [2] is used herein for solving the problem, coupled with a module coded in C++, where the implementation of the EPANET Programmers Toolkit functions allows to run the hydraulic and water quality simulations and to calculate the objective functions

Reaprendizagens sobre democracia e Educação na diferença: a perspectiva das redes de mulheres afro-latinas

A questão que nos convoca para uma análise sobre como podemos insuflar uma mudança significativa na relação entre democracia e educação desde a diferença, passa pela inclusão de visões construídas a partir da politização de mulheres afro-latinas. Consideramos o papel das redes de lideranças tomando o Brasil como ponto de partida, ancoradas nas experiências em países como Uruguai, Cuba, Argentina e Colômbia. A perspectiva descolonizadora, que encontramos em suas proposições, realocam nossas impressões sobre os lugares definidos, a partir dos processos de racialização e, consequentemente, de estigmas e preconceitos produzidos na interseccionalidade. Entendemos que as alternativas que podemos encontrar no fomento de novos pactos sociais devem estar alinhadas com as demandas das bases, levando em conta os segmentos impactados pelos projetos genocidas, como ocorre com as populações femininas e negras. A partir de suas dinâmicas de intervenção, defende-se a proposição de pedagogias outsiders produzidas no âmbito dessas coletividades. 

Robust optimization of valve management to improve water quality in WDNs under demand uncertainty

ABSTRACTWater quality deterioration in water distribution networks can be associated with high water residence time in the network. To this end, some previous studies have proposed optimization procedures for valve management. However, these studies generally come up with operational configurations assuming deterministic user demand patterns that may never occur in reality. In consequence, the proposed solutions may not be effective for improving water quality or do not comply with pressure constraints if different demand patterns are observed. This study proposes a methodology to determine robust configurations of the valves to keep water residence time at acceptable levels regardless of the variability in demand patterns. The methodology is tested on four different distribution systems of varying topology and size. Results show the importance of executing robust – instead of deterministic, optimization to find valve configurations that guarantee the performance of the networks in terms of hydraulics and..

Doença do Verme do Coração (Dirofilaria immitis) em gato-do-mato-pequeno (Leopardus tigrinus) no Brasil

Heartworm disease is caused by the intravascular nematode Dirofilaria immitis, a pathogen of public health importance usually associated to domestic dogs and cats, and to a lesser extend to other mammal species. The oncilla (Leopardus tigrinus) is a threatened neotropic felid species that naturally occurs in Brazil. Here, we report the encounter of adult and larval stages of heartworms in a female specimen of L. tigrinus, probable of free-ranging origin, from Ubatuba, São Paulo, Brazil, which died showing clinical signals compatible with heartworm disease. This was the first reported case of D. immitis infection and associated disease in L. tigrinus, also suggesting that the oncilla acted as a definitive host for this parasite. The present findings confirmed D. immitis as a pathogenic agent for this felid species, thus supporting the recommendation for the inclusion of diagnostic testing for this pathogen in routine health screening procedures for captive and free-ranging oncillas in Brazil, especially in those localities where climate conditions support the occurrence of the parasite. Potential reservoirs as oncillas are established beyond the reach of veterinary care, thus representing a continuing risk for domestic animals and humans acquiring heartworm infection. We encourage further serologic and molecular studies aiming to establish D. immitis prevalences in L. tigrinus and other wild carnivores in the region of Ubatuba, as well as ecological and veterinary studies to access the role of this pathogen for the survival of this threatened felid species.A doença do verme do coração é causada pelo nematódeo intravascular Dirofilaria immitis, um patógeno de importância em Saúde Pública geralmente associado a cães e gatos domésticos e, em menor extensão, a outras espécies de mamíferos. O gato-do-mato-pequeno (Leopardus tigrinus) é uma espécie ameaçada de felídeo neotropical que ocorre naturalmente no Brasil. Aqui relatamos o encontro de estágios adultos e larvais de vermes do coração em uma fêmea de L. tigrinus, provavelmente de vida livre e originária de Ubatuba, São Paulo, Brasil, que veio a óbito demonstrando sinais clínicos compatíveis desta doença. Este é o primeiro caso relatado de infecção e doença associada com D. immitis em L. tigrinus, sugerindo também que o gato-do-mato-pequeno agiu como hospedeiro definitivo para este parasita. Estes achados confirmaram que D. immitis é um agente patogênico para esta espécie de felino, sugerindo a recomendação para a inclusão de testes diagnósticos para este patógeno em procedimentos rotineiros de avaliação da saúde para gatos-do-mato-pequenos mantidos em cativeiro e de vida livre no Brasil, especialmente em localidades onde as condições climáticas permitam a ocorrência do parasita. Os gatos-do-mato-pequenos são potenciais reservatórios da D. immitis, mas vivem fora do alcance veterinário, representando desta forma um risco contínuo para animais domésticos e humanos. Encorajamos a realização de outros estudos epidemiológicos a fim de estabelecer as prevalências de infecção por D. immitis em L. tigrinus e outros carnívoros selvagens na região de Ubatuba, assim como estudos ecológicos e médicos veterinários para se acessar o papel deste patógeno para a sobrevivência desta espécie ameaçada de felídeo.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

ESTUDO DE INDICADORES DE RISCOS AMBIENTAIS DA SUB- BACIA HIDROGRÁFICA DO RIBEIRÃO DO CARMO – PORTO NACIONAL(TO)

A pesquisa trata do estudo de indicadores de riscos ambientais da sub-bacia hidrográfica do ribeirão do Carmo, no município de Porto Nacional, estado do Tocantins/Brasil, visa caracterizar os aspectos físicos, através de parâmetros morfométricos (comprimento dos rios, índice de circularidade da bacia, hierarquização da drenagem, densidade de rios, densidade de drenagem, coeficiente de manutenção), e contribui para novos estudos que venham ao encontro de propostas de conservação dessa sub-bacia. Para sua concretização, obedeceu-se a uma metodologia de execução baseada em levantamento bibliográfico e cartográfico, seguido de trabalho de campo para reconhecimento da área e entrevista com os moradores de Porto Nacional, com vista à percepção dos mesmos sobre a instalação da UHE do Lajeado. O material cartográfico foi digitalizado e vetorizado para obtenção dos dados morfométricos, através de softwares específicos de geoprocessamento. Os resultados indicam que naturalmente, a sub-bacia do ribeirão do Carmo não apresenta riscos ambientais significativos. Entretanto, as atividades implementadas exercem expressivas modificações na mesma, que implicam em perdas no que se refere ao capital natural e moral(ético) e cultural. Palavras-chave: Bacia Hidrográfica. Risco Ambiental. Morfometria. Study of indicators of environmental risks of the hydrographic sub-basin of the Carmo Stream – Porto Nacional (TO) The research deals with the study of indicators of environmental risks of sub-basin of the stream of Carmo, in the city of Porto Nacional, Tocantins State / Brazil, to characterize the physical aspects, through morphometric parameters (the length of the rivers, the index of the basin circularity, hierarchy of drainage, the density of rivers, the coefficient of maintenance), and it contributes to new studies that meet the proposed conservation goals of this sub-basin. For its realization, it obeys an implementation methodology based on literature and mapping survey, followed by field work for recognition of the area and interviewing the residents of Porto Nacional, overlooking the perception about the installation of paved UHE. The map material was scanned and vectorized to obtain the morphometric data, using specific software of geoprocessing. The results indicate that, naturally, the sub-basin of the stream of Carmo does not present significant environmental risks. However, the activities implemented exert significant modifications to it, involving losses in relation to natural capital and moral (ethical) and cultural. Key words: Watershed. Environmental Risk. Morphometry

Multi-objective valve management optimization formulations for water quality enhancement in WDNs.

Water distribution networks (WDNs) need to guarantee that water is delivered with adequate quality. This paper compares the performance of 12 multiobjective procedures to limit water quality deterioration in a WDN through the optimal operation of valves. The first objective (ObF1) is to minimize the water age, chosen as a surrogate parameter of quality deterioration, and the second objective (ObF2) is to minimize the number of valve closures. The 12 procedures are derived from the combination of 4 different optimization algorithms and 3 formulations of ObF1, namely, to minimize the maximum, the arithmetic mean, and the demand-weighted mean water age. The optimization algorithms considered are random search (RS), Loop for Optimal Valve Status Configuration (LOC), and a combination of each of these two with the Archive-based Micro Genetic Algorithm. The procedures are tested on two networks of different complexity. Results show how LOC is able to find near-optimal solutions using a fraction of the computational time required by a brute force search. Furthermore, among the ObF1 formulations, the use of the averages (either arithmetic or demand-weighted) gives better results in terms of impact on the population served by a WDN

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe