Perceptual and instrumental evaluation of voice and tongue function after carotid endarterectomy

Objective: Laryngeal and tongue function was assessed in 28 patients to evaluate the presence, nature, and resolution of superior recurrent laryngeal and hypoglossal nerve damage resulting from standard open primary carotid endarterectomy (CEA). Methods. The laryngeal and tongue function in 28 patients who underwent CEA were examined prospectively with various physiologic (Aerophone II, laryngograph, tongue transducer), acoustic (Multi-Dimensional Voice Program), and perceptual speech assessments. Measures were obtained from all participants preoperatively, and at 2 weeks and at 3 months postoperatively. Results. The perceptual speech assessment indicated that the vocal quality of roughness was significantly more apparent at the 2-week postoperative assessment than preoperatively. However, by the 3-month postoperative assessment these values had returned to near preoperative levels, with no significant difference detected between preoperative and 3-month postoperative levels or between 2-week and 3-month postoperative levels. Both the instrumental assessments of laryngeal function and the acoustic assessment of vocal quality failed to identify any significant difference on any measure across the three assessment periods. Similarly, no significant impairment in tongue strength, endurance, or rate of repetitive tongue movements was detected at instrumental assessment of tongue function. Conclusions: No permanent changes to vocal or tongue function occurred in this group of participants after primary CEA. The lack of any significant long-term laryngeal or tongue dysfunction in this group suggests that the standard open CEA procedure is not associated with high rates of superior recurrent and hypoglossal nerve dysfunction, as previously believed.

Quality assurance of paediatric cardiac surgery: A prospective 6-year analysis

Objective: To audit effective quality assurance methods to monitor outcomes following paediatric cardiac surgery at a single institution. Methods: All patients undergoing cardiac surgery from January 1996 to December 2001 were enrolled prospectively. Patients were stratified by complexity of surgical procedure into four groups, with Category 4 being the most complex procedure. Outcome measures included death, length of admission and morbidity from complications. Results: A total of 1815 patients underwent 1973 surgical procedures. Of these, 1447 (73.3%) were cardiopulmonary bypass procedures, and 543 (27.5%) were more complex (Category 3 and 4) procedures. Median patient age was 3.5 years (range, 1 day-20 years) and patient weight 15.0 kg (range, 900 g to 90 kg). Sixty-six patients (3.6%) died during the study period. Of the procedures in 1996, 22.7% were classified as complex compared with 29.2% of procedures in 2001. The annual surgical mortality ranged from 1.9-4.7% (P=0.20), and when mortality was adjusted for complexity of surgery, there was no significant yearly variation in the mortality rate (P=0.57). Analysis of individual surgeon's results showed no significant difference in the mortality rate by complexity of surgery performed (P=0.90). Mean ventilation times did not change significantly over time (P=0.79). The yearly incidence of significant neurological complications ranged from 0.6% to 4.5% and the incidence of arrhythmias from 4.2% to 8.0%. No difference was detected between the years. Conclusions: Stratifying complexity of surgery proved valuable in monitoring surgical outcomes and detecting differences in performance over time as large subgroups were created for analysis.

Comment on "On the regulation of populations of mammals, birds, fish, and insects" II

Sibly et at. (Reports, 22 July 2005, p. 607) recently estimated the relationship between population size and growth rate for 1780 time series of various species. I explain why some aspects of their analysis are questionable and, therefore, why their results and estimation procedure should be used with care.

Ultrastructure, osmotic tolerance, glycerol toxicity and cryopreservation of caput and cauda epididymidal kangaroo spermatozoa

The aim of the present study was to compare cryopreservation, osmotic tolerance and glycerol toxicity between mature and immature epididymal kangaroo spermatozoa to investigate whether the lack of cryopreservation success of cauda epididymidal spermatozoa may be related to the increased complexity of the sperm ultrastructure acquired during epididymal transit. Caput and cauda epididymidal spermatozoa were recovered from red-necked wallabies (RNW; Macropus rufogriseus) and eastern grey kangaroos (EGK; M. giganteus). In Experiment 1, caput and cauda epididymidal spermatozoa were frozen and thawed using a standard cryopreservation procedure in Triscitrate buffer with or without 20% glycerol. Although cryopreservation of caput epididymidal spermatozoa resulted in a significant increase in sperm plasma membrane damage, they were more tolerant of the procedure than spermatozoa recovered from the cauda epididymidis (P< 0.05). In Experiment 2, caput and cauda epididymidal EGK spermatozoa were diluted into phosphate-buffered saline media of varying osmolarity and their osmotic tolerance determined. Plasma membranes of caput epididymidal spermatozoa were more tolerant of hypo-osmotic media than were cauda epididymidal spermatozoa ( P< 0.05). In Experiment 3, caput and cauda epididymidal RNW spermatozoa were incubated in Tris-citrate buffer with and without 20% glycerol at 35 and 4 degrees C to examine the cytotoxic effects of glycerol. At both temperatures, caput epididymidal spermatozoa showed less plasma membrane damage compared with cauda epididymidal spermatozoa when exposed to 20% glycerol ( P< 0.05). These experiments clearly indicate that epididymal maturation of kangaroo spermatozoa results in a decreased ability to withstand the physiological stresses associated with cryopreservation.

PSICODINÂMICA FAMILIAR A PARTIR DA PERCEPÇÃO DE CRIANÇAS INDÍGENAS GUARANI MBYA DE SÃO PAULO

Este estudo investigou, a partir do referencial psicanalítico, a percepção de crianças indígenas Guarani Mbya sobre a psicodinâmica de suas relações familiares; mais especificamente, descreveu aspectos da dinâmica familiar, na percepção dessas crianças indígenas, bem como aspectos intra-psíquicos e da introjeção das figuras parentais por essas crianças. O estudo foi realizado numa aldeia indígena da etnia Guarani Mbya, situada na periferia da cidade de São Paulo. Participaram deste estudo quatro crianças, na faixa etária de 07 a 10 anos, sendo três meninas e um menino. Como instrumentos, foram utilizados Oficinas Lúdicas e o Procedimento de Desenhos de Família com Estórias. Os dados foram coletados concomitantemente à realização das oficinas que ocorreram na escola da própria aldeia durante o ano de 2007. O material clínico, analisado de forma qualitativa, foi agrupado e descrito a partir do conteúdo extraído dos Desenhos de Família com Estórias, dos comportamentos apresentados e das relações que se estabeleceram nas oficinas. Os resultados, além de mostraram a importância das Oficinas Lúdicas como elemento fundamental para a coleta do material, dado a configuração do setting por elas proporcionado, permitiram a identificação de conflitos no que se refere à introjeção de figuras parentais, especialmente a paterna; conflitos na formação da identidade da criança e que pareciam relacionados à influência das relações entre cultura indígena e cultura não indígena. Observou-se ainda que, na percepção das crianças, a casa de reza representa apoio, proteção e segurança, que entendemos como tendo uma função egóica. Concluiu-se que há conflitos no desenvolvimento dessas crianças e na dinâmica das relações familiares. Ressalta-se a necessidade de mais pesquisas de natureza psicológica sobre esses povos, a fim de compreendê-los melhor, dado as especificidades desses grupos étnicos, para que assim se possam planejar ações preventivas e de promoção de saúde, que visem, principalmente, à proteção e preservação da identidade dessas crianças.(AU)

The hypocaloric diet in type 2 diabetes - déjà vu

Dietary modification is considered a cornerstone in the management of diabetes superimposed upon which are pharmacological therapies as required. The value of hypocaloric diets in reducing and eliminating glycosuria was extolled in the pre-insulin era. A common feature of the nutrient balance of these diets was restriction in the availability of carbohydrate. Herein we review the use of diet as therapy in the past and discuss the rationale for hypocaloric dietary management of type 2 diabetes in the 21st century, drawing comparisons with bariatric surgery and considering why weight loss is particularly difficult for overweight and obese individuals with type 2 diabetes. © SAGE Publications 2012.

Design and designing:a critical introduction

Design and Designing provides a broad and critical understanding of what is essentially a practical subject. Designing today is less a craft and more a part of the knowledge economy. It's all about knowing how to acquire knowledge and how to apply it creatively. Design and Designing covers the design process, modelling and drawing, working with clients, production and consumption, sustainability, professional practice and design futures. Chapters are written by expert teachers and practitioners from around the globe, each presenting an accessible and engaging overview of their field of design. Every chapter is highly illustrated with a combination of images and information boxes, which extend or highlight key material. Each section concludes with a design project, a hands-on activity for the reader. Design and Designing covers the full spectrum of design types, from graphic communication to product design, from fashion to games design, setting every type in its aesthetic, ethical and social contexts. With this essential book, readers will learn from today's best practice and best thinking in design, they will develop a critical sense, and become the designers of tomorrow.

Growing Neural Networks Using Nonconventional Activation Functions

In the paper, an ontogenic artificial neural network (ANNs) is proposed. The network uses orthogonal activation functions that allow significant reducing of computational complexity. Another advantage is numerical stability, because the system of activation functions is linearly independent by definition. A learning procedure for proposed ANN with guaranteed convergence to the global minimum of error function in the parameter space is developed. An algorithm for structure network structure adaptation is proposed. The algorithm allows adding or deleting a node in real-time without retraining of the network. Simulation results confirm the efficiency of the proposed approach.

Sandals Resorts International: The Quality Advantage

Founded in 1981, Sandals Resorts International is now 17 properties and 3,880 rooms, and also has become a world-class success story with one of the 10 most recognizable brand names in the international hospitality industry, according to the author, group director for human resources development and training for Sandals.

Daughter of Eve, "Femme Fatale", and Persecuted Artist: The Mythic Transgressive Woman in Oscar Wilde's and Richard Strauss's "Salome"

Historically, Salome was an unexceptional figure who never catalyzed John the Baptist's death. However, in Christian Scripture, she becomes the dancing seductress as fallen daughter of Eve.  Her stepfather Herod promises Salome his kingdom if she dances for him, but she follows her mother’s wish to have John beheaded. In Strauss’s opera, after Wilde's Symbolist-Decadent play, Salome becomes independent of Herodias’ will, and the mythic avatar of the femme fatale and persecuted artist who Herod has killed after she kisses John's severed head.  Her signature key of C# major, resolving to the C major sung by Herod and Jokanaan at her death, represent her tragic fate musically.

Commentary on Lowndes

This was the first British treatise dedicated specifically to the history of copyright law. The second edition, published in the same year as the passage of the Copyright Amendment Act 1842 (see: uk_1842) and the edition referred to in this commentary, was dedicated to the Sergeant Thomas Noon Talfourd, the driving force behind the 1842 Act, "for his generous advocacy of the rights of authors". Lowndes was a strong proponent of the natural rights of the author and his historical account reflects as much. The second edition is also notable in terms of drawing comparisons with various continental models of copyright protection in advocating a longer term of protection for literary works within the UK.

Évaluation du contrôle sensorimoteur chez les patients ayant une scoliose idiopathique de l'adolescent - Vers un biomarqueur des troubles sensorimoteur basé sur la stimulation vestibulaire galvanique

La scoliose est la pathologie déformante du rachis la plus courante de l’adolescence. Dans 80 % des cas, elle est idiopathique, signifiant qu’aucune cause n’a été associée. Les scolioses idiopathiques répondent à un modèle multifactoriel incluant des facteurs génétiques, environnementaux, neurologiques, hormonaux, biomécaniques et de croissance squelettique. Comme hypothèse neurologique, une anomalie vestibulaire provoquerait une asymétrie d’activation des voies vestibulospinales et des muscles paravertébraux commandés par cette voie, engendrant la déformation scoliotique. Certains modèles animaux permettent de reproduire ce mécanisme. De plus, des anomalies liées au système vestibulaire, comme des troubles de l’équilibre, sont observées chez les patients avec une scoliose. La stimulation vestibulaire galvanique permet d’explorer le contrôle sensorimoteur de l’équilibre puisqu’elle permet d’altérer les afférences vestibulaires. L’objectif de cette thèse est d’explorer le contrôle sensorimoteur en évaluant la réaction posturale provoquée par cette stimulation chez les patients et les participants contrôle. Dans la première étude, les patients sont plus déstabilisés que les contrôles et il n’y a pas de lien entre l’ampleur de l’instabilité et la sévérité de la scoliose. Dans la deuxième étude, à l’aide d’un modèle neuromécanique, un poids plus grand aux signaux vestibulaires a été attribué aux patients. Dans la troisième étude, un problème sensorimoteur est également observé chez les jeunes adultes ayant une scoliose, excluant ainsi que le problème soit dû à la maturation du système nerveux. Dans une étude subséquente, des patients opérés pour réduire leur déformation du rachis, montrent également une réaction posturale de plus grande amplitude à la stimulation comparativement à des participants contrôle. Ces résultats suggèrent que l’anomalie sensorimotrice ne serait pas secondaire à la déformation. Finalement, un algorithme a été développé pour identifier les patients ayant un problème sensorimoteur. Les patients montrant un contrôle sensorimoteur anormal ont également une réponse vestibulomotrice plus grande et attribuent plus de poids aux informations vestibulaires. Globalement, les résultats de cette thèse montrent qu’un déficit sensorimoteur expliquerait l’apparition de la scoliose mais pas sa progression. Le dysfonctionnement sensorimoteur n’est pas présent chez tous les patients. L’algorithme permettant une classification de la performance sensorimotrice pourrait être utile pour de futures études cliniques.

HPC management and engineering in the hybrid cloud

The evolution and maturation of Cloud Computing created an opportunity for the emergence of new Cloud applications. High-performance Computing, a complex problem solving class, arises as a new business consumer by taking advantage of the Cloud premises and leaving the expensive datacenter management and difficult grid development. Standing on an advanced maturing phase, today’s Cloud discarded many of its drawbacks, becoming more and more efficient and widespread. Performance enhancements, prices drops due to massification and customizable services on demand triggered an emphasized attention from other markets. HPC, regardless of being a very well established field, traditionally has a narrow frontier concerning its deployment and runs on dedicated datacenters or large grid computing. The problem with common placement is mainly the initial cost and the inability to fully use resources which not all research labs can afford. The main objective of this work was to investigate new technical solutions to allow the deployment of HPC applications on the Cloud, with particular emphasis on the private on-premise resources – the lower end of the chain which reduces costs. The work includes many experiments and analysis to identify obstacles and technology limitations. The feasibility of the objective was tested with new modeling, architecture and several applications migration. The final application integrates a simplified incorporation of both public and private Cloud resources, as well as HPC applications scheduling, deployment and management. It uses a well-defined user role strategy, based on federated authentication and a seamless procedure to daily usage with balanced low cost and performance.

The Hall-Findlay mammaplasty pattern for skin-sparing mastectomy. Case report

We present an application of the Hall-Findlay mammaplasty skin pattern for skin-sparing mastectomy (SSM). This is a simplified vertical reduction mammaplasty. Vertical reduction mammaplasty is the procedure advised for patients with moderator or large ptotic breasts, who wish to have a simultaneous contra-lateral breast reduction/mastopexy at the time of SSM for cancer or prophylactic mastectomy. It is particularly suitable for breast reconstruction with autologous tissue in the form of free transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric artery perforator (DIEP) and extended latissimus dorsi (ELD) flaps.

Oclusão percutânea do apêndice auricular esquerdo e estrutura auricular: efeito na função mecânica e endócrina auricular

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Intervenção Cardiovascular.