Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data.

OBJECTIVES: To estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia. METHODS: We carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes. RESULTS: The estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people. CONCLUSIONS: Although the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

Concurrent validity between field tests and cardiopulmonary exercise testing in patients with idiopathic pulmonary fibrosis.

BACKGROUND: Maximal treadmill cardiopulmonary exercise testing is the gold standard for assessing functional capacity in patients with idiopathic pulmonary fibrosis (IPF). PURPOSE: Primarily to investigate the concurrent validity between three field tests and cardiopulmonary exercise testing in these patients. METHODS: Patients performed the cardiopulmonary exercise testing, a six-minute walk test, an incremental shuttle walk test, and, the Glittre-ADL test. For cardiopulmonary exercise testing, the ten seconds with the higher average of the peak oxygen uptake obtained within the last 30 seconds were considered; for six-minute walk test and incremental shuttle walk test, the longer distance; and for the Glittre-ADL test, the shorter time spent. Concurrent validity was assessed using different regression models based on the best adjustment of the data. RESULTS: Twenty-two patients with IPF were assessed, aged: 68 ± 8.1 years, 13 male. Patients presented a peak oxygen uptake of 16.5 ± 3.6 mL.kg-1.min1, achieving a distance of 512.6 ± 102.8 meters in the six-minute walk test and 415.7 ± 125.1 meters in incremental shuttle walk test. The walking distance in the six-minute walk test and the incremental shuttle walk test explained, respectively, 64% and 56% peak oxygen uptake variance observed in the cardiopulmonary exercise testing (R2 = 0.64,p < .001; R2 = 0.56,p < .001). The time spent in the Glittre-ADL test was 233.4 ± 88.7 seconds and explained 47% of the peak oxygen uptake variance observed in cardiopulmonary exercise testing (R2 = 0.47,p = .001). CONCLUSION: The six-minute walk test, incremental shuttle walk test, and Glittre-ADL test were considered valid tests to explain the peak oxygen uptake variance obtained by the cardiopulmonary exercise testing in patients with IPF.

Cost-Effectiveness Analysis Comparing QuantiFERON-TB Gold Plus Test and Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Immunocompetent Subjects in Colombia.

OBJECTIVES: To determine the cost-effectiveness of the QuantiFERON-TB Gold Plus (QFT-Plus) test versus the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent subjects in the context of the Colombian healthcare system. METHODS: A hypothetical cohort of 2000 immunocompetent adults vaccinated with Bacillus Calmette-Guérin at birth who are asymptomatic for tuberculosis disease was simulated and included in a decision tree over a horizon of <1 year. The direct healthcare costs related to tests, antituberculosis treatment, and medical care were considered, and diagnostic performance was used as a measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was estimated, and univariate deterministic and probabilistic sensitivity analyses were carried out using 5000 simulations. The currency was the US dollar for the year 2022, with a cost-effectiveness threshold of $6666 USD (1 gross domestic product per capita for 2022). RESULTS: QFT-Plus was cost-effective with an ICER of $5687 USD for each correctly diagnosed case relative to a threshold of $6666 USD. In the deterministic analysis, QFT-Plus was cost-effective in half of the proposed scenarios. The variable that most affected the ICER was the prevalence of latent tuberculosis and test sensitivities. In the probabilistic analysis, QFT-Plus was cost-effective in 54.74% of the simulated scenarios, and tuberculin skin test was dominant in 13.84%. CONCLUSIONS: The study provides evidence of the cost-effectiveness of QFT-Plus compared with the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent adults in the Colombian context.

5-year clinical performance of posterior bulk-filled resin composite restorations: A double-blind randomized controlled trial.

OBJECTIVES: The aim of this double-blind, and randomized controlled clinical trial was to evaluate the 5-year clinical performance of posterior resin composite restorations placed with the incremental filling technique [IF] or the bulk-fill technique [BF]. Two different adhesive systems were used: etch-&-rinse (ER) or self-etch (SE). METHODS: Posterior dental teeth of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. Restorations were applied with either Tetric N-Bond or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either with IF or BF. Restorations were evaluated using FDI criteria at baseline and after 1, 2, 3, 4, and 5 years. Statistical analysis was performed using the Wilcoxon Signed rank test (a=0.05). RESULTS: Two hundred and four restorations were evaluated after 5 years. Eleven restorations were considered 'failed', ten due to fracture (4 IF and 6 BF) and one due to secondary caries (IF). The annual failure rate was 1.2% for BF and 1% for IF (p = 0.35). When comparing BF and IF, no significant differences were found for any of the parameters evaluated (p > 0.05). Regarding the adhesive systems, 44 and 51 restorations showed minor problems in terms of marginal adaptation and staining, with significantly more marginal discoloration when the self-etch adhesive was used (p = 0.002). SIGNIFICANCE: The bulk-fill restorative technique showed good clinical behavior compared to the incremental filling technique, especially when using an etch-&-rinse adhesive, after 5 years of clinical evaluation.

Cost-Utility Analysis Comparing Ocrelizumab Versus Rituximab in the Treatment of Relapsing-Remitting Multiple Sclerosis: The Colombian Perspective.

OBJECTIVES: This study aimed to determine the cost-utility of ocrelizumab versus rituximab in patients with RRMS, from the perspective of the Colombian healthcare system. METHODOLOGY: Cost-utility study based on a Markov model, with a 50-year horizon and payer perspective. The currency was the US dollar for the year 2019, with a cost-effectiveness threshold of $5180 defined for Colombian health system. The model used annual cycles according to the health status determined by the disability scale. Direct costs were considered, and the incremental cost-effectiveness ratio per 1 quality-adjusted life-year (QALY) gained was used as the outcome measure. A discount rate of 5% was applied to costs and outcomes. Multiple one-way deterministic sensitivity analyses and 10 000 Monte Carlo simulation were conducted. RESULTS: For the treatment of patients with RRMS, ocrelizumab versus rituximab had an incremental cost-effectiveness ratio of $73 652 for each QALY gained. After 50 years, 1 subject treated with ocrelizumab earns 4.8 QALYs >1 subject treated with rituximab, but at a higher cost of $521 759 versus $168 752, respectively. Ocrelizumab becomes a cost-effective therapy if its price is discounted > 86% or if there is a high willingness to pay. CONCLUSIONS: Ocrelizumab was not a cost-effective drug as compared with rituximab in treating patients with RRMS in Colombia.

Performance of Medium-Rise Buildings with Reinforced Concrete Shear Walls Designed for High Seismic Hazard.

This work has evaluated the collapse fragility of a typical Chilean building for residential use, structured based on shear-resistant RC walls and inverted beams arranged along its entire perimeter, using the incremental dynamic analysis (IDA) for the evaluation of its structural behavior, using for this the 2018 version of the SeismoStruct software. This method evaluates the global collapse capacity of the building from the graphical representation of its maximum inelastic response, obtained through a non-linear time-history analysis, against the scaled intensity of a set of seismic records obtained in the subduction zone, thus creating the IDA curves of the building. The processing of the seismic records is included within the applied methodology to make them compatible with the elastic spectrum of the Chilean design, achieving an adequate seismic input in the two main structural directions. In addition, an alternative IDA method based on the elongated period is applied to calculate the seismic intensity. The results of the IDA curve obtained with this procedure and the standard IDA analysis are analyzed and compared. The results show that the method relates very well to the structure's demand and capacity and confirms the non-monotonous behavior exposed by other authors. Regarding the alternative IDA procedure, the results indicate that the method is inadequate, failing to improve the results obtained by the standard method.

Effects of lesion size on the 30-month clinical performance of restorations with bulk fill and a regular nanofilled resin composite in noncarious cervical lesions.

OBJECTIVE: The aim of this double-blind, randomized trial was to evaluate the influence of the occlusogingival distance (OGD) in noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite. MATERIALS AND METHODS: One hundred and forty NCCLs in 77 participants were randomly divided into four groups (n = 35), according to OGD (1.5 mm ± 10% or 3 mm ± 10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]), namely: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. The restorations were bonded using a two-step self-etch adhesive (Clearfil SE Bond), applied following the manufacturer's instructions. Restorations were polished 1 week after placement. Two experienced and calibrated examiners evaluated the restorations using modified US Public Health Service criteria at baseline (7 days) and after 6, 12, 18, 24, and 30 months. Statistical analyses were carried out using Kruskal-Wallis, Friedman's repeated measures analysis of variance, and the Wilcoxon signed rank test (α = 0.05). RESULTS: After 30 months, the recall rate was 94.2%. Eight restorations were lost (3 for 1.5 mm-C, 2 for 1.5 mm-B, 1 for 3 mm-C, and 2 for 3 mm-B). All groups resulted in a significantly worse marginal discoloration and surface texture at 30 months in comparison with the baseline (1 week). No significant difference was found for the other parameters. CONCLUSION: The restorations performed with both resin composites produced clinically acceptable restorations. The OGD of NCCLs did not influence the clinical performance of restorations. CLINICAL SIGNIFICANCE: The OGD of NCCLs did not have a significant effect on the clinical performance of a regular bulk-fill and nanofilled restorations. Both materials showed a very good performance on 30-month evaluation.

Ozone precursors and boundary layer meteorology before and during a severe ozone episode in Mexico city.

Volatile organic compounds (VOCs) data in conjunction with other inorganic pollutants, surface meteorological data and continuous measurement of the Planetary Boundary Layer height (PBLH) at an urban site in Mexico City were performed from 6 to 18 March 2016. Positive Matrix Factorization (PMF) identified four emission source factors of VOCs along with equivalent black carbon (eBC), gaseous pollutants (CO, NO, NO2, SO2, NH3) and ions (Na+, Mg2+, Ca2+, NO3-, NH4+): (1) secondary aerosol precursors, (2) evaporation and non-LPG fuel combustion, (3) geogenic source and (4) vehicle exhaust. Propylene Equivalent and Maximum Incremental Reactivity (MIR) methods identified isoprene and ethylene as the highest oxidant and O3 forming species. Pollutant data normalized to the variation of the PBLH revealed continued production of O3 precursors in the afternoon beyond the typical morning rush hour. In particular this could be observed during the second part of the measurement period (12-15 March) when a strong O3 episode occurred under weak wind and lower PBLH conditions compared to the preceding period (6-11 March) when well mixed conditions due to elevated daytime PBLH and strong advection led to overall reduced pollutant mixing ratios in the afternoon hours.

Resin Composites in Posterior Teeth: Clinical Performance and Direct Restorative Techniques.

Resin composites are the most versatile restorative materials used in dentistry and the first choice for restoring posterior teeth. This article reviews aspects that influence the clinical performance of composite restorations and addresses clinically relevant issues regarding different direct techniques for restoring posterior teeth that could be performed in varied clinical situations. The article discusses the results of long-term clinical trials with resin composites and the materials available in the market for posterior restorations. The importance of photoactivation is presented, including aspects concerning the improvement of the efficiency of light-curing procedures. With regard to the restorative techniques, the article addresses key elements and occlusion levels for restoring Class I and Class II cavities, in addition to restorative strategies using different shades/opacities of resin composites in incremental techniques, restorations using bulk-fill composites, and shade-matching composites.

Estabilidad temporal, validez convergente e incremental de la versión argentina para adultos del Cuestionario de Regulación Emocional (ERQ) / Temporal Stability, Convergent and Incremental Validity of the Argentine Adult Version of the Emotion Regulation Questionnaire (ERQ)

Resumen La Regulación Emocional (RE) ha asumido relevancia en la psicología clínica. Su medición requiere de instrumentos adecuados a nivel psicométrico. Se examinaron la validez convergente e incremental del Cuestionario de Regulación Emocional (ERQ) en 224 personas entre 18 y 63 años (M = 32.04; DE = 11.51), y la estabilidad temporal en 52 participantes de 21 a 63 años (M = 30.46; DE = 10.65). Los resultados indicaron una estabilidad temporal moderada (.74) en el caso de la supresión expresiva y buena (.81) para la reevaluación cognitiva; también, validez convergente a través de asociaciones positivas entre la supresión expresiva y sintomatología depresiva y ansiógena. La reevaluación cognitiva se asoció negativamente a la sintomatología depresiva, pero no con la ansiógena. Mediante una regresión múltiple jerárquica se obtuvo evidencia de la validez incremental sobre la sintomatología depresiva (R2 ajustado = .44; p < .001). En conclusión, la presente investigación obtuvo nuevas evidencias acerca de las propiedades psicométricas de la versión argentina del ERQ, puntualmente, acerca de su estabilidad temporal, su validez convergente y su validez incremental.

Abstract Emotional Regulation (ER) has assumed relevance in clinical psychology. Its measurement requires appropriate instruments at a psychometric level. The convergent and incremental validity of the Emotional Regulation Questionnaire (ERQ) was examined in 224 people between 18 and 63 years old (M = 32.04; SD = 11.51), and temporal stability in 52 participants between 21 and 63 years old ( M = 30.46, SD = 10.65). The results indicated moderate temporal stability (.74) in the case of expressive suppression and good (.81) for cognitive reappraisal. Also convergent validity through positive associations between expressive suppression and depressive and anxiogenic symptomatology. Cognitive reappraisal was negatively associated with depressive symptomatology, but not with anxiety. Hierarchical multiple regression evidence of incremental validity on depressive symptomatology was obtained (adjusted R2 = .44; p < .001). In conclusion, this research obtained new evidence about the psychometric properties of the Argentine version of the ERQ. Specifically, about its temporal stability, its convergent validity and its incremental validity.

Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

Is the clinical performance of composite resin restorations in posterior teeth similar if restored with incremental or bulk-filling techniques? A systematic review and meta-analysis.

OBJECTIVES: A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, marginal discoloration, caries, and postoperative sensitivity. METHODS: Electronic and manual searches were performed for randomized clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The Cochrane Collaboration risk of bias tool was used to assess the quality of the studies and the GRADE tool was used to access the quality of the evidence. RESULTS: Fourteen studies were included in this systematic review and most of them had unclear risk of bias. The risk difference (RD) for retention/fracture was 0.00 (95%CI = - 0.01, 0.01; p = 0.86) for 1-1.5 years of follow-up; 0.00 (95%CI = - 0.02, 0.02; p = 0.88) for 2-3 years of follow-up; 0.05 (95%CI = - 0.08, 0.18; p = 0.46) for 5 or more years of follow-up. The RD for postoperative sensitivity was 0.04 (95%CI = - 0.02, 0.10; p = 0.18) for up to 30 days; 0.00 (95%CI = - 0.01, 0.02; p = 0.63) for 1-1.5 years of follow-up; and 0.00 (95%CI = - 0.01, 0.02; p = 0.71) for 2-3 years of follow-up. For the other secondary outcomes, no significant differences were observed (p > 0.05) between the restorative techniques. The certainty of evidence was graded as moderate. CONCLUSIONS: The clinical performance of class I and II restorations in posterior teeth is similar when placed with the incremental and bulk-filling techniques. CLINICAL RELEVANCE: Based on the results of this study, posterior restorations placed with bulk-filling technique present satisfactory clinical performance, which is similar to direct restorations placed with the conventional incremental technique, considering various follow-up periods evaluated. TRIAL REGISTRATION:  CRD42018108450.

Incremental peritoneal dialysis after unplanned start initiation.

Incremental peritoneal dialysis (PD) is characterized as less than a "standard dose" PD prescription. Compared to standard treatment, it has many potential advantages, including better preservation of residual renal function, a lower risk of peritonitis, and a decreased care delivery burden while reducing the environmental impact and economic cost. Unplanned PD can be defined when treatment starts up to 14 days after catheter insertion and is recognized as a safe and feasible clinical approach. In this perspective paper, we briefly discuss both strategies and share our experience and clinical routine in managing incremental PD after unplanned initiation.

Polycyclic aromatic hydrocarbons (PAHs) in human breast milk from Colombia: Spatial occurrence, sources and probabilistic risk assessment.

The diet is the main route that polycyclic aromatic hydrocarbons (PAHs) enter the body and measuring breast milk is one of the best ways to understand the maternal body burden and can be passed on to infants. In this study, it was determinate the concentrations of 23 PAHs in 60 milk samples taken from 3 cities in Colombia and to determine the potential routes of exposure and risk to human health. On average, concentration for the ∑PAHs across all locations was 186.6 ng g-1, lipid mass (LM), with city means of 260.1, 175.7, and 123.9 ng g-1 LM for Cartagena, Bogota and Medellin, respectively. Monte Carlo simulations were used to estimate the hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) for infant dietary exposure to PAHs. HQs were below the safe thresholds (HQ = 1) while ILCRs were greater than the reference value equal to 10-6 (mg kg-1day-1). Dietary source assessment indicated that fish is a significant source of PAHs, with mothers that consumed fish at least once per week having ∼2.5 times greater PAH milk concentrations than other groups. While a disparity was also observed among consumers of exclusively marine (∑PAHs 198.5 ng g-1 LM) or freshwater fish (∑PAHs 85.7 ng g-1 LM). However, geographical considerations can be significant in this finding.

A novel treadmill protocol for uphill running assessment: the incline incremental running test (IIRT).

This study aimed to compare the maximal and submaximal aerobic parameters between two incremental running tests, one being horizontal and the other an incline-based test, namely the incline incremental running test (IIRT). Twenty endurance-trained trail runners completed two incremental treadmill tests, until exhaustion. The first test was performed using an incline of 1%, with speed increments. Then, the IIRT was performed with the speed set at 50% of the peak speed obtained during the previous test, and the incline was incremented. Cardiorespiratory measurements and blood lactate concentration ([La]) were assessed. The mean peak workload from the horizontal test was 17.6 ± 1.4 km.h-1 and peak workload from IIRT was 17.3 ± 1.3% of incline. The VO2peak and [La]peak were not significantly different between the protocols. However, the HRpeak was significantly lower at IIRT. In conclusion, most of the maximal and submaximal aerobic indices showed no differences between the incremental tests analysed. The exceptions were the HRpeak and HR at the lactate turnpoints, that were lower, and the peak O2 pulse that was greater for the IIRT. Taken together, these data support the validity of the IIRT as a specific test for the physiological assessment of runners involved with uphill performances.

Physiological effects of land and water treadmill exercise in dogs / Efeitos do exercício em esteira terrestre ou aquática sobre os parâmetros fisiológicos de cães

The application of hydrotherapy is growing in the field of animal rehabilitation to improve strength, endurance, fitness, and range of motion, in addition to reducing pain. In the same way, land-based activity is recommended for various conditions, including hypertension, muscle atrophy, and obesity. There is a lack of studies that evaluate the safety of incremental exercise in American Pit Bull Terriers. This study assessed the influence of activity on underwater and dry land treadmills on the physiological parameters of dogs. In this regard, 12 adult, male, healthy, and untrained American Pit Bull Terriers were subjected to an incremental exercise test (IET) on the underwater treadmill (Group I) and the dry land treadmill (Group II). Heart rate (HR), respiratory rate (RR), rectal temperature (RT), systolic blood pressure (SBP), and electrocardiographic evaluation, were evaluated before activity (T0), immediately after (T1), 30 min after (T2), and 90 min after the end of exercise (T3), and plasmatic lactate concentrations were measured at T0, T1, and T2 time points. Results obtained were submitted to the Shapiro-Wilk test, ANOVA and Tukey's test, considering P<0.05. Water activity induced a reduction in RR (P=0.00674) in all examinations after the test on the underwater treadmill and proved to be more demanding than activity on the land treadmill, considering the presence of a deeper and slower RR. Exercise sessions in both groups did not elevate the lactate concentration. The IET can be performed safely on an underwater or dry land treadmill in healthy American Pit Bulls.

A hidroterapia apresenta crescente aplicação no ramo da reabilitação animal, com o intuito de aumentar a força, resistência muscular e amplitude de movimento articular, além de reduzir a dor e melhorar o condicionamento físico do paciente. Assim como a hidroterapia, a atividade desenvolvida em solo é indicada para diversas afecções, inclusive para pacientes hipertensos, com atrofia muscular ou com sobrepeso. São escassos os estudos que avaliam a segurança de testes incrementais em esteira aquática e em esteira seca em American Pit Bull Terriers. Este estudo teve como objetivo avaliar os efeitos da atividade em esteira aquática e em esteira seca sobre os parâmetros fisiológicos de cães. Para isto, cães da raça American Pit Bull Terrier (n=12) machos, adultos, saudáveis e não treinados foram submetidos a teste de esforço incremental (TEI) em hidroesteira com água (Grupo I) e sem água (Grupo II). A frequência cardíaca (FR), frequência respiratória (FR), temperatura retal (TR), pressão arterial sistólica (PAS) e avaliação eletrocardiográfica, foram aferidas antes da atividade (T0), imediatamente após (T1), 30 minutos após (T2) e 90 minutos após o exercício (T3), e a concentração plasmática de lactato foi dosada nos momentos T0, T1 e T2. Os resultados foram submetidos ao teste de Shapiro-Wilk, análise de variância (ANOVA) e pelo Teste de Tukey, considerando significativo o valor de P < 0.05. Houve diminuição da frequência respiratória (P = 0,00674) após a atividade em esteira aquática, que se mostrou mais exigente que a atividade em esteira terrestre, considerando a apresentação de padrão respiratório mais lento e profundo. As sessões de exercício em ambos os grupos não elevaram a concentração de lactato. O teste de esforço incremental em esteira aquática, ou em esteira seca, pode ser desenvolvido com segurança por cães American Pit Bull saudáveis.

Microleakage in class II restorations of two bulk fill resin composites and a conventional nanohybrid resin composite: an in vitro study at 10,000 thermocycles.

BACKGROUND: The contraction presented by resin composites causes an increase in stress at the tooth-resin interface, causing micro-gaps that allow microleakage. This study aims to evaluate the degree of in vitro marginal microleakage in class II restorations with two bulk fill resin composites compared to a conventional nanohybrid resin composite. METHODS: The present study was an in vitro experimental design. A total of 30 standardized class II cavities were prepared in 15 human molars (mesially and distally). These cavities were later distributed in 3 groups according to the type of resin. Groups A and B were restored with bulk fill resin composites (Filtek-3 M/ESPE and Tetric N-Ceram-Ivoclar/Vivadent respectively) in a single increment of 4 mm. Group C was restored with the Filtek Z350 XT - 3 M/ESPE resin composite and two increments of 2 mm. Later, the restorations were subjected to 10,000 thermocycles between 5 °C to 55 °C and immersed in a silver nitrate solution (1 M for 24 h). The crowns were then sectioned mesiodistally and observed under the stereomicroscope to determine the degree of marginal microleakage at the occlusal and cervical areas. The results were analyzed with the Kruskal-Wallis and the Mann-Whitney U statistical tests. RESULTS: There were no statistically significant differences regarding the degree of microleakage between the three types of resin composites in the occlusal and cervical areas (p > 0.05). Similarly, there were no significant differences after comparing each resin type in its occlusal and cervical area (p > 0.05). CONCLUSION: Filtek Bulk Fill and Tetric N-Ceram Bulk Fill resin composites showed no statistically significant differences with the conventional nanohybrid resin composite Filtek Z350XT at both occlusal and cervical areas.

Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis.

BACKGROUND: Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. METHODS: We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. RESULTS: Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). CONCLUSIONS: Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don't forgo prenatal care for fear of punitive consequences.

Study of Friction and Wear Effects in Aluminum Parts Manufactured via Single Point Incremental Forming Process Using Petroleum and Vegetable Oil-Based Lubricants.

This paper focuses on studying how mineral oil, sunflower, soybean, and corn lubricants influence friction and wear effects during the manufacturing of aluminum parts via the single point incremental forming (SPIF) process. To identify how friction, surface roughness, and wear change during the SPIF of aluminum parts, Stribeck curves were plotted as a function of the SPIF process parameters such as vertical step size, wall angle, and tool tip semi-spherical diameter. Furthermore, lubricant effects on the surface of the formed parts are examined by energy dispersive spectroscopy (EDS) and scanning electron microscope (SEM) images, the Alicona optical 3D measurement system, and Fourier-transform infrared spectroscopy (FTIR). Results show that during the SPIF process of the metallic specimens, soybean and corn oils attained the highest friction, along forces, roughness, and wear values. Based on the surface roughness measurements, it can be observed that soybean oil produces the worst surface roughness finish in the direction perpendicular to the tool passes (Ra =1.45 µm) considering a vertical step size of 0.25 mm with a 5 mm tool tip diameter. These findings are confirmed through plotting SPIFed Stribeck curves for the soybean and corn oils that show small hydrodynamic span regime changes for an increasing sample step-size forming process. This article elucidates the effects caused by mineral and vegetable oils on the surface of aluminum parts produced as a function of Single Point Incremental Sheet Forming process parameters.

Resultados y reproducibilidad a corto plazo de la prueba de lanzadera incremental (Incremental Shuttle Walking Test) en pacientes con enfermedad renal crónica en hemodiálisis / Results and short-term reproducibility of the Incremental Shuttle Walking Test in patients with chronic kidney disease on hemodialysis

RESUMEN Antecedentes: La prueba de lanzadera incremental ha sido empleada para determinar la capacidad física en pacientes con enfermedad renal crónica. Sin embargo, su aplicabilidad y reproducibilidad ha sido poco estudiada en pacientes bajo tratamiento de hemodiálisis. El objetivo de este estudio fue evaluar el rendimiento y reproducibilidad de la prueba de lanzadera incremental en pacientes con enfermedad renal crónica en hemodiálisis. Material y métodos: Se incluyeron pacientes con enfermedad renal crónica en diálisis y sujetos sin enfermedad renal crónica. Cada individuo realizó dos pruebas de lanzadera incremental con un intervalo de 30 minutos. Se registró la distancia recorrida, velocidad máxima, frecuencia cardiaca y el esfuerzo percibido. La reproducibilidad se analizó mediante el cálculo del coeficiente de correlación intraclase y el error estándar de la media. Mediante el método de Bland-Altman, se calculó la discordancia de la distancia recorrida y la frecuencia cardiaca pico. Además, se calculó el cambio mínimo detectable para todos los parámetros de la prueba de lanzadera incremental. Un valor de p=<0,05 se consideró significativo. Resultados: 68 sujetos entraron al estudio (34 pacientes con enfermedad renal crónica y 34 sujetos en el grupo control). Los pacientes con enfermedad renal crónica caminaron una menor distancia recorrida respecto al grupo control (-40%; p=<0,0001). En ambos grupos, se encontró una excelente confiabilidad test/retest en todas las medidas de resultado (cálculo del coeficiente de correlación intraclase >0,80). Los registros del error estándar de medición y cambio mínimo detectable para la distancia recorrida fueron de 26,0 m y 72,1 m, respectivamente. El método de Bland-Altman para la distancia recorrida mostró una diferencia media de -0,9 m con límites de concordancia entre 65,5 y -63,7 m. Conclusión: Los pacientes con enfermedad renal crónica en hemodiálisis presentan un menor rendimiento durante la prueba de lanzadera incremental comparado con individuos sin enfermedad renal crónica. Las medidas de resultado de la prueba de lanzadera incremental presentan una alta reproducibilidad test/retest a corto plazo en este grupo de pacientes.

ABSTRACT Introduction: The Incremental Shuttle Walk Test has been used to determine physical capacity in patients with chronic kidney disease. However, its applicability and reproducibility have seldom been studied in hemodialysis patients. The objective of this study was to evaluate the performance and reproducibility of the incremental shuttle walk test in patients with chronic kidney disease on hemodialysis. Methods: Patients with chronic kidney disease on dialysis and subjects without chronic kidney disease were included. Each individual performed two Incremental Shuttle Walk Test with an interval of 30 minutes. We recorded the distance traveled, maximum speed, heart rate and perceived effort. Reproducibility was analyzed by calculating the intraclass correlation coefficient and the standard error of the mean. Using the Bland-Altman analysis, we calculated the discrepancy of the distance traveled and the peak heart rate. The minimum detectable change was also calculated for all parameters of the incremental shuttle walk test. A value of p=<0.05 was considered significant. Results: 68 subjects entered the study (34 were patients with chronic kidney disease, and 34 subjects constituted the control group). Patients with chronic kidney disease walked a shorter distance than those in the control group (-40%; p=<0.0001). In both groups, excellent test-retest reliability was found in all outcome measurements (intraclass correlation coefficient calculation >0.80). The standard error of measurement and the minimum detectable change for the distance traveled were 26.0 m and 72.1 m, respectively. The Bland-Altman analysis for the distance traveled showed a mean difference of -0.9 m with limits of agreement between 65.5 and -63.7 m. Conclusion: Patients with chronic kidney disease on hemodialysis show lower performance during the incremental shuttle walk test, compared to individuals without chronic kidney disease. The outcome measurements of the Incremental Shuttle Walk Test show high test-retest reproducibility in the short run in this group of patients.