Reply: 'Myopic foveoschisis: An ectatic retinopathy, not a schisis'

Full text: We thank Tsilimbaris et al1 for their comments on the appropriateness of the term ‘myopic foveoschisis’ to describe the condition that is characterized by the separation of neural retina layers associated with high myopia and posterior staphyloma. They have proposed the term ‘myopic ectatic retinopathy’ as a more literal and functionally more accurate descriptor of the condition to avoid the use of the word ‘schisis’, which may be misleading because it is also used to describe other conditions where there is separation of neural retina layers without the presence of staphyloma.2 Using the word ‘ectatic’ for this condition would imply that we are fairly certain about the pathogenesis and mechanistic factors that underlie its development and progression. However, this is not the case, unfortunately, as our review of the literature has shown. There are several theories ranging from vitreous traction to sclerosing changes of retinal vessels to progression of staphylomas as possible etiological factors. Therefore, it is likely to be multifactorial in nature—hence the success reported with different procedures that address either the vitreous traction factor using vitrectomy, peel plus tamponade or the scleral ectasia factor using posterior buckling techniques. In the absence of a good understanding of underlying pathogenesis, it is probably best to use purely descriptive names rather than mechanistic terms. The use of descriptive terms, even though similar, do not necessarily cause confusion as long as they are widely accepted as differentiating terminology, for example, postoperative pseudophakic cystoid macular edema (Irvine–Gass syndrome) vs cystoid macular edema associated with posterior uveitis in a phakic patient. The introduction of too many mechanistic or pathogenetic terms in the absence of clear understating of etiology can in fact cause more confusion, for example, serous chorioretinopathy vs central serous retinopathy vs serous choroidopathy. The confinement to broad descriptive terms can enhance communication and reduce confusion without committing to any presumption about etiology until it is better understood. This approach is probably best illustrated by the recent advances in the understanding of mactel21, a condition initially described and classified, using descriptive nomenclature, by Don Gass as bilateral, idiopathic acquired juxtafoveolar telangiectasis (Group2A) and as distinctly different from unilateral, congenital parafoveolar telangiectasis (Group 1A; Gass,3 pp 504–506 vs 127–128). Finally, it is worthy to note that for myopic foveoschisis associated with a staphyloma that is associated with outer layer macular detachment, Don Gass also descriptively included the additional observation (before the advent of OCT) that the retinal profile was concave rather than convex in shape, thereby differentiating it from rhegmatogenous detachments with recruitment of subretinal fluid that is associated with posteriorly located breaks and macular holes in myopic eyes. References 1.Tsilimbaris MK, Vavvas DG, Bechrakis NE. Myopic foveoschisis: an ectatic retinopathy, not aschisis. Eye 2016; 30: 328–329. 2.Powner MB, Gillies MC, Tretiach M, Scott A, Guymer RH, Hageman GS et al. Perifoveal müller cell depletion in a case of macular telangiectasia type 2. Ophthalmology 2010; 117(12): 2407–2416. 3.Gass DM. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th edn. Mosby-Yearbook: St. Louis, 1997.

Evaluation of a six-week professional education curriculum designed to retain registered psychiatric nurses

During the past few years there has been a drastic shortage of registered nurses in the field. The shortage appears to have affected the field of psychiatric mental health nursing most intensely. The psychiatric nursing shortage is a multifaceted problem grounded in decreasing federal funds for advanced clinical training, inadequate undergraduate psychiatric experiences, lack of a well prepared articulate role model, the integrated curriculum and the confusion and blurring associated with the roles and functions of the psychiatric mental health nurse.^ This dissertation will describe the current nursing shortage; the decline in enrollment to nursing programs; the history of psychiatric nursing as a discipline; the shortage of psychiatric mental health nurses; factors contributing to the psychiatric nursing shortage and a plan for a solution to the nursing shortage in psychiatry.^ The paper focuses on an evaluation conducted on an internship curriculum designed to facilitate effective nursing care in the treatment of clients who exhibit emotional problems. The purpose of this study was to attract and retain nurses to employment opportunities in four Hospital Corporation of America (HCA) facilities, using a six week internship program.^ The study will yield an analysis of the effect of combining psychodynamic principles and knowledge with skills in the clinical area. The demands of educational practice have been merged with the discipline of psychiatric nursing in the development of this curriculum. ^

Internet Protocol Television (IPTV) controller realization with Very Large Scale Integration (VLSI) modules

Internet Protocol Television (IPTV) is a system where a digital television service is delivered by using Internet Protocol over a network infrastructure. There is considerable confusion and concern about the IPTV, since two different technologies have to be mended together to provide the end customers with some thing better than the conventional television. In this research, functional architecture of the IPTV system was investigated. Very Large Scale Integration based system for streaming server controller were designed and different ways of hosting a web server which can be used to send the control signals to the streaming server controller were studied. The web server accepts inputs from the keyboard and FPGA board switches and depending on the preset configuration the server will open a selected web page and also sends the control signals to the streaming server controller. It was observed that the applications run faster on PowerPC since it is embedded into the FPGA. Commercial market and Global deployment of IPTV were discussed.

Taxonomy and distribution of taxa in the genus Gomphonema from the Florida Everglades, U.S.A.

Located at a subtropical latitude, the expansive Florida Everglades contains a mixture of tropical and temperate diatom taxa, as well as a unique flora adapted to the calcareous, often excessively hot, seasonally flooded wetland conditions. This flora has been poorly documented taxonomically, although diatoms are recognized as important indicators of environmental change in this threatened ecosystem. Gomphonema is a dominant genus in the freshwater marsh, and is represented by highly variable species complexes, including Gomphonema gracile Ehrenberg, Gomphonema intricatum var. vibrio Ehrenberg sensu Fricke, Gomphonema vibrioides Reichardt & Lange-Bertalot and Gomphonema parvulum (Kützing) Grunow. These taxa have been shown to exhibit wide morphological variation in other regions, resulting in considerable nomenclatural confusion. We collected Gomphonema from 237 sites distributed throughout the freshwater Everglades and used qualitative and quantitative morphological data to identify 20 distinguishable populations. Taxonomie assignments were based on descriptions and/or observations of type material of relevant taxa when possible, but deviations from original morphological range descriptions were common. We then compared morphological variation in Everglades Gomphonema taxa to that reported for the same taxa in other regions and suggest revisions of taxonomie concepts when necessary.

Sales Promotion in Hotels:A British Perspective

In their article - Sales Promotion In Hotels: A British Perspective - by Francis Buttle, Lecturer, Department of Hotel, Restaurant, and Travel Administration, University of Massachusetts and Ini Akpabio, Property Manager, Trusthouse Forte, Britain, Buttle and Akpabio initially state: “Sales promotion in hotels is in its infancy. Other industries, particularly consumer goods manufacturing, have long recognized the contribution that sales promotion can make to the cost-effective achievement of marketing objectives. Sales promotion activities in hotels have remained largely uncharted. The authors define, identify and classify these hotel sales promotion activities to understand their function and form, and to highlight any scope for improvement.” The authors begin their discussion by attempting to define what the phrase sales promotion [SP] actually means. “The Institute of Sales Promotion regards sales promotions as “adding value, usually of a temporary nature, to a product or service in order to persuade the end user to purchase that particular brand as opposed to a competitive brand,” the authors offer. Williams, however, describes sales promotions more broadly as “short term tactical marketing tools which are used to achieve specific marketing objectives during a defined time period,” Buttle and Akpabio present with attribution. “The most significant difference between these two viewpoints is that Williams does not limit his definition to activities which are targeted at the consumer,” is their educated view. A lot of the discussion is centered on the differences in the collective marketing-promotional mix. “…it is not always easy to definitively categorize promotional activity,” Buttle and Akpabio say. “For example, in personal selling, a sales promotion such as a special bonus offer may be used to close the sale; an advertisement may be sales promotional in character in that it offers discounts.” Are promotion and marketing distinguishable as two separate entities? “…not only may there be conceptual confusion between components of the promotional mix, but there is sometimes a blurring of the boundaries between the elements of the marketing mix,” the authors suggest. “There are several reasons why SP is particularly suitable for use in hotels: seasonality, increasing competitiveness, asset characteristics, cost characteristics, increased use of channel intermediaries, new product launches, and deal proneness.” Buttle and Akpabio offer their insight on each of these segments. The authors also want you to know that SP customer applications are not the only game in town, SP trade applications are just as essential. Bonuses, enhanced commission rates, and vouchers are but a few examples of trade SP. The research for the article was compiled from several sources including, mail surveys, telephone surveys, personal interviews, trade magazines and newspapers; essentially in the U.K.

From Clerk and Cashier to Guest Service Agent

In their study - From Clerk and Cashier to Guest Service Agent - by Nancy J. Allin, Director of Quality Assurance and Training and Kelly Halpine, Assistant Director of Quality Assurance and Training, The Waldorf-Astoria, New York, the authors state at the outset: “The Waldorf-Astoria has taken the positions of registration clerk and cashier and combined them to provide excellent guest service and efficient systems operation. The authors tell how and why the combination works. That thesis statement defines the article, and puts it squarely in the crosshairs of the service category. Allin and Halpine use their positions at the Waldorf-Astoria in New York City to frame their observations “The allocation of staff hours has been a challenge to many front office managers who try their hardest to schedule for the norm but provide excellent, efficient service throughout the peaks,” Allin and Halpine allude. “…the decision [to combine the positions of registration clerk and cashier] was driven by a desire to improve guest service where its impact is most obvious, at the front desk. Cross-trained employees speed the check-in and check-out process by performing both functions, as the traffic at the desk dictates,” the authors say. Making such a move has resulted in positive benefits for both the guests and the hotel. “Benefits to the hotel, in addition to those brought to bear by increased guest satisfaction, include greater flexibility in weekly scheduling and in granting vacations while maintaining adequate staffing at the desk,” say Allin and Halpine . “Another expected outcome, net payroll savings, should also be realized as a consequence of the ability to schedule more efficiently.” The authors point to communication as the key to designing a successful combination such as this, with the least amount of service disruption. They bullet-point what that communication should entail. Issues of seniority, wage and salary rates, organizational charting, filing, scheduling, possible probationary periods, position titles, and physical layouts are all discussed. “It is critical that each of the management issues be addressed and resolved before any training is begun,” Allin and Halpine suggest. “Unresolved issues project confusion and lack of conviction to line employees and the result is frustration and a lack of commitment to the combination process,” they push the thought Allin and Halpine insist: “Once begun, training must be ongoing and consistent.” In the practical sense, the authors provide that authorizing overtime is helpful in accomplishing training. “Training must address the fact that employees will be faced with guest situations which are new to them, for example: an employee previously functioning as a cashier will be faced with walking guests. Specific exercises should be included to address these needs,” say the authors.

Using sonic enhancement to augment non-visual tabular navigation

More information is now readily available to computer users than at any time in human history; however, much of this information is often inaccessible to people with blindness or low-vision, for whom information must be presented non-visually. Currently, screen readers are able to verbalize on-screen text using text-to-speech (TTS) synthesis; however, much of this vocalization is inadequate for browsing the Internet. An auditory interface that incorporates auditory-spatial orientation was created and tested. For information that can be structured as a two-dimensional table, links can be semantically grouped as cells in a row within an auditory table, which provides a consistent structure for auditory navigation. An auditory display prototype was tested.^ Sixteen legally blind subjects participated in this research study. Results demonstrated that stereo panning was an effective technique for audio-spatially orienting non-visual navigation in a five-row, six-column HTML table as compared to a centered, stationary synthesized voice. These results were based on measuring the time- to-target (TTT), or the amount of time elapsed from the first prompting to the selection of each tabular link. Preliminary analysis of the TTT values recorded during the experiment showed that the populations did not conform to the ANOVA requirements of normality and equality of variances. Therefore, the data were transformed using the natural logarithm. The repeated-measures two-factor ANOVA results show that the logarithmically-transformed TTTs were significantly affected by the tonal variation method, F(1,15) = 6.194, p= 0.025. Similarly, the results show that the logarithmically transformed TTTs were marginally affected by the stereo spatialization method, F(1,15) = 4.240, p=0.057. The results show that the logarithmically transformed TTTs were not significantly affected by the interaction of both methods, F(1,15) = 1.381, p=0.258. These results suggest that some confusion may be caused in the subject when employing both of these methods simultaneously. The significant effect of tonal variation indicates that the effect is actually increasing the average TTT. In other words, the presence of preceding tones increases task completion time on average. The marginally-significant effect of stereo spatialization decreases the average log(TTT) from 2.405 to 2.264.^

Chords

CHORDS is a collection of diverse lyric and narrative poems. The book is primarily composed of free verse in the colloquial tradition of James Wright. CHORDS employs the Romantic device of a strong narrative "I," and utilizes four thematic sections, each named after a specific musical chord, which correspond to four periods in the narrator's life. Section one, "Suspended," follows the young narrator through a tumultuous childhood, underscored by family loss and the disruption of a move from Miami to rural Kentucky; section two, "Diminished," details his adolescence and young adulthood, a period of rebellion and confusion; section three, "Augmented," finds the adult narrator contemplating several life-changing events-marriage, the break-up of his rock and roll band, and the dedication of his life to Christ; finally, in "Resolved," the narrator comes to accept the complexities of his life, and to build, from its dissonant notes, a final chord of resolution.

Of madness and many-valuedness: an investigation into Suszko's Thesis

Suszko’s Thesis is a philosophical claim regarding the nature of many-valuedness. It was formulated by the Polish logician Roman Suszko during the middle 70s and states the existence of “only but two truth values”. The thesis is a reaction against the notion of many-valuedness conceived by Jan Łukasiewicz. Reputed as one of the modern founders of many-valued logics, Łukasiewicz considered a third undetermined value in addition to the traditional Fregean values of Truth and Falsehood. For Łukasiewicz, his third value could be seen as a step beyond the Aristotelian dichotomy of Being and non-Being. According to Suszko, Łukasiewicz’s ideas rested on a confusion between algebraic values (what sentences describe/denote) and logical values (truth and falsity). Thus, Łukasiewicz’s third undetermined value is no more than an algebraic value, a possible denotation for a sentence, but not a genuine logical value. Suszko’s Thesis is endorsed by a formal result baptized as Suszko’s Reduction, a theorem that states every Tarskian logic may be characterized by a two-valued semantics. The present study is intended as a thorough investigation of Suszko’s thesis and its implications. The first part is devoted to the historical roots of many-valuedness and introduce Suszko’s main motivations in formulating the double character of truth-values by drawing the distinction in between algebraic and logical values. The second part explores Suszko’s Reduction and presents the developments achieved from it; the properties of two-valued semantics in comparison to many-valued semantics are also explored and discussed. Last but not least, the third part investigates the notion of logical values in the context of non-Tarskian notions of entailment; the meaning of Suszko’s thesis within such frameworks is also discussed. Moreover, the philosophical foundations for non-Tarskian notions of entailment are explored in the light of recent debates concerning logical pluralism.

O crucifixo nos tribunais: a neutralidade religiosa e o uso dos espaços públicos

This thesis aims to analyze the cross exhibition in sessions halls and audiences of the judiciary, considered the religious freedom and the limitations arising from the idea of State neutrality. It is known that the 1988 Constitution protects freedom of expression of thought, conscience and religion, in its various aspects, proclaiming, on the other hand, the neutrality of the state, to reinforce these same freedoms. Thus, the aim is to avoid confusion between state and religion, admitted, however, collaboration of public interest, in respect of attitude to the beliefs and individual choices of citizens. In modern societies, the dualism between the civil power and religion has to do with laicity and a broader phenomenon that took the name of secularism, meaning the loss of space of religion in societies or even decreased idea religious belonging. It is based on this finding that the work develops with reference to concepts such as civil society and rule of law relevant to an accurate understanding of the problem. The methodology consists of bibliographic and documentary research through books and thesis, in addition to the legislation and some precedents related to the topic in question, looking to investigate whether, even though the predominantly Catholic Brazilian people and recognized the strong influence that Christian values exercise on the public authorities, it is possible to sustain the symbolic differentiation state, a republic that is said secular and democratic and which has as one of the fundamental objectives to promote the good of all, without any form of discrimination. Starting from the idea that the presence in buildings and public institutions, symbols and Catholic imagery, like the crucifix, has some difficulty in reconciling the guarantee of religious freedom and the principle of laicity, the idea is to exactly propose a solution who can respect pluralism and diversity in a context where Catholicism remains a strong presence.

Seleção de características para identificação de diferentes proporções de tipos de fibras musculares por meio da eletromiografia de superfície

Skeletal muscle consists of muscle fiber types that have different physiological and biochemical characteristics. Basically, the muscle fiber can be classified into type I and type II, presenting, among other features, contraction speed and sensitivity to fatigue different for each type of muscle fiber. These fibers coexist in the skeletal muscles and their relative proportions are modulated according to the muscle functionality and the stimulus that is submitted. To identify the different proportions of fiber types in the muscle composition, many studies use biopsy as standard procedure. As the surface electromyography (EMGs) allows to extract information about the recruitment of different motor units, this study is based on the assumption that it is possible to use the EMG to identify different proportions of fiber types in a muscle. The goal of this study was to identify the characteristics of the EMG signals which are able to distinguish, more precisely, different proportions of fiber types. Also was investigated the combination of characteristics using appropriate mathematical models. To achieve the proposed objective, simulated signals were developed with different proportions of motor units recruited and with different signal-to-noise ratios. Thirteen characteristics in function of time and the frequency were extracted from emulated signals. The results for each extracted feature of the signals were submitted to the clustering algorithm k-means to separate the different proportions of motor units recruited on the emulated signals. Mathematical techniques (confusion matrix and analysis of capability) were implemented to select the characteristics able to identify different proportions of muscle fiber types. As a result, the average frequency and median frequency were selected as able to distinguish, with more precision, the proportions of different muscle fiber types. Posteriorly, the features considered most able were analyzed in an associated way through principal component analysis. Were found two principal components of the signals emulated without noise (CP1 and CP2) and two principal components of the noisy signals (CP1 and CP2 ). The first principal components (CP1 and CP1 ) were identified as being able to distinguish different proportions of muscle fiber types. The selected characteristics (median frequency, mean frequency, CP1 and CP1 ) were used to analyze real EMGs signals, comparing sedentary people with physically active people who practice strength training (weight training). The results obtained with the different groups of volunteers show that the physically active people obtained higher values of mean frequency, median frequency and principal components compared with the sedentary people. Moreover, these values decreased with increasing power level for both groups, however, the decline was more accented for the group of physically active people. Based on these results, it is assumed that the volunteers of the physically active group have higher proportions of type II fibers than sedentary people. Finally, based on these results, we can conclude that the selected characteristics were able to distinguish different proportions of muscle fiber types, both for the emulated signals as to the real signals. These characteristics can be used in several studies, for example, to evaluate the progress of people with myopathy and neuromyopathy due to the physiotherapy, and also to analyze the development of athletes to improve their muscle capacity according to their sport. In both cases, the extraction of these characteristics from the surface electromyography signals provides a feedback to the physiotherapist and the coach physical, who can analyze the increase in the proportion of a given type of fiber, as desired in each case.

The Herschel Lensing Survey (HLS): Overview

The Herschel Lensing Survey (HLS) will conduct deep PACS and SPIRE imaging of ~40 massive clusters of galaxies. The strong gravitational lensing power of these clusters will enable us to penetrate through the confusion noise, which sets the ultimate limit on our ability to probe the Universe with Herschel. Here we present an overview of our survey and a summary of the major results from our science demonstration phase (SDP) observations of the Bullet cluster (z = 0.297). The SDP data are rich and allow us to study not only the background high-redshift galaxies (e. g., strongly lensed and distorted galaxies at z = 2.8 and 3.2) but also the properties of cluster-member galaxies. Our preliminary analysis shows a great diversity of far-infrared/submillimeter spectral energy distributions (SEDs), indicating that we have much to learn with Herschel about the properties of galaxy SEDs. We have also detected the Sunyaev-Zel'dovich (SZ) effect increment with the SPIRE data. The success of this SDP program demonstrates the great potential of the Herschel Lensing Survey to produce exciting results in a variety of science areas.

Improving the identification of high-z Herschel sources with position priors and optical/NIR and FIR/mm photometric redshifts

We present preliminary results about the detection of high redshift (U)LIRGs in the Bullet cluster field by the PACS and SPIRE instruments within the Herschel Lensing Survey (HLS) Program. We describe in detail a photometric procedure designed to recover robust fluxes and deblend faint Herschel sources near the confusion noise. The method is based on the use of the positions of Spitzer/MIPS 24 μm sources as priors. Our catalogs are able to reliably (5σ) recover galaxies with fluxes above 6 and 10 mJy in the PACS 100 and 160 μm channels, respectively, and 12 to 18 mJy in the SPIRE bands. We also obtain spectral energy distributions covering the optical through the far-infrared/millimeter spectral ranges of all the Herschel detected sources, and analyze them to obtain independent estimations of the photometric redshift based on either stellar population or dust emission models. We exemplify the potential of the combined use of Spitzer position priors plus independent optical and IR photometric redshifts to robustly assign optical/NIR counterparts to the sources detected by Herschel and other (sub-)mm instruments.

The far-infrared/submillimeter properties of galaxies located behind the Bullet cluster

The Herschel Lensing Survey (HLS) takes advantage of gravitational lensing by massive galaxy clusters to sample a population of high-redshift galaxies which are too faint to be detected above the confusion limit of current far-infrared/submillimeter telescopes. Measurements from 100-500 μm bracket the peaks of the far-infrared spectral energy distributions of these galaxies, characterizing their infrared luminosities and star formation rates. We introduce initial results from our science demonstration phase observations, directed toward the Bullet cluster (1E0657-56). By combining our observations with LABOCA 870 μm and AzTEC 1.1 mm data we fully constrain the spectral energy distributions of 19 MIPS 24 μm-selected galaxies which are located behind the cluster. We find that their colors are best fit using templates based on local galaxies with systematically lower infrared luminosities. This suggests that our sources are not like local ultra-luminous infrared galaxies in which vigorous star formation is contained in a compact highly dust-obscured region. Instead, they appear to be scaled up versions of lower luminosity local galaxies with star formation occurring on larger physical scales.

Les approches de synthèse exploratoire dans le domaine de la santé

Contexte: Les approches de synthèse exploratoire (ou scoping studies) font actuellement l’objet de confusion dans leur appellation, définition et but. Elles continuent aussi de manquer de description méthodologique suffisante ou de détails sur le processus de l’analyse de données. Objectif : Cette synthèse exploratoire fait le point des connaissances sur les approches de synthèse exploratoire utilisées en santé. Plus spécifiquement, ses objectifs sont : 1) d’examiner le volume et l’étendue des synthèses exploratoires ainsi que les domaines d’étude dans lesquels elles ont été conduites; 2) de faire l’inventaire de leurs définitions, buts, forces et faiblesses; et 3) et de faire l’inventaire des approches méthodologiques existantes. Méthodes : Une recherche systématique des synthèses exploratoires a été entreprise jusqu’en avril 2014 dans les bases de données Medline, PubMed, ERIC, PsycINFO, CINAHL, EMBASE, EBM Reviews/Cochrane. Des critères d’inclusion et d’exclusion ont été appliqués afin de ne retenir que des études de langue française et anglaise présentant des définitions, méthodes et écarts de connaissances sur les synthèses exploratoires, ainsi que celles les comparant à d’autres types de revues de littérature. Deux reviseurs ont examiné de façon indépendante les références pertinentes. Une grille d’extraction des données a été conçue afin de recueillir pour chacune des études, les données contextuelles, les étapes méthodologiques ainsi que les définitions, buts et limites des synthèses exploratoires. Les données ont été répertoriées et classées afin de dresser un portrait global des approches de synthèses exploratoires dans un format narratif et tabulaire. Résultats : Sur deux cent cinquante-deux références identifiées, quatre-vingt-douze références pertinentes ont été retenues. Les synthèses exploratoires ont été publiées par 6 pays dans 10 domaines d’études et 73 journaux. Elles ont pour finalité d’être à la fois un support aux connaissances, une aide à la décision et un préalable à une revue systématique de littérature. Cinq auteurs ont été cités en référence et huit autres ont publié sur leur méthodologie. Elles ont 3 étapes importantes de réalisation dont la revue de littérature, la consultation des parties prenantes et la synthèse globale avec ou sans validation des résultats. Les synthèses exploratoires utilisent une méthode systématique, pas toujours exhaustive et sans évaluation formelle des études incluses Des notions claires portant sur leur définition, buts, forces et faiblesses ont été identifiées. Conclusion : Nous suggérons que de nouvelles études soient entreprises afin d’asseoir complètement cette méthode et dégager des lignes directrices pour les chercheurs qui s’y intéresseront.