Zyoptix-LASIK : sarveiskalvon taittovirhekirurgian aiheuttamat komplikaatiot myopian korjaamisessa

Opinnäytetyön tarkoituksena oli tutkia sarveiskalvon taittovirhekirurgian aiheuttamia komplikaatioita ja niiden ilmenemiseen vaikuttavia tekijöitä myopian korjaamisessa. Tarkastelun kohteena olivat myös leikkaustuloksen pysyvyys, regressio ja ylikorjaukset kuukauden, kuuden kuukauden ja vuoden kuluttua Zyoptix®LASIK-leikkauksesta. Tutkimus oli laadultaan kvantitatiivinen ja se toteutettiin yhteistyössä Eiran sairaalan kanssa. Sain käyttööni Eiran sairaalan potilaskortiston, josta siirsin tarvittavat tiedot Datagraph-ohjelmaan. Tutkimusjoukko muodostui 322 myooppisesta silmästä, jotka silmäkirurgi Harri Koskela leikkasi Eiran sairaalassa tammi-kesäkuussa vuonna 2005 Zyoptix®LASIK-leikkausmenetelmällä. Tutkimustulosten mukaan komplikaatioita esiintyi vain 1,2 %:lla koko tutkimusjoukosta. Myopian määrällä ei tutkimuksen mukaan ollut tilastollisesti merkitsevää vaikutusta komplikaatioiden ilmenemiseen eikä leikkaustuloksen pysyvyyteen. Esiintyneitä komplikaatioita olivat debris, läpän dislokaatio, haze ja epiteelin kasvu. Eniten komplikaatioita esiintyi erittäin suuriasteisessa myopiassa, jolloin myös sarveiskalvon paksuus ja sarveiskalvolle tehtävän läpän paksuus olivat pienempiä verrattuna vähäisempään myopian määrään. Ablaatiosyvyys korreloi negatiivisesti taittovirheen määrän kanssa, jolloin myopian määrän kasvaessa ablaatiosyvyys kasvoi tilastollisesti erittäin merkitsevästi. Leikkaustulos oli pysyvä kuukauden ja kuuden kuukauden kuluttua Zyoptix®LASIK-leikkauksesta riippumatta myopian määrästä. Vuoden kuluttua leikkauksesta suurilla myoopeilla tapahtui lievää regressiota. Tulevaisuudessa taittovirhekirurgia on tärkeä taittovirheen korjausmuoto silmälasien ja piilolinssien ohella. Opinnäytetyö tukee ammattiosaamistani toimiessani näönhuollon asiantuntijana. Tutkimuksen suuren otoskoon vuoksi opinnäytetyön tulosta voi pitää luotettavana.

Medication exposure during pregnancy: a pilot pharmacovigilance system using health and demographic surveillance platform.

BACKGROUND: There is limited safety information on most drugs used during pregnancy. This is especially true for medication against tropical diseases because pharmacovigilance systems are not much developed in these settings. The aim of the present study was to demonstrate feasibility of using Health and Demographic Surveillance System (HDSS) as a platform to monitor drug safety in pregnancy. METHODS: Pregnant women with gestational age below 20 weeks were recruited from Reproductive and Child Health (RCH) clinics or from monthly house visits carried out for the HDSS. A structured questionnaire was used to interview pregnant women. Participants were followed on monthly basis to record any new drug used as well as pregnancy outcome. RESULTS: 1089 pregnant women were recruited; 994 (91.3%) completed the follow-up until delivery. 98% women reported to have taken at least one medication during pregnancy, mainly those used in antenatal programmes. Other most reported drugs were analgesics (24%), antibiotics (17%), and antimalarial (15%), excluding IPTp. Artemether-lumefantrine (AL) was the most used antimalarial for treating illness by nearly 3/4 compared to other groups of malaria drugs. Overall, antimalarial and antibiotic exposures in pregnancy were not significantly associated with adverse pregnancy outcome. Iron and folic acid supplementation were associated with decreased risk of miscarriage/stillbirth (OR 0.1; 0.08 - 0.3). CONCLUSION: Almost all women were exposed to medication during pregnancy. Exposure to iron and folic acid had a beneficial effect on pregnancy outcome. HDSS proved to be a useful platform to establish a reliable pharmacovigilance system in resource-limited countries. Widening drug safety information is essential to facilitate evidence based risk-benefit decision for treatment during pregnancy, a major challenge with newly marketed medicines.

Infective endocarditis.

Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease--mostly chronic rheumatic heart disease--IE now tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices, and patients exposed to healthcare-associated bacteremia. As a result, skin organisms (for example, Staphylococcus spp.) are now reported as the pathogen in these populations more often than oral streptococci, which still prevail in the community and in native-valve IE. Moreover, progress in molecular diagnostics has helped to improve the diagnosis of poorly cultivable pathogens, such as Bartonella spp. and Tropheryma whipplei, which are responsible for blood-culture-negative IE more often than expected. Epidemiological data indicate that IE mostly occurs independently of medico-surgical procedures, and that circumstantial antibiotic prophylaxis is likely to protect only a minute proportion of individuals at risk. Therefore, new strategies to prevent IE--including improvement of dental hygiene, decontamination of carriers of Staphylococcus aureus, vaccination, and, possibly, antiplatelet therapy--must be explored.

Analysis of torque and speed ripple producing non-idealities of frequency converters in electric drives

Electric motors driven by adjustable-frequency converters may produce periodic excitation forces that can cause torque and speed ripple. Interaction with the driven mechanical system may cause undesirable vibrations that affect the system performance and lifetime. Direct drives in sensitive applications, such as elevators or paper machines, emphasize the importance of smooth torque production. This thesis analyses the non-idealities of frequencyconverters that produce speed and torque ripple in electric drives. The origin of low order harmonics in speed and torque is examined. It is shown how different current measurement error types affect the torque. As the application environment, direct torque control (DTC) method is applied to permanent magnet synchronous machines (PMSM). A simulation model to analyse the effect of the frequency converter non-idealities on the performance of the electric drives is created. Themodel enables to identify potential problems causing torque vibrations and possibly damaging oscillations in electrically driven machine systems. The model is capable of coupling with separate simulation software of complex mechanical loads. Furthermore, the simulation model of the frequency converter's control algorithm can be applied to control a real frequency converter. A commercial frequencyconverter with standard software, a permanent magnet axial flux synchronous motor and a DC motor as the load are used to detect the effect of current measurement errors on load torque. A method to reduce the speed and torque ripple by compensating the current measurement errors is introduced. The method is based on analysing the amplitude of a selected harmonic component of speed as a function oftime and selecting a suitable compensation alternative for the current error. The speed can be either measured or estimated, so the compensation method is applicable also for speed sensorless drives. The proposed compensation method is tested with a laboratory drive, which consists of commercial frequency converter hardware with self-made software and a prototype PMSM. The speed and torque rippleof the test drive are reduced by applying the compensation method. In addition to the direct torque controlled PMSM drives, the compensation method can also beapplied to other motor types and control methods.

The Francoist repression in the Catalan Countries

This article offers an overview of Francoist repression in the Catalan Countries from the outbreak of the Civil War to the first decade after the establishment of the dictatorship. It covers both physical violence and measures such as economic repression, imprisonment, professional purges and the social and moral control to which the population as a whole was subjected. First the type of violence and domination exercised by the insurgents in the territories occupied is briefly examined. Then the author offers an account of the events: she commences in the summer of 1936 in Majorca, the only Catalan-speaking territory to remain in rebel hands, then proceeds to the Lleida region, which was occupied in the spring of 1938, and concludes with the final offensive against Catalonia and Valencia, launched in the winter of that same year. Special stress is laid on the repercussions of the 1939 Law of Political Responsibilities and the meaning attached by the occupiers to the pacification and reconstruction of the conquered territories.

Doses de nitrogênio e potássio em fertirrigação em maracujazeiro-amarelo consorciado com coqueiro-anão verde, na região Norte Fluminense

Com o objetivo de avaliar os efeitos de doses de nitrogênio (N) e potássio (K) na água de irrigação, sobre a produtividade e os teores foliares de nutrientes minerais em maracujazeiro-amarelo consorciado com coqueiro-anão verde no Norte Fluminense, foi instalado um experimento em delineamento inteiramente casualizado, com 2 tratamentos (2 doses de adubação, em fertirrigação: 1) N=161 e K=215 kg ha-1 ano-1, e 2) N=322 e K=430 kg ha-1 ano-1) e 12 repetições, em um solo classificado como Neossolo Quartzarênico. As plantas foram irrigadas por microaspersão, com emissores com vazão de 60 L hora-1, sendo um para cada pé de coco com quatro pés de maracujá, utilizando lâmina de 75% de Et0. A injeção do fertilizante foi feita por injetor do tipo Venturi. As unidades experimentais constaram de 5 plantas de coco e 20 de maracujá. Realizaram-se 5 amostragens foliares no maracujazeiro, com intervalos trimestrais. As amostras consistiram de 20 folhas recém-maduras, coletando-se a 5ª folha do ápice para a base do ramo. Determinaram-se os teores de N, P, K, Ca, Mg, S, Cl, Na, Fe, Zn, Cu, Mn e B. As doses de N e K não influenciaram na produtividade e no peso médio do fruto; apenas, os teores foliares de N, Ca e Zn, em algumas épocas de amostragem.

La formación del personal político liberal y la resistencia del absolutismo en Lleida en la transición del Antiguo Régimen al liberalismo

Este trabajo aborda la formación de los grupos dirigentes absolutista y liberal en la Lleida del último cuarto de siglo XVIII y primer tercio de siglo XIX. Siguiendo los principales hechos políticos de este periodo, dibujamos el enfrentamiento progresivo de ambos grupos en la comunidad. Asimismo, reflejamos una distinta adscripción socioprofesional según fuese su filiación política. De esta manera, constatamos que las filas absolutistas se nutrieron de las familias con más influencia social (pequeña nobleza local, ciudadanos honrados, notables y doctores) y los campesinos; mientras que los liberales concentraron las simpatías de los artesanos, hacendados sin privilegio, profesionales liberales e intelectuales.

Aristóteles y la teoría del género literario

The paper intend to analyse and sistematize the problems of the literary genus from Aristotle's Poetry. The Todorov's transgression of the genrus is already preconceived in Aristotle talking about the Margites and in some allusions to the prose: anyway this question is complicated with the disappearance of second book of Poetry.

Cambios y tendencias de la formación en España, del Primer al Segundo programa nacional de Formación Profesional

A la formación se le asigna capacidad para favorecer la productividad, la competitividad y el acceso a una ocupación. Teniendo en cuenta esta característica, el artículo analiza los cambios y tendencias de la formación inicial, continua y ocupacional en España desde la aprobación del primer Programa Nacíonal de Formación Profesional en 1993, hasta el segundo Programa aprobado en 1998. En este sentido, se observa que los tres subsistemas de formación no están exentos de ciertos puntos débiles que dificultan la plena consecución de los objetivos que tienen asignados y que en ciertos aspectos no han sido corregidos en el nuevo Programa Nacional de Formación Profesional.

Inmigrantes menores de edad en Cataluña: un reto para las instituciones educativas

La llegada de menores inmigrantes procedentes principalmente de África, ha comportado que en España, y concretamente en Cataluña, las instituciones públicas y privadas se planteen cómo atenderles. La respuesta dada desde la administración catalana se ha caracterizado por una evolución desde el uso de las estructuras existentes hasta la propuesta más reciente de creación de nuevos centros ante la dificultad de dar una respuesta adecuada con lo existente. El artículo que presentamos analiza, a partir de grupos de discusión con los profesionales de los centros que acogían a estos menores, cómo se ha vivido esta presencia y qué retos estructurales (adaptación a las demandas, idoneidad de crear centros específicos para estos menores y/o contar con la presencia de educadores que pertenezcan o conozcan la cultura de origen de estos menores, etc.) y formativos ha planteado.

The transtheoretical model in weight management: Validation of the Processes of Change Questionnaire

Objective: The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined. Methods: Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m2. They all completed the P-Weight and the stages of change questionnaire (SWeight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting. Results: A 34-item version of the PWeight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach"s alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale. Conclusion: The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.