Joinville, Brazil
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Bonilauri Ferreira A.P.R.,Univille | Bonilauri Ferreira A.P.R.,Duke University | Ferreira R.F.,Univille | Rajgor D.,National University of Singapore | And 6 more authors.
PLoS ONE | Year: 2010

Background: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. Method: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. Results: Four main themes were identified: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. Discussion: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration. Copyright: © 2010 Bonilauri Ferreira et al.


Vegini J.B.,IOT Orthopedics Institute | Steglich V.,IOT Orthopedics Institute | Bonilauri Ferreira A.P.R.,Univille | Bonilauri Ferreira A.P.R.,Duke University | And 6 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2012

Hypothesis: Race and insurance status are independent predictors of the choice between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) of the shoulder joint. Background: Current literature shows that ethnic and socioeconomic status may influence access to health care. However, no study has demonstrated whether insurance status and race are independent predictors that patients with glenohumeral osteoarthritis will undergo TSA. Materials and methods: Patients with primary International Classification of Diseases, 9th revision, Clinical Modification, procedure codes for TSA and HA were selected from the 1988 to 2007 United States Nationwide Inpatient Sample. Primary predictors were race (Caucasian, African American, Hispanic, other) and insurance status (private, Medicare, Medicaid, other). Multiple logistic regressions were used to determine whether insurance status and race were associated with the choice of procedure for patients presenting with glenohumeral osteoarthritis. Results: The study included data for 3529 patients, of whom 2369 underwent TSA (67.1%) and the remaining 1160 (32.9%) underwent HA. Of patients treated using TSA, 29% were privately insured, 63.2% had Medicare, and 2.5% had Medicaid (P < .001), and 62.1% were Caucasian, 2.5% were African American, 2.46% were Hispanic, and 30.9% had other ethnicities (P < .001). Discussion: Multiple logistic regression analysis found that privately insured patients and Medicare patients did not show statistically different odds of having TSA compared with patients within the Medicaid (reference category) or " other payment" categories, after adjustment for a variety of potential confounders. Caucasian patients also did not show statistically different chances of undergoing TSA compared with African Americans. Conclusions: We were unable to support statistical evidence that race and insurance status are independent factors associated with the choice of the surgical procedure in patients with glenohumeral osteoarthritis. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.


Ferreira R.F.,Univille | Serapiao C.J.,Univille | Ferreira A.P.R.B.,Univille | Rajgor D.,National University of Singapore | And 4 more authors.
Laryngoscope | Year: 2010

Objective/Hypothesis: To compare cold and mixed (electrocautery tonsillectomy with curettage adenoidectomy) adenotonsillectomies in children in terms of hospital medications' and materials' costs, surgical time, aspirated blood volume, and postoperative pain. Study Design: Randomized clinical trial in community hospitals. Methods: Seventy-two patients aged 3 to 12 years, undergoing adenotonsillectomy, were randomized in two groups through sealed envelopes that were opened just prior to the procedure. Surgical time and aspirated blood volume were measured by a staff nurse. Hospital medication and material costs were supplied by the hospital's accounting department. A validated facial pain scale was used from the day of surgery to the 10th postoperative day to quantify pain. Results: Bicaudal t test showed that materials' cost was lower in the mixed technique. Surgical time and aspirated blood volume were also lower with the mixed technique. The postoperative pain was more intense in the cold technique on the day of surgery, but was more intense in the mixed technique from the 4th day to the 6th day. Linear regression showed a weak association between materials' cost and aspirated blood volume. Conclusions: Mixed technique reduces the costs of materials while offering the patient and the surgeon a safer and faster method to perform adenotonsillectomy, although it is slightly more painful than the cold technique in the latter part of the postoperative period. © 2010 The American Laryngological, Rhinological and Otological Society, Inc.


PubMed | University of the Region of Joinville and Univille
Type: Journal Article | Journal: Archives of endocrinology and metabolism | Year: 2015

To evaluate whether there is an association between altered maternal lipid profile and the lipid profile of the newborn in a maternity hospital.Cross-sectional study with 435 parturients and their respective newborns. Blood samples from the newborns were collected during delivery by venipuncture of the umbilical cord close to the placenta. Blood samples from the parturients were collected in the pre-delivery room or right after delivery. The concentrations of total cholesterol, triglycerides and HDL-c were determined by an enzymatic colorimetric method and LDL-c was calculated by the Friedewald formula.There was no significant difference in mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in neonates according to altered or non-altered maternal total cholesterol, LDL-c, HDL-c and triglycerides.Change in maternal lipid profile is not significantly associated with the mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in newborns.


De Castro Avila L.F.,Univille | Martins W.D.,Pontifical Catholic University of Parana | Ignacio S.A.,PUCPR | Bonfim C.M.S.,Federal University of Paraná | De Oliveira Ribas M.,Oral and Maxillofacial Surgery
Cleft Palate-Craniofacial Journal | Year: 2014

Objective: This study is aimed to evaluate craniofacial features in patients with Fanconi anemia (FA) through cephalometric analysis and to classify the facial growth pattern to observe possible facial discrepancies. Design: This is a cross-sectional study which employed a quantitative approach to compare linear and angular measurements of cephalometric analysis in lateral teleradiographic images of a clinical type sample of patients with FA. A retrospective cephalometric study was performed using cephalometric analyses of Ricketts and Steiner; growth patterns according to Ricketts' vertical growth pattern (VERT index) were also analyzed. Patients: Fifty patients diagnosed with FA who were undergoing anti-aplasia treatment at the outpatient Hematology service at the Federal University of Parana , Curitiba, Brazil were included in the study. Interventions: The patients were evaluated in the School of Dentistry of the Pontifical Catholic University of Parana (PUCPR), Curitiba, Brazil. Exclusion criteria included patients who had used or were using growth hormone medication, had undergone bone marrow transplant, or had been previously subjected to dental treatment. Main Outcome Measures: Cephalometric points were plotted in order to set up linear and angular cephalometric measurements. Angular and linear measurements from 17 factors proposed by Ricketts' cephalometric analysis were assessed. Results: Dolicofacial appearance was observed in 52% of individuals; braquifacial in 28%, and mesofacial in 20%. Significant maxillary/mandibular discrepancy was observed. It was concluded that upon anteroposterior evaluation of facial bone structures, the FA sample presented smaller median measurements in most variables evaluated; it also presented mandibular micrognathism and mainly dolicofacial vertical growth pattern. These findings, together with other features such as skin pigmentation and microphthalmia, may lead to a possible recognition of a FA condition from a patient's facial features. © Copyright 2014 American Cleft Palate-Craniofacial Association.


Plastics such as polypropylene (PP) and poly (ethylene terephthalate) (PET) are produced from oil are nonrenewable sources and take many years to disappear from the environment where they are deposited after use. Fungi of the genus Pleurotus, by having a single enzyme complex, which enables them to degrade lignocellulosic materials have been widely studied. These fungi in addition to possessing nutritional properties have applications in bioremediations such as 2, 4-dichlorophenol biodegradation of poly (ethylene terephthalate), and polyurethanes. In this work, we studied the biodegradation of polymers PP and recycled PET (PrP, PETr) by Pleurotus ostreatus DSM 1833 in a solid farming, using the POL culture medium without glucose. The PPR and PETr polymers in the form of flakes and pellets, respectively, were deposited on Petri plates containing the culture medium. Previously pasteurized plates were inoculated with mycelium of P. ostreatus and incubated at 30 °C. The characterization of the polymers was made by the test mass loss ([%]) and the curves of differential scanning calorimetry (DSC). After 45 days of biodegradation PETr presents the 3.3[%] mass loss while the PrP was 0.3[%]. With regard to the curves obtained from DSC crystallinity (ac) polymers had the following values: for PETr biodegraded in 45 days was 13[%], while the abiotic control was 29[%]. Since the PrP C ac was 31[%] in the control abiotic 45 days and increased to 35[%] in the biodegradation test. © 2015, Universidade Federal do Rio de Janeiro. All right resurved.


Souza O.,DEQ | Schulz M.A.,UNIVILLE | Fischer G.A.A.,DEQ | Wagner T.M.,DEQ | Sellin N.,DEQ
Revista Brasileira de Engenharia Agricola e Ambiental | Year: 2012

The conversion of agroindustrial biomasses in bioethanol with consequent enrichment of wastes has been the object of various research projects conducted in Brazil and around the world. This study evaluated the potential of the Musa cavendishii banana pulp and peels using in natural state and also waste previously hydrolyzed by acid and enzimes, as substrate of alcoholic fermentation. The mean bioethanol yields (on wet biomass base), obtained with the pulp (0.48 ± 0.05 g g-1) and with the peels (0.34 ± 0.11 g g-1), both in natural state, enabled a conversion process efficiency to the order of 95% of theoretical yield. Maximum value reached in bioethanol was 3.0 ± 0.7 g L-1 h-1 with pulp and 1.32 ± 0.03 g L-1 h-1 with peels. Under the evaluated operating conditions, the pre-treatment of wastes with sulfuric acid is not recommended for bioethanol production.


Souza O.,DEQ UNIVILLE | Federizzi M.,UNIVILLE | Coelho B.,DEQ UNIVILLE | Wagner T.M.,DEQ UNIVILLE | Wisbeck E.,DEQ UNIVILLE
Revista Brasileira de Engenharia Agricola e Ambiental | Year: 2010

This study aimed to evaluate the capability of using lignocellulosic residues from banana cultivation as a fermentation substrate of the methanization process. The following Musa cavendischii residues were evaluated: bananas peels, stalk, leaves and the pseudostem. The fermentation studies were developed at 30°C and pH 7.2 with different working volumes in Erlenmeyers flasks, plastic bottles and bioreactor bench. The ideal composition of the methanization substrate was set containing: 50% (w/w) of peels, 25% of leaves and 25% of pseudostem. The stalk, presenting a lower rate of biodegradation in comparison to other biomasses, was not recommended for the methanization together with such residues. The acid hydrolysis advance of the substrate was detrimental to the production of biogas. In addition to making possible the production of H2S in biogas generated, it inhibited the formation of CH4. The maximum yield of biogas, obtained in biodigestor bench of employing substrate in nature, was 244 LCNTP kg-1ST with 66.8% (v/v) of CH4.


Bousfield P.,UNIVILLE | Zanottelli C.,UNIVILLE | Ganske C.,UNIVILLE | Schossland S.,UNIVILLE | And 2 more authors.
Proc. of the IADIS Int. Conf. Intelligent Systems and Agents 2010, Proc. of the IADIS European Conference on Data Mining 2010, Part of the MCCSIS 2010 | Year: 2010

Aiming to eliminate or minimize some problems caused by floods in hydrographic basins, this paper intends to develop a flood forecasting system. As a technique to solve the flood forecasting problem, it uses artificial intelligence, the learning paradigm of connexionist networks. In order to create the Artificial Neural Network - ANN, a database was created through the use of historical series from 2008 and 2009 of the daily pluviometric data (amount of rain accumulated in one day, in millimeters) collected from 21 meteorological stations located in a given Hydrographic Basin. Daily fluviometric data has also been used (river level, in centimeters) collected at the specific location the forecast is wanted. The data has been obtained and made available by the National Agency of Water (ANA - AgÊncia Nacional de Águas). In order to obtain an ANN that had a good generalization possibility and aiming at finding the number of neurons in the hidden layers, a number of experiments has been designed using feedforward network, supervised learning and backpropagation algorithm. The success of the experiments was based on the result of the average square error and linear regression of the network forecast obtained results. It was clear that the use of alternative techniques, such as the connexionist learning, in this case the ANNs to be used in flood forecasting systems, is appropriate and is highly relevant to improve the hydrological modeling techniques. The Itajaí-Açu River Basin has been chosen as the area of interest, with flood forecast for the city of Blumenau, in the State of Santa Catarina - Brazil. © 2010 IADIS.


PubMed | Centro Oftalmologico Of Curitiba, Pontifical Catholic University of Parana, Positivo University and Univille
Type: Evaluation Studies | Journal: Clinics (Sao Paulo, Brazil) | Year: 2014

To evaluate the effect of blocking the angiotensin II AT-1 receptor by the systemic administration of candesartan on the expression of intercellular adhesion molecule-1 in the sclera and choroid of hypercholesterolemic rabbits.New Zealand rabbits were divided into 3 groups, as follows: GI, which was fed a rabbit standard diet; GII, which was fed a hypercholesterolemic diet; and GIII, which received hypercholesterolemic diet plus candesartan. Samples of the rabbits sclera and choroid were then studied by hematoxylin-eosin staining and histomorphometric and immunohistochemical analyses for intercellular adhesion molecule-1 expression.Histological analysis of hematoxylin- and eosin-stained sclera and choroid revealed that macrophages were rarely present in GI, and GII had significantly increased macrophage numbers compared to GIII. Moreover, in GII, the sclera and choroid morphometry showed a significant increase in thickness in comparison to GI and GIII. GIII presented a significant increase in thickness in relation to GI. Sclera and choroid immunohistochemical analysis for intercellular adhesion molecule-1 expression revealed a significant increase in immunoreactivity in GII in relation to GI and GIII. GIII showed a significant increase in immunoreactivity in relation to GI.Candesartan reduced the expression of intercellular adhesion molecule-1 and consequently macrophage accumulation in the sclera and choroid of hypercholesterolemic rabbits.

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