915 resultados para accommodation paralysis


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Our study examines asymmetric rivalry within and between strategic groups defined according to the size of their members. We hypothesize that, owing to several forms of group-level effects, including switching costs and efficiency, strategic groups comprising large firms expect to experience a large amount of retaliation from firms within their group and accommodation from the group comprising smaller firms. Small firms, on the other hand, expect to experience a small amount of retaliation from the group comprising large firms and no reaction from the other firms in their group. We estimate the effect of group-level strategic interactions on firm performance. Our analysis reveals that the rivalry behavior within and between groups is asymmetric, which supports the dominant-fringe relation between firms, as described in our hypothesis.

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Purpose: To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. Methods: We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. Results: The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients’ symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

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Objective: To evaluate two cases of intermittent exotropia (IX(T)) treated by vision therapy the efficacy of the treatment by complementing the clinical examination with a 3-D video-oculography to register and to evidence the potential applicability of this technology for such purpose. Methods: We report the binocular alignment changes occurring after vision therapy in a woman of 36 years with an IX(T) of 25 prism diopters (Δ) at far and 18 Δ at near and a child of 10 years with 8 Δ of IX(T) in primary position associated to 6 Δ of left eye hypotropia. Both patients presented good visual acuity with correction in both eyes. Instability of ocular deviation was evident by VOG analysis, revealing also the presence of vertical and torsional components. Binocular vision therapy was prescribed and performed including different types of vergence, accommodation, and consciousness of diplopia training. Results: After therapy, excellent ranges of fusional vergence and a “to-the-nose” near point of convergence were obtained. The 3-D VOG examination (Sensoro Motoric Instruments, Teltow, Germany) confirmed the compensation of the deviation with a high level of stability of binocular alignment. Significant improvement could be observed after therapy in the vertical and torsional components that were found to become more stable. Patients were very satisfied with the outcome obtained by vision therapy. Conclusion: 3D-VOG is a useful technique for providing an objective register of the compensation of the ocular deviation and the stability of the binocular alignment achieved after vision therapy in cases of IX(T), providing a detailed analysis of vertical and torsional improvements.

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Objetivo: Evaluar la eficacia del tratamiento en 3 casos de exotropia intermitente (XT(i)) mediante ejercicios de terapia visual, completando la exploración clínica con Videooculografia-30 y evidenciar la potencial aplicabilidad de esta tecnología para dicho propósito. Métodos: Exponemos los cambios ocurridos tras ejercicios de terapia visual en una mujer de 36 años con XT(i) de -25 dioptrías prismáticas (dp) de lejos y 18 dp de cerca; Un niño de 10 años de edad con 8 dp de XT(i) en posición primaria, asociados a +6 dp de hipotropia izquierda; y un hombre de 63 años con XT(i) de 6 dp en posición primaria asociada a +7 dp de hipertropia derecha. Todos los pacientes presentaron buena agudeza visual corregida en ambos ojos. La inestabilidad de la desviación ocular se evidenció mediante análisis de VOG-30, revelando la presencia de components verticales y torsionales. Se realizaron ejercicios de terapia visual, incluyendo diferentes tipos de ejercicios de vergencias, acomodación y percepción de la diplopía. Resultados: Tras la terapia visual se obtuvieron excelentes rangos de vergencias fusionales y de punto próximo de convergencia («hasta la nariz»). El examen mediante VOG-3D (Sensoro Motoric lnstruments, Teltow, Germany) confirmó la compensación de la desviación con estabilidad del alineamiento ocular. Se observó una significativa mejora después de la terapia en los components verticals y torsionales, lo cuales se hicieron más estables. Los pacientes se mostraron muy satisfechos de los resultados obtenidos. Conclusión: La VOG-3D es una técnica útil para dotamos de un método objetivo de registro de la compensación y estabilidad de la desviación ocular después de realizar ejercicios de terapia visual en casos de XT(i), ofreciéndonos un detallado análisis de la mejoría de los components verticales y torsionales.

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The current tendency to undertake more trips, but of shorter duration, throughout the year, has meant that the tourist industry has started to show greater interest in attracting those market segments that opt for more prolonged stays, as they are especially profitable. One of these segments is that of seniors. Given the aging demographic of the population worldwide, which is particularly noticeable in Spain, the object of this study is to identify the variables that determine the length of stay of Spanish seniors at their destination. The Negative Binomial model was adapted to the context of length of stay by Spanish seniors and the determinant factors identified were: age, travel purpose, climate, type of accommodation, group size, trip type and the activities carried out at the destination. This study is a contribution to this field from an empirical point of view, given the scarcity of studies of this type and their eminently descriptive character; as well as from a practical level, with interesting implications for the sector.

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Presbyopia is an age-related physiological condition that causes a gradual loss in the ability to focus on near objects, secondary to changes in zonular fibers, ciliary muscle and crystalline lens. Different surgical approaches are being pursued to surgically compensate presbyopia, such as corneal techniques or implantation of multifocal intraocular lenses (IOLs); however, their inability to restore accommodation has led to the development of single-optic positional accommodative IOLs. The axial shift, with the contraction of the ciliary muscle, of these IOLs increases the refractive power of the eye, improving the level of uncorrected near vision. Single-optic positional accommodative IOLs present few disturbances and larger ocular aberrations that improve near vision. However, reduced amplitudes of accommodation are obtained, little IOL shifts are measured and overall visual outcomes are limited.

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Resulte incuestionable que, en la actualidad, el Turismo constituye un complejo fenómeno con perfiles complejos y heterogéneos dentro del cual son abordados ámbitos muy diversos (económico, jurídico, político, cultural…). De forma inicial, dentro de la pluralidad de las relaciones que circunscriben el mismo, presentan especial transcendencia las conectadas, en mayor o menor grado, con la gestión y el alojamiento turístico. Lo que hace medio siglo resultaba inimaginable o, casi extravagante, constituye hoy una circunstancia común y frecuente en el escenario propuesto, de forma particular, dentro del complejo y escasamente analizado ámbito de la gestión hotelera. Al hilo de lo expresado, en este trabajo se analizará, partiendo del supuesto de que la colaboración interempresarial en el sector turístico puede sustentarse en capital o en relaciones contractuales, sus esenciales trazos conformadores (gestor hotelero y titular del hotel gestionado) sobre los cuales poder elaborar un concepto ordenado y de subsunción del mismo como paso previo para la fijación de su régimen jurídico básico. Con idéntico tenor, se discutirá la posibilidad de integración del hotel determinado en las grandes cadenas hoteleras, la utilización de su know-how estandarizado y marca propia. Finalmente, será estudiada su incidencia en las grandes cadenas hoteleras al objeto de valorar su expansión tanto desde un punto de vista nacional como internacional.

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The ‘Emergent Brazil’ growth model is reaching its limits. Its main engines have been slowing significantly since the beginning of the global financial and economic crisis. Even its much-praised predictable macroeconomic policy has been eroded by political interference. Inflationary pressures are growing and GDP performance is anaemic. As ominous, Brazil cannot compensate for its domestic deficiencies with an export drive. Commodity exports are suffering with the world economic slow-down and the manufacturing industries’ competitiveness is in sharp decline. Brazil has put all its trade negotiation eggs into the South American and WTO baskets, and now its export market share is threatened by the Doha Round paralysis, the Latin American Alianza del Pacífico, and the US-led initiatives for a Trans-Pacific Partnership and a trade and investment agreement with the EU. Paradoxically, this alarming situation opens a window of opportunity. There is a mounting national consensus on the need to tackle head-on the country’s and its industries’ lack of competitiveness. That means finding a solution to the much-decried ‘Brazil Cost’ and stimulating private-sector investment. It also entails an aggressive trade-negotiating stance in order to secure better access to foreign markets and to foster more competition in the domestic one. The most promising near-term goal would be the conclusion of the EU–Mercosur trade talks. A scenario to overcome the paralysis of these negotiations could trail two parallel paths: bilateral EU–Brazil agreements on ‘anything but trade’ combined with a sequencing of the EU–Mercosur talks where each member of the South American bloc could adopt faster or slower liberalisation commitments and schedules.

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This article describes the process of self-determination and the creation of a territorial autonomy of the Gagauz people in the Republic of Moldova. It also analyses the situation in the autonomy after the change of government in Chisinau in 2009 and evaluates the current status of accommodation of the Gagauz’ interests in the country. Aspects of state-building and the influence of external actors are explored as well. Gagauzia (Gagauz Yeri) is one of the first post-Soviet autonomies. Since its establishment in 1994, no violent conflict has taken place there. However, the Gagauz language and culture remain relatively unprotected, and incentives as well as support for the integration of the Gagauz are low. The article outlines the potential for future disputes between the central government and local authorities, due to continuous attempts to limit Gagauzia’s self-governance and conflicting interpretations of how the autonomy should work. Furthermore, struggles between Gagauz political leaders and other local realities hamper the successful realization of Gagauz Yeri. With respect to Moldova’s efforts to resolve the Transnistrian conflict and to integrate with the European Union, compromises and cooperation through an ongoing dialogue between the centre and autonomy are clearly due. Resolving the remaining stumbling blocks could make Gagauzia a living, rather than symbolic autonomy.

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Tese de mestrado integrado em Engenharia da Energia e do Ambiente, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2016

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The European Union (EU) was the frontrunner for the establishment of the world’s first multinational emissions trading scheme (ETS). Committed to combating climate change, the EU sought to overcome the multilateral paralysis within the International Civil Aviation Organization (ICAO) to mitigate aviation emissions. Unsuccessful in pushing for a global market-based measure (MBM) within the organisation, the EU was ready for take-off to include the sector in the EU emissions trading system (EU ETS). The geographical scope, however, including all flights from and to Europe in their entire trajectory, caused frictions with the international community about sovereignty issues. Ultimately, Climate Commissioner Connie Hedegaard announced a ‘stop-the-clock’ for international flights, a temporary derogation until the 2013 ICAO Assembly in order to find a global agreement. The ’stop-the-clock’ initiative provides ample opportunity to analyse EU leadership in curbing aviation emissions based on an analytical framework specifying different types of leadership. Its shows the global challenge to the EU’s claim of structural leadership on various levels in and beyond ICAO. The paper aims to analyse to what extent the EU is a global leader in mitigating aviation emissions and to identify the kind of EU leadership according to a threefold analytical framework. In addition, it will factor in the 'stop-the-clock' initiative and to what extent it altered the perception of EU leadership in the field. The paper comes to the conclusion that EU leadership in mitigating aviation emissions is not stalling. On the contrary, the EU, by pursuing the extension of the EU ETS, has put aviation emissions on everybody’s radar – and thus showed idea-based leadership. Proving the scheme’s feasibility further underlined EU leadership, in the form of directional leadership. The 'stop-the-clock' decision, however, already indicated what was later on confirmed in the 38th ICAO Assembly: Unilateral structural leadership of the EU in the field of aviation emissions is not credible at the moment.

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A driving argument behind recent EU treaty reforms was that more qualified majority voting (QMV) was required to reduce the potential dangers of legislative paralysis caused by enlargement. Whilst existing literature on enlargement mostly focuses on the question of what changed in the legislative process after the 2004 enlargement, the question of why these changes occurred has been given far less attention. Through the use of a single veto player theoretical model, this paper seeks to test and explain whether enlargement reduces the efficiency of the legislative process and alters the type of legislation produced, and whether QMV can compensate for these effects. In doing this, it offers a theoretical explanation as to why institutional changes that alter the level of cohesion between actors in the Council have an influence over both the legislative process and its outcomes.

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At the Vilnius summit of the Eastern Partnership in November 2013, Moldova initialled its Association Agreement with the EU, including a Deep and Comprehensive Free Trade Area (DCFTA) agreement, and is expected to sign the documents before the end of August 2014. Meanwhile, Russia has increased its presence and pressure in the region, as a consequence of which Armenia declined the AA and DCFTA with the EU and Ukraine, after months of protests and political paralysis, now has part of its territory occupied by Russia. Moldova is no exception to Russian pressure. As the country gets closer to upgrading relations with the EU, Russia has increased its activities in Moldova, including in the autonomous region of Gagauzia and in the breakaway region of Transnistria. Even though the “5+2” negotiations for the settlement of the Transnistria conflict continue, the number of incidents in and around this region have increased. The window of opportunity created by the involvement of Germany in the settlement of the conflict and the restart of the “5+2” negotiations in late 2011 seems to have closed. Given the recent events in the region and in Moldova/Transnistria, including the potential impact of DCFTA and visa liberalisation, Chisinau finds it increasingly difficult to manage the juggling act between its EU commitment and dialogue with Tiraspol. This Policy Brief presents the background, state of play and prospects of the Transnistria conflict while also focusing on the potential impact of Moldova’s Association Agreement with the EU on the settlement of the conflict.

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A thorough literature review has shown that although there are many theories to explain international trade, researchers are unanimous in affirming that hotel chains' internationalisation is influenced by pull factors, related to specific characteristics of the host country (contextual and transactional environment), and by push factors, related to specific characteristics of the companies and of their home country. This chapter aims to identify which factors influence hotel chains choosing a destination to invest over another. With this purpose, a theoretical model, that included six pull factors related to the contextual environment and five factors linked to the tourism industry, was developed. This model was validated through questionnaire surveys applied to foreign investors running accommodation units in mainland Portugal. Fifty three questionnaires were considered valid, representing 64% of the universe of foreign investors in Portugal (accommodation sector).

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O objetivo deste trabalho é saber se o direito indigenista, como denominarei o direito estatal que diz respeito aos povos indígenas, reconhece a legitimidade do direito indígena, como denominarei o direito produzido pelos povos indígenas, nas experiências colombiana, boliviana e brasileira. A escolha da Bolívia se justifica pelo fato de as Constituições recentes deste país e do Equador serem consideradas um novo marco do constitucionalismo pluralista ao refundarem suas ordens buscando superar a ausência indígena constituinte. Já a Colômbia se destaca entre os países que, sob a influência recente do Convênio 169, incorporaram expressamente o pluralismo jurídico em suas Constituições. A jurisprudência produzida pela Corte Constitucional do país a respeito do direito indígena é considerada exemplar e inspiradora dos desenvolvimentos mais recentes na Bolívia. O trabalho está voltado para dois aspectos do tema: a autonomia jurisdicional, ou a capacidade para julgar conflitos conforme as normas e procedimentos próprios, e os mecanismos de controle de tais decisões. A metodologia do trabalho abrange revisão bibliográfica, seleção e análise documental de decisões judiciais e textos legais. Argumento que a acomodação de autonomias políticas e ordens jurídicas de diferentes culturas depende da criação de meta-instituições e metarregras que solucionem conflitos e promovam a coordenação entre os direitos, permitindo que os grupos se relacionem de maneira equitativa, controlem a dinâmica de suas identidades culturais e se sintam parte de uma mesma comunidade política. A prática das instituições brasileiras, no entanto, está muito mais voltada a aplicar o direito estatal aos índios do que a exercer controle sobre o direito indígena, o que indica que o paradigma da assimilação prevalece sobre eventuais concepções multiculturais de Estado e sociedade, ainda que o direito legislado apresente regras que reconhecem o pluralismo jurídico. Em outras palavras, as instituições estatais enxergam os indígenas como pessoas que percorrem o caminho da incapacidade jurídica à capacidade plena à medida em que se familiarizam com a cultura dominante, e não como pessoas que podem transitar entre diferentes ordens jurídicas. Por outro lado, a experiência recente de países latino-americanos que se abriram ao pluralismo jurídico mostra um caminho difícil e repleto de questões em aberto. As que mais se destacam são a possibilidade de violações de direitos humanos por autoridades indígenas e a tensão entre centralização política e autonomia política. Em relação ao primeiro caso, o aspecto crucial é saber quem deve julgar as violações e sob quais critérios, além de evitar decisões culturalmente enviesadas. Já o segundo caso depende da superação de traços autoritários relacionados ao governo central e da predominância das estruturas estatais já consolidadas, tanto no nível central quanto no nível local, sobre as instituições mantidas pelos povos indígenas. Ainda há um descompasso entre o discurso constitucional de igualdade entre as ordens jurídicas e a prática de subordinação das ordens indígenas às instâncias estatais.