Partial cricotracheal resection for severe pediatric subglottic stenosis: update of the Lausanne experience.

Until recently, severe pediatric subglottic stenosis (SGS) has been treated almost exclusively by laryngotracheoplasty procedures. Even in the most experienced centers, the results of single-stage operations for Cotton's grade III and IV stenoses have been disappointing. This paper reports our experience on 31 partial cricotracheal resections for severe SGS in infants and children. The stenosis was congenital in 6 cases and acquired after prolonged intubation in 25 cases. Twenty-seven patients were tracheotomy-dependent at the time of surgery. Twenty-two cases were classified as grade III and 9 cases as grade IV stenoses according to Cotton. The decannulation rate was 97% (30 of 31 cases) after an open procedure. There were no fatalities and no lesions to the recurrent laryngeal nerves, but there was 1 complete restenosis. Twenty-seven patients show no exertional dyspnea, 3 have a slight stridor with some dyspnea while exercising, and 1 patient is not decannulated. The voice is normal in 21 cases, a dysphonia is present in 9 cases, and the patient with complete restenosis acquired an esophageal voice. Postoperative follow-up is longer than 10 years in 8 cases and longer than 5 years in an additional 6 cases. All patients who reached adulthood show normal growth of the larynx and trachea. Considering the excellent results obtained in this consecutive series of 31 cases, partial cricoid resection with primary thyrotracheal anastomosis should be considered an important treatment option for severe SGS in infants and children.

O turismo e a percepção dos seus impactes pela comunidade local : o caso da Ilha do Sal, Cabo Verde

The traditional analysis of tourism, having in mind only its economic impacts has been shown to be reductive and insufficient to explain the numerous and versatile modifications these can and will stimulate in a society at many levels, e.g. socially, culturally, politically and in the environment. The complexity of touristic activities and the insufficient measuring instruments that can provide exact data about these, gives terrain to the emergence of myths and value judgments around the effects in countries where tourism is a reality. This study aims at understanding how the impacts of tourism are grasped by the local community in Sal island – Cape Verde – convinced as we are that a quality and sustainable touristic offer can only be done by trialing the population, and involving them in the planning, managing and monitoring processes. The analysis of the perception of the impacts of touristic activities by the population tells us a lot about the levels of satisfaction of such communities towards the way in which the touristic development has been carried out in their surroundings. This study has been made through the inquiry of 231 locals, by means of a questionnaire, that showed that the population in this island has a very clear conscience of the impacts of tourism in their day-to-day lives. Conclusions drawn are that the negative economic and social impacts are greater than the positive; the cultural and environmental impacts are not so significant, and that the people feel that their voice has not been heard in what planning touristic activities is concerned. Nevertheless, they have high expectations regarding tourism as a way of ameliorating their life conditions. The inexistence of a linear behavior of impacts of touristic activities in the receptive countries and a perfect and adjustable model for tourism development make these countries delineate new politics aiming at the sustainability and the creation of conditions that help them monitor and mitigate its negative impacts.

O turismo e a percepção dos seus impactes pela comunidade local: o caso da Ilha do Sal, Cabo Verde

A análise tradicional do turismo visando apenas a sua dimensão económica tem-se mostrado redutora e insuficiente para explicar as inúmeras e versáteis alterações que pode provocar a nível social, cultural, político e ambiental. A complexidade da actividade turística e a carência de instrumentos ajustados para avaliar e tornar mensuráveis os seus impactes constituem terreno fértil à emergência de mitos e de juízos de valor em torno dos efeitos por ele causado nos países receptores. A linha orientadora da investigação parte do pressuposto que a actividade turística só faz sentido e se torna viável se proporcionar uma experiência qualitativa aos principais agentes envolvidos: os turistas e os residentes. A tentativa de compreender a forma como os impactes do turismo são percepcionados pela comunidade receptora da ilha do Sal em Cabo Verde está intimamente associado à convicção que um turismo de qualidade e sustentável só é possível auscultando a população e envolvendo-a no planeamento, gestão e monitorização da actividade. A análise da percepção dos impactes da actividade turística por parte da comunidade desemboca indirectamente no conhecimento dos níveis de satisfação da comunidade em relação à forma como se tem realizado o desenvolvimento turístico na ilha. No âmbito do trabalho de investigação foram realizados duzentos e trinta e um questionários cujos resultados da investigação levam a acreditar que a comunidade local salense possui uma clara consciência dos impactes do turismo no seu quotidiano. Verifica-se que a percepção dos impactes económicos e sociais negativos reúnem maior consenso que os impactes positivos. Os impactes culturais e ambientais são ainda pouco perceptíveis por parte dos inquiridos. Por outro lado, os inquiridos na sua generalidade não se sentem envolvidos no planeamento da actividade turística, embora haja elevadas expectativas em relação à actividade como forma de melhoria das condições de vida da população. A inexistência de um comportamento linear dos impactes da actividade turística no destino e de um modelo de desenvolvimento turístico perfeito e ajustável a todas as realidades obriga a que sejam delineados por parte dos países receptores políticas de planeamento visando a sustentabilidade e condições para a monitorização e mitigação dos seus impactes.

O turismo e a percepção dos seus impactes pela comunidade local : o caso da Ilha do Sal, Cabo Verde

The traditional analysis of tourism, having in mind only its economic impacts has been shown to be reductive and insufficient to explain the numerous and versatile modifications these can and will stimulate in a society at many levels, e.g. socially, culturally, politically and in the environment. The complexity of touristic activities and the insufficient measuring instruments that can provide exact data about these, gives terrain to the emergence of myths and value judgments around the effects in countries where tourism is a reality. This study aims at understanding how the impacts of tourism are grasped by the local community in Sal island – Cape Verde – convinced as we are that a quality and sustainable touristic offer can only be done by trialing the population, and involving them in the planning, managing and monitoring processes. The analysis of the perception of the impacts of touristic activities by the population tells us a lot about the levels of satisfaction of such communities towards the way in which the touristic development has been carried out in their surroundings. This study has been made through the inquiry of 231 locals, by means of a questionnaire, that showed that the population in this island has a very clear conscience of the impacts of tourism in their day-to-day lives. Conclusions drawn are that the negative economic and social impacts are greater than the positive; the cultural and environmental impacts are not so significant, and that the people feel that their voice has not been heard in what planning touristic activities is concerned. Nevertheless, they have high expectations regarding tourism as a way of ameliorating their life conditions. The inexistence of a linear behavior of impacts of touristic activities in the receptive countries and a perfect and adjustable model for tourism development make these countries delineate new politics aiming at the sustainability and the creation of conditions that help them monitor and mitigate its negative impacts.

Do Jardim-de-Infância ao Centro de Actividades de Tempos Livres: Representações das Crianças sobre o Brincar

A investigação “Do Jardim-de-infância ao Centro de Actividades de Tempos Livres: Representações das Crianças sobre o Brincar” reconhece as crianças como actores sociais, sujeitos de direitos, entre eles, o direito à participação em assuntos que lhes digam directamente respeito, a assuntos de seu interesse, nomeadamente o direito ao brincar. O brincar é uma actividade lúdica, assim como o jogar, importante no processo de crescimento e desenvolvimento da criança e, nos tempos que correm, a sociedade, de uma forma geral, e particularmente as famílias, preocupam-se muito com o trabalho e colocam as necessidades básicas das crianças em segundo plano ao valorizarem acima de tudo o sucesso e o desempenho das mesmas. Assim, se participar significa “tomar parte em”, reconhece-se a necessidade de ouvir as crianças e o que elas têm a dizer sobre essa actividade lúdica, sobre a forma como organizam o seu dia e o tempo que despendem para brincar e sobre a forma como gostariam de ver os seus dias ocupados. É neste pressuposto, de que é através da acção e da voz das crianças, que é possível a construção de um conhecimento teórico e válido que contribua para uma melhor intervenção educativa com as crianças. Esta investigação, que decorreu numa instituição com várias vertentes, entre elas a vertente da Animação Infantil, enquadra-se no paradigma qualitativo de natureza participativa, e procura interpretar os significados atribuídos pelas crianças, que frequentam o Jardim-deinfância da rede pública e a mesma instituição, na condição de Componente de Apoio à Família, ao brincar, às suas vivências no que concerne à gestão do seu quotidiano, quer no que refere ao tempo que passam no Jardim-de-infância, quer no que passam no Prolongamento de Horário/Actividades de Tempos Livres. Neste trabalho de investigação que decorreu numa instituição situada numa freguesia pertencente ao Distrito de Viana do Castelo e que disponibiliza os serviços de ATL, participaram como protagonistas as crianças da faixa etária entre os três e os seis anos de idade e que frequentam dois contextos: educacional e lúdico. Este trabalho é sustentado por um referencial teórico que engloba o brincar na sociedade actual e a sua importância, a educação pré-escolar e as suas funções, a natureza da componente de apoio à família, a animação sócio-educativa e os contextos de vida das crianças, que permitiram questionar a participação infantil em assuntos de seu interesse. Ainda que este estudo não permita generalizações, reflecte-se sobre a realidade existente, dá voz às crianças e indica aspectos que, de uma forma geral, precisam de mais atenção. Afinal o brincar na infância é um assunto sério…

[Archives de la Parole]. , Luma namthar : Tibetan Duet / Wangdi, chant duo. Sonam Panguay : Tibetan Song / Nima, chant

Langue tibétaine

Lire l'oral : pour une typologie linguistique des représentations écrites de l'oralité (le cas du français)

Cette thèse propose de passer en revue les modalités de la représentation écrite de l'oralité en français. La pratique littéraire constitue le matériau et l'horizon de la théorisation. La problématique - comment l'écrit représente-t-il l'oral ? - est d'abord située et reformulée dans le cadre de la linguistique de la parole (I). Les rapports entre oralité et scripturalité sont ensuite étudiés sous trois angles. L'angle biotechnologique compare la matérialité et l'affordance des signaux graphiques et des signaux acoustiques (II 1). L'examen sémiotique reconnaît dans le français écrit un système dit phonographique dont la fonction est de représenter l'expression des signes du français oral. Sont analysées alors les relations entre les systèmes de signes impliqués, la diversité des actualisations possibles du système phonographique (effets d'écoute), ainsi que diverses sémiotiques analogiques (II 2). On étudie ensuite le rôle de la prosodie dans la lecture. La position adoptée est la suivante : bien qu'elle soit facultative dans l'activité de lecture, la prosodie est spécialement sollicitée par des écrits qu'on peut caractériser linguistiquement. L'interprétation prosodique apporte à ces écrits un surcroît de signification en même temps qu'il produit un mode spécifique de représentation de l'oral appelé effet prosodique (II 3). L'angle sémantique est esquissé finalement : il conduit à dégager deux modalités de représentation supplémentaire. Pour la première, l'oral se situe sur le plan sémantico-référentiel de l'expression écrite (écrire à propos d'oral) ; pour la seconde, l'oral est un extérieur discursif modalisant le dire écrit : l'écrit est reconnu comme énoncé à la manière de l'oral (effet de style oral). - This PhD thesis attempts to review the modalities of orality in written representation. Literary writings act as the material for theorization. First of all, the thesis statement - how does writing represent oral - is situated and then, reformulated within the frame of linguistique de la parole (the linguistic field of speech) (I). The connections between orality and writing are then studied under three angles. The biotechnological angle compares the materiality and the affordance of graphic signs and acoustic signals (II 1). A semiotic examination acknowledges, in French, a phonographical system whose function is to represent the expression of French oral signs. Thus, the relationships between the systems of implicated signs, the diversity of possible actualisations of the phonographic system (voice effects), as well as various analogical semiotics are analysed (II 2). Furthermore, the role of prosody is studied within reading. The stand taken is the following : even though it is optional during a reading activity, prosody is especially sought-after by linguistically characterised writings. The prosodie interpretation brings to these writings a surge of signification while producing a specific mode of oral representation called the prosodie effects (II 3). The semantic angle is finally drawn : it leads to two additional modalities of representation. For the first part, speech is located on the semantic and referential plan of the written expression (writing about speech); as for the second part, spoken language is a discursive exteriority : writing is recognised as an oral-like utterance {oral-like effect).

Like Man, Like Woman: Roman Women, Gender Qualities and Conjugal Relationships at the Turn of the First Century

Modern scholarship often discusses Roman women in terms of their difference from their male counterparts, frequently defining them as 'other'. This book shows how Roman male writers at the turn of the first century actually described women as not so different from men: the same qualities and abilities pertaining to the domains of parenthood, intellect and morals are ascribed by writers to women as well as to men. There are two voices, however: a traditional, ideal voice and an individual, realistic voice. This creates a duality of representations of women, which recurs across literary genres and reflects a duality of mentality. How can we interpret the paradoxical information about Roman women given by the male-authored texts? How does this duality of mentality inform us about gender roles and gender hierarchy? This work analyses well-known, as well as overlooked, passages from the writings of Pliny the Younger, Tacitus, Suetonius, Quintilian, Statius, Martial and Juvenal and sheds new light on Roman views of women and their abilities, on the notions of private and public and on conjugal relationships. In the process, the famous sixth satire of Juvenal is revisited and its topic reassessed, providing further insights into the complex issues of gender roles, marriage and emotions. By contrasting representations of women across a broad spectrum of literary genres, this book provides consistent findings that have wide significance for the study of Latin literature and the social history of the late first and early second centuries.

Alteritzar la singularitat: veus per a una pedagogia de l'experiència

Parte de la investigación en torno a la realidad educativa que se ha desarrollado durante los últimos años se caracteriza por intentar encontrar formas de interpretación orientadas a significar los procesos formativos centrados en las vivencias singulares de los agentes que participan de la educación así como en la posibilidad que éstas ofrecen de devenir experiencia, eso es,vivencia concienciada. A raíz de las mismas podemos observar como la biografía apunta a ser una de las más emblemáticas formalizaciones del proceso de narración de vivencias. Pero, aún cuando la misma se perfila como una de las narraciones que más promueven la interpretación e intercambio de vivencias, posibilitando la reflexión e, incluso, formación mediada, la biografía todavía presenta como forma teorética algunos escollos. Los cuales, pueden ser utilizados como preguntas base para formular una voz de las pedagogías de la experiencia. Justamente, interrogarse y repensar su factibilidad es el tema que se ensaya en el presente artículo.

Reconeixement de veu mitjançant xarxes neuronals

La interacció home-màquina per mitjà de la veu cobreix moltes àrees d’investigació. Es destaquen entre altres, el reconeixement de la parla, la síntesis i identificació de discurs, la verificació i identificació de locutor i l’activació per veu (ordres) de sistemes robòtics. Reconèixer la parla és natural i simple per a les persones, però és un treball complex per a les màquines, pel qual existeixen diverses metodologies i tècniques, entre elles les Xarxes Neuronals. L’objectiu d’aquest treball és desenvolupar una eina en Matlab per al reconeixement i identificació de paraules pronunciades per un locutor, entre un conjunt de paraules possibles, i amb una bona fiabilitat dins d’uns marges preestablerts. El sistema és independent del locutor que pronuncia la paraula, és a dir, aquest locutor no haurà intervingut en el procés d’entrenament del sistema. S’ha dissenyat una interfície que permet l’adquisició del senyal de veu i el seu processament mitjançant xarxes neuronals i altres tècniques. Adaptant una part de control al sistema, es podria utilitzar per donar ordres a un robot com l’Alfa6Uvic o qualsevol altre dispositiu.

Iowa Communications Network Fiscal Year 2009 Annual Report

On behalf of the Iowa Telecommunications and Technology Commission (ITTC) overseeing the Iowa Communications Network, I am pleased to submit the Fiscal Year 2009 Annual Report. Throughout the report you will find stories and examples that demonstrate the many ways in which ICN video, voice, Internet, and data services have touched the lives of Iowans across our state. The ITTC strongly supports the IJOBS initiative and has enthusiastically accepted its responsibilities as stated in SF376 bill passed during the 2009 legislative session. Through the collaboration of the Iowa Utilities Board, Iowa Department of Economic Development and ITTC, a talented governing board is bringing together the interests of many public and private stakeholders to strengthen our telecommunications infrastructure and make broadband access a reality for every Iowan.

Iowa Communications Network Fiscal Year 2009 Annual Report

On behalf of the Iowa Telecommunications and Technology Commission (ITTC) overseeing the Iowa Communications Network, I am pleased to submit the Fiscal Year 2009 Annual Report. Throughout the report you will find stories and examples that demonstrate the many ways in which ICN video, voice, Internet, and data services have touched the lives of Iowans across our state. The ITTC strongly supports the IJOBS initiative and has enthusiastically accepted its responsibilities as stated in SF376 bill passed during the 2009 legislative session. Through the collaboration of the Iowa Utilities Board, Iowa Department of Economic Development and ITTC, a talented governing board is bringing together the interests of many public and private stakeholders to strengthen our telecommunications infrastructure and make broadband access a reality for every Iowan.

Memòria final Catalunya i França: cors amics

Aquest projecte s'emmarca dins l'estudi i aplicació de la creativitat i la cultura mitjançant la difusió musical als àmbits de la divulgació i a l'articulació de programes de concert per part de possibles entitats que poguessin estar interessades en aprofundir i difondre al públic en general, els repertoris, autors i estils de la música coral que han estat a cavall d'ambdós territoris: Catalunya i França, al llarg de la història.

Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with methylated MGMT promoter (CENTRIC EORTC 26071-22072 study): a multicentre, randomised, open-label, phase 3 trial.

BACKGROUND: Cilengitide is a selective αvβ3 and αvβ5 integrin inhibitor. Data from phase 2 trials suggest that it has antitumour activity as a single agent in recurrent glioblastoma and in combination with standard temozolomide chemoradiotherapy in newly diagnosed glioblastoma (particularly in tumours with methylated MGMT promoter). We aimed to assess cilengitide combined with temozolomide chemoradiotherapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. METHODS: In this multicentre, open-label, phase 3 study, we investigated the efficacy of cilengitide in patients from 146 study sites in 25 countries. Eligible patients (newly diagnosed, histologically proven supratentorial glioblastoma, methylated MGMT promoter, and age ≥18 years) were stratified for prognostic Radiation Therapy Oncology Group recursive partitioning analysis class and geographic region and centrally randomised in a 1:1 ratio with interactive voice response system to receive temozolomide chemoradiotherapy with cilengitide 2000 mg intravenously twice weekly (cilengitide group) or temozolomide chemoradiotherapy alone (control group). Patients and investigators were unmasked to treatment allocation. Maintenance temozolomide was given for up to six cycles, and cilengitide was given for up to 18 months or until disease progression or unacceptable toxic effects. The primary endpoint was overall survival. We analysed survival outcomes by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00689221. FINDINGS: Overall, 3471 patients were screened. Of these patients, 3060 had tumour MGMT status tested; 926 patients had a methylated MGMT promoter, and 545 were randomly assigned to the cilengitide (n=272) or control groups (n=273) between Oct 31, 2008, and May 12, 2011. Median overall survival was 26·3 months (95% CI 23·8-28·8) in the cilengitide group and 26·3 months (23·9-34·7) in the control group (hazard ratio 1·02, 95% CI 0·81-1·29, p=0·86). None of the predefined clinical subgroups showed a benefit from cilengitide. We noted no overall additional toxic effects with cilengitide treatment. The most commonly reported adverse events of grade 3 or worse in the safety population were lymphopenia (31 [12%] in the cilengitide group vs 26 [10%] in the control group), thrombocytopenia (28 [11%] vs 46 [18%]), neutropenia (19 [7%] vs 24 [9%]), leucopenia (18 [7%] vs 20 [8%]), and convulsion (14 [5%] vs 15 [6%]). INTERPRETATION: The addition of cilengitide to temozolomide chemoradiotherapy did not improve outcomes; cilengitide will not be further developed as an anticancer drug. Nevertheless, integrins remain a potential treatment target for glioblastoma. FUNDING: Merck KGaA, Darmstadt, Germany.

La ciència del bé i del mal en El jardí simbòlic

Chapter 21 of the Byzantine work known as The Symbolic Garden refers to an unidentified plant (the smilax) which symbolizes science. The author has taken this symbol from patristic literature (Athanasius of Alexandria and other patristic texts). On the other hand, a passage (p. 71, 17- 73, 1) unti1 now misinterpreted can be understood if confronted with severa1 texts by John Darnascenus and Nicetas Stethatos, who both voice the same opinions about science