Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles

The aim of the present study was to test the reproducibility, sensitivity, and specificity of cone-beam computed tomography (CBCT) in detecting incipient furcation involvement. Fifteen macerated pig mandibles, with intact second molar teeth and preserved adjacent cortical areas, were used. Simulated lesions were created in the furcation region of these teeth by applying 70% perchloric acid in up to four possible buccal/lingual sites in the right/left sides of each mandible. The mandibles were then submitted to a CBCT scan. Two blinded and calibrated experienced oral and maxillofacial radiologists interpreted the exams. Furcation involvement was also assessed in the regions without simulated lesions. CBCT showed high levels of accuracy, ranging from 78% to 88%. The variations in Kappa values for intra- and inter-observer agreement (0.41-0.59) were considered moderate. CBCT can be considered a reliable and accurate method for detecting incipient furcation involvement.National Council for Scientific and Technological Development (CNPq), Brasilia, DF, BrazilNational Council for Scientific and Technological Development (CNPq), Brasilia, DF, BrazilUniversal Research Project [472895/2009-5]Universal Research ProjectResearch Productivity Scholarship [303847/2009-3]Research Productivity ScholarshipCoordination for the Improvement of Higher Education Personnel (CAPES), Brasilia, DF, BrazilCoordination for the Improvement of Higher Education Personnel (CAPES), Brasilia, DF, Brazi

Is the total mixed ration the best option for feeding crossbred dairy cows using diets based on cactus cladodes on family farms?

The study aimed to evaluate the effects on the performance of lactating cows of different strategies for supplying diets based on cactus cladodes. Eight Girolando cows at 97 ?? 7.6 days into lactation, producing 12.2 ?? 0.26 kg milk/day, were assigned to 4 treatments in two 4 ?? 4 Latin squares. The feeding strategies were: total mixed ration (TMR) based on a mixture of concentrates, cactus cladodes [Opuntia stricta (Haw.) Haw.] and sugarcane (Saccharum officinarum L.) fed after milking; concentrate fed during milking with cactus cladodes and sugarcane offered later (Con/CC+SC); cactus cladodes combined with concentrate fed after milking with sugarcane offered later (CC+Con/SC); and sugarcane combined with concentrate fed after milking with cactus cladodes offered later (SC+Con/CC). Intakes of neutral detergent fiber (NDF; 4.54 ?? 0.09 kg/d) and total digestible nutrients (TDN; 9.30 ?? 0.50 kg/d) were similar (P>0.05) for all feeding strategies and there was no effect of feeding strategy on milk yield (12.2 ?? 0.26 kg/d). The different feeding strategies did not change the ingestive behavior or performance of lactating Girolando cows. Since the shortage of labor prohibits the feeding of TMRs on family farms because of labor required for preparation, these rations would be appropriate only on large farms where the costs of machines to prepare diets efficiently might be available. Cows fed concentrate during milking spent longer to consume the concentrate than the time to milk, resulting in inefficient usage of scarce labor. Appropriate feeding strategies for family farms appear to be SC+Con/CC and CC+Con/SC, i.e. partial separation of dietary ingredients, and all feeding should be done after milking

The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients

OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96) CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients

an international survey before and during the COVID-19 pandemic

Funding Information: The Société Française d’Anesthésie et de Réanimation (SFAR), Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Sociedad Argentina de Terapia Intensiva (SATI), Sociedad Chilena de Medicina Intensiva (SOCHIMI), Associação de Medicina Intensiva Brasileira (AMIB-Net) and the Brazilian Research in Intensive Care Network (BricNet) supported this survey. We would also like to thank our friend Tiago Rocha for making the amazing logo for this study. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001. Publisher Copyright: © 2022, The Author(s).Background: Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them. Methods: This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. Results: We analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently. Conclusions: Most sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement.publishersversionpublishe

Detection of Horizontal Root Fracture with Small-volume Cone-Beam Computed Tomography in the Presence and Absence of Intracanal Metallic Post

Introduction: The aim of the present study was to test the accuracy of small-volume cone-beam computed tomography (CBCT) scanning in the detection of horizontal root fractures and to assess the influence of a metallic post. Methods: Forty teeth were divided into four groups based on the presence of metallic posts and horizontal root fracture. The teeth were examined by small-volume CBCT scanning at 0.2-mm voxel resolution. Three observers analyzed the samples for the presence of a horizontal root fracture. Sensitivity and specificity were calculated. Results: High values for accuracy (73%-88%) were obtained in the groups without a metallic post, and statistically significant differences were found when the group with a metallic post has been observed (55%-70%). Intraobserver agreement also showed statistically significant differences in the groups with a metallic post. Conclusions: Small-volume CBCT scanning showed high accuracy in detecting horizontal root fracture without a metallic post. However, the presence of a metallic post significantly reduced the specificity and sensitivity of this examination. (J Endod 2011;37:1456-1459)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) National Council for Research[303847/2009-3]Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Master Degree Scholarship[472895/2009-5

Female-biased sex ratios in marine pelagic copepods: Response to Hirst et al. (2013)

Hirst et al. (2013; Mar Ecol Prog Ser 489:297-298) suggest that Gusmao et al. (2013; Mar Ecol Prog Ser 482:279-298) misinterpreted the findings of Hirst et al. (2010; Limnol Oceanogr 55:2193-2206). They restate that the major factors determining sex ratio in pelagic copepods act upon the adult stage, but they place less emphasis on the idea that predation on male copepods is a likely determinant, and highlight the role of physiological longevity. Here we reconsider the data and confirm our position that at present there is limited evidence to support the theory of male-skewed predation. However, we agree that sex determination is governed by a combination of factors, with the relative emphasis being the main point of contention between the 2 parties