Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: A new surgical approach

Purpose: To describe and present the results of a new surgical technique for patients with floppy eyelid syndrome, based on the medial upper eyelid stretching encountered in this condition. Methods: A case series of 24 patients with floppy eyelid syndrome who where found to have symptomatic predominately medial upper eyelid laxity was analyzed. The history, clinical features, histopathology, and outcome were reviewed after patients underwent medial upper eyelid shortening with or without upper eyelid skin reduction as the first surgical procedure. Results: Of the 24 patients, 18 were men (75%) with a mean age at referral of 56 years, having ocular discomfort and conjunctival irritation/papillary conjunctivitis as the main complaints at presentation. Obesity was present in 96% of cases, with lower eyelid laxityl/ectropion (50%) and upper eyelid eyelash ptosis (29%) in conjunction with the upper eyelid laxity. The affected side was related to sleeping habits or recurrent mechanical eyelid trauma. Histologic studies showed a nonspecific inflammatory cell infiltrate and loss of elastin with loose dermal connective tissue. After surgery, complete relief of ocular symptoms and good functional and cosmetic results were present in all cases after 18 months of follow-up. Conclusions: This new surgical approach is based on the presence of predominately medial upper laxity in patients with floppy eyelid syndrome. The excision of this stretched area stabilized the upper eyelid in an anatomic fashion, providing a good and stable long-term result. The possible mechanisms involved in the medial upper eyelid stretching are discussed.

The head and body lice of humans are genetically distinct (Insecta : Phthiraptera, Pediculidae): evidence from double infestations

Little is known about the population genetics of the louse infestations of humans. We used microsatellite DNA to study 11 double infestations, that is, hosts infested with head lice and body lice simultaneously. We tested for population structure on a host, and for population structure among seven hosts that shared sleeping quarters. We also sought evidence of migration among louse populations. Our results showed that: (i) the head and body lice on these individual hosts were two genetically distinct populations; (ii) each host had their own populations of head and body lice that were genetically distinct to those on other hosts; and (iii) lice had migrated from head to head, and from body to body, but not between heads and bodies. Our results indicate that head and body lice are separate species.

Faciltating the transition into motherhood through lullaby singing: A pilot study

This study explored how singing lullabies to babies impacts on first-time mothers' perceived coping and experience of mothering. Eighteen first-time mothers participated in a six-week lullaby intervention program. Data comprised of detailed diaries kept by the mothers over the six weeks in addition to semi-structured interviews with the mothers, pre and post-intervention. Results suggest that lullabies benefit mothers by relaxing and calming them, distracting them from other stressful thoughts, enhancing their experience of the bedtime task and enhancing their perception that they are good mothers. Results indicate that mothers' experience of the bedtime task and her transition to motherhood may be enhanced through singing lullabies to their babies at bedtime.

Acupressure for the in-patient treatment of nausea and vomiting in early pregnancy: A randomized control trial

Objective: The purpose of this study was to evaluate the efficacy of acupressure at the P6 point for the in-patient treatment of severe nausea and vomiting in early pregnancy. Study design: This was a prospective single-blind randomized control trial that involved 80 patients with nausea and vomiting plus ketonuria before 14 weeks of gestation. Results: There was no difference between length of stay, amount of medication, or fluid required between the acupressure and placebo groups, although acupressure reduced the number of patients who stayed >= 4 nights in the hospital. Acupressure was well tolerated and not associated with an increase in perinatal morbidity or death. Conclusion: The use of acupressure Lit the P6 point does not reduce the amount of antiemetric medication that is required, the requirement for intravenous fluid, and median duration of inpatient stay more than the use of placebo. A small reduction was seen in the number of women who required >= 4 days in the hospital. (c) 2006 Mosby, Inc. All rights reserved.

Apnea diving: Long-term neurocognitive sequelae of repeated hypoxemia

This article examines the neurocognitive sequelae of repeated exposure to hypoxemia in apnea (breath-hold) divers. A brief review of the literature on the physiological and neurological adaptations involved in the human diving reflex is presented. The results from a neuropsychological investigation of N = 21 elite apnea divers are evaluated. Standard neuropsychological tests, with known sensitivity to mild brain insults, included speed of visuo-motor responding, speed of language comprehension, response inhibition, and visual and verbal attention and recall tasks. Results indicated that the breath-hold divers performed tasks within the average range compared to norms on all tests, suggesting that 1-20 years of repeated exposure to hypoxemia including multiple adverse neurological events did not impact on performance on standard neuropsychological tasks. The results are discussed in relation to implications for clinical conditions such as sleep apnea, respiratory disorders, altitude sickness, and recreational apnea activities.

The history of theory

Do you see now why it feels so good to be a critical mind? Why critique, this most ambiguous pharmakon, has become such a potent euphoric drug? You are always right! When naïve believers are clinging forcefully to their objects ... you can turn all of those attachments into so many fetishes and humiliate all the believers by showing that it is nothing but their own projection, that you, yes you alone, can see. But as soon as naïve believers are thus inflated by some belief in their own importance, in their own projective capacity, you strike them by a second uppercut and humiliate them again, this time by showing that, whatever they think, their behavior is entirely determined by the action of powerful causalities coming from objective reality they don't see, but that you, yes you, the never sleeping critic, alone can see. Isn't this fabulous? Isn't it really worth going to graduate school to study critique?

ESPERANÇAS E DECEPÇÕES Uma análise crítica da Prática Pastoral do neopentecostalismo na Igreja Internacional da Graça de Deus sob a perspectiva da Práxis Religiosa

O texto analisa a prática pastoral do neopentecostalismo na Igreja Internacional da Graça de Deus. Esta Igreja expandiu-se substancialmente no Brasil, conseguiu arregimentar um número enorme de seguidores e conquistou expressiva visibilidade na mídia. A pesquisa estuda a trajetória histórica do neopentecostalismo, o seu desenvolvimento no Brasil e os aspectos teológicos do movimento. Estuda-se também a Igreja da Graça, sua origem, sua teologia, sua estrutura de governo, seu ministério pastoral e expansão. Por estar inserida dentro do neopentecostalismo, a Igreja da Graça reflete também a sua teologia, que propõe banir a doença, a pobreza e todo o tipo de sofrimento da vida humana, a fim de produzir uma nova geração de fiéis: ricos e saudáveis. De acordo com a sua teologia, o cristão deve viver todo o tempo de sua vida livre de qualquer aspecto negativo da existência humana. Se isso não acontece, é porque ele não tem fé, está sob o poder de Satã ou tem um comportamento que desagrada a Deus. Assim, a marca do verdadeiro cristão é a plena saúde física e emocional, além da prosperidade financeira. Entretanto, a pregação neopentecostal tem produzido desapontamentos, principalmente, quando a cura física não acontece e o dinheiro não aparece. Portanto, esta tese formula uma proposta de prática pastoral de esperança que possibilite aos decepcionados com essa mensagem triunfalista retomarem a vida cristã dentro do seu espaço cristão.(AU)

INTERVENÇÕES LÚDICAS COM MÃES DE RECÉM-NASCIDOS PRÉ-TERMO HOSPITALIZADOS

Esta pesquisa investiga a influência de intervenções lúdicas na diminuição da ansiedade materna com mães de recém-nascidos pré-termo hospitalizados, em um hospital universitário da Grande São Paulo. São estudadas 30 mães que tiveram parto prematuro, com faixa etária entre 16 e 40 anos e escolaridade até 2º grau, por meio de estudo avaliativo-interventivo-evolutivo. Inicia-se por uma entrevista psicológica semidirigida, com o objetivo de traçar o histórico gestacional, seguida de aplicação da Escala de Ansiedade, Depressão e Irritabilidade IDA, visando identificar o nível de ansiedade materna e do Inventário de Percepção Neonatal IPN-I para verificar a expectativa das mães em relação ao comportamento de choro, alimento e vômito de seus bebês pré-termo. A seguir são efetuadas intervenções grupais lúdicas em 16 encontros, um a cada semana, de 60 minutos, segundo modelo piagetiano, que estimula processos afetivosemocionais e cognitivos. Os dados relativos ao histórico gestacional revelam que 75% das mães encontram-se na segunda gestação e já sofreram aborto ou óbito fetal; têm ida de gestacional média de 31 semanas; peso médio do bebê ao nascer de 1.640g. e tempo de internação médio de 39,93 dias. Na análise do IDA em relação à ansiedade, 75% delas apresentam escore de alta intensidade (11,25), também alto quanto à depressão (10); o escore médio (3,73) da irritabilidade exteriorizada acompanha o da irritabilidade interiorizada (3,23). A correlação entre depressão e ansiedade indica que uma reação emocional segue a outra, não havendo diferença significativa importante entre ambas (p=0,306). O IPN-I comprova que as 30 mães têm expectativas em relação ao próprio filho similares aos bebês em geral, mostrando escores médios de 8,63 e 9,20, respectivamente, confirmados pelo escore 10,0 apontado em 75% da amostra, o que configura uma alta expectativa quanto aos aspectos de sono, alimentação e vômito dos bebês. A análise qualitativa revela que a criação de grupos lúdicos mostra-se favorável, com alta adesão e motivação das mães, favorecendo a diminuição da ansiedade, a adaptação à realidade vivida e a interação mãe-bebê de forma saudável durante a internação. O estudo apresenta a trajetória interventiva de três casos emblemáticos de diferentes níveis de ansiedade, ilustrando esta evolução. Estes dados sugerem que esta modalidade de intervenção caracterize-se como uma medida de prevenção, promoção e preservação da saúde física e psíquica da mãe e do recémnascido prematuro, com repercussões na família e na sociedade.(AU)

Knowledge maintenance and the frame problem

Knowledge maintenance is a major challenge for both knowledge management and the Semantic Web. Operating over the Semantic Web, there will be a network of collaborating agents, each with their own ontologies or knowledge bases. Change in the knowledge state of one agent may need to be propagated across a number of agents and their associated ontologies. The challenge is to decide how to propagate a change of knowledge state. The effects of a change in knowledge state cannot be known in advance, and so an agent cannot know who should be informed unless it adopts a simple ‘tell everyone – everything’ strategy. This situation is highly reminiscent of the classic Frame Problem in AI. We argue that for agent-based technologies to succeed, far greater attention must be given to creating an appropriate model for knowledge update. In a closed system, simple strategies are possible (e.g. ‘sleeping dog’ or ‘cheap test’ or even complete checking). However, in an open system where cause and effect are unpredictable, a coherent cost-benefit based model of agent interaction is essential. Otherwise, the effectiveness of every act of knowledge update/maintenance is brought into question.

Sleep disruption and domestic violence: exploring the interconnections between mothers and children

This paper argues that sleep disruption is both a strategy and an effect of violence and abuse which profoundly affects the lives of women and children. This paper traces the interconnections between the patterns of sleeping (not sleeping) for women and children living with and recovering from the effects of violence and abuse. It highlights the threat to the emotional and physical well-being of children and women and provides a non-pathologizing route into an exploration of one of the symptoms of trauma. It is based on a pilot study which interviewed 17 women, 14 of whom were mothers to 28 children. Mothers reported that many of their children experienced nightmares, bed-wetting, night panics and disrupted sleep patterns. Recovery of the ability to sleep was often slow and uneven with interactive effects between women and children slowing progress.

Embodying and embedding children's sleep: some sociological comments and observations

This paper, drawing on our own research findings data, explores the embodiment and embedment of sleeping in children's everyday/night lives. Key themes here include children's attitudes and feelings toward the dormant body, the processes, routines and rituals associated with going to bed and going to sleep, issues associated with bedrooms and privacy, and finally the relationship between dormancy and domicile. This in turn provides the basis, in the remainder of the paper, for a further series of reflections on the mutually informing relations between the sociology of sleep and the sociology of childhood. Remaining questions and challenges involved in researching children's sleep are also considered. Sleep, it is concluded, is not simply a rich and fascinating sociological topic in its own right it also has the potential to shed valuable new light on a significant yet hitherto under-researched part of children's lives, contributing important new insights in doing so.

An evaluation of certain aspects of an occupational health service

This thesis has been concerned with obtaining evidence to explore the proposition that the provision of occupational health services as arranged at the present time represents a misallocation of resources. The research has been undertaken within the occupational health service of a large Midlands food factory. As the research progressed it became evident that questions were being raised about the nature and scope of occupational health as well as the contribution, in combating danger at work, that occupational health services can make to the health and safety team. These questions have been scrutinized in depth, as they are clearly important, and a resolution of the problem of the definition of occupational health has been proposed. I have taken the approach of attempting to identify specific objectives or benefits of occupational health activities so that it is possible to assess how far these objectives are being achieved. I have looked at three aspects of occupational health; audiometry, physiotherapy and pre-employment medical examinations as these activities embody crucial concepts which are common to all activities in an occupational health programme. A three category classification of occupational health activities is proposed such that the three activities provide examples within each category. These are called personnel therapy, personnel input screening and personnel throughput screening. I conclude that I have not shown audiometry to be cost-effective. My observations of the physiotherapy service lead me to support the suggestion that there is a decline in sickness absence rates due to physiotherapy in industry. With pre-employment medical examinations I have shown that the service is product safety oriented and that benefits are extremely difficult to identify. In regard to the three services studied, in the one factory investigated, and because of the immeasurability of certain activities, I find support for the proposition that the mix of occupational health services as provided at the present time represents a misallocation of resources.

The clinical utility of the middle latency and 40Hz auditory evoked potentials in audiological electrodiagnosis

The two elcctrophysiological tests currently favoured in the clinical measurement of hearing threshold arc the brainstorm evoked potential (BAEP) and the slow vertex response (SVR). However, both tests possess disadvantages. The BAEP is the test of choice in younger patients as it is stable at all levels of arousal, but little information has been obtained to date at a range of frequencies. The SVR is frequency specific but is unreliable in certain adult subjects and is unstable during sleep or in young children. These deficiencies have prompted research into a third group of potentials, the middle latency response (MLR) and the 40HZ responses. This research has compared the SVR and 40HZ response in waking adults and reports that the 40HZ test can provide a viable alternative to the SVR provided that a high degree of subject relaxation is ensured. A second study examined the morphology of the MLR and 40HZ during sleep. This work suggested that these potentials arc markedly different during sleep and that methodological factors have been responsible for masking these changes in previous studies. The clinical possibilities of tone pip BAEPs were then examined as these components were proved to be the only stable responses present in sleep. It was found that threshold estimates to 5OOHz, lOOOHz and 4000Hz stimuli could be made to within 15dBSL in most cases. A final study looked more closely at methods of obtaining frequency specific information in sleeping subjects. Threshold estimates were made using established BAEP parameters and this was compared to a 40HZ procedure which recorded a series of BAEPs over a 100msec. time sweep. Results indicated that the 40mHz procedure was superior to existing techniques in estimating threshold to low frequency stimuli. This research has confirmed a role for the MLR and 40Hz response as alternative measures of hearing capability in waking subjects and proposes that the 40Hz technique is useful in measuring frequency specific thresholds although the responses recorded derive primarily from the brainstem.

Coverage overlapping problems in applications of IEEE 802.15.4 wireless sensor networks

IEEE 802.15.4 standard is a relatively new standard designed for low power low data rate wireless sensor networks (WSN), which has a wide range of applications, e.g., environment monitoring, e-health, home and industry automation. In this paper, we investigate the problems of hidden devices in coverage overlapped IEEE 802.15.4 WSNs, which is likely to arise when multiple 802.15.4 WSNs are deployed closely and independently. We consider a typical scenario of two 802.15.4 WSNs with partial coverage overlapping and propose a Markov-chain based analytical model to reveal the performance degradation due to the hidden devices from the coverage overlapping. Impacts of the hidden devices and network sleeping modes on saturated throughput and energy consumption are modeled. The analytic model is verified by simulations, which can provide the insights to network design and planning when multiple 802.15.4 WSNs are deployed closely. © 2013 IEEE.

The development of a symptom questionnaire for assessing virtual reality viewing using a head-mounted display

ABSTRACT: Purpose. Virtual reality devices, including virtual reality head-mounted displays, are becoming increasingly accessible to the general public as technological advances lead to reduced costs. However, there are numerous reports that adverse effects such as ocular discomfort and headache are associated with these devices. To investigate these adverse effects, questionnaires that have been specifically designed for other purposes such as investigating motion sickness have often been used. The primary purpose of this study was to develop a standard questionnaire for use in investigating symptoms that result from virtual reality viewing. In addition, symptom duration and whether priming subjects elevates symptom ratings were also investigated. Methods. A list of the most frequently reported symptoms following virtual reality viewing was determined from previously published studies and used as the basis for a pilot questionnaire. The pilot questionnaire, which consisted of 12 nonocular and 11 ocular symptoms, was administered to two groups of eight subjects. One group was primed by having them complete the questionnaire before immersion; the other group completed the questionnaire postviewing only. Postviewing testing was carried out immediately after viewing and then at 2-min intervals for a further 10 min. Results. Priming subjects did not elevate symptom ratings; therefore, the data were pooled and 16 symptoms were found to increase significantly. The majority of symptoms dissipated rapidly, within 6 min after viewing. Frequency of endorsement data showed that approximately half of the symptoms on the pilot questionnaire could be discarded because <20% of subjects experienced them. Conclusions. Symptom questionnaires to investigate virtual reality viewing can be administered before viewing, without biasing the findings, allowing calculation of the amount of change from pre- to postviewing. However, symptoms dissipate rapidly and assessment of symptoms needs to occur in the first 5 min postviewing. Thirteen symptom questions, eight nonocular and five ocular, were determined to be useful for a questionnaire specifically related to virtual reality viewing using a head-mounted display.