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RESUMO Obesidade tem alto prevalência na população geral gerando custos econômicos para a sociedade. Indivíduos obesos apresentam risco maior de desenvolver de diabetes mellitus, doenças cardiovasculares, dislipidemia, e outras doenças crônicas como a Síndrome da Apnéia Obstrutiva do Sono (SAOS). A SAOS é uma doença crônica, progressiva, incapacitante, com alta mortalidade e morbidade cardiovascular. Os sintomas noturnos incluem roncos, pausas respiratórias, sono agitado com múltiplos despertares, noctúria e sudorese. Os sintomas diurnos são principalmente sonolência excessiva, cefaléia matinal, déficits neuro-cognitivos, alterações de personalidade, redução da libido, sintomas depressivos e ansiedade. Fatores anatômicos e fatores funcionais con-tribuem para esta instabilidade das VAS. O diagnóstico de confirmação é feito pela polissonografia, que também estabelece critérios de gravi-dade. O tratamento está centrado em quatro pontos: tratamento da obesidade, tratamento comportamental da SAOS, tratamento físico e procedimentos cirúrgicos. Em pacientes selecionados algumas drogas podem ser úteis no sentido de diminuir o número ou a duração dos períodos de apnéia. A possibilidade de hipotiroidismo deve sempre ser descartada, uma vez que em alguns casos a reposição com tiroxína pode levar a desaparecimento da apnéia. Também foram desenvolvi-dos aparelhos intra-orais removíveis e pacientes menos obesos e com alterações específicas palatofaríngeas apresentam melhores chances de resposta cirúrgica à úvulo-pálato-faringoplastia. (Arq Bras Endocrinol Metab 2000; 44/1: 81-90) Unitermos: Apnéia do sono, Obesidade, Diagnóstico, Tratamento ABSTRACT Obesity is a disease with high prevalence and obese individuals have a higher risk of cardiovascular diseases, diabetes mellitus, dyslipidemia and Obstructive Sleep Apnea Syndrome (OSAS). OSAS is a chronic, progressive , incapacitating disease with high cardiovascular mortality and morbidity. Clinical symptoms include snoring, respiratory pauses, agitated sleep, nocturia, sudoresis, excessive sleepiness, headache in the morning, neurocognitive deficits, personality and libido changes, depres-sive symptoms and irritability. Anatomic and functional factors can contribute to the instability of the upper respiratory tract. The confirmations is made by the polisomnography, that also stablish severity criteria. Treatment is based in four points: obesity, behavioral, physical and surgical treatments. In selected patients, some drugs can be useful. Hypothy-roidism must be always screened. Intraoral ortesis were developed and patients with normal weight with specific palatopharingeal changes have better chances to success in surgery (uvulopalatopharingoplasty) (Arq Bras Endocrinol Metab 2000; 44/1: 81-90)

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From safe‐life to fail‐safe and damage‐tolerance approaches, the last one emerged as the main design philosophy for aerostructures, allowing weight savings and at the same time increasing reliability and structural integrity in the presence of damages which may have occurred during the manufacturing process or during service. The application of damage‐tolerance philosophy requires extensive know‐how of the fatigue and fracture properties, corrosion strength, potential failure modes and non‐destructive inspection techniques, particularly minimum detectable defect and inspection intervals. To face scatter in material properties, conservative approaches considering the worst scenario or statistical methods dealing with the variability of material have been employed in the fatigue assessment of structures. The fatigue life estimation can display substantial variability, illustrating the need for a probabilistic assessment in practical applications. As an example, the variation in the fatigue life for the common scenario of a through crack in an Al alloy plate was evaluated taking into account scatter of properties. The 2010 FAA rule establishing a limit of validity (LOV) puts a bound in the indefinite operational life allowed for by earlier regulations. This requirement, together with the diminishing role of aluminium in airframes, will certainly shape the directions of fatigue, fracture and damage mechanics research in years to come, expanding the knowledge base upon which substantiation of LOV values is made, and ensuring safety under sustainable conditions.

This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuitionbased experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail 'dynamization' and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the boneintramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.

The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy.Novas diretrizes no diagnóstico e tratamento das insônias resumo A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina. Palavras-chave: insônia, diagnóstico da insônia, tratamento da insônia, terapia comportamental cognitiva.

-The Epworth Sleepiness Scale (ESS) measures daytime sleepiness in adults. This paper reports the following data in 616 medical students: 1 -ESS scores, 2-its correlation with the declared night sleep time, 3-comparison with ESS values obtained from Australia, 4-comparison of ESS values in a sub-population of 111 students tested early and late 1995. There were 387 males, 185 females and 4 not specified. Age = 20.16±2.23 (SD). ESS score = 10.00 ± 3.69 (SD), declared sleep time = 7.04± 1.03 (SD). ESS scores did not statistically correlate with sleep time. Average ESS score was statistically higher than in the Australian sample. Retesting of the medical students showed an increase in ESS values from March to November 1995. Sleep time difference was non-significant. Higher ESS scores in this sample seem to be related to shorter sleep time, but fatigue effects can not be ruled out.

a b s t r a c tThis paper addresses the study of the pre-experimental planning phase of the Design of Experiments (DoE) in order to improve the final product quality. The pre-experimental planning phase includes a clear identification of the problem statement, selection of control factors and their respective levels and ranges. To improve production quality based on the DoE a new approach for the pre-experimental planning phase, called Non-Conformity Matrix (NCM), is presented. This article also addresses the key steps of the pre-experimental runs considering a consumer goods manufacturing process. Results of the application for an industrial case show that this methodology can support a clear definition of the problem and also a correct identification of the factor ranges in particular situations. The proposed new approach allows modeling the entire manufacturing system holistically and correctly defining the factor ranges and respective levels for a more effective application of DoE. This new approach can be a useful resource for both research and industrial practitioners who are dedicated to large DoE projects with unknown factor interactions, when the operational levels and ranges are not completely defined. Códigos JEL: L660Palabras clave: Series pre-experimentales Matriz de no conformidades Diseño de Experimentos r e s u m e n El presente ensayo aborda el estudio de la fase pre-experimental de planificación del Diseño de Experimentos (DoE) con el fin de mejorar la calidad del producto final. En dicha fase pre-experimental de planificación se incluye una identificación clara del planteamiento del problema, de la selección de los factores de control y de sus correspondientes niveles y rangos. Para mejorar la calidad de producción basada en el DoE se presenta un nuevo enfoque para la fase pre-experimental de planificación llamado Matriz de No Conformidades (NCM). Este ensayo aborda también los pasos clave de las series experimentales teniendo en cuenta el proceso de fabricación de artículos de consumo. Los resultados de la puesta en marcha para un caso industrial demuestran que esta metodología puede respaldar una definición clara del problema y también la correcta identificación de los rangos de factores para situaciones concretas. Este nuevo enfoque propuesto permite modelar todo el sistema de fabricación de manera holística y definir correctamente los rangos de factores y niveles correspondientes para una puesta en marcha eficaz del DoE. Dicho enfoque puede ser un recurso útil tanto para profesionales de la investigación como de la industria que se dedican a grandes proyectos de DoE cuyas interacciones de factores son desconocidas, cuando los niveles y rangos operativos no están definidos del todo.