Probabilistic base calling of Solexa sequencing data.

BACKGROUND: Solexa/Illumina short-read ultra-high throughput DNA sequencing technology produces millions of short tags (up to 36 bases) by parallel sequencing-by-synthesis of DNA colonies. The processing and statistical analysis of such high-throughput data poses new challenges; currently a fair proportion of the tags are routinely discarded due to an inability to match them to a reference sequence, thereby reducing the effective throughput of the technology. RESULTS: We propose a novel base calling algorithm using model-based clustering and probability theory to identify ambiguous bases and code them with IUPAC symbols. We also select optimal sub-tags using a score based on information content to remove uncertain bases towards the ends of the reads. CONCLUSION: We show that the method improves genome coverage and number of usable tags as compared with Solexa's data processing pipeline by an average of 15%. An R package is provided which allows fast and accurate base calling of Solexa's fluorescence intensity files and the production of informative diagnostic plots.

Argon-laser iridoplasty in the management of uveitis-induced acute angle-closure glaucoma.

PURPOSE: To report the use of argon laser iridoplasty in the management of uveitic acute angle-closure glaucoma. METHODS: Interventional case report. RESULTS: A 46-year-old man developed uveitic acute angle-closure glaucoma with an intraocular pressure (IOP) of 65 mmHg. After unsuccessful attempts with medical treatment and two laser peripheral iridotomies, iridoplasty allowed to break posterior synechiae, open the angle, and reduce the IOP within a few hours. CONCLUSIONS: Argon laser iridoplasty allowed rapid reduction of IOP and prevented the need for emergency surgery. Therefore, the authors stipulate that it is a viable management option in active uveitic acute angle-closure glaucoma.

Nursing Activities Score (NAS) como instrumento para medir carga de trabalho de enfermagem em UTI adulto

Pesquisa de campo, prospectiva, quantitativa, descritiva-exploratória, realizada na UTI geral/adulto de um hospital privado do município de São Paulo. Objetivos: avaliar o NAS - Nursing Activities Score - como medida de carga de trabalho de enfermagem; sua aplicabilidade por turnos e sua correspondência com o quantitativo de enfermagem efetivo. Classificados 33 pacientes: idade média: 70,4 anos (+/-16,5), 66,7% do sexo masculino; permanência média na UTI: 17 dias (+/- 20,4); SAPSII: 41,7 (+/-17,9); risco de morte: (RM) 33,5% (+/- 26,8); 63,6% transferidos para Unidades de Cuidados Semi-Intensivos, 18,2% evoluíram a óbito. Obtiveram-se 396 medidas por turnos (134-manhã; 132-tarde; 130-noturno), média de 55,4 (+/-12,3) e 147 medidas de NAS de 24h, média de 69,6 (+/-18,2). O instrumento mostrou-se mais adequado à aplicação em 24 horas que por turnos, tendendo a refletir o número de profissionais efetivo, revelando-se interessante instrumento de classificação de pacientes e carga de trabalho de enfermagem em terapia intensiva.

Agonistes de neurotrofines com a teràpia neuroprotectora per la Esclerosi Múltiple

Les neurotrofines son factors tròfics que poden induir la supervivencia, la diferenciació i el creixement de les neurones i aquesta és la principal raó per la qual les estudiem en el context de les malalties neurológiques. Les propietats nombrades son crucials per a la cerca d’efectes funcionals pel que fa a tractaments de malalties neurológiques. Avui en dia. donada la seva activitat neuroprotectora, s’ha intentat l’administració extena de neurotrofines com una terapia per diverses enfermetats cerebrals, pero fins ara han tingut poc o cap resultat donada la inhabilitat d’aquestes molècules per creuar la barrera hematoencefàlica i pels seus efectes secondaris, com ara el dolor neuroilogic. Per això, l’aplicació de petites molècules similars a les neurotrofines es considerada com unapossible sol•lució com un possible tractament neuroprotector amb el cervell com a diana. L’objectiu principal d’aquest projecte és testar l’eficacia d’un compost replicant de la neurotrofina pel tractament de algunes enfermetats neurològiques i per a estudiar el mecanisme d’acció d’aquesta molècula. Els resultats obtinguts fins al moment mostren que hem desenvolupat e identificat un compost replicant de la neurotrofina (G79) que manté la seva capacitat com a factor de creixement nerviós (NGF) en un assaig funcional d’NGF (diferenciació i tests de supervivència). A més a més, hem obtingut una proba de concepte per a la eficacia d’aquest compost com un agent terapèutic en diversos models in vivo e in vitro d’Esclerosi Múltiple, glaucoma, enfermetat de Parkinson y Esclerosi Lateral Amiotrófica. En conclusió, els resultats obtinguts durant aquests dos anys suggereixen que la molècula replicant d’NGF G79 és un bon candidat per a ser desenvolutat com a part d’una estratégica terapeutica la diferenciació neuronal, promou la supervivència, activa la fosforilització de TrkA i TrkB, vies de senyalització específiques de la neurotrofina. Aquesta molècula ademés pot creuar la barrera hematoencefàlica per vies de transport actiu, millora el score clínic en animals infectats per Encefalomielitis Autoinmune Experimental, protegeix les cèlules gangliars retinals en el model in vivo de Glaucoma, promou la supervivència de les cèlules en els models in vitro de l’enfermetat de Parkinson i en ELA. En resum, els nostres resultats sugereixen que les molècules replicants de neurotrofina poden desenvoluparse com part d’una estratègia terapéutica neuroprotectora.

Nursing Activities Score (NAS): adaptação transcultural e validação para a língua portuguesa

O estudo teve como objetivos adaptar para o português e avaliar as propriedades psicométricas do Nursing Activities Score (NAS), instrumento de medida de carga de trabalho de enfermagem em UTI. Após o processo de adaptação cultural, o NAS foi aplicado em uma amostra de 200 pacientes adultos internados em UTIs. A análise da consistência interna pelo coeficiente Alfa de Cronbach revelou que o NAS possui 23 medidas independentes que não comportam consolidação ou redução. A avaliação da confiabilidade interobservadores demonstrou alta concordância (99,8%) e índice Kappa médio de 0,99. A validade concorrente foi demonstrada pela correlação estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), assim como pela análise de regressão multivariada (R²=94,4%; p<0,0001). Na avaliação da validade convergente, a regressão multivariada mostrou associação estatisticamente significativa entre o NAS e o SAPS II, quando ajustada pela idade (R²=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confiável e válido para mensurar carga de trabalho de enfermagem em UTIs brasileiras.

Outage probability analysis for MRC in η-μ fading channels with co-channel interference

Exact closed-form expressions are obtained for the outage probability of maximal ratio combining in η-μ fadingchannels with antenna correlation and co-channel interference. The scenario considered in this work assumes the joint presence of background white Gaussian noise and independent Rayleigh-faded interferers with arbitrary powers. Outage probability results are obtained through an appropriate generalization of the moment-generating function of theη-μ fading distribution, for which new closed-form expressions are provided.

Sustained release of nanosized complexes of polyethylenimine and anti-TGF-beta 2 oligonucleotide improves the outcome of glaucoma surgery.

The purpose of this study was to design microspheres combining sustained delivery and enhanced intracellular penetration for ocular administration of antisense oligonucleotides. Nanosized complexes of antisense TGF-beta2 phosphorothioate oligonucleotides (PS-ODN) with polyethylenimine (PEI), and naked PS-ODN were encapsulated into poly(lactide-co-glycolide) microspheres prepared by the double-emulsion solvent evaporation method. The PS-ODN was introduced either naked or complexed in the inner aqueous phase of the first emulsion. We observed a marked influence of microsphere composition on porosity, size distribution and PS-ODN encapsulation efficiency. Mainly, the presence of PEI induced the formation of large pores observed onto microsphere surface. Introduction of NaCl in the outer aqueous phase increased the encapsulation efficiency and reduced microsphere porosity. In vitro release kinetic of PS-ODN was also investigated. Clearly, the higher the porosity, the faster was the release and the higher was the burst effect. Using an analytical solution of Fick's second law of diffusion, it was shown that the early phase of PS-ODN and PS-ODN-PEI complex release was primarily controlled by pure diffusion, irrespectively of the type of microsphere. Finally, microspheres containing antisense TGF-beta2 nanosized complexes were shown, after subconjunctival administration to rabbit, to significantly increase intracellular penetration of ODN in conjunctival cells and subsequently to improve bleb survival in a rabbit experimental model of filtering surgery. These results open up interesting prospective for the local controlled delivery of genetic material into the eye.

Teaching motivational interviewing to medical students : a pre-post test pilot study

Objective: To test the efficacy of teaching motivational interviewing (MI) to medical students. Methods: Thirteen 4th year medical students volunteered to participate. Seven days before and 7 days after an 8-hour interactive training MI workshop, each student performed a videorecorded interview with two standardized patients: a 60 year old alcohol dependent woman and a 50 year old cigarette smoking man. Students' counseling skills were coded by two blinded clinicians using the Motivational Interviewing Treatment Integrity 3.0 (MITI). Inter-rater reliability was calculated for all interviews and a test-retest was completed in a sub-sample of 10 consecutive interviews three days apart. Difference between MITI scores before and after training were calculated and tested using non-parametric tests. Effect size was approximated by calculating the probability that posttest scores are greater than pretest scores (P*=P(Pre<Post)+1/2P(Pre=Post)), P*>1/2 indicating greater scores in posttest, P*=1/2 no effect, and P*<1/2 smaller scores in posttest. Results: Median differences between MITI scores before and after MI training indicated a general progression in MI skills: MI spirit global score (median difference=1.5, Inter quartile range=1.5, p<0.001, P*=0.90); Empathy global score (med diff=1, IQR=0.5, p<0.001, P*=0.85); Percentage of MI adherent skills (med diff=36.6, IQR=50.5, p<0.001, P*=0.85); Percentage of open questions (med diff=18.6, IQR=21.6, p<0.001, P*=0.96); reflections/ questions ratio (med diff=0.2, IQR=0.4, p<0.001, P*=0.81). Only Direction global score and the percentage of complex reflections were not significantly improved (med diff=0, IQR=1, p=0.53, P*=0.44, and med diff=4.3, IQR=24.8, p=0.48, P*=0.62, respectively). Inter-rater reliability indicated weighted kappa ranged between 0.14 for Direction to 0.51 for Collaboration and ICC ranged between 0.28 for Simple reflection to 0.95 for Closed question. Test-retests indicated weighted kappa ranged between 0.27 for Direction to 0.80 for Empathy and ICC ranged between 0.87 for Complex reflection to 0.98 for Closed question. Conclusion: This pilot study indicated that an 8-hour training in MI for voluntary 4th year medical students resulted in significant improvement of MI skills. Larger sample of unselected medical students should be studied to generalize the benefit of MI training to medical students. Interrater reliability and test-retests suggested that coders' training should be intensified.

Postoperative subconjunctival mitomycin-C injection after non-penetrating glaucoma surgery.

PURPOSE: To evaluate subconjunctival mitomycin C (MMC) injection efficacy and safety in patients with failing glaucoma non-penetrating filtering blebs. METHODS: Twenty-eight eyes were consecutively recruited for this study. Only one eye for each patient was randomly selected. All the recruited patients had glaucoma and uncontrolled intraocular pressure after a non-penetrating filtering glaucoma surgery and/or a pathological aspect of the filtering bleb (i.e., vascularized and/or encysted). One or more MMC injections were performed under the conjunctiva closed to the bleb to improve filtration. Local effects and complications of subconjunctival MMC injections were analyzed. RESULTS: Out of the 28 patients, 21 (75%) had MMC also applied intraoperatively. The mean postoperative IOP before MMC injections was 17 +/- 6.6 mmHg. The final IOP after MMC injections was 13.9 +/- 2.9 mmHg after a mean follow-up of 6 months. A total of 67 subconjunctival MMC injections were performed with a mean of 2.9 (ranging from 1 to 5) injections per patient. The only complication found to be possibly related to MMC injections was two cases of corneal Dellen. CONCLUSION: From these preliminary results, subconjunctival MMC injections in selected cases appear to be not only safe but also effective in promoting further the postoperative IOP drop.

Sistema NAS: Nursing Activities Score em tecnologia móvel

Este estudo objetivou apresentar a estrutura informatizada que viabiliza a utilização do Nursing Activities Score (NAS) em tecnologia móvel. Trata-se de um projeto de desenvolvimento de produção tecnológica baseado na engenharia de software, fundamentada na teoria do ciclo de vida de desenvolvimento de sistema. O Sistema NAS foi construído em dois módulos: módulo de pesquisa, cujo acesso é realizado através de computador pessoal (PC) e módulo de coleta de dados, acessado por meio de dispositivo móvel (smartphone). O Sistema NAS foi construído de modo a permitir que outros formulários, além do instrumento NAS, sejam incluídos futuramente. Assim, entende-se que o desenvolvimento do Sistema NAS permitirá a aproximação entre os enfermeiros e a tecnologia móvel facilitando o acesso imediato aos dados do instrumento referentes aos pacientes, auxiliando na tomada de decisão e na adequação do quantitativo de pessoal de enfermagem para prestação da assistência.

Deep sclerectomy combined with trabeculectomy in pediatric glaucoma

Résumé : Ce travail porte sur l'étude rétrospective d'une série de jeunes patients opérés de glaucomes pédiatriques. Le but est d'évaluer le résultat au long cours d'une intervention chirurgicale combinant une sclérectomie profonde et une trabéculectomie (sclérectomie profonde pénétrante). Durant la période de mars 1997 à octobre 2006, 28 patients on été suivis pour évaluer le résultat de cette chirurgie effectuées sur 35 yeux. Un examen ophtalmologique complet a été pratiqué avant la chirurgie, 1 et 7 jours, puis 1, 2, 3, 4, 6, 9, 12 mois, enfin tous les 6 mois après l'opération. Les critères d'évaluation du résultat postopératoire sont : les changements de pression intraoculaire, le traitement antiglaucomateux adjuvant, le taux de complication, le nombre de reprises chirurgicales,- l'erreur de réfraction, la meilleure acuité visuelle corrigée, l'état et le diamètre de la cornée. L'âge moyen est de 3.6 ± 4.5 ans et le suivi moyen de 3.6 ± 2.9 ans. La pression intraoculaire préopératoire de 31.9 ± 11.5 mmHg baisse de 58.3% (p<0.005) à la fin du suivi. Sur les 14 patients dont l'acuité visuelle a pu être mesurée, 8 (57.1 %) ont une acuité égale ou supérieure à 5/10e, 3 (21.4%) une acuité de 2/10e après intervention. Le taux de succès cumulatif complet à 9 ans est de 52.3%, le succès relatif 70.6%. Les complications menaçant la vision (8.6%) ont été plus fréquentes dans les cas de glaucome réfractaire. Pour conclure la sclérectomie profonde combinée à une trabéculectomie est une technique chirurgicale développée afin de contrôler la pression intraoculaire dans les cas de glaucomes congénitaux, juvéniles et secondaires. Les résultats intermédiaires sont encourageants et prometteurs. Les cas préalablement opérés avant cette nouvelle technique ont cependant un pronostic moins favorable. Le nombre de complications menaçant la vision est essentiellement lié à la sévérité du glaucome et au nombre d'interventions préalables. Abstract : Purpose : To evaluate the outcomes of combined deep sclerectomy and trabeculectomy (penetrating deep sclerectomy) in pediatric glaucoma. Design : Retrospective, non-consecutive, non-comparative, interventional case series. Participants : Children suffering from pediatric glaucoma who underwent surgery between March 1997 and October 2006 were included in this study. Methods : A primary combined deep sclerectomy and trabeculectomy was performed in 35 eyes of 28 patients. Complete examinations were performed before surgery, postoperatively at 1 and 7 days, at 1, 2, 3, 4, 6, 9, 12 months and then every 6 months after surgery. Main Outcome Measures : Surgical outcome was assessed in terms of intraocular pressure (IOP) change, additional glaucoma medication, complication rate, need for surgical revision, as well as refractive errors, best corrected visual acuity (BCVA), and corneal clarity and diameters. Results : The mean age before surgery was 3.6 ± 4.5 years, and the mean follow-up was 3.5 ± 2.9 years. The mean preoperative IOP was 31.9 ± 11.5 mmHg. At the end of follow-up, the mean IOP decreased by 58.3% (p<0.005), and from 14 patients with available BCVA 8 patients (57.1 %) achieved. 0.5 (20/40) or better, 3 (21.4%) 0.2 (20/100), and 2 (14.3%) 0.1 (20/200) in their better eye. The mean refractive error (spherical equivalent) at final follow-up visits was +0.83 ± 5.4. Six patients (43%) were affected by myopia. The complete and qualified success rates, based on a cumulative survival curve, after- 9 years were 52.3% and 70.6%, respectively (p<0.05). Sight threatening complications were more common (8.6%) in refractory glaucomas. Conclusions : Combined deep sclerectomy and trabeculectomy is a surgical technique developed to control IOP in congenital, secondary and juvenile glaucomas. The intermediate results are satisfactory and promising. Previous classic glaucoma surgeries performed before this new technique had less favourable results. The number of sight threatening complications is related to the severity of glaucoma and number of previous surgeries.