Craniofacial radiographic patterns of multiple myeloma in patients treated with bisphosphonates

Orientadores: Alan Roger dos Santos Silva, Mario Fernando de GoesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Esta tese de doutoramento avaliou a frequência e os padrões de manifestação radiográfica do mieloma múltiplo (MM) nos ossos craniofaciais por meio de investigações clinicopatológicas de natureza retrospectiva. Os resultados da consecução desta tese estão apresentados em 2 artigos. No primeiro capítulo (artigo 1), comparou-se uma série de 88 pacientes diagnosticados com MM que receberam bisfosfonatos administrados por via endovenosa (BFs e.v.) (grupo estudo) com a uma série de 100 pacientes diagnosticados com MM que não utilizaram BFs e.v. (grupo controle). Radiografias panorâmicas digitais foram estudadas em ambos os grupos para avaliação da presença (ou ausência) dos seguintes critérios: imagens osteolíticas solitárias, imagens osteolíticas múltiplas, osteoporose difusa, esclerose difusa, anormalidades de lâmina dura, alvéolo pós-extração não cicatrizado e sequestro ósseo. A análise dos dados revelou que múltiplas lesões osteolíticas (p=0.001), osteoporose difusa (p=0.001) e esclerose difusa (p=0.0036) foram mais frequentemente observadas em mandíbula do que em maxila em ambos os grupos estudados. A presença de lesão osteolítica solitária foi observada com menor frequência no grupo que recebeu BFs e.v. (p=0.0078, OR=0.1994, CI95%=0.057-0.696). As anormalidades de lâmina dura (p=0.0006, OR=2.447, CI95%=1.47-4.08) e alvéolo ósseo persistente (p=0.0021, OR=20.23, CI95%=1.158-353.3) também estavam associados ao tratamento com BFs e.v. Concluiu-se que o tratamento com BFs e.v. altera os padrões radiográficos de manifestação do MM em mandíbula e maxila. O segundo capítulo (artigo 2) comparou a frequência da detecção radiográfica de imagens osteolíticas do MM nos ossos craniofaciais de uma série de 155 pacientes por meio de três técnicas digitais (radiografia panorâmica, radiografia frontal e radiografia lateral de crânio). Radiografias panorâmicas detectaram imagens osteolíticas em 137 (88,3%) casos, radiografia frontal de crânio em 141 (91%) casos e radiografia lateral de crânio em 144 (93%) casos. Apenas 18 (11,61%) casos se manifestaram exclusivamente no crânio e 6 (3,87%) exclusivamente em mandíbula e maxila; entretanto, 129 (83,23%) pacientes apresentaram imagens osteolíticas sincrônicas em crânio, mandíbula e maxila. Concluiu-se que apesar da radiografia lateral de crânio ter apresentado maior frequência de detecção de imagens osteolíticas do MM, as três técnicas radiográficas utilizadas neste estudo demonstraram altas frequências de detecção de imagens osteolíticas relacionadas ao MM nos ossos craniofaciaisAbstract: This thesis evaluated the frequency and radiographic patterns of multiple myeloma (MM) in craniofacial bones through clinical, pathological and radiographic investigations in a retrospective approach. The results are presented in two papers. The first chapter (manuscript 1) compared a series of 88 patients diagnosed with MM who received intravenous bisphosphonates (i.v. BPs) (study group) with a series of 100 MM patients naive to i.v. BPs (group control).Digital panoramic radiographs were analized in both groups to evaluate the presence (or absence) of the following criteria: solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, abnormalities of the lamina dura, non-healing alveolar sockets and bone sequestration. Data analysis revealed multiple osteolytic lesions (p=0.001), diffuse osteoporosis (p=0.001) and diffuse sclerosis (p=0.0036) were more often observed in the mandible than in the maxilla in both studied groups. The presence of solitary osteolytic lesions showed to be reduced in the BPs group (p=0.0078, OR=0.1994, CI95%=0.057-0.696). Abnormalities of the lamina dura (p=0.0006, OR=2.447, CI95%=1.47-4.08) and non-healing alveolar sockets (p=0.0021, OR=20.23, CI95%=1.158-353.3) were also associated with BPs treatment. I.v. BPs therapy changes the typical radiographic patterns of MM in the jawbones. The second chapter (manuscript 2) compared the frequency of radiographic detection of osteolytic MM lesions in craniofacial bones of a series of 155 patients, using three digital techniques (panoramic radiograph, frontal radiograph and lateral radiograph of the skull). Panoramic radiographs detected osteolytic images in 137 (88.3%) cases, frontal radiograph of skull in 141 (91%) cases and lateral radiograph of skull in 144 (93%) cases. Eighteen (11.61%) cases showed images affecting exclusively the skull and 6 (3.87%) cases only affected mandible and maxilla; however, 129 (83.23%) patients presented MM osteolytic images synchronously affecting skull and jawbones. It was concluded that although the lateral radiograph of skull presented increased rates of osteolytic MM lesions detection, all studied radiographic techniques were effective in detecting osteolytic images related to MM in craniofacial bonesDoutoradoEstomatologiaDoutora em EstomatopatologiaCAPE

A real time pricing approach to deal with excessive wind power situations

The introduction of wind power generation in several countries around the world, including in European countries, where energy policy directives have encouraged the use of renewables, led to several changes in market and power systems operation. The intensive integration of these sources has led to situations in which the demand is lower than the available renewable resources. In these situations a part of the available generation is wasted if not used for storage or to supply additional demand. This paper proposes a real time demand response methodology based on changing the electricity price for the consumers expecting an increase in the demand in the periods in which that demand is lower than the available renewable generation. The consumers response to the changes in electricity price is characterized by their price elasticity of demand considered distinct for each consumer type. The proposed methodology is applied to the Portuguese power system, in the context of the Iberian electricity market (MIBEL). The renewable-based producers are considered as special producers, with special tariffs, and so it is important to use the energy available as it will be paid anyway. In this context, consumers are entities actively participating in the operation of the market

Maximizing the Social Welfare of Virtual Power Players Operation in Case of Excessive Wind Power

The integration of growing amounts of distributed generation in power systems, namely at distribution networks level, has been fostered by energy policies in several countries around the world, including in Europe. This intensive integration of distributed, non-dispatchable, and natural sources based generation (including wind power) has caused several changes in the operation and planning of power systems and of electricity markets. Sometimes the available non-dispatchable generation is higher than the demand. This generation must be used; otherwise it is wasted if not stored or used to supply additional demand. New policies and market rules, as well as new players, are needed in order to competitively integrate all the resources. The methodology proposed in this paper aims at the maximization of the social welfare in a distribution network operated by a virtual power player that aggregates and manages the available energy resources. When facing a situation of excessive non-dispatchable generation, including wind power, real time pricing is applied in order to induce the increase of consumption so that wind curtailment is minimized. This method is especially useful when actual and day-ahead resources forecast differ significantly. The distribution network characteristics and concerns are addressed by including the network constraints in the optimization model. The proposed methodology has been implemented in GAMS optimization tool and its application is illustrated in this paper using a real 937-bus distribution network with 20.310 consumers and 548 distributed generators, some of them non-dispatchable and with must take contracts. The implemented scenario corresponds to a real day in Portuguese power system

Neonatal Appendicitis – an Uncommon Diagnosis, not to be Forgotten

Acute appendicitis is a common disease in older children, but extremely rare in the neonate. Nevertheless, the true incidence might be underestimated, given the difficulty of the diagnosis. Subtle clinical signs and symptoms usually result in high morbidity and mortality due to delayed diagnosis and surgical intervention. The presentation of neonatal appendicitis can be identical to necrotizing enterocolitis, leading to misdiagnosis. Appendicitis should therefore be considered in the differential diagnosis for necrotizing enterocolitis and needs strong clinical suspicion. We report a case of a premature newborn who presented with vomiting, abdominal distension and free intra-peritoneal air on plain x-ray. He was initially diagnosed and treated as necrotizing enterocolitis, but the absence of clinical improvement with standard treatment led to exploratory laparotomy. Surgical exploration revealed an acutely inflamed appendix with normal small and large intestines and appendectomy was performed. The post-operatory period was uneventful and the infant was discharged home. Follow-up confirmed a normal growth and neurodevelopment. We herein report this case in order to raise awareness to this unusual pathology, so that an early diagnosis and treatment can lead to a better outcome, improving survival rate and reducing long term morbidity. We believe uncommon pathologies, like neonatal appendicitis, should be reported to facilitate proper epidemiologic studies

How can the association between PRM and nutritional therapy protocol improve health outcomes and what is the impact on reducing expenditure in a public hospital?

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Marketing IntelligenceIntroduction: For most type 2 diabetic patients, the most challenging issue of treatment is knowing what to eat. A healthy and adequate diet, associated with regular physical activity and, in most cases, pharmacotherapy, are the pillars of disease control. To minimise patient noncompliance, the goal is to use Patient Relationship Management (PRM), which allows planning in a systematic and skilled manner, enhancing decision making, as well as delegation and control of tasks. Many hospitals have already recognised the use of the best practice in PRM practices, which has enabled them to deal more effectively and efficiently with the entire healthcare process by responding directly to patients' needs and experiences throughout the assistance process. Objectives: The main objective of this project is to find strategies that support the Win-Win model (patient, institution) to understand the importance of PRM associated with a specific nutritional protocol in adherence to therapy, and whether it is associated with effective health gains. Methodology and Sample: Epidemiological and interventional research study in a convenience sample of all type 2 diabetes outpatients followed in the external diabetes consultation within the time frame established for the study and who agreed to participate and use the proposed tools. The study took place at the Garcia de Orta Hospital, E.P.E., during the period between April and June 2019, in the Diabetes medical appointment. It was used the Statistical Package for Social Sciences (IBM SPSS Statistics), version 21 IBM. The results are considered significant at a 5% significance level. Descriptive statistics were used to evaluate the changes in the different parameters mentioned in the questionnaires, as well as the variation of glycated hemoglobin (HbA1c), weight and BMI. To compare the groups CG and IG we used the Mann-Whitney U test. To compare weight and BMI between the two groups, the independent samples test was used, since the assumption of normality of data in BMI categories is not verified. To compare the parameters between two moments, we used the Wilcoxon test. Results: This study included 62 type 2 diabetes outpatients who were admitted for nutritional therapy through the Endocrinology service in Garcia de Orta Hospital, E.P.E.: 39 men and 23 women, with ages ranging between 32-82 years (51 patients ≥ 50 years old) and a mean age of 59 years (SD=11.18). Patients were randomly divided into two groups using the envelope method: intervention group (IG) and control group (CG). Of the total sample (n = 62), BMI ranged between 21.17 and 48.56 kg/m2, with a mean value of 32 kg/m2. Weight was assessed in 62 patients, ranging from 52-143 kg. It was found a mean HbA1c of 9 ± 0.4g / L, with values ranging from 5.6 to 13.9 g/L. Regarding groups evolution, after six weeks, the CG between T0 and T2 had a variation between 3-6% of their BMI, variation between a 9% loss in body weight and a 6% increase of their weight and a variation between a 3.2g/L decrease and a 2g/L increase in HbA1c. For the IG, the BMI between T0 and T2 had a variation between 1-9%, all patients lost a total of weight ranging from 1-9% and none of the patients had an increase in HbA1c value. The decrease in this value ranged from 0-7 g/L. Conclusions: The use of a nutritional protocol that combines a regular and adapted nutritional therapy, accompanied by a digital tool, boosted health gains in the group of diabetics who had this follow-up

Nomad foods equity research - growth within crisis

This Work Project presents a Nomad Foods Equity Research, which is one of the frozen food leaders in Europe. This report aims to forecast the company’s future, and value it based on its expected cash flows. Nomad Foods benefitted from the current pandemic outbreak, as lockdowns brought the need for durable and convenient products, and therefore, its future performance might be contingent on the short-term development of the COVID-19 vaccine, as well as the evolution of cases and government measures regarding lockdowns. Thus, a “HOLD” position was recommended, with a target price of $27.63forDecember 31, 2021

Intergenerational caregiving: the role of attachment and mental representation of caregiving in filial anxiety of middle-aged children

Adult children may experience filial anxiety when anticipatingthe need to care for their aging parents. To investigate theextent to which attachment and mental representation of car-egiving predict filial anxiety, a cross-sectional study was con-ducted among 304 middle-age adults with at least one livingparent aged 65 or more. Results suggest that the variance in filialanxiety is mainly accounted for by the mental representation ofcaregiving and then by attachment. These findings suggest thatmental representation of caregiving and attachment are impor-tant dimensions to consider when adult children feel unpre-pared and worried with the need to care for their aging parents.E51F-89A1-B769 | Carla FariaN/

Distribution system operation supported by contextual energy resource management based on intelligent SCADA

Future distribution systems will have to deal with an intensive penetration of distributed energy resources ensuring reliable and secure operation according to the smart grid paradigm. SCADA (Supervisory Control and Data Acquisition) is an essential infrastructure for this evolution. This paper proposes a new conceptual design of an intelligent SCADA with a decentralized, flexible, and intelligent approach, adaptive to the context (context awareness). This SCADA model is used to support the energy resource management undertaken by a distribution network operator (DNO). Resource management considers all the involved costs, power flows, and electricity prices, allowing the use of network reconfiguration and load curtailment. Locational Marginal Prices (LMP) are evaluated and used in specific situations to apply Demand Response (DR) programs on a global or a local basis. The paper includes a case study using a 114 bus distribution network and load demand based on real data

Avaliação da Proteção de Interconexão entre Concessionária e Sistema de Cogeração utilizando o RTDS.

Este trabalho de dissertação teve como objetivo avaliar o desempenho da proteção de interconexão entre a concessionária e um sistema industrial de grande porte com cogeração, através da realização de testes em malha fechada (hardware-in-the-loop), utilizando o RTDS (Simulador Digital em Tempo Real). O sistema utilizado como caso teste corresponde a um sistema real, com demanda de 68 MW, alimentado através da concessionária local em 138 kV, que opera em paralelo com cinco turbogeradores, três acionados por turbina a vapor e dois por turbinas a gás, totalizando 53,74 MW de geração própria. Foram avaliados se os ajustes implantados no sistema real, para cada função de proteção habilitada, estão adequados ou não, através da simulação de faltas internas e externas as instalações do autoprodutor. Constatou-se que diversas funções de proteção ou tinham ajustes inadequados ou que poderiam ser otimizados, destacando as funções 27, 59, 59N, 67, 21, 32 e 81. Os ajustes de tempo das funções de sobretensão (59) e direcional de potência (32) foram alterados para 1 segundo e da função 27 para 2 segundos. A utilização de dois estágios para a função 59N permitiu grandes melhorias no tempo de eliminação de faltas fase terra nas linhas de 138 kV e redução das temporizações das funções 67 para 300 ms e da função 21, 2ª e 3ª zona, para 300 e 600 ms, respectivamente, resolveu o problema associada a tensão de memória utilizado para polarização dos relés 67 e 21 e em curto-circuitos trifásicos sólidos, evitando desta forma a perda de direcionalidade destas proteções As melhorias obtidas foram constatadas tanto no ambiente de simulação, como no mundo real, onde verificou-se que a atuação da proteção de interconexão foi efetiva, após a implantação dos novos ajustes, por ocasião do registro de 4 ocorrências recentes no sistema elétrico

Defining Electricity Tariffs Using the Knowledge About the Consumers Profiles in ELECON Project

The increasing importance of the integration of distributed generation and demand response in the power systems operation and planning, namely at lower voltage levels of distribution networks and in the competitive environment of electricity markets, leads us to the concept of smart grids. In both traditional and smart grid operation, non-technical losses are a great economic concern, which can be addressed. In this context, the ELECON project addresses the use of demand response contributions to the identification of non-technical losses. The present paper proposes a methodology to be used by Virtual Power Players (VPPs), which are entities able to aggregate distributed small-size resources, aiming to define the best electricity tariffs for several, clusters of consumers. A case study based on real consumption data demonstrates the application of the proposed methodology