Assessment of cataract surgical outcomes in settings where follow-up is poor:PRECOG, a multicentre observational study

Background: Poor follow-up after cataract surgery in developing countries makes assessment of operative quality uncertain. We aimed to assess two strategies to measure visual outcome: recording the visual acuity of all patients 3 or fewer days postoperatively (early postoperative assessment), and recording that of only those patients who returned for the final follow-up examination after 40 or more days without additional prompting. Methods: Each of 40 centres in ten countries in Asia, Africa, and Latin America recruited 40-120 consecutive surgical cataract patients. Operative-eye best-corrected visual acuity and uncorrected visual acuity were recorded before surgery, 3 or fewer days postoperatively, and 40 or more days postoperatively. Clinics logged whether each patient had returned for the final follow-up examination without additional prompting, had to be actively encouraged to return, or had to be examined at home. Visual outcome for each centre was defined as the proportion of patients with uncorrected visual acuity of 6/18 or better minus the proportion with uncorrected visual acuity of 6/60 or worse, and was calculated for each participating hospital with results from the early assessment of all patients and the late assessment of only those returning unprompted, with results from the final follow-up assessment for all patients used as the standard. Findings: Of 3708 participants, 3441 (93%) had final follow-up vision data recorded 40 or more days after surgery, 1831 of whom (51% of the 3581 total participants for whom mode of follow-up was recorded) had returned to the clinic without additional prompting. Visual outcome by hospital from early postoperative and final follow-up assessment for all patients were highly correlated (Spearman's r_s=0·74, p<0·0001). Visual outcome from final follow-up assessment for all patients and for only those who returned without additional prompting were also highly correlated (r_s=0·86, p<0·0001), even for the 17 hospitals with unprompted return rates of less than 50% (r_s=0·71, p=0·002). When we divided hospitals into top 25%, middle 50%, and bottom 25% by visual outcome, classification based on final follow-up assessment for all patients was the same as that based on early postoperative assessment for 27 (68%) of 40 centres, and the same as that based on data from patients who returned without additional prompting in 31 (84%) of 37 centres. Use of glasses to optimise vision at the time of the early and late examinations did not further improve the correlations. Interpretation: Early vision assessment for all patients and follow-up assessment only for patients who return to the clinic without prompting are valid measures of operative quality in settings where follow-up is poor. Funding: ORBIS International, Fred Hollows Foundation, Helen Keller International, International Association for the Prevention of Blindness Latin American Office, Aravind Eye Care System. © 2013 Congdon et al. Open Access article distributed under the terms of CC BY.

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Objective: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
Design: Cross-sectional observational study.Setting The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
Participants: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)—severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
Main outcome measures: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
Results: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

Conclusions: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

Species composition of coastal dune vegetation in Scotland has proved resistant to climate change over a third of a century

Climate change is expected to have an impact on plant communities as increased temperatures are expected to drive individual species' distributions polewards. The results of a revisitation study after c. 34years of 89 coastal sites in Scotland, UK, were examined to assess the degree of shifts in species composition that could be accounted for by climate change. There was little evidence for either species retreat northwards or for plots to become more dominated by species with a more southern distribution. At a few sites where significant change occurred, the changes were accounted for by the invasion, or in one instance the removal, of woody species. Also, the vegetation types that showed the most sensitivity to change were all early successional types and changes were primarily the result of succession rather than climate-driven changes. Dune vegetation appears resistant to climate change impacts on the vegetation, either as the vegetation is inherently resistant to change, management prevents increased dominance of more southerly species or because of dispersal limitation to geographically isolated sites.

Can Future Managers and Business Executives be Influenced to Behave more Ethically in the Workplace? The Impact of Approaches to Learning on Business Students’ Cheating Behavior

This study considers the potential for influencing business students to become ethical managers by directing their undergraduate learning environment. In particular, the relationship between business students’ academic cheating, as a predictor of workplace ethical behavior, and their approaches to learning is explored. The three approaches to learning identified from the students’ approaches to learning literature are deep approach, represented by an intrinsic interest in and a desire to understand the subject, surface approach, characterized by rote learning and memorization without understanding, and strategic approach, associated with competitive students whose motivation is the achievement of good grades by adopting either a surface or deep approach. Consistent with the hypothesized theoretical model, structural equation modeling revealed that the surface approach is associated with higher levels of cheating, while the deep approach is related to lower levels. The strategic approach was also associated with less cheating and had a statistically stronger influence than the deep approach. Further, a significantly positive relationship reported between deep and strategic approaches suggests that cheating is reduced when deep and strategic approaches are paired. These findings suggest that future managers and business executives can be influenced to behave more ethically in the workplace by directing their learning approaches. It is hoped that the evidence presented may encourage those involved in the design of business programs to implement educational strategies which optimize students’ approaches to learning towards deep and strategic characteristics, thereby equipping tomorrow’s managers and business executives with skills to recognize and respond appropriately to workplace ethical dilemmas.

Biodiversidad y derechos de los pueblos: Amazonía por la vida

Busca regular el uso que Occidente hace del conocimiento tradicional, y no la abstracción del conocimiento o del uso interno del conocimiento tradicional.

The marriage of João de Alarcão and Margarida Soares and the creation of a transnational Portuguese-Spanish nobility

The main aim of this chapter is to analyze the social and political effects of dynastic marriages between the Portuguese and Castilian-Aragonese crowns on the configuration of transnational, aristocratic families during the sixteenth and seventeenth centuries. To illustrate these questions we have chosen to follow the Soares de Alarcão family (known in Spain as Suárez de Alarcón) and the paths it took between the royal houses of Portugal and Castile for seven generations. The working hypothesis of the chapter is that the identity of the Iberian nobility during this era was characterized by a shared noble culture rather than by any particular features derived from the family’s land of origin. That assumption allows us to discuss whether the use of a particular language or culture indicates ties or political loyalties based on criteria of nationality, or, at the very least, place of birth. Therefore, this essay discusses the miscegenation of Iberian nobilities derived from dynastic marriages. It articulates the structural characteristics of this group and its political impact with the individual trajectories and historical contexts in which they developed. While these topics can be of interest for the comprehension of Portuguese early modern history, they can also help us to reflect more broadly on processes of identity construction.

Marcas portuguesas: uma metodologia para a afirmação e avaliação dos seus impactos

O processo de criação de marcas – branding – decorre da intervenção de um diversificado número de especialistas de áreas científicas distintas como são: a da comunicação, da publicidade, do marketing e das relações públicas. O designer, apesar de ser um dos mais significantes actores no processo de construção da marca é, geralmente, relegado para o plano de fazedor das coisas esteticamente úteis. As razões deste facto podem ser encontradas neste estereótipo que constrange o entendimento sobre a vocação do designer, desvalorizando- se o seu papel de conceptualizador e não respeitando os seus argumentos. A flexibilidade do seu pensar analítico, criativo e sistémico associado à acção direccionada para a mudança leva à consideração de que o Designer é um agente multifacetado e, numa equipa, é um membro agregador de diversas sensibilidades. A síntese que opera através do desenho permite ao designer colocar-se numa posição de dinamização e, porventura, de liderança de carácter identitário. Tendo em conta o exposto o designer necessita de metodologias de apoio ao seu desempenho que lhe permitam realizar o trabalho para o qual está vocacionado. Enquadrado pela lógica sistémica da comunicação institucional, essas metodologias potenciam a observação, análise e avaliação da marca, uma vez que está focalizada na recolha das orientações dos destinatários da marca – cidadãos e consumidores. Conhecer como percepcionam a marca, qual a relação que mantêm com ela e como reagem à forma como a marca comunica é o desafio da metodologia criada. Deste modo, o designer poderá contribuir para a desconstrução dos estereótipos referidos, reforçar a sua posição no mercado de trabalho e afirmar a sua diferença face aos especialistas das áreas complementares com quem intervém. A tese que se apresenta tem por finalidade elaborar uma metodologia para a afirmação e avaliação dos impactos da marca, no sentido de conhecer as orientações de quem melhor sabe lidar com a marca - o público-alvo. E, integrar toda a informação no processo decisão que o designer protagoniza.

Spatial hearing and sound perception in musical composition

This thesis explores the possibilities of spatial hearing in relation to sound perception, and presents three acousmatic compositions based on a musical aesthetic that emphasizes this relation in musical discourse. The first important characteristic of these compositions is the exclusive use of sine waves and other time invariant sound signals. Even though these types of sound signals present no variations in time, it is possible to perceive pitch, loudness, and tone color variations as soon as they move in space due to acoustic processes involved in spatial hearing. To emphasize the perception of such variations, this thesis proposes to divide a tone in multiple sound units and spread them in space using several loudspeakers arranged around the listener. In addition to the perception of sound attribute variations, it is also possible to create rhythm and texture variations that depend on how sound units are arranged in space. This strategy permits to overcome the so called "sound surrogacy" implicit in acousmatic music, as it is possible to establish cause-effect relations between sound movement and the perception of sound attribute, rhythm, and texture variations. Another important consequence of using sound fragmentation together with sound spatialization is the possibility to produce diffuse sound fields independently from the levels of reverberation of the room, and to create sound spaces with a certain spatial depth without using any kind of artificial sound delay or reverberation.

A neolitização do Portugal meridional: os exemplos do maciço calcário estremenho e do Algarve ocidental

Tese de doutoramento, Arqueologia, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2007

For host factors weddings and a Koch’s bacillus funeral: actin, lipids, phagosome maturation and inflammasome activation

The chapter describes the 10 years research of Anes Laboratory on the interactions of M. tuberculosis with macrophages namely with the actin. modulation by lipids, phagosome maturation and inflammasome activation

A obra no gerúndio

Tese de doutoramento, Belas-Artes (Instalação), Universidade de Lisboa, Faculdade de Belas-Artes, 2014

University Concert Band, April 28, 1948

Concert program for University Concert Band, April 28, 1948

The Contemporary Group, May 1, 1985

Concert program for The Contemporary Group, May 1, 1985

Composers' Workshop, February 25, 1999

Concert program for Composers' Workshop, February 25, 1999

A Concert of 17th and 18th Century Music, November 16, 1953

Concert Program for A Concert of 17th and 18th Century Music, November 16, 1953