Corneal hysteresis and axial length among Chinese secondary school children: the Xichang Pediatric Refractive Error Study (X-PRES) report no. 4.

PURPOSE: To evaluate the association between corneal hysteresis and axial length/refractive error among rural Chinese secondary school children. DESIGN: Cross-sectional cohort study. METHODS: Refractive error (cycloplegic auto-refraction with subjective refinement), central corneal thickness (CCT) and axial length (ultrasonic measurement), intraocular pressure (IOP), and corneal hysteresis (Reichert Ocular Response Analyzer) were measured on a rural school-based cohort of children. RESULTS: Among 1,233 examined children, the mean age was 14.7 +/- 0.8 years and 699 (56.7%) were girls. The mean spherical equivalent (n = 1,232) was -2.2 +/- 1.6 diopters (D), axial length (n = 643) was 23.7 +/- 1.1 mm, corneal hysteresis (n = 1,153) was 10.7 +/- 1.6 mm Hg, IOP (n = 1,153) was 17.0 +/- 3.4 mm Hg, and CCT (n = 1,226) was 553 +/- 33 microns. In linear regression models, longer axial length was significantly (P < .001 for both) associated with lower corneal hysteresis and higher IOP. Hysteresis in this population was significantly (P < .001) lower than has previously been reported for normal White children (n = 42, 12.3 +/- 1.3 mm Hg), when adjusting for age and gender. This difference did not appear to depend on differences in axial length between the populations, as it persists when only Chinese children with normal uncorrected vision are included. CONCLUSIONS: Prospective studies will be needed to determine if low hysteresis places eyes at risk for axial elongation secondary or if primary elongation results in lower hysteresis.

Corneal biomechanics, refractive error, and axial length in Chinese primary school children.

PURPOSE: Low corneal hysteresis is associated with longer axial length in Chinese secondary school children. The authors sought to explore this association in primary school children. METHODS: LogMAR presenting visual acuity, cycloplegic refractive error, ocular biometry, central corneal thickness (CCT), and corneal hysteresis (CH) was assessed for children in grades 1 to 3 at an academically competitive urban school in Shantou, China. RESULTS: Among 872 eligible children (mean age, 8.6 ± 2.1 years), 651 (74.7%) completed the examination. Among 1299 examined eyes, 111 (8.5%) had uncorrected vision ≤6/12. Mean spherical equivalent refractive error for all eyes was +0.26 ± 1.41 D, and axial length (AL) was 22.7 ± 0.90 mm. CH for the lowest (mean AL, 21.7 ± 0.39 mm), two middle (mean AL, 22.4 ± 0.15 and 22.9 ± 0.15 mm), and highest quartiles (mean AL, 23.7 ± 0.74 mm) of AL were 10.6 ± 2.1 mm Hg, 10.4 ± 2.1 mm Hg, 10.3 ± 2.3 mm Hg, and 10.2 ± 2.3 mm Hg respectively (age- and gender-adjusted Pearson's correlation coefficient r = -0.052; P = 0.001). In generalized estimating equation models adjusting for age, gender, and CCT, lower CH was significantly associated with longer AL (P < 0.001) and more myopic refractive error (P = 0.001). CONCLUSIONS: CH measurement is practical in young children because this is when myopia undergoes its most rapid progression. Prospective follow-up of this cohort at high risk for myopia is under way to determine whether low CH is predictive, or a consequence, of long AL.

Determinants of postoperative corneal edema and impact on goldmann intraocular pressure.

PURPOSE: Recent studies report that increased corneal edema because of contact lens wear under closed lids is associated with elevated Goldmann intraocular pressure (GAT IOP). We sought to assess whether the impact of postoperative corneal edema on GAT IOP would be similar and to determine the differential effect of different amounts of edema. METHODS: The setting is a tertiary level cataract clinic in Shantou, China. Pre- and postoperative (day 1) GAT IOP, central corneal thickness (CCT), corneal hysteresis, corneal resistance factor, and radius of corneal curvature were measured for consecutive patients undergoing phacoemulsification surgery by 2 experienced surgeons. Corneal edema was calculated as the percentage increase in CCT. RESULTS: Among 136 subjects (mean age, 62.5 ± 15.4 years; 53.7% women), the mean increase in CCT was 10.3% postoperatively. Greater corneal edema was associated with lower GAT IOP in unadjusted analyses (P < 0.03) and in linear regression models (P < 0.01). In the model, higher corneal resistance factor (P < 0.001), lower corneal hysteresis (P < 0.001), and steeper radius of corneal curvature (P < 0.001) were associated with higher GAT IOP. Among subjects with edema < the median, edema was associated with lower GAT IOP (P = 0.004), whereas among those with edema ≥ the median, edema was not associated with GAT IOP. An increase in CCT of 7% was associated with an 8 mm Hg underestimation of GAT IOP in our models. CONCLUSIONS: The effect of postoperative edema on GAT IOP seems to be the opposite of contact lens-induced edema. The magnitude of the effect is potentially relevant to patient management.

Corneal hysteresis is correlated with reduction in axial length after trabeculectomy.

BACKGROUND: We sought to determine whether corneal biomechanical parameters are predictive of reduction in axial length after anti-metabolite trabeculectomy. METHODS: Chinese subjects undergoing trabeculectomy with mitomycin C by a single experienced surgeon underwent the following measurements: Corneal hysteresis (CH, Ocular Response Analyzer, Reichert Ophthalmic Instruments), Goldmann intra-ocular pressure (IOP), central corneal thickness (CCT) and axial length (AL, IOLMaster, Carl Zeiss Meditec, Dublin, CA) were measured pre-operatively, and AL, CH and IOP were measured 1 day and 1 week post-operatively. RESULTS: Mean age of 31 subjects was 52.0 ± 15.2 years, and 15 (48.4%) were female. The mean pre-operative IOP of 21.4 ± 9.3 mmHg was reduced to 8.2 ± 4.6 mmHg 1 day and 11.0 ± 4.4 mmHg 1 week post-operatively (p < 0.001). AL declined from 22.99 ± 0.90 to 22.76 ± 0.87 mm at 1 day and 22.74 ± 0.9 mm at 1 week; 30/31 (%) eyes had a decline in AL (p < 0.001, sign test). In multivariate linear regression models including post-operative data from 1 day and 1 week, greater decline in Goldmann IOP (p < 0.0001, greater pre-op axial length (p < 0.001) and lower pre-operative CH (p = 0.03), were all associated with greater decline in post-operative axial length. CONCLUSIONS: Eyes with lesser ability of the ocular coat to absorb energy (lower CH) had significantly greater decrease in axial length after trabeculectomy-induced IOP-lowering.

The use of Log-file analysis within VMAT audits

OBJECTIVE: This work investigates the delivery accuracy of different Varian linear accelerator models using log-file derived MLC RMS values.

METHODS: Seven centres independently created a plan on the same virtual phantom using their own planning system and the log files were analysed following delivery of the plan in each centre to assess MLC positioning accuracy. A single standard plan was also delivered by seven centres to remove variations in complexity and the log files were analysed for Varian TrueBeams and Clinacs (2300IX or 2100CD models).

RESULTS: Varian TrueBeam accelerators had better MLC positioning accuracy (<1.0mm) than the 2300IX (<2.5mm) following delivery of the plans created by each centre and also the standard plan. In one case log files provided evidence that reduced delivery accuracy was not associated with the linear accelerator model but was due to planning issues.

CONCLUSIONS: Log files are useful in identifying differences between linear accelerator models, and isolate errors during end-to-end testing in VMAT audits. Log file analysis can rapidly eliminate the machine delivery from the process and divert attention with confidence to other aspects. Advances in Knowledge: Log file evaluation was shown to be an effective method to rapidly verify satisfactory treatment delivery when a dosimetric evaluation fails during end-to-end dosimetry audits. MLC RMS values for Varian TrueBeams were shown to be much smaller than Varian Clinacs for VMAT deliveries.

Evidence for the reliability and validity, but not the practical utility of the two-factor Consideration of Future Consequences Scale-14

Researchers have proposed 1-factor, 2-factor, and bifactor solutions to the 12-item Consideration of Future Consequences Scale (CFCS-12). In order to overcome some measurement problems and to create a robust and conceptually useful two-factor scale the CFCS-12 was recently modified to include two new items and to become the CFCS-14. Using a University sample, we tested four competing models for the CFCS-14: (a) a 12-item unidimensional model, (b) a model fitted for two uncorrelated factors (CFC-Immediate and CFC-Future), (c) a model fitted for two correlated factors (CFC-I and CFC-F), and (d) a bifactor model. Results suggested that the addition of the two new items has strengthened the viability of a two factor solution of the CFCS-14. Results of linear regression models suggest that the CFC-F factor is redundant. Further studies using alcohol and mental health indicators are required to test this redundancy.

Effect of vehicle characteristics on safety, fuel use and emissions

Nos últimos anos, o número de vítimas de acidentes de tráfego por milhões de habitantes em Portugal tem sido mais elevado do que a média da União Europeia. Ao nível nacional torna-se premente uma melhor compreensão dos dados de acidentes e sobre o efeito do veículo na gravidade do mesmo. O objetivo principal desta investigação consistiu no desenvolvimento de modelos de previsão da gravidade do acidente, para o caso de um único veículo envolvido e para caso de uma colisão, envolvendo dois veículos. Além disso, esta investigação compreendeu o desenvolvimento de uma análise integrada para avaliar o desempenho do veículo em termos de segurança, eficiência energética e emissões de poluentes. Os dados de acidentes foram recolhidos junto da Guarda Nacional Republicana Portuguesa, na área metropolitana do Porto para o período de 2006-2010. Um total de 1,374 acidentes foram recolhidos, 500 acidentes envolvendo um único veículo e 874 colisões. Para a análise da segurança, foram utilizados modelos de regressão logística. Para os acidentes envolvendo um único veículo, o efeito das características do veículo no risco de feridos graves e/ou mortos (variável resposta definida como binária) foi explorado. Para as colisões envolvendo dois veículos foram criadas duas variáveis binárias adicionais: uma para prever a probabilidade de feridos graves e/ou mortos num dos veículos (designado como veículo V1) e outra para prever a probabilidade de feridos graves e/ou mortos no outro veículo envolvido (designado como veículo V2). Para ultrapassar o desafio e limitações relativas ao tamanho da amostra e desigualdade entre os casos analisados (apenas 5.1% de acidentes graves), foi desenvolvida uma metodologia com base numa estratégia de reamostragem e foram utilizadas 10 amostras geradas de forma aleatória e estratificada para a validação dos modelos. Durante a fase de modelação, foi analisado o efeito das características do veículo, como o peso, a cilindrada, a distância entre eixos e a idade do veículo. Para a análise do consumo de combustível e das emissões, foi aplicada a metodologia CORINAIR. Posteriormente, os dados das emissões foram modelados de forma a serem ajustados a regressões lineares. Finalmente, foi desenvolvido um indicador de análise integrada (denominado “SEG”) que proporciona um método de classificação para avaliar o desempenho do veículo ao nível da segurança rodoviária, consumos e emissões de poluentes.Face aos resultados obtidos, para os acidentes envolvendo um único veículo, o modelo de previsão do risco de gravidade identificou a idade e a cilindrada do veículo como estatisticamente significativas para a previsão de ocorrência de feridos graves e/ou mortos, ao nível de significância de 5%. A exatidão do modelo foi de 58.0% (desvio padrão (D.P.) 3.1). Para as colisões envolvendo dois veículos, ao prever a probabilidade de feridos graves e/ou mortos no veículo V1, a cilindrada do veículo oposto (veículo V2) aumentou o risco para os ocupantes do veículo V1, ao nível de significância de 10%. O modelo para prever o risco de gravidade no veículo V1 revelou um bom desempenho, com uma exatidão de 61.2% (D.P. 2.4). Ao prever a probabilidade de feridos graves e/ou mortos no veículo V2, a cilindrada do veículo V1 aumentou o risco para os ocupantes do veículo V2, ao nível de significância de 5%. O modelo para prever o risco de gravidade no veículo V2 também revelou um desempenho satisfatório, com uma exatidão de 40.5% (D.P. 2.1). Os resultados do indicador integrado SEG revelaram que os veículos mais recentes apresentam uma melhor classificação para os três domínios: segurança, consumo e emissões. Esta investigação demonstra que não existe conflito entre a componente da segurança, a eficiência energética e emissões relativamente ao desempenho dos veículos.

Describing vocal performance of Portuguese cantadeiras of Alto Minho

Portugal has strong musical traditions, which have been perpetrated by decades through folkloristic activities. In folk groups from Alto Minho (north of Portugal), folk singing is mostly performed by cantadeiras, amateur female solo singers who learn this style orally. Their vocal characteristics are distinctive when compared with other regions of the country; however, deep understanding of these vocal practices is still missing. The present work aims at studying Alto Minho cantadeira’s vocal performance in a multidimensional perspective, envisioning social, cultural and physiological understanding of this musical style. Thus, qualitative and quantitative data analyses were carried out, to: (i) describe current performance practices, (ii) explore existent perceptions about most relevant voice features in this region, (iii) investigate physiological and acoustic properties of this style, and (iv) compare this style of singing with other non-classical singing styles of other countries. Dataset gathered involved: 78 groups whose members were telephone interviewed, 13 directors who were asked to fill in a questionnaire on performance practices, 1 cantadeira in a pilot study, 16 cantadeiras in preliminary voice recordings, 77 folk group members in listening tests, and 10 cantadeiras in multichannel recordings, including audio, ELG, air flow and intra-oral pressure signals. Data were analysed through thematic content analysis, descriptive and inferential statistics, hierarchical principal components, and multivariate linear regression models. Most representative voices have a high pitched and loud voice, with a bright timbre, predominance of chest register without excessive effort, and good text intelligibility with regional accent. High representativeness levels were obtained by few cantadeiras; these sing with high levels of subglottal pressure and vocal fold contact quotient, predominance of high spectrum energy and vocal loudness, corroborating indications of prevalence of pressed phonation. These vocal characteristics resemble belting in musical theatre and share similarities with country (USA) and ojikanje (Croatia) singing. Strategies that may contribute to the preservation of this type of singing and the vocal health of current cantadeiras are discussed, pointing at the direction of continuous education among folk groups, following practices that are already adopted elsewhere in Europe.

Satisfação do cliente na área da restauração

Dissertação de Mestrado , Ciências Económicas e Empresariais, Faculdade de Economia, Universidade do Algarve, 2008

Implementation of a service quality strategy: application to the Algarve hotel industry

Tese dout., Doctor of Philisophy, Sheffield Hallam University, 2001

Constructing a 7-day Ahead Forecast Model for Grass Pollen at North London, United Kingdom

A number of media outlets now issue medium-range (~7 day) weather forecasts on a regular basis. It is therefore logical that aerobiologists should attempt to produce medium-range forecasts for allergenic pollen that cover the same time period as the weather forecasts. The objective of this study is to construct a medium-range (< 7 day) forecast model for grass pollen at north London. The forecast models were produced using regression analysis based on grass pollen and meteorological data from 1990-1999 and tested on data from 2000 and 2002. The modelling process was improved by dividing the grass pollen season into three periods; the pre-peak, peak and post peak periods of grass pollen release. The forecast consisted of five regression models. Two simple linear regression models predicting the start and end date of the peak period, and three multiple regression models forecasting daily average grass pollen counts in the pre-peak, peak and post-peak periods. Overall the forecast models achieved 62% accuracy in 2000 and 47% in 2002, reflecting the fact that the 2002 grass pollen season was of a higher magnitude than any of the other seasons included in the analysis. This study has the potential to make a notable contribution to the field of aerobiology. Winter averages of the North Atlantic Oscillation were used to predict certain characteristics of the grass pollen season, which presents an important advance in aerobiological work. The ability to predict allergenic pollen counts for a period between five and seven days will benefit allergy sufferers. Furthermore, medium-range forecasts for allergenic pollen will be of assistance to the medical profession, including allergists planning treatment and physicians scheduling clinical trials.

Modelos de resposta à interação entre fármacos anestésicos : análise de regressão e análise de Clusters

Os avanços tecnológicos e científicos, na área da saúde, têm vindo a aliar áreas como a Medicina e a Matemática, cabendo à ciência adequar de forma mais eficaz os meios de investigação, diagnóstico, monitorização e terapêutica. Os métodos desenvolvidos e os estudos apresentados nesta dissertação resultam da necessidade de encontrar respostas e soluções para os diferentes desafios identificados na área da anestesia. A índole destes problemas conduz, necessariamente, à aplicação, adaptação e conjugação de diferentes métodos e modelos das diversas áreas da matemática. A capacidade para induzir a anestesia em pacientes, de forma segura e confiável, conduz a uma enorme variedade de situações que devem ser levadas em conta, exigindo, por isso, intensivos estudos. Assim, métodos e modelos de previsão, que permitam uma melhor personalização da dosagem a administrar ao paciente e por monitorizar, o efeito induzido pela administração de cada fármaco, com sinais mais fiáveis, são fundamentais para a investigação e progresso neste campo. Neste contexto, com o objetivo de clarificar a utilização em estudos na área da anestesia de um ajustado tratamento estatístico, proponho-me abordar diferentes análises estatísticas para desenvolver um modelo de previsão sobre a resposta cerebral a dois fármacos durante sedação. Dados obtidos de voluntários serão utilizados para estudar a interação farmacodinâmica entre dois fármacos anestésicos. Numa primeira fase são explorados modelos de regressão lineares que permitam modelar o efeito dos fármacos no sinal cerebral BIS (índice bispectral do EEG – indicador da profundidade de anestesia); ou seja estimar o efeito que as concentrações de fármacos têm na depressão do eletroencefalograma (avaliada pelo BIS). Na segunda fase deste trabalho, pretende-se a identificação de diferentes interações com Análise de Clusters bem como a validação do respetivo modelo com Análise Discriminante, identificando grupos homogéneos na amostra obtida através das técnicas de agrupamento. O número de grupos existentes na amostra foi, numa fase exploratória, obtido pelas técnicas de agrupamento hierárquicas, e a caracterização dos grupos identificados foi obtida pelas técnicas de agrupamento k-means. A reprodutibilidade dos modelos de agrupamento obtidos foi testada através da análise discriminante. As principais conclusões apontam que o teste de significância da equação de Regressão Linear indicou que o modelo é altamente significativo. As variáveis propofol e remifentanil influenciam significativamente o BIS e o modelo melhora com a inclusão do remifentanil. Este trabalho demonstra ainda ser possível construir um modelo que permite agrupar as concentrações dos fármacos, com base no efeito no sinal cerebral BIS, com o apoio de técnicas de agrupamento e discriminantes. Os resultados desmontram claramente a interacção farmacodinâmica dos dois fármacos, quando analisamos o Cluster 1 e o Cluster 3. Para concentrações semelhantes de propofol o efeito no BIS é claramente diferente dependendo da grandeza da concentração de remifentanil. Em suma, o estudo demostra claramente, que quando o remifentanil é administrado com o propofol (um hipnótico) o efeito deste último é potenciado, levando o sinal BIS a valores bastante baixos.

O impacto do excesso de gordura corporal sobre a remodelação óssea de adolescentes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The effect of long-chain polyunsaturated fatty acids intake during pregnancy on adiposity of healthy full-term offspring at birth

Objective - The adjusted effect of long-chain polyunsaturated fatty acid (LCPUFA) intake during pregnancy on adiposity at birth of healthy full-term appropriate-for-gestational age neonates was evaluated. Study Design - In a cross-sectional convenience sample of 100 mother and infant dyads, LCPUFA intake during pregnancy was assessed by food frequency questionnaire with nutrient intake calculated using Food Processor Plus. Linear regression models for neonatal body composition measurements, assessed by air displacement plethysmography and anthropometry, were adjusted for maternal LCPUFA intakes, energy and macronutrient intakes, prepregnancy body mass index and gestational weight gain. Result - Positive associations between maternal docosahexaenoic acid intake and ponderal index in male offspring (β=0.165; 95% confidence interval (CI): 0.031–0.299; P=0.017), and between n-6:n-3 LCPUFA ratio intake and fat mass (β=0.021; 95% CI: 0.002–0.041; P=0.034) and percentage of fat mass (β=0.636; 95% CI: 0.125–1.147; P=0.016) in female offspring were found. Conclusion - Using a reliable validated method to assess body composition, adjusted positive associations between maternal docosahexaenoic acid intake and birth size in male offspring and between n-6:n-3 LCPUFA ratio intake and adiposity in female offspring were found, suggesting that maternal LCPUFA intake strongly influences fetal body composition.

The Effect of Long-Chain Polyunsaturated Fatty Acids Intake During Pregnancy on Adiposity of Healthy Full-Term Offspring at Birth

OBJECTIVE: The adjusted effect of long-chain polyunsaturated fatty acid (LCPUFA) intake during pregnancy on adiposity at birth of healthy full-term appropriate-for-gestational age neonates was evaluated. STUDY DESIGN: In a cross-sectional convenience sample of 100 mother and infant dyads, LCPUFA intake during pregnancy was assessed by food frequency questionnaire with nutrient intake calculated using Food Processor Plus. Linear regression models for neonatal body composition measurements, assessed by air displacement plethysmography and anthropometry, were adjusted for maternal LCPUFA intakes, energy and macronutrient intakes, prepregnancy body mass index and gestational weight gain. RESULT: Positive associations between maternal docosahexaenoic acid intake and ponderal index in male offspring (β=0.165; 95% confidence interval (CI): 0.031-0.299; P=0.017), and between n-6:n-3 LCPUFA ratio intake and fat mass (β=0.021; 95% CI: 0.002-0.041; P=0.034) and percentage of fat mass (β=0.636; 95% CI: 0.125-1.147; P=0.016) in female offspring were found. CONCLUSION: Using a reliable validated method to assess body composition, adjusted positive associations between maternal docosahexaenoic acid intake and birth size in male offspring and between n-6:n-3 LCPUFA ratio intake and adiposity in female offspring were found, suggesting that maternal LCPUFA intake strongly influences fetal body composition.