Optimisation of paediatrics computed radiography for full spine curvature measurements using a phantom: a pilot study

Aim: Optimise a set of exposure factors, with the lowest effective dose, to delineate spinal curvature with the modified Cobb method in a full spine using computed radiography (CR) for a 5-year-old paediatric anthropomorphic phantom. Methods: Images were acquired by varying a set of parameters: positions (antero-posterior (AP), posteroanterior (PA) and lateral), kilo-voltage peak (kVp) (66-90), source-to-image distance (SID) (150 to 200cm), broad focus and the use of a grid (grid in/out) to analyse the impact on E and image quality (IQ). IQ was analysed applying two approaches: objective [contrast-to-noise-ratio/(CNR] and perceptual, using 5 observers. Monte-Carlo modelling was used for dose estimation. Cohen’s Kappa coefficient was used to calculate inter-observer-variability. The angle was measured using Cobb’s method on lateral projections under different imaging conditions. Results: PA promoted the lowest effective dose (0.013 mSv) compared to AP (0.048 mSv) and lateral (0.025 mSv). The exposure parameters that allowed lower dose were 200cm SID, 90 kVp, broad focus and grid out for paediatrics using an Agfa CR system. Thirty-seven images were assessed for IQ and thirty-two were classified adequate. Cobb angle measurements varied between 16°±2.9 and 19.9°±0.9. Conclusion: Cobb angle measurements can be performed using the lowest dose with a low contrast-tonoise ratio. The variation on measurements for this was ±2.9° and this is within the range of acceptable clinical error without impact on clinical diagnosis. Further work is recommended on improvement to the sample size and a more robust perceptual IQ assessment protocol for observers.

A cirurgia reconstrutiva em patologia oncológica do nariz : paralisia do nervo facial anatomia cirurgia do nariz

RESUMO: Os carcinomas localizados no nariz são muito frequentes em todas as séries conhecidas. São de diagnóstico clínico fácil e a sua confirmação por biópsia é muito segura. As terapêuticas mais indicadas são a cirurgia e a radioterapia, genericamente eficazes. Verifica-se, no entanto, que os pacientes continuam a solicitar tratamento em estádios muito avançados, mesmo conhecendo o diagnóstico e tendo acesso aos serviços sem custos. Esta situação poderá explicar-se face ao curso relativamente lento de muitos destes tumores e à idade geralmente avançada dos doentes que, de acordo com alguns inquéritos, receiam mais a terapeûtica do que a doença. Para obtenção de informação útil para condução deste problema, foram ainda analisados outros parâmetros. A maioria dos pacientes continua a solicitar tratamento quando as lesões envolvem duas subunidades nasais. Esta circunstância permite planear o tratamento cirúrgico com relativa facilidade, isto é, com exérese e reconstrução cujo resultado estético final é bastante aceitável. Os tumores de grandes dimensões, envolvendo várias subunidades, sendo frequentes, raramente implicam rinectomia total. Pelo contrário, são mais frequentes os tumores que envolvem metade do nariz e as estruturas vizinhas tais como o maxilar, a órbita e o lábio superior, atingindo mesmo a base do crânio. O controlo da doença nestes estádios é muito difícil. Não raramente, quando se crê que a doença está controlada, a cirurgia reconstrutiva bem como outras formas de reabilitação conjugadas, deixam ainda muita insatisfação. A nossa actividade tem-se desenvolvido seguindo os critérios adoptados nos melhores centros, isto é, as técnicas clássicas, complementadas com refinamentos recentes. Porém reflectindo sobre os resultados obtidos no tratamento de tumores do nariz, surge-nos um conjunto de questões para as quais ainda não encontrámos respostas cabais. Actuando de acordo com os princípios que definem o estado da arte, não obtivemos ainda resultados que satisfaçam tanto os doentes quanto os cirurgiões. Incessantemente procuramos novos dados técnicos e científicos que nos permitam sair deste ciclo vicioso em que o doente retarda a procura de assistência, receoso de que a terapêutica o deixe desfigurado. Tendo sempre em vista a obtenção dos melhores resultados com o mínimo de tempos cirúrgicos, valorizamos alguns detalhes praticados nos retalhos com padrão vascular bem definido. Dado que as sequelas na zona dadora de tecidos são uma incontornável preocupação, procuramos refinar a sua aplicação no sentido de as atenuarmos. A fronte, excelente zona dadora para reconstrucção nasal major, era sede de sequelas actualmente inaceitáveis. Estudado o comportamento dos tecidos na fronte, depois de levantado o retalho e efectuado o seu encerramento com uso da técnica de expansão intra-operatória, determinámos a presença do Factor de Crescimento Vascular Endotelial no próprio retalho e na zona dadora, tendo em vista que a sua presença poderá explicar o comportamento dos tecidos que foram submetidos a esta técnica. Procurou-se estudar a qualidade da reconstrução em 45 pacientes submetidos a cirurgia de exérese e reconstrução nasal major, assim como a qualidade de vida, relacionada com a doença e a terapêutica. Embora se possa admitir a existência de dados sugestivos de estratégias mais adequadas, não foi possível relacionar a qualidade da reconstrução com qualidade de vida dos pacientes. Poderá eventualmente concluir-se que a observação permanente da reconstrução, com qualidade estética e funcional, será o melhor método de alterar a ideia clássica, ainda muito divulgada, mas já ultrapassada, de que a cirurgia reconstrutiva do nariz não é mais que transformar um defeito horroroso num defeito ridículo.---------------ABSTRACT: Malignant tumours found in the nose are very frequent in all known series. Clinical diagnosis is simple and confirmation of biopsy diagnosis is accessible and safe. The most advisable therapies are surgery and radiotherapy. Despite everything patients continue to wait until the tumour is in an advanced stage before asking for therapy, although they know the diagnosis and have free access to specialised services. This situation could probably be explained by the slow development rate of the tumours which is associated with the age of the patient. Upon inquiry, it was found that a significant number of patients are more afraid of therapy than of the disease itself. Other parameters have been analysed in order to obtain useful information about the management of this problem. The majority of patients seek adequate treatment when the lesions involve two nasal subunits. This allows the programming of surgical therapy with relative ease as they may be removed and reconstructed with interesting final aesthetical results. Large tumours involving several subunits are frequent, but they rarely call for total rhinectomy. On the contrary, tumours more frequently involve half of the nose and their neighbouring structures: for example, maxillary, orbital and upper lip, even reaching as far as the base of the skull. The control of the disease is very difficult in these stages.In cases in which it is believed that the disease is under control, reconstructive surgery in conjunction with other forms of rehabilitation still result in a lot of dissatisfaction. In our activity we try to follow the criteria adopted by the best centres following classic techniques, complemented with recent refinements. Reflecting on the treatment of tumours of the nose has led us to a series of questions to which we haven’t yet found the answers. In accordance with the defined principles of ‘the state of the art’ it still doesn’t satisfy either the patients or the surgeons. We are looking for new technical and scientific data which allows us to leave this vicious cycle, in that the deferred patient avoids looking for assistance, based on the fear that therapy could leave them disfigured. We attach importance to some practiced details on the well-defined vascular pattern of the flaps, with the principle aim of obtaining a good result, from the minimum number of operations. It is known that sequels in donor sites are a concern, so applied refinements are used in order to reduce the defect. The forehead has been considered an excellent donor site for major nasal reconstruction but the area of sequel is nowadays unacceptable. We tried to study the behaviour of the tissues of the forehead after taking the flap and closing the wound, using the intraoperative expansion technique. We determined the presence of Vascular Endothelial Growth Factor in the flaps and in the donor site, in which its presence could explain the behaviour of the tissues of the forehead that are submitted to this technique. The quality of the reconstruction was studied in 45 patients who were submitted to surgical exeresisand major nasal reconstruction, as was the relationship between the disease and the therapy regarding quality of life. It was not possible to directely relate the quality of the reconstruction to the quality of patients life, although some suggestive data of more adequate manegement may be interesting. One might eventually conclude that, permanent exposure of the reconstruction with aesthetic and funcional quality would be the best method in order to modify the classic idea which is still known although overridden today, that nasal reconstruction could transform a horrible defect into a ridiculous one.-------RÉSUMÉ: Les carcinomes situés sur le nez sont très fréquents dans toutes les séries connues. Ils sont de diagnostic facile et la confirmation de ce dernier par une biopsie, est accessible et très fiable. La chirurgie et la radiothérapie sont les thérapeutiques les mieux indiquées. Toutefois les patients continuent de solliciter un traitement, seulement dans des états très avancés bien qu’ils aient eu connaissance du diagnostic et ayant accès aux services. Cette situation pourra probablement s’expliquer par l’évolution relativement indolente de beaucoup de tumeurs, associée à l’âge des malades; bien que selon quelques enquêtes réalisées un nombre élevé de malades craint davantage la thérapeutique que la maladie. D’autres paramètres sont analysés en vue d’obtenir des informations utiles pour l’accompagnement de ce problème. La majorité de nos patients sollicite le traitement adéquat quand les lésions entourent deux sous-unités nasales, ce qui permet de planifier le traitement chirurgique avec une certaine facilité, c’est à dire l’exérèse et la reconstruction ayant un résultat final esthétique généralement très acceptable. Les tumeurs de grandes dimensions entourant différentes sous-unités sont fréquentes mais elles impliquent rarement une amputation nasal total. Au contraire, les tumeurs les plus fréquentes sont celles qui entourent la moitié du nez et les structures voisines comme le maxillaire, l’orbite et la lèvre supérieure, parfois, elles peuvent même atteindre la base du crâne. Le contrôle de la maladie dans ces états est très difficile et quand nous pensons que la maladie est contrôlée, la chirurgie reconstructrice associée à d’autres formes de réhabilitation provoquent encore une grande insatisfaction. Nous exerçons notre activité en essayant de suivre les critères adoptés dans les meilleurs centres. Nous appliquons les techniques classiques complétées de retouches pour obtenir un meilleur resultat. Le fait de traiter les tumeurs nasales nous fait réfléchir et poser un ensemble de questions auxquelles nous n’avons pas pu trouver de réponses. En actuant en accord avec les principes qui définissent l’état de l’art, nous n’avons pas obtenu de résultats qui satisfassent les malades et les chirurgiens. Nous recherchons de nouvelles données techniques et scientifiques qui nous permettent de sortir de ce cercle vicieux dans lequel le patient retarde la recherche d’aide craignant que la thérapeutique le défigure. Nous valorisons certains détails pratiqués sur les lambeaux de patron vasculaire bien défini et ayant comme principaux objectifs l’obtention d’un bon résultat en moins de temps de chirurgie. Nous savons que les séquelles de la zone donneuse de tissus sont préoccupantes, ainsi, que les retouches qui ont été appliqués dans l’objectif de les atténuer. Le front, excellente zone donneuse pour la reconstruction nasale majeure, était une source de séquelle actuellement inacceptable. Nous avons étudié le comportement des tissus du front après avoir relevé le lambeau et effectué la fermeture avec la technique de l’expansion intraoperative. Nous avons déterminé la présence du Facteur de Croissance Vasculaire Endothéliale dans le propre lambeau et dans la zone donneuse, celle-ci pourra expliquer le comportement des tissus du front qui ont été soumis à cette technique. On a essayé d´etudier la qualité de la reconstruction sur 45 patients soumis à la chirurgie d´exérèse et la reconstruction nasal majeure, ainsi comme la qualité de vie en relation avec la maladie et la thérapie. Quoique l´on puisse conclure par l´existence des données subjectives des stratégies plus justes, il est impossible de faire un rapport sur la qualité de la reconstruction avec la qualité de vie des patients. Eventuellement l´on purrait conclure que l´observation permanente de la reconstruction avec qualité esthétique et fonctionnelle, se serait la meilleure méthod de changer l´idée classique, mais depassée, de que la rhinopoièse n´est pas que transformer un affreux défaut par un défaut ridicule.

Impérios Digitais: dos Choques Culturais Anglo-Portugueses aos Jogos de Vídeo de Estratégia

À medida que o mundo Ocidental se apresenta cada vez mais subjugado ao primado da tecnologia (Forman, 2007:1), a possibilidade de ignorar o crescente impacte da Ludologia vai-se gradualmente inviabilizando. Através da adopção de uma perspectiva anglo-portuguesa, a presente dissertação focar-se-á no amplamente popular jogo de vídeo Sid Meier’s Civilization V: Brave New World (2013). Ao (re)interpretar as relações luso-britânicas no espaço de tempo compreendido entre 1890 (Ultimatum britânico) e 1910 (implantação da Primeira República Portuguesa), a presente dissertação tem em vista não só estudar a imprensa periódica portuguesa e inglesa, mas também demonstrar o modo como o jogo de vídeo em questão permite ao jogador desconstruir o “prepotente” domínio britânico sobre o “little Portugal”. Neste contexto, atribuir-se-á um lugar de destaque ao evolucionismo de Herbert Spencer. Profundamente respeitado por toda a Europa, durante a segunda metade do século XIX e princípios do século XX, o pensamento spenceriano revelou-se fundamental para compreender, por um lado, e em toda a sua extensão, o discurso jornalístico de finais do século XIX e inícios do XX, e, por outro, a narrativa e a estética do jogo Sid Meier’s Civilization V: Brave New World. De um modo geral, a presente análise visa, acima de tudo, questionar o cariz pós-colonial do jogo de vídeo sob observação e, simultaneamente, a sua capacidade de desafiar, de forma subversiva, o que pode ser tido como uma arrogante soberania britânica sobre um Portugal militar, económica e politicamente indefeso.

Banks and sovereigns: An econometric analysis of an entangled relationship

In this discussion OLS regressions are used to study the factors that influence sovereign yield spreads and domestic bank indeces for a set of euro area countries. The results show that common factors explain changes in bank indeces better than in the yields. Moreover, although there is some country differentiation, a common pattern among all is visible. A contemporary spillover effect between banks and sovereigns emerged after bank bailouts and became stronger with the burst of the sovereign debt crisis. The vicious cycle between the two has contributed to the escalation of spreads and to painful austerity measures.

Pain evaluation of patients with fibromyalgia, osteoarthritis, and low back pain

The purpose of this study was to evaluate and compare pain as reported by outpatients with fibromyalgia, osteoarthritis, and low back pain, in view of designing more adequate physical therapy treatment. PATIENTS AND METHODS: A Portuguese version of the McGill Pain Questionnaire - where subjects are asked to choose, from lists of pre-categorized words, one or none that best describes what they feel - was used to assess pain intensity and quality of 64 patients, of which 24 had fibromyalgia, 22 had osteoarthritis, and 18 had low back pain. The pre-categorized words were organized into 4 major classes -- sensory, affective, evaluative, and miscellaneous. RESULTS: Patients with fibromyalgia reported, comparatively, more intense pain through their choice of pain descriptors, both sensory and affective; they also chose a higher number of words from these classes than patients in the other groups and were the only ones to choose specific affective descriptors such as "vicious", "wretched", "exhausting", "blinding". CONCLUSION: Assuming that each disease presents unique qualities of pain experience, and that these can be pointed out by means of this questionnaire by patients' choice of specific groups of words, the findings suggest that fibromyalgia include not only a physical component, but also a psycho-emotional component, indicating that they require both emotional/affective and physical care.

Mulheres (in)visíveis: que "género" de comentadores no horário nobre da televisão?

Dissertação de mestrado em Ciências da Comunicação (área de especialização em Informação e Jornalismo)

Nutrition et Cerveau

L'énergie requise pour assurer un fonctionnement cérébral adéquat est considérable, et la synthèse et l'acheminement des nutriments sont largement tributaires de l'apport alimentaire. A l'inverse, le cerveau est nécessaire à la régulation de la prise de nourriture, soulignant son Interdépendance avec la nutrition. Bien que plus résistant à un apport calorique réduit que la majorité des autres organes, il peut souffrir de carences diverses, et également en être la cause. Cet article discute les mécanismes impliqués dans la régulation de la prise d'aliments, au travers d'exemples tels que les troubles du comportement alimentaire. Les carences vitaminiques et les régimes amaigrissants sont discutés à la lumière des conséquences neurologiques qu'ils entraînent.

Environmental pollution with soil-transmitted helminths in Sanliurfa, Turkey

Soil transmitted helminth (STH) infection are endemic in developing countries. A study was carried out of sewage farms, streams and vegetables to determine the sources and routes of STH infection in Sanliurfa, Turkey. Stool samples from farmhouse inhabitants as well as soil and vegetable samples from the gardens were collected and examined. In addition, water samples from streams and vegetable samples from the city market were collected and examined. One hundred and eighty-seven (59.5%) of a total of 314 samples, including 88.4% of the stool samples, 60.8% of the water samples, 84.4% of the soil samples and 14% of the vegetable samples, were found to be positive for STH eggs. These results indicate that the water, soil and vegetables are heavily contaminated, and suggest a vicious circle between humans and the environment. Improving environmental sanitation is imperative for the control of soil-transmitted helminthiasis in Sanliurfa.

Wilhelm Ziely ("Olwier und Artus", "Valentin und Orsus", 1521) und das Fiktionsproblem des frühneuhochdeutschen Prosaromans

Wilhelm Zielys ca. 1511-21 in Bern entstandene Prosaromane ‛Olwier und Artus' und ‛Valentin und Orsus' nach französischer Vorlage sind bisher kaum erschlossen. Lediglich ihre Paratexte werden seit jeher registriert: Zielys Vorrede zum 1521 als Doppelausgabe erschienenen Erstdruck beider Romane sowie ein erläuterndes Schlusskapitel zu ‛Olwier und Artus' gelten als innovative Lösungsversuche des im 16. Jahrhundert virulenten Wahrheitsproblems der Literatur und als frühe Zeugnisse für die Entwicklung modernen Fiktionsbewusstseins. Der Beitrag analysiert zunächst in systematischem Zugriff Verbindungspunkte zur neuzeitlichen Literaturästhetik und zeigt auf, daß diese Verbindungen nicht historisch sein können. In einem zweiten, historischen Zugriff untersucht er Zielys Modell im Kontext seines Gesamtwerks und stellt es in den kulturgeschichtlichen Zusammenhang der Jahre um 1520 in der alten Eidgenossenschaft. Er arbeitet die enge Anbindung der poetologischen Positionierung Zielys an den glaubensgeschichtlichen Diskurs am Vorabend der Berner Reformation heraus und wirft neue Fragen zur Auseinandersetzung mit dem Fiktionsproblem im Prosaroman, zugleich auch nach dem literaturwissenschaftlichen Zugang zu vormoderner Fiktionalität, auf.

Cognitive behavioural therapy leaflet.

This leaflet is for anyone who wants to know more about Cognitive Behavioural Therapy (CBT).It discusses how it works, why it is used, its effects, its side-effects, and alternative treatments. If you can't find what you want here, there are sources of further information at the end of this leaflet. What is CBT? It is a way of talking about: ï,§ how you think about yourself, the world and other people ï,§ how what you do affects your thoughts and feelings. CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now. When does CBT help? CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue. How does it work? CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are: ï,§ A Situation - a problem, event or difficult situation. From this can follow: ï,§ Thoughts ï,§ Emotions ï,§ Physical feelings ï,§ Actions Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. All these areas of life can connect like this: {5 Areas - click related link below} What happens in one of these areas can affect all the others. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. The way you think can be helpful - or unhelpful. An example: If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself. If you avoid the other person, you won't be able to correct any misunderstandings about what they think of you - and you will probably feel worse. This 'vicious circle' can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways. CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can 'do it yourself', and work out your own ways of tackling these problems. [For full factsheet â?" click on link above]This resource was contributed by the National Documentation Centre on Drug Use.

Mieux connaître la médecine du travail

Les Suisses travaillent... et consultent leur médecin. La Suisse est un pays de travailleurs: un des taux de chômage les plus bas du monde (moins de 5 %), 4,4 millions de personnes actives professionnellement sur 7,5 millions d'habitants... Et, heureusement, de travailleurs sains pour la plupart: selon une enquête de 2002, 85 % des Suisses de quinze ans et plus s'estimaient en bonne santé. Malgré cela, 77 % d'entre eux avaient tout de même eu recours à un médecin dans les douze mois précédant l'enquête. Si l'on ne retient que les personnes de 15 à 64 ans (donc professionnellement actives pour la plupart), la proportion se monte même à 81 %, ce qui représente près de deux millions de personnes ayant consulté au minimum une fois dans l'année. [Auteurs]