Um sistema inteligente de teleoftalmologia para o auxílio no diagnóstico de catarata

The increasing in world population, with higher proportion of elderly, leads to an increase in the number of individuals with vision loss and cataracts are one of the leading causes of blindness worldwide. Cataract is an eye disease that is the partial or total opacity of the crystalline lens (natural lens of the eye) or its capsule. It can be triggered by several factors such as trauma, age, diabetes mellitus, and medications, among others. It is known that the attendance by ophthalmologists in rural and poor areas in Brazil is less than needed and many patients with treatable diseases such as cataracts are undiagnosed and therefore untreated. In this context, this project presents the development of OPTICA, a system of teleophthalmology using smartphones for ophthalmic emergencies detection, providing a diagnostic aid for cataract using specialists systems and image processing techniques. The images are captured by a cellphone camera and along with a questionnaire filled with patient information are transmitted securely via the platform Mobile SANA to a online server that has an intelligent system available to assist in the diagnosis of cataract and provides ophthalmologists who analyze the information and write back the patient’s report. Thus, the OPTICA provides eye care to the poorest and least favored population, improving the screening of critically ill patients and increasing access to diagnosis and treatment.

The effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma : a randomized controlled trial (EAGLE)

Medical Research Council (ref G0701604) and administered by the NIHR-EME (ref 09-800-26)

Can aberrometry provide rapid and reliable measures of subjective depth of focus following multifocal intraocular lens implantation?

Purpose: To determine whether the ‘through-focus’ aberrations of a multifocal and accommodative intraocular lens (IOL) implanted patient can be used to provide rapid and reliable measures of their subjective range of clear vision. Methods: Eyes that had been implanted with a concentric (n = 8), segmented (n = 10) or accommodating (n = 6) intraocular lenses (mean age 62.9 ± 8.9 years; range 46-79 years) for over a year underwent simultaneous monocular subjective (electronic logMAR test chart at 4m with letters randomised between presentations) and objective (Aston open-field aberrometer) defocus curve testing for levels of defocus between +1.50 to -5.00DS in -0.50DS steps, in a randomised order. Pupil size and ocular aberration (a combination of the patient’s and the defocus inducing lens aberrations) at each level of blur was measured by the aberrometer. Visual acuity was measured subjectively at each level of defocus to determine the traditional defocus curve. Objective acuity was predicted using image quality metrics. Results: The range of clear focus differed between the three IOL types (F=15.506, P=0.001) as well as between subjective and objective defocus curves (F=6.685, p=0.049). There was no statistically significant difference between subjective and objective defocus curves in the segmented or concentric ring MIOL group (P>0.05). However a difference was found between the two measures and the accommodating IOL group (P<0.001). Mean Delta logMAR (predicted minus measured logMAR) across all target vergences was -0.06 ± 0.19 logMAR. Predicted logMAR defocus curves for the multifocal IOLs did not show a near vision addition peak, unlike the subjective measurement of visual acuity. However, there was a strong positive correlation between measured and predicted logMAR for all three IOLs (Pearson’s correlation: P<0.001). Conclusions: Current subjective procedures are lengthy and do not enable important additional measures such as defocus curves under differently luminance or contrast levels to be assessed, which may limit our understanding of MIOL performance in real-world conditions. In general objective aberrometry measures correlated well with the subjective assessment indicating the relative robustness of this technique in evaluating post-operative success with segmented and concentric ring MIOL.

Radiation Dose to the Lens of the Eye from Computed Tomography Scans of the Head

While it is well known that exposure to radiation can result in cataract formation, questions still remain about the presence of a dose threshold in radiation cataractogenesis. Since the exposure history from diagnostic CT exams is well documented in a patient’s medical record, the population of patients chronically exposed to radiation from head CT exams may be an interesting area to explore for further research in this area. However, there are some challenges in estimating lens dose from head CT exams. An accurate lens dosimetry model would have to account for differences in imaging protocols, differences in head size, and the use of any dose reduction methods.

The overall objective of this dissertation was to develop a comprehensive method to estimate radiation dose to the lens of the eye for patients receiving CT scans of the head. This research is comprised of a physics component, in which a lens dosimetry model was derived for head CT, and a clinical component, which involved the application of that dosimetry model to patient data.

The physics component includes experiments related to the physical measurement of the radiation dose to the lens by various types of dosimeters placed within anthropomorphic phantoms. These dosimeters include high-sensitivity MOSFETs, TLDs, and radiochromic film. The six anthropomorphic phantoms used in these experiments range in age from newborn to adult.

First, the lens dose from five clinically relevant head CT protocols was measured in the anthropomorphic phantoms with MOSFET dosimeters on two state-of-the-art CT scanners. The volume CT dose index (CTDIvol), which is a standard CT output index, was compared to the measured lens doses. Phantom age-specific CTDIvol-to-lens dose conversion factors were derived using linear regression analysis. Since head size can vary among individuals of the same age, a method was derived to estimate the CTDIvol-to-lens dose conversion factor using the effective head diameter. These conversion factors were derived for each scanner individually, but also were derived with the combined data from the two scanners as a means to investigate the feasibility of a scanner-independent method. Using the scanner-independent method to derive the CTDIvol-to-lens dose conversion factor from the effective head diameter, most of the fitted lens dose values fell within 10-15% of the measured values from the phantom study, suggesting that this is a fairly accurate method of estimating lens dose from the CTDIvol with knowledge of the patient’s head size.

Second, the dose reduction potential of organ-based tube current modulation (OB-TCM) and its effect on the CTDIvol-to-lens dose estimation method was investigated. The lens dose was measured with MOSFET dosimeters placed within the same six anthropomorphic phantoms. The phantoms were scanned with the five clinical head CT protocols with OB-TCM enabled on the one scanner model at our institution equipped with this software. The average decrease in lens dose with OB-TCM ranged from 13.5 to 26.0%. Using the size-specific method to derive the CTDIvol-to-lens dose conversion factor from the effective head diameter for protocols with OB-TCM, the majority of the fitted lens dose values fell within 15-18% of the measured values from the phantom study.

Third, the effect of gantry angulation on lens dose was investigated by measuring the lens dose with TLDs placed within the six anthropomorphic phantoms. The 2-dimensional spatial distribution of dose within the areas of the phantoms containing the orbit was measured with radiochromic film. A method was derived to determine the CTDIvol-to-lens dose conversion factor based upon distance from the primary beam scan range to the lens. The average dose to the lens region decreased substantially for almost all the phantoms (ranging from 67 to 92%) when the orbit was exposed to scattered radiation compared to the primary beam. The effectiveness of this method to reduce lens dose is highly dependent upon the shape and size of the head, which influences whether or not the angled scan range coverage can include the entire brain volume and still avoid the orbit.

The clinical component of this dissertation involved performing retrospective patient studies in the pediatric and adult populations, and reconstructing the lens doses from head CT examinations with the methods derived in the physics component. The cumulative lens doses in the patients selected for the retrospective study ranged from 40 to 1020 mGy in the pediatric group, and 53 to 2900 mGy in the adult group.

This dissertation represents a comprehensive approach to lens of the eye dosimetry in CT imaging of the head. The collected data and derived formulas can be used in future studies on radiation-induced cataracts from repeated CT imaging of the head. Additionally, it can be used in the areas of personalized patient dose management, and protocol optimization and clinician training.

The (Un)Folding of Multidomain Proteins Through the Lens of Single-molecule Force-spectroscopy and Computer Simulation

Proteins are specialized molecules that catalyze most of the reactions that can sustain life, and they become functional by folding into a specific 3D structure. Despite their importance, the question, "how do proteins fold?" - first pondered in in the 1930's - is still listed as one of the top unanswered scientific questions as of 2005, according to the journal Science. Answering this question would provide a foundation for understanding protein function and would enable improved drug targeting, efficient biofuel production, and stronger biomaterials. Much of what we currently know about protein folding comes from studies on small, single-domain proteins, which may be quite different from the folding of large, multidomain proteins that predominate the proteomes of all organisms.

In this thesis I will discuss my work to fill this gap in understanding by studying the unfolding and refolding of large, multidomain proteins using the powerful combination of single-molecule force-spectroscopy experiments and molecular dynamic simulations.

The three model proteins studied - Luciferase, Protein S, and Streptavidin - lend insight into the inter-domain dependence for unfolding and the subdomain stabilization of binding ligands, and ultimately provide new insight into atomistic details of the intermediate states along the folding pathway.

Two devices, each of which measure water velocity; on the right is an acoustic device that is permanently maintained at Gumbo Limbo by PI Rene Price; on the left is a 3D camera with a long fiberoptic lens, deployed for testing purposes by collaborator Evan Variano.

http://digitalcommons.fiu.edu/fce_lter_photos/1303/thumbnail.jpg

Characterization of New Carbosilane Liquid Crystalline Monomers and Dimers

‘De Vries-like’ smectic liquid crystals exhibit low layer contraction of approximately 1% on transitions from the SmA to the SmC phase. These materials have received considerable attention as potential solutions for problems affecting liquid crystal displays using surface-stabilized ferroelectric liquid crystals (SSFLC). In SSFLCs, layer contraction of 710% is normally observed during the SmA to SmC phase transition. A study by the Lemieux group has shown that liquid crystals with nanosegregating carbosilane segments exhibit enhanced ‘de Vries-like’ properties through the formation of smectic layers and by lengthening the nanosegregating carbosilane end-groups from monocarbosilane to tricarbosilane. This observed enhancement is assumed to be due to an increase in the cross-section of the free volume in the hydrocarbon sub-layer. To test this hypothesis, it is assumed that dimers with a tricarbosilane linking group have smaller cross-sections on time average. In his thesis, this hypothesis is tested through the characterization of new liquid crystalline monomers (QL39-n) and dimers (QL40-n) with 2-phenylpyrimidine cores and tricarbosilane end-groups and spacers, respectively. The thesis describes the synthesis of two homologous series of liquid crystals and their characterization using a variety of techniques, including polarized optical microscopy, differential scanning calorimetry and X-ray diffraction. The results show that the monomers QL39-n form a tilted SmC phase only, whereas the dimers QL40-n form an orthogonal SmA phase. These results are discussed in the context of our hypothesis.

Africa through Chinese eyes: new frames or the same old lens? African news in English from China Central Television, compared with the BBC

[No abstract as this is a book chapter: the following represents the first 2 paragraphs.] The screen fills with close-ups of smiling African faces against a black-and-orange background: the carefree child, the gap-toothed man with smoke curling from his pipe. The faces retreat into an outline of a map of Africa as the saccharine background music dissolves into birdsong. The silhouette of an acacia tree appears. This is not the much-derided Western romantic stereotype of the continent: it is an extract from a promotional trailer on CCTV Africa, the embodiment of China’s “soft power” drive and a spearhead of Chinese state television’s overseas expansion. Yet this image is at variance with the English-language channel’s professed ambitions. The Chinese premier, Li Keqiang, himself declared that “CCTV embraces the vision of seeing Africa from an African perspective and reporting Africa from the viewpoint of Africa”. These contradictory messages prompt fundamental questions about CCTV’s expansion into Africa. Are the channel’s English-language news bulletins aimed at African or Chinese viewers? What kind of Africa – and indeed China – do they represent, and could the framing of African events by CCTV News provide an alternative to the perspective of international rivals? Is CCTV’s main mission in Africa to provide news or to act as mouthpiece of the Chinese Communist Party and state? This chapter addresses these questions by applying a cross-cultural variant of framing theory to the news content of CCTV’s Africa Live and that of its closest direct competitor, Focus on Africa from BBC World News TV.

The Devil and Views on the “Other” in Part One of Pedro Cieza de León’s "Crónica del Perú" (1553)

Many 16th century Spanish chroniclers and missionaries, arriving at what they interpreted as a New World, saw the Devil as a “hermeneutic wildcard” that allowed them to comprehend indigenous religions. Pedro Cieza de León, a soldier in the conquest of Peru, is a case in point. Cieza considers the Devil responsible for the most aberrant religious practices and customs of the Indians, although he views the natives in a positive light, as men susceptible to divine salvation. From a providentialist perspective of the history of the conquest, Cieza interprets that the evangelization and conversion of the Indians and the implantation of Christian civilization by the Spanish Crown, were able to defeat the Devil.

The effect of poly(lactide)-poly(carbonate) based block copolymers on the morphology and crystallization of double crystalline poly(lactide)/poly(ε-caprolactone) blends

Block copolymers of poly(lactide) and poly(carbonate) were synthetized in three different compositions and characterized by 1H-NMR and ATR analyses. The compatibilization effect of this copolymers on 80/20 (w/w%) PLA/PCL blend was evaluated. SEM micrographs show that all the blends exhibit the typical sea-island morphology characteristic of immiscible blends with PCL finely dispersed in droplets on a PLA matrix. Upon the addiction of the copolymers a reduction on PCL droplets size is observable. At the same time, a Tg depression of the PLA phase is detected when the copolymers are added in the blend. These results indicate that these copolymers are effective as compatibilizers. The copolymer that acts as the best compatibilizer is the one characterized by the same amount of PLA and PC as repeating units. As result, in the blend containing this copolymer PLA phase exhibits the highest spherulitic growth rate. An analyses on PLA phase crystallization behaviour from the glassy state within the blends was evaluated by DSC experiments. Isothermal cold crystallization of the PLA phase is enhanced up an order of magnitude upon the blending with PCL. Annealing experiments demonstrated that the crystallization of the PCL phase induces the formation of active nuclei in PLA when cooled above cooled below Tg. When the crystallization rate of PCL is retarded, a reduction on PLA nucleation is observed.

Device Physics of Two-Dimensional Crystalline Materials

Thesis (Ph.D.)--University of Washington, 2016-07