The quality of reporting of diagnostic accuracy studies in glaucoma using the Heidelberg retina tomograph

PURPOSE. Scanning laser tomography with the Heidelberg retina tomograph (HRT; Heidelberg Engineering, Heidelberg, Germany) has been proposed as a useful diagnostic test for glaucoma. This study was conducted to evaluate the quality of reporting of published studies using the HRT for diagnosing glaucoma. METHODS. A validated Medline and hand search of English-language articles reporting on measures of diagnostic accuracy of the HRT for glaucoma was performed. Two reviewers selected and appraised the papers independently. The Standards for Reporting of Diagnostic Accuracy (STARD) checklist was used to evaluate the quality of each publication. RESULTS. A total of 29 articles were included. Interobserver rating agreement was observed in 83% of items (? = 0.76). The number of STARD items properly reported ranged from 5 to 18. Less than a third of studies (7/29) explicitly reported more than half of the STARD items. Descriptions of key aspects of the methodology were frequently missing. For example, the design of the study (prospective or retrospective) was reported in 6 of 29 studies, and details of participant sampling (e.g., consecutive or random selection) were described in 5 of 29 publications. The commonest description of diagnostic accuracy was sensitivity and specificity (25/29) followed by area under the ROC curve (13/29), with 9 of 29 publications reporting both. CONCLUSIONS. The quality of reporting of diagnostic accuracy tests for glaucoma with HRT is suboptimal. The STARD initiative may be a useful tool for appraising the strengths and weaknesses of diagnostic accuracy studies. Copyright © Association for Research in Vision and Ophthalmology.

Effects of sintering temperature on morphology and mechanical characteristics of 3D printed porous titanium used as dental implant

Porous titanium samples were manufactured using the 3D printing and sintering method in order to determine the effects of final sintering temperature on morphology and mechanical properties. Cylindrical samples were printed and split into groups according to a final sintering temperature (FST). Irregular geometry samples were also printed and split into groups according to their FST. The cylindrical samples were used to determine part shrinkage, in compressive tests to provide stress-strain data, in microCT scans to provide internal morphology data and for optical microscopy to determine surface morphology. All of the samples were used in microhardness testing to establish the hardness. Below 1100 C FST, shrinkage was in the region of 20% but increased to approximately 30% by a FST of 1300 C. Porosity varied from a maximum of approximately 65% at the surface to the region of 30% internally. Between 97 and 99% of the internal porosity is interconnected. Average pore size varied between 24 µm at the surface and 19 µm internally. Sample hardness increased to in excess of 300 HV0.05 with increasing FST while samples with an FST of below 1250 C produced an elastic-brittle stress/strain curve and samples above this displayed elastic-plastic behaviour. Yield strength increased significantly through the range of sintering temperatures while the Young's modulus remained fairly consistent. © 2013 Elsevier B.V.

Focal irradiation of perforating eye injuries

Plaques constructed with 125I were used to irradiate the sites of perforating ocular injuries in rabbits. An approximate dose of 16Gy given over a period of 6 days was shown to significantly reduce intraocular cellular proliferation when irradiation was commenced within 24 hours after injury. If irradiation was delayed until day 5, this reduction in cellular proliferation and intraocular membrane formation did not occur. Smaller radiation doses of approximately 6Gy given within 24 hours post-injury and administered over 6 days also reduced the extent of cellular proliferation but was not as effective as the 16Gy dose.

Medication use review in Qatar: Are community pharmacists prepared for the extended professional role?

Background
The incidence of chronic illnesses is increasing globally. Non-adherence to medications and other medication-related problems are common among patients receiving long-term medications. Medication use review (MUR) is a service provision with an accredited pharmacist undertaking structured, adherence-centered reviews with patients receiving multiple medications. MUR services are not yet available in community pharmacies in Qatar.

Objective
The current study aims to evaluate community pharmacists' knowledge, attitudes, and perception towards establishing MUR as an extended role in patient care.

Setting
Private community pharmacies in Qatar including chains and independent pharmacies.

Methodology
A cross-sectional survey using a self-administered questionnaire was conducted among licensed community pharmacists from December 2012 to January 2013. Data analysis was conducted using descriptive and inferential statistics.

Main outcome measures
Knowledge, attitudes, and practices related to MUR concept and services.

Results A total of 123 participants responded to the survey (response rate 56 %). The mean total knowledge score was 71.4 ± 14.7 %. An overwhelming proportion of the participants (97 %) were able to identify the scope of MUR in relation to chronic illnesses and at enhancing the quality of pharmaceutical care. Furthermore, 80 % of the respondents were able to identify patients of priority for inclusion in an MUR program. However, only 43 % of the participants knew that acute medical conditions were not the principal focus of an MUR service, while at least 97 % acknowledged that the provision of MUR services is a great opportunity for an extended role of community pharmacists and that MUR makes excellent use of the pharmacist's professional skills in the community. The participants generally reported concerns about time, dedicated consultation area, and support staff as significant barriers towards MUR implementation.

Conclusion
This study suggests that community pharmacists in Qatar had sufficient knowledge about the concept of MUR and its scope, but there were still important deficiencies that warrant further education. The findings have important implications on policy and practice pertaining to the implementation of MUR as an extended role of pharmacists and as part of Qatar's National Health Strategy to move primary health care forward.

The View from the Edge: The Proyecto Arqueológico Chihuahua (PAC) 1990 to 2010: An Overview

The work of the Proyecto Arqueológico Chihuahua (PAC) has played an integral role in defining the origins and characteristics of the Chihuahua culture area, also known as the Casas Grandes Regional System. PAC has developed a critical suite of radiocarbon dates for the southern zone, undertaken the first substantial investigations of the Viejo period (ca. A.D. 800textendash1200 or 1250) since the early 1960s, and added to knowledge of the southern Medio period (ca. A.D. 1250textendash1450). The project has also elucidated the chronology, settlement patterns, subsistence strategies, and technology for both periods. Results of our research indicate continuity between the Viejo period, characterized by small pithouse settlements, and the pueblo focused Medio period in the southern zone, with some poorly understood external influences from both western Mesoamerica to the south and the American Southwest to the north shaping events within the area.

High Performance Real-time Pre-Processing for Fixed-Complexity Sphere Decoder

Pre-processing (PP) of received symbol vector and channel matrices is an essential pre-requisite operation for Sphere Decoder (SD)-based detection of Multiple-Input Multiple-Output (MIMO) wireless systems. PP is a highly complex operation, but relative to the total SD workload it represents a relatively small fraction of the overall computational cost of detecting an OFDM MIMO frame in standards such as 802.11n. Despite this, real-time PP architectures are highly inefficient, dominating the resource cost of real-time SD architectures. This paper resolves this issue. By reorganising the ordering and QR decomposition sub operations of PP, we describe a Field Programmable Gate Array (FPGA)-based PP architecture for the Fixed Complexity Sphere Decoder (FSD) applied to 4 × 4 802.11n MIMO which reduces resource cost by 50% as compared to state-of-the-art solutions whilst maintaining real-time performance.

Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma

AIM: To investigate the safety and potential savings of decreasing medication use in low-risk patients with ocular hypertension (OH).
METHODS: Patients with OH receiving pressure-lowering medication identified by medical record review at a university hospital underwent examination by a glaucoma specialist with assessment of visual field (VF), vertical cup-to-disc ratio (vCDR), central corneal thickness and intraocular pressure (IOP). Subjects with estimated 5-year risk of glaucoma conversion <15% were asked to discontinue ≥1 medication, IOP was remeasured 1 month later and risk was re-evaluated at 1 year.
RESULTS: Among 212 eyes of 126 patients, 44 (20.8%) had 5-year risk >15% and 14 (6.6%) had unreliable baseline VF. At 1 month, 15 patients (29 eyes, 13.7%) defaulted follow-up or refused to discontinue medication and 11 eyes (5.2%) had risk >15%. The remaining 69 patients (107 eyes, 50.7%) successfully discontinued 141 medications and completed 1-year follow-up. Mean IOP (20.5±2.65 mm Hg vs 20.3±3.40, p=0.397) did not change, though mean VF pattern SD (1.58±0.41 dB vs 1.75±0.56 dB, p=0.001) and glaucoma conversion risk (7.31±3.74% vs 8.76±6.28%, p=0.001) increased at 1 year. Mean defect decreased (-1.42±1.60 vs -1.07±1.52, p=0.022). One eye (0.47%) developed a repeatable VF defect and 13 eyes (6.1%) had 5-year risk >15% at 1 year. The total 1-year cost of medications saved was US$4596.
CONCLUSIONS: Nearly half (43.9%) of low-risk OH eyes in this setting could safely reduce medications over 1 year, realising substantial savings.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Willingness to pay for cataract surgery in rural Southern China.

PURPOSE: To study willingness to pay for cataract surgery, and its associations, in Southern China. DESIGN: Cross-sectional willingness-to-pay interview incorporating elements of the open-ended and bidding formats. PARTICIPANTS: Three-hundred thirty-nine persons presenting for cataract screening in Yangjiang, China, with presenting visual acuity (VA) < or = 6/60 in either eye due to cataract. METHODS: Subjects underwent measurement of their VA and a willingness-to-pay interview. Age, gender, literacy, education, and annual income also were recorded. MAIN OUTCOME MEASURES: Maximum amount that the subjects would be willing to pay for cataract surgery. RESULTS: Among 325 (95.9%) subjects completing the interview, 169 (52.0%) were 70 years or older, 213 (65.5%) were women, and 217 (66.8%) had an annual income of <5000 renminbi (5000 = US 625 dollars). Eighty percent (n = 257) of participants were willing to pay something for surgery (mean, 442+/-444 renminbi [US 55 dollars+/-55]). In regression models, older subjects were willing to pay less (8 renminbi [US 1 dollar] per year of age; P = 0.01). Blind subjects were significantly more likely (odds ratio, 5.7; 95% confidence interval, 1.7-19.3) to pay anything for surgery, but would pay on average 255 renminbi (US 32 dollars) less (P = 0.004). Persons at the highest annual income level (>10,000 renminbi [US 1250 dollars]) would pay 50 dollars more for surgery than those at the lowest level (<5000 renminbi) (P = 0.0003). The current cost of surgery in this program is 500 renminbi (US 63 dollars). CONCLUSIONS: Sustainable programs will need to attract younger, more well-to-do persons with better vision, while still providing access to the neediest patients.

Caracterização e transformação de Lenhosulfonatos de Eucalyptus globulus

Os lenhosulfonatos representam um sub-produto formado durante o cozimento ao sulfito ácido, sendo queimados para a regeneração da base e recuperação de energia. No entanto, os lenhosulfonatos são também considerados uma importante matéria-prima para a produção de vários produtos de valor acrescentado. Os objectivos principais deste trabalho foram contribuir para uma melhor compreensão sobre a caracterização química e estrutural dos lenhosulfonatos do Eucalyptus globulus, assim como, para complementar a informação disponível sobre a síntese e a caracterização estrutural e térmica de materiais poliméricos obtidos a partir de compostos modelo dos produtos de oxidação dos lenhosulfonatos. O licor de cozimento ao sulfito foi analisado em termos do teor de cinzas, extractáveis, compostos voláteis, açúcares e lenhosulfonatos. O teor de cinzas e açúcares no licor de cozimento é muito elevado, tendo sido necessário purificar o mesmo (2,8-13,8 % e 3,2-9,1 %, respectivamente). A análise dos açúcares mostrou uma quantidade considerável de pentoses, sendo o açúcar predominante a xilose. Os lenhosulfonatos foram purificados, isolados e caracterizados por química molhada (titulação potenciométrica e oxidação com permanganato), análise elementar, espectroscopia de ultravioleta/visível (UV/Vis), espectroscopia de infravermelho de transformada de Fourier (FTIR), espectroscopia de ressonância magnética nuclear de protão (RMN de 1H) e carbono (RMN de 13C), espectrometria de massa de ionização por electrospray (ESI-MS), cromatografia de permeação em gel (GPC), termogavimetria (TGA) e calorimetria diferencial de varrimento (DSC). Os lenhosulfonatos são constituídos principalmente por unidades S, são parcialmente sulfonados e possuem um peso molecular relativamente baixo (Mw = 1250-2400 Da). A ruptura das ligações β-O-4 e α-O-4 da lenhina do Eucalyptus globulus após cozimento ao sulfito ácido originam olígomeros de baixo peso molecular cuja estrutura foi elucidada por RMN 1D/2D e ESI-MS. A degradação térmica dos lenhosulfonatos apresentou dois máximos de degradação a 188-190ºC e a 315-380ºC. As curvas de DSC mostraram um pico endotérmico para temperaturas inferiores a 130ºC e um pico exotérmico a 300-500ºC. Os lenhosulfonatos foram despolimerizados na presença de oxigénio molecular em meio alcalino. Os produtos de oxidação principais foram o aldeído siríngico, a vanilina, o ácido vanílico e o ácido siríngico. A adição do catalisador (sal de cobre) promoveu a oxidação dos lenhosulfonatos aumentando o rendimento dos aldeídos aromáticos (< 50%). A presença de açúcares nos lenhosulfonatos teve um efeito negativo no rendimento dos produtos de oxidação principais. Alguns compostos modelo dos produtos de oxidação dos lenhosulfonatos foram polimerizados por poliadição (catiónica e radicalar) e policondensação. Os monómeros e os polímeros foram caracterizados por espectroscopia de infravermelho de transformada de Fourier e reflectância total atenuada (FTIR-ATR), RMN em solução e no estado sólido, UV/Vis no estado sólido, GPC, difracção de raios-X (XRD), TGA e DSC. Os compostos modelo estudados foram os estirenos metoxi-substituídos (p-metoxiestireno e 3,4-dimetoxiestireno) e os ácidos hidroxi aromáticos metoxi-substituídos (ácido vanílico e ácido siríngico). O 3,4-dimetoxiestireno foi ainda copolimerizado com o éter isobutil vinílico e os seus copolímeros foram desmetilados, assim como, o poli(p-metoxiestireno) e o poli(3,4-dimetoxiestireno). A polimerização catiónica do p-metoxiestireno e 3,4-dimetoxiestireno é mais rápida e mais completa do que a polimerização radicalar produzindo polímeros com pesos moleculares elevados. O poli(p-metoxiestireno) (Mw = 235000 Da) possui um peso molecular maior do que o poli(3,4-dimetoxiestireno) (Mw = 18800 Da). A estabilidade térmica e a temperatura de transição vítrea diminuiram com a presença do segundo grupo metoxilo. A desmetilação dos homopolímeros foi bem sucedida, tendo sido corroborada por FTIR-ATR e RMN. A policondensação do ácido siríngico foi dificultada pela presença do segundo grupo metoxilo, tendo sido necessário adicionar uma maior quantidade do agente de condensação devido a factores estéricos. O poli(ácido vanílico) e poli(ácido siríngico) são insolúveis na maior parte dos solventes orgânicos, sendo parcialmente solúveis em clorofórmio, ácido triflúoracético, 1,1,2,2- tetracloroetano, dimetilsulfóxido, tetrahidrofurano, N,N’-dimetilformamida e 1,1,1,3,3,3-hexaflúor-2-propanol. A estabilidade térmica diminuiu com a presença do segundo grupo metoxilo e os dois polímeros não exibiram temperatura de transição vítrea. O poli(ácido vanílico) e poli(ácido siríngico) apresentaram uma estrutura muito cristalina (grau de cristalinidade 70% e 50%, respectivamente). O segundo grupo metoxilo aumentou o valor da absorvância, mas a forma do espectro de UV/Vis foi similar. A polimerização catiónica do éter isobutil vinílico resultou na produção de um polímero muito viscoso com peso molecular elevado (Mw = 20400 Da). A degradação térmica do polímero ocorreu em várias gamas de temperatura e foi completa (0% de resíduo a 800ºC). A copolimerização catiónica do 3,4-dimetoxiestireno com o éter isobutil vinílico foi realizada com proporções diferentes 80:20, 50:50 e 20:80. Os copolímeros apresentaram uma viscosidade elevada e um peso molecular baixo (Mw = 2000-4000 Da) que aumentou com a quantidade de éter isobutil vinílico. A degradação térmica dos copolímeros ocorreu também em várias gamas de temperatura, sendo a sua degradação completa (0,9-1,5% de resíduo a 800ºC). A desmetilação dos copolímeros não foi bem sucedida, tendo sido confirmada por FTIR-ATR e RMN.

Ante-projecto de uma unidade de tratamento de águas residuais oleosas, no porto de Cádis

Dissertação de mest., Engenharia do Ambiente, Faculdade de Ciências do Mar e do Ambiente, Universidade do Algarve, 2008

Optimisation du traitement thermomécanique de pièces d’acier fabriquées par métallurgie des poudres

Le forgeage de préformes fabriquées par métallurgie des poudres nous permet d’atteindre une densification voisine de la densité théorique ce qui a comme incidence directe une amélioration substantielle des propriétés mécaniques finales des pièces, notamment la résistance en fatigue. La démarche préconisée pour améliorer cette performance critique de pièces forgées par métallurgie des poudres consiste à optimiser leurs caractéristiques métallurgiques et leur densité concomitante. À ce propos, une nouvelle formulation d’acier MP a été développée et caractérisée. La stratégie de développement portait sur l’utilisation d’éléments de microalliage préalliés, comme le vanadium et le niobium. Pour ce faire, on a optimisé le paramètre de mise en œuvre primordial, qui est la température de forgeage, afin d’obtenir une fine taille de grains à la fin du cycle du traitement réalisé accompagnée d’une densité élevée des pièces forgées. Une série de traitements d’austénisation sur une gamme étendue de température variant entre 900 °C à 1250 °C a été effectuée ce qui nous a permis par la suite de connaître, pour chaque mélange, l’évolution de la taille des grains en fonction de la température d’austénisation. La nouvelle formulation de composition chimique a démontré un impact marqué quant au contrôle de la taille de grains en fonction de la température d’austénitisation. Une étude comparative nous a permis d’identifier la température de forgeage la plus appropriée pour ce type de pièces et de dégager la méthodologie à suivre en fonction des propriétés mécaniques et microstructurales.

Self-optimization module for scheduling using case-based reasoning

Metaheuristics performance is highly dependent of the respective parameters which need to be tuned. Parameter tuning may allow a larger flexibility and robustness but requires a careful initialization. The process of defining which parameters setting should be used is not obvious. The values for parameters depend mainly on the problem, the instance to be solved, the search time available to spend in solving the problem, and the required quality of solution. This paper presents a learning module proposal for an autonomous parameterization of Metaheuristics, integrated on a Multi-Agent System for the resolution of Dynamic Scheduling problems. The proposed learning module is inspired on Autonomic Computing Self-Optimization concept, defining that systems must continuously and proactively improve their performance. For the learning implementation it is used Case-based Reasoning, which uses previous similar data to solve new cases. In the use of Case-based Reasoning it is assumed that similar cases have similar solutions. After a literature review on topics used, both AutoDynAgents system and Self-Optimization module are described. Finally, a computational study is presented where the proposed module is evaluated, obtained results are compared with previous ones, some conclusions are reached, and some future work is referred. It is expected that this proposal can be a great contribution for the self-parameterization of Metaheuristics and for the resolution of scheduling problems on dynamic environments.

Study of the production of polyesters for polyurethanes at pilot plant scale

Dissertação para obtenção do grau de Mestre em Engenharia Química

Factores sociodemográficos na saúde oral : influências nos comportamentos de rotinas de saúde oral, frequências de idas a consultas, auto avaliação do estado de saúde oral e presença de dor em jovens de 12 anos

RESUMO - Introdução: A saúde oral é uma componente essencial na saúde geral e no bem-estar dos indivíduos. Sabe-se que os problemas de saúde oral afectam predominantemente os elementos de níveis socioeconómicos mais baixos, evidenciando a influência dos determinantes sociais da saúde na saúde oral das populações. Os objectivos deste estudo são caracterizar os comportamentos de rotinas diárias de higiene oral, frequências de idas a consultas de saúde oral, auto-avaliação do estado de saúde oral e percepção de dor na cavidade oral em crianças de 12 anos em Portugal e analisar a associação entre estes e os factores sociodemográficos. Métodos: Foi realizado um estudo observacional, transversal e analítico, abrangendo 1309 jovens e baseado em informação recolhida no III Estudo Nacional de Prevalência de Doenças Orais (ENPDO). Para além das estatísticas descritivas usuais, as estatísticas inferenciais basearam-se predominantemente em modelos de regressão logística binária. Resultados: Dos participantes, 70.6% (n=924) escova “duas ou mais vezes por dia” com associação com todas as variáveis sociodemográficas. Na análise multivariada, o género masculino (OR=2.088; IC95%: 1.574-2.770, em relação ao género feminino), a área de residência predominantemente rural ou mediamente urbana (OR= 1.800; IC95%: 2.587; OR=1.516; IC95%: 1.093-2.103, em relação a zonas predominantemente urbanas), a escolaridade da mãe ser o ensino básico (OR= 2.112; IC95%: 1.408-3.168, em relação ao ensino superior) e a actividade laboral do pai ser desempregado (OR= 1.938; IC95%: 1.280-2.934, em relação a ser trabalhador) foram as variáveis com mais impacto para a adopção de comportamentos de escovagem potencialmente inadequados (p<0.05). A maioria dos inquiridos (94.2%; n=1247) já tinham ido a uma consulta de saúde oral e 74.5% (n=860) nos últimos 12 meses, 95.5% (n=1250) encontram-se satisfeitos com a saúde oral e 44.5% (n=578) afirma ter tido algum tipo de dor na cavidade oral nos últimos 12 meses. Conclusão: Os resultados obtidos estão de acordo com a literatura em termos de factores de associação. Desta forma, a saúde oral nos jovens de 12 anos em Portugal, nos diversos contextos aqui analisados, pode ser considerada como satisfatória. A única excepção relevante é a componente da dor, com valores alarmantes embora de natureza mais subjectiva. A influência dos factores sociodemográficos sugere que futuras abordagens para a promoção da saúde oral tenham em conta os determinantes de saúde no delineamento de estratégias quer a nível individual quer a nível comunitário.