Control of intraocular pressure after deep sclerectomy

Aim: To study the long-term outcome of deep sclerectomy in patients with open angle glaucoma. Methods: Prospective consecutive series of 43 eyes (38 patients) with medically uncontrolled open-angle glaucoma undergoing deep sclerectomy. All patients underwent clinical assessment before and after surgery at day 7 and at months 1, 3, 6, 12, 18, 24, 36. Surgical success was considered if the patient's intraocular pressure (IOP)>22 mmHg and the IOP was lowered by more than 20% without the use of any medication. Kaplan-Meier survival curves were used to evaluate the success rate. Results: The mean follow-up time was 28.1±8.2 months. Mean IOP decreased significantly from a preoperative value of 24.6±5.5 mmHg to a postoperative value of 18.5±4.6 mmHg at 36 months (P>0.001). Microperforation of TDM occurred in three cases (7.0%) and ciliary body prolapse in one case (2.3%) but did not prevent completion of the operation. Postoperatively, hyphaema was detected in one case and shallow anterior chamber in another case and both were treated conservatively. Bleb encapsulation with elevation of IOP occurred in two cases (4.7%) and was treated with 5-fluorouracil subconjunctival injection. Goniopuncture with neodymium : YAG laser was performed in two cases (4.7%). There were no other late complications with the exception of failure of the operation. On the life-table analysis the success rate at 12, 24, and 30 months were 61.4, 36.6, and 18.9%, respectively. Conclusion: Deep sclerectomy reduced the IOP temporarily while minimising the risk of postoperative complications commonly encountered with standard trabeculectomy. However, after long-term follow-up surgery failed to maintain a low IOP. © 2006 Nature Publishing Group. All rights reserved.

Factors that impact the sustainability of wait time management strategies for total joint replacement surgeries in canadian provinces

Pour répondre aux exigences du gouvernement fédéral quant aux temps d’attente pour les chirurgies de remplacement du genou et de la hanche, les établissements canadiens ont adopté des stratégies de gestion des listes d’attentes avec des niveaux de succès variables. Notre question de recherche visait à comprendre Quels facteurs ont permis de maintenir dans le temps un temps d’attente répondant aux exigences du gouvernement fédéral pendant au moins 6-12 mois? Nous avons développé un modèle possédant quatre facteurs, inspiré du modèle de Parsons (1977), afin d’analyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois études de cas ont été menées. En somme, le 1er cas a été capable d’obtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a été capable de maintenir les exigences > 18 mois et le 3e cas a été incapable d’atteindre les objectifs. Des documents furent recueillis et des entrevues furent réalisées auprès des personnes impliquées dans la stratégie. Les résultats indiquent que l’hôpital qui a été en mesure de maintenir le temps d’attente possède certaines caractéristiques: réalisation exclusive de chirurgie de remplacement de la hanche et du genou, présence d’un personnel motivé, non distrait par d’autres préoccupations et un esprit d’équipe fort. Les deux autres cas ont eu à faire face à une culture médicale moins homogène et moins axés sur l’atteinte des cibles; des ressources dispersées et une politique intra-établissement imprécise. Le modèle d’hôpital factory est intéressant dans le cadre d’une chirurgie surspécialisée. Toutefois, les patients sont sélectionnés pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas être retenu comme le modèle durable par excellence.

The Constitutional basis of aboriginal rights

Aboriginal rights are rights held by aboriginal peoples, not by virtue of Crown grant, legislation or treaty, but “by reason of the fact that aboriginal peoples were once independent, self-governing entities in possession of most of the lands now making up Canada.” It is, of course, the presence of aboriginal peoples in North America before the arrival of the Europeans that distinguishes them from other minority groups in Canada, and explains why their rights have special legal status. However, the extent to which those rights had survived European settlement was in considerable doubt until as late as 1973, which was when the Supreme Court of Canada decided the Calder case.2 In that case, six of the seven judges held that the Nishga people of British Columbia possessed aboriginal rights to their lands that had survived European settlement. The actual outcome of the case was inconclusive, because the six judges split evenly on the question whether the rights had been validly extinguished or not. However, the recognition of the rights was significant, and caught the attention of the Government of Canada, which began to negotiate treaties (now called land claims agreements) with First Nations in those parts of the country that were without treaties. That resumed a policy that had been abandoned in the 1920s, when the last numbered treaty was entered into.

Enfoque del paciente con sospecha de neuroinfección en urgencias

Las infecciones del sistema nervioso son importantes fuentes de morbilidad y mortalidad en el mundo, debido a diferentes factores como son el amplio uso de antibióticos que aunque contribuyen con éxito al manejo de infecciones, pero el mal uso por automedicación o tratamientos incompletos favorecen la emergencia de organismos resistentes y la existencia de “mimos infecciosos” que incluyen el síndrome de reconstitución inflamatoria (IRIS). Adicionalmente el crecimiento de las poblaciones inmunocomprometidas por el síndrome de inmunodeficiencia adquirida (SIDA) y por tratamientos agresivos para trasplante sólido o hematopoyético han mejorado la sobrevida de diferentes tipos de malignidades y alteraciones reumatológicas pero son poblaciones que tienen más susceptibilidad a contraer infecciones y encefalitis mediadas inmunológicamente, como son la encefalomielitis diseminada aguda (ADEM) o la encefalitis contra el receptor de N-metil-D aspartato (NMDA).

Mesoscale simulations of organized convection: importance of convective equilibrium

The validity of convective parametrization breaks down at the resolution of mesoscale models, and the success of parametrized versus explicit treatments of convection is likely to depend on the large-scale environment. In this paper we examine the hypothesis that a key feature determining the sensitivity to the environment is whether the forcing of convection is sufficiently homogeneous and slowly varying that the convection can be considered to be in equilibrium. Two case studies of mesoscale convective systems over the UK, one where equilibrium conditions are expected and one where equilibrium is unlikely, are simulated using a mesoscale forecasting model. The time evolution of area-average convective available potential energy and the time evolution and magnitude of the timescale of convective adjustment are consistent with the hypothesis of equilibrium for case 1 and non-equilibrium for case 2. For each case, three experiments are performed with different partitionings between parametrized and explicit convection: fully parametrized convection, fully explicit convection and a simulation with significant amounts of both. In the equilibrium case, bulk properties of the convection such as area-integrated rain rates are insensitive to the treatment of convection. However, the detailed structure of the precipitation field changes; the simulation with parametrized convection behaves well and produces a smooth field that follows the forcing region, and the simulation with explicit convection has a small number of localized intense regions of precipitation that track with the mid-levelflow. For the non-equilibrium case, bulk properties of the convection such as area-integrated rain rates are sensitive to the treatment of convection. The simulation with explicit convection behaves similarly to the equilibrium case with a few localized precipitation regions. In contrast, the cumulus parametrization fails dramatically and develops intense propagating bows of precipitation that were not observed. The simulations with both parametrized and explicit convection follow the pattern seen in the other experiments, with a transition over the duration of the run from parametrized to explicit precipitation. The impact of convection on the large-scaleflow, as measured by upper-level wind and potential-vorticity perturbations, is very sensitive to the partitioning of convection for both cases. © Royal Meteorological Society, 2006. Contributions by P. A. Clark and M. E. B. Gray are Crown Copyright.

Some Schroeder-Bernstein type theorems for Banach spaces

We first introduce the notion of (p, q, r)-complemented subspaces in Banach spaces, where p, q, r is an element of N. Then, given a couple of triples {(p, q, r), (s, t, u)} in N and putting Lambda = (q + r - p)(t + u - s) - ru, we prove partially the following conjecture: For every pair of Banach spaces X and Y such that X is (p, q, r)-complemented in Y and Y is (s, t, u)-complemented in X, we have that X is isomorphic Y if and only if one of the following conditions holds: (a) Lambda not equal 0, Lambda divides p - q and s - t, p = 1 or q = 1 or s = 1 or t = 1. (b) p = q = s = t = 1 and gcd(r, u) = 1. The case {(2, 1, 1), (2, 1,1)} is the well-known Pelczynski`s decomposition method. Our result leads naturally to some generalizations of the Schroeder-B em stein problem for Banach spaces solved by W.T. Gowers in 1996. (C) 2007 Elsevier Inc. All rights reserved.

Simulation of Sawmill Yard Operations Using Software Agents

Bergkvist insjön AB is a sawmill yard which is capable of producing 350,000 cubic meter of timber every year this requires lot of internal resources. Sawmill operations can be classified as unloading, sorting, storage and production of timber. In the company we have trucks arriving at random they have to be unloaded and sent back at the earliest to avoid queuing up of trucks creating a problem for truck owners. The sawmill yard has to operate with two log stackers that does several tasks including transporting the logs from trucks to measurement station where the logs will be sorted into classes and dropped into pockets from pockets to the sorted timber yard where they are stored and finally from there to sawmill for final processing. The main issue that needs to be answered here is the lining up trucks that are waiting to be unload, creating a problem for both sawmill as well as the truck owners and given huge production volume, it is certain that handling of resources is top priority. A key challenge in handling of resources would be unloading of trucks and finding a way to optimize internal resources.To address this problem i have experimented on different ways of using internal resources, i have designed different cases, in case 1 we have both the log stackers working on sawmill and measurement station. The main objective of having this case is to make sawmill and measurement station to work all the time. Then in case 2, i have divided the work between both the log stackers, one log stacker will be working on sawmill and pocket_control and second log stacker will be working on measurement station and truck. Then in case 3 we have only one log stacker working on all the agents, this case was designed to reduce cost of production, as the experiment cannot be done in real-time due to operational cost, for this purpose simulation is used, preliminary investigation into simulation results suggested that case 2 is the best option has it reduced waiting time of trucks considerably when compared with other cases and it showed 50% increase in optimizing internal resources.

A new perspective on the PPP hypothesis

This paper the stastistical properties of the real exchange rates of G-5 countries for the Bretton-Woods peiod, and draw implications on the purchasing power parity (PPP) hypothesis. In contrast to most previous studies that consider only unit root and stationary process to describe the real exchange tae, this paper also considers two in-between processes, the locally persistent process ans the fractionally integrated process, to complement past studies. Seeking to be consistent with tha ample evidence of near unit in the real exchange rate movements very well. This finding implies that: 1) the real exchange movement is more persistent than the stationary case but less persistent than the unit root case; 2) the real exchange rate is non-stationary but the PPP reversion occurs and the PPP holds in the long run; 3) the real exchange rate does not exhibit the secular dependence of the fractional integration; 4) the real exchange rate evolves over time in a way that there is persistence over a range of time, but the effect of shocks will eventually disappear over time horizon longer than order O (nd), that is, at finite time horizon; 5) shocks dissipation is fasters than predicted by the fractional integracion, and the total sum of the effects of a unit innovation is finite, implying that a full PPP reversion occurs at finite horizons. These results may explain why pasrt empirical estudies could not provide a clear- conclusion on the real exchange rate processes and the PPP hypothesis.

Tontura em idosos institucionalizados da cidade do NATAL/RN: Um estudo caso-controle em vestibulopatas e não-vestibulopatas

the institutionalized elderly presents for being more fragile a lot of body balance s changes, which can induce falls and health frailty. One of the consequences of it is the appearance of dizziness, vestibular or not. This study aims to identify the risk factors related to dizziness in institutionalized elderly, with and without vestibular disorders, in the city of Natal-RN. Method: a case-control study realized in 12 regulated by Health Surveillance Long Term Care Institutions for the elderly in Natal-RN. Elected seniors with good cognitive level and able to walk, totaling 115 individuals, and of these, 102 were selected according to the presence of dizziness in the last year (n = 51) and their controls (n = 51), paired by sex and age. The 51 elderly patients with dizziness were divided into 3 groups case: case one, for elderly with dizziness and without vestibulopathy (n=38); case two, for elderly with dizziness and vestibulopathy (n=13) and case three, for all the seniors with dizziness, or added to the case 1 case 2 (n=51). The 51 seniors who served as controls were also divided into three groups, according to the number of individuals of each case: control 1, n = 38, control 2, n = 13 control and 3 (sum of 1 control with control 2), n = 51. As possible risk factors were analyzed variables related to characteristics of the institution, to the habits of life of older people and those concerned with the health of the elderly. For statistical analysis, we used the chi-square or Fisher exact test for a significance level of 5% and calculating the association magnitude between variables by measuring the Odds Ratio. Results: as risk factors for dizziness without vestibular disorders were found the presence of hypertension and cardiovascular disease, as well as the presence of three or more disorders for elderly and use of gastric protector drugs. For the elderly group from case two were found no associated risk factor. For elderly patients with dizziness in the case group three, we observed the same risk factors found for the elderly in the case group one, plus the presence of osteoarthritis pathology, which was also significant for this group. Conclusion: dizziness in institutionalized elderly is associated with systemic common diseases in this age group and the vestibulopathy presents itself as pathology on an isolated way, not being possible, with our data, associate it with non-risk factors

Vulvar carcinoma in young patients and its relationship with genital warts

We report the occurrence of aggressive vulvar carcinoma associated with condyloma acuminata in three patients: under 33 years old. Discussion of the role of the human papilloma virus (HPV) in the development of vulvar cancer is also presented. Three patients with condyloma associated with aggressive vulvar squamous cell carcinoma, in situ (1 case) and invasive (2 cases), documented by biopsy and/or vulvectomy are presented. In situ hybridization (ISH) was used to characterize the subtypes of HPV. One patient with erythematous systemic lupus developed in situ carcinoma after 5 years. The other two cases also developed aggressive multicentric, invasive squamous cell carcinoma after 10 years of diagnosis of condyloma. In all cases HPV cytological abnormalities were seen throughout the pathological examination. HPV 16 and 18 were present in cells of invasive squamous cell carcinoma in cases 2 and 3. HPV 6 and 11 were detected only in the condyloma area in case 2. HPV 30 was seen only in the condyloma area in case 3. This report emphasizes the need for biopsies of all unusually persistent or treatment-resistant condylomas, particularly in young and/or immunoisuppressed patients.

KSHV genotypes A and C are more frequent in Kaposi sarcoma lesions from Brazilian patients with and without HIV infection, respectively

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Boundary oscillations and nonlinear boundary conditions

We study how oscillations in the boundary of a domain affect the behavior of solutions of elliptic equations with nonlinear boundary conditions of the type partial derivative u/partial derivative n + g(x, u) = 0. We show that there exists a function gamma defined on the boundary, that depends on an the oscillations at the boundary, such that, if gamma is a bounded function, then, for all nonlinearities g, the limiting boundary condition is given by partial derivative u/partial derivative n + gamma(x)g(x, u) = 0 (Theorem 2.1, Case 1). Moreover, if g is dissipative and gamma infinity then we obtain a Dirichlet an boundary condition (Theorem 2.1, Case 2).

Terapia de linguagem de irmãos com transtornos invasivos do desenvolvimento: estudo longitudinal

O objetivo deste trabalho foi descrever o processo de intervenção fonoaudiológica de dois irmãos com transtornos invasivos do desenvolvimento, por meio de um estudo longitudinal de caso clínico. Participaram dois irmãos, um de nove e outro de 11 anos de idade, ambos do gênero masculino, com autismo (Caso 1) e transtorno invasivo do desenvolvimento sem outra especificação (Caso 2). Como procedimento de coleta e análise de dados foi realizado um estudo longitudinal, por meio de acompanhamento dos casos ao longo de quatro anos de intervenção fonoaudiológica. Foram realizadas filmagens durante as sessões de terapia, análise documental de informações dos prontuários referentes à anamnese, avaliação e relatórios terapêuticos fonoaudiológicos, exames e avaliações multidisciplinares. em ambos os casos houve melhora no contato visual, na interação social, no vocabulário e na brincadeira simbólica. No Caso 1 ocorreu aumento de 2,0 para 6,2 atos comunicativos por minuto, no Caso 2 de 3,5 para 8,0 atos e ambos demonstraram predominância do meio verbal e maior variedade de funções comunicativas. Outros fatores influenciaram estes resultados, como a deficiência intelectual, a dinâmica familiar, os conflitos no relacionamento entre os irmãos e o ambiente escolar em que estavam inseridos. Confirmou-se a relevância do fonoaudiólogo em intervenções nos transtornos invasivos do desenvolvimento, junto a equipes multidisciplinares, para a discussão diagnóstica e de condutas mais adequadas. Estudos longitudinais podem contribuir para uma análise mais detalhada e fidedigna de intervenções terapêuticas nesses casos, para esclarecer lacunas existentes na literatura e subsidiar a atuação do fonoaudiólogo clínico.

Granuloma facial: A proposito de dois casos

Granuloma faciale is a benign and rare disease restricted to the skin. Its etiopathogenesis is not related to systemic granulomatous and eosinophilic diseases. Two adult patients with reddish-brown lesions on the facial are reported. Among the treatments used, the more consistent results were observed with intralesional triamcinolona (Case 1) and with CO2 Laser (Case 2), with clear advantage of the laser therapy. The histopathology and the therapeutic options are discussed.

Compression of the peripheral branches of the sciatic nerve by lipoma

The authors report two female patients with chronic sensitive and motor findings in lower limbs caused by compression of distal branches of sciatic nerve by lipoma. Similar eases were not described on literature. Nerve conduction studies allowed to localize the exact site of compression. At surgery, lipomas compressing the deep peroneal nerve (case 1) and the posterior tibial nerve (case 2) were observed. Histologic studies of tumors confirmed the diagnoses.