A widening gap? Static and dynamic performance differences between specialist and general hospitals

This paper develops and tests a dynamic model of hospital focus. It does so by tracing the performance trajectories of specialist and general hospitals to identify whether a performance gap exists and whether it widens or shrinks over time. Our longitudinal analyses of all hospital organizations within the English National Health Service (NHS) reveal not only a notable performance gap between specialist and general hospitals in particular with regards to patient satisfaction that widens over time, but also the emergence of a gap especially with regards to hospital staff job satisfaction. These findings reflect the considerable potential of specialization as a means to enhance hospital effectiveness. However, they also alert health policy makers to the threat of a widening performance gap between specialist and general hospitals with potential negative repercussions at the patient and health system level.     

Histological and Genotoxic Biomarkers in <Emphasis Type="Italic">Prochilodus lacustris</Emphasis> (Pisces,Prochilodontidae) for Environmental Assessment in a Protected Area in the Northeast of Brazil

The quality of aquatic environments all around the world is being altered by different human activities that represent direct threat to the ecological system and the aquatic biota. This study aimed to evaluate the occurrence of histological and genotoxic alterations in Prochilodus lacustris as indicators of anthropic impacts in a lacustrine environment in northeast Brazil. The histological alterations were evaluated using the histological alteration index, and the genotoxic alterations were detected using the micronuclei test, at three sampling stations (S1, S2 and S3). The gills presented lesions with three stages of severity, with mild lesions more frequent in the specimens collected at station S1. Mild hepatic tissue lesions were the most frequent type in both areas. Micronucleus analysis showed that station S3 was the most affected. The biological responses observed indicated that the fish are under influence of environmental changes. It is important to highlight that the organisms collected at station S3 had a more compromised health status.     

Childhood Sex-Typed Behavior and Gender Change in Individuals with 46,XY and 46,XX Disorders of Sex Development: An Iranian Multicenter Study

Disorders of sex development (DSD) are congenital conditions in which the typical genetic and hormonal profiles are affected and thereby the usual process of sexual differentiation. Most of these studies, however, have been conducted in Western countries. In the present study, preschool sex-typed activities of Iranian individuals with DSD and their age-matched non-affected male and female relatives were assessed using the Pre-School Activities Inventory (PSAI) modified for retrospective self-report. A total of 192 individuals participated in our study, including 33 46,XX individuals with congenital adrenal hyperplasia (CAH; M age?=?10.36, SD?=?5.52), 15 46,XY individuals with complete androgen insensitivity syndrome (CAIS; M age?=?19.8, SD?=?7.14), and 16 46,XY individuals with 5-alpha reductase deficiency type-2 (5α-RD-2; M age?=?17.31, SD?=?7.28), as well as one age-matched non-affected male and female relative for each patient. With regard to PSAI scores, male-identifying participants with 5α-RD-2 and male controls reported similar levels of male-typical childhood play. Female-identifying participants with 5α-RD-2 and CAH showed comparable scores: significantly less masculine and more feminine than male controls, but significantly more masculine and less feminine than females with CAIS and female controls. These findings support the role of androgens in the development of sex-typical childhood play behavior, with those being exposed to higher levels of fetal functional androgens expressing more masculine behavior at preschool ages.     

Effect of antibodies on chemiluminescence and on killing of Streptococcus sobrinus by polymorphonuclear leukocytes

The effect of a polyclonal antiserum and OMVU10, a monoclonal antibody reactive with Antigen B of Streptococcus sobrinus , on the interaction of polymorphonuclear leukocytes with S. sobrinus was studied, using chemiluminescence and bacterial killing assays. Increased stimulation of neutrophils as measured in the chemiluminescence assays was established when S. sobrinus was preincubated with polyclonal antiserum or when polyclonal antiserum was added to the reaction mixture. Higher counts were measured in comparison to preimmune serum. After 90 min, 52% of S. sobrinus preincubated with polyclonal antiserum was killed. Killing was also increased when polyclonal antiserum was added to the reaction mixture in comparison to the controls. No killing was found when bacteria were preincubated with OMVU10 or when OMVU10 was added to the reaction mixture in comparison to Clone 24, a control antibody.     

Cerec 3 for orthodontics: a tool for treating deep bite

Bite-opening procedures are used in the early stages of orthodontic fixed treatment in order to: ease antero-posterior tooth movements; bracket the mandibular arch and level the Curve of Spee; prevent mandibular brackets from debonding; use regular straight archwires to proceed with treatment. For these purposes, removable or bonded biteplanes are universally recognized as very effective when the bite-opening is needed. Conventional orthodontic procedures include clinical solutions which effectively open the bite, but they all lack sufficient hygiene, comfort, and esthetics. The authors propose the use of the CAD-CAM technology with the Cerec 3 system (Sirona, Bensheim, Germany) to create an overcrown able to open the bite through clinical crown lengthening of the mandibular second premolars. The laboratory steps are described and the clinical efficacy is demonstrated with an orthodontic case report.     

The CICERO system for CAD/CAM fabrication of full-ceramic crowns

The CICERO method of crown fabrication consists of optically digitizing a gypsum die, designing the crown layer buildup, and subsequently pressing, sintering, and milling consecutive layers of a shaded high-strength alumina-based core material, a layer of dentin porcelain, and a final layer of incisal porcelain. Final finishing is performed in the dental laboratory. The CICERO method allows efficient production of all-ceramic restorations without compromising esthetics or function. This article reviews the process involved in the fabrication of a CICERO crown.     

Leiomyomatous hamartoma of the incisive papilla

A case of unusual hamartoma in a six-year-old otherwise healthy Brazilian girl is reported, with emphasis on histological and immunohistochemical features. A mass observed in the incisive papilla was detected whose appearance was similar to congenital epulis or fibroma. Histological findings showed interlacing fascicles of large spindle cells resembling smooth muscle cells. Immunohistochemical staining for desmin and for smooth-muscle actin was positive. The histological diagnosis was leiomyomatous hamartoma, based on clinical and microscopic observations.     

CT diagnosis of synovial chondromatosis of the temporomandibular joint

Synovial chondromatosis of the temporomandibular joint (TMJ) is a very rare condition. It is characterised by the presence of loose bodies in the joint space. Clinical signs, histopathological findings and radiography play an important role in the diagnostic process. Conventional X-rays have shown to be of limited value, for they fail to depict the intra-articular loose bodies in a significant amount of cases. Axial as well as coronal computer tomography (CT) is extremely useful in detecting loose bodies in the temporomandibular joint (TMJ). In this report we present and discuss a further case, and the use of CT in the diagnosis of TMJ-synovial chondromatosis is illustrated.     

Descriptive epidemiological study of personal factors in relation to chronology of tooth eruption

We are made 730 inquirys about mothers to study the age in the teething begin to relationship with personal details. The issue shows a light relation in the advance teething with tall, weight, beginning the walking and female sex, and we have not shown relation with the nursing.