Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

Objective. Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. Patients and methods. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. Results. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Conclusions. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

The Westerly Index as complementary indicator of the North Atlantic oscillation in explaining drought variability across Europe

This paper analyses the influence of different atmospheric circulation indices on the multi-scalar drought variability across Europe by using the Standardized Precipitation Evapotranspiration Index (SPEI). The monthly circulation indices used in this study include the North Atlantic oscillation (NAO), the East Atlantic (EA), the Scandinavian (SCAN) and the East Atlantic-Western Russia (EA-WR) patterns, as well as the recently published Westerly Index (WI), defined as the persistence of westerly winds over the eastern north Atlantic region. The results indicate that European drought variability is better explained by the station-based NAO index and the WI than by any other combination of circulation indices. In northern and central Europe the variability of drought severity for different seasons and time-scales is strongly associated with the WI. On the contrary, the influence of the NAO on southern Europe droughts is stronger than that exerted by the WI. The correlation patterns of the NAO and WI with the SPEI show a spatial complementarity in shaping drought variability across Europe. Lagged correlations of the NAO and WI with the SPEI also indicate enough skill of both indices to anticipate drought severity several months in advance. As long as instrumental series of the NAO and WI are available, their combined use would allow inferring European drought variability for the last two centuries and improve the calibration and interpretation of paleoclimatic proxies associated with drought.

Detecting Free Riders in Collective Brands through a Hierarchical Choice Process

Free-riding behaviors exist in tourism and they should be analyzed from a comprehensive perspective; while the literature has mainly focused on free riders operating in a destination, the destinations themselves might also free ride when they are under the umbrella of a collective brand. The objective of this article is to detect potential free-riding destinations by estimating the contribution of the different individual destinations to their collective brands, from the point of view of consumer perception. We argue that these individual contributions can be better understood by reflecting the various stages that tourists follow to reach their final decision. A hierarchical choice process is proposed in which the following choices are nested (not independent): “whether to buy,” “what collective brand to buy,” and “what individual brand to buy.” A Mixed Logit model confirms this sequence, which permits estimation of individual contributions and detection of free riders.

PETRÓLEO E QUESTÃO ENERGÉTICA: UMA ABORDAGEM PARA O ENSINO DE GEOGRAFIA

O presente artigo foi escrito embasado em um trabalho realizado no colégio Estadual Vital Brasil, localizado na região central de Maringá – PR - Brasil. O mesmo foi feito em conjunto com o estágio supervisionado obrigatório da Universidade Estadual de Maringá – PR - Brasil em uma turma de 7ª série. A temática trabalhada foi a questão energética, segmento de extrema importância na atualidade, foi dado ênfase ao petróleo, devido à sua posição econômica e política. Um dos objetivos é demonstrar por meio de alguns dos trabalhos realizados com uma turma de 7ª série, essa dinâmica estabelecida entre a teoría do curso e a prática em sala de aula. A partir do embasamento teórico das aulas expositivas solicitamos que os alunos realizassem uma atividade. Esta consistía em uma questão que deveria ser respondia em no mínimo 15 linhas. A pregunta foi a seguinte: ‘‘Sendo o petróleo a principal fonte de energia na atualidade. Faça um texto descrevendo como seria o mundo sem ele (o petróleo). E quais os tipos de energia mais viáveis nesse contexto. ’’ O tempo para conclusão da resposta foi de uma hora aula. A partir das respostas estabeleceremos os resultados.

CARACTERÍSTICAS CLIMÁTICAS Y CONTAMINACIÓN URBANA EN SAN JOSÉ

En ensayo analiza el clima y la contaminación del medio urbano, específicamente el caso del centro de la ciudad de San José, Costa Rica, asimismo sus posibles soluciones.