CT-guided cervical foraminal injection: Is a direct foraminal approach still necessary?

Purpose: Cervical foraminal injection performed with a direct foraminal approach may induce serious neurologic complications. We describe a technique of CT-guided cervical facet joint (CFJ) injection as an indirect foraminal injection, including feasibility and diffusion pathways of the contrast agent. Methods and materials: Retrospective study included 84 punctures in 65 consecutive patients presenting neck pain and/or radiculopathy related to osteoarthritis or soft disc herniation. CT images were obtained from C2 to T1 in supine position, with a metallic landmark on the skin. CFJ punctures were performed by MSK senior radiologists with a lateral approach. CT control of the CFJ opacification was performed after injections of contrast agent (1 ml), followed by slow-acting corticosteroid (25 mg). CFJ opacification was considered as successful when joint space and/or capsular recess opacification occurred. The diffusion of contrast agent in foraminal and epidural spaces was recorded. We assessed the epidural diffusion both on axial and sagittal images, with a classification in two groups (small diffusion or large diffusion). Results: CFJ opacification was successful in 82% (69/84). An epidural and/or foraminal opacification was obtained in 74% (51/69). A foraminal opacification occurred in 92% (47/51) and an epidural opacification in 63% (32/51), with small diffusion in 47% (15/32) and large diffusion in 53% (17/32). No complication occurred. Conclusion: CT- guided CFJ injection is easy to perform and safe. It is most often successful, with a frequent epidural and/or foraminal diffusion of the contrast agent. This technique could be an interesting and safe alternative to foraminal cervical injection.

A inclusão social e digital de pessoas com limitação visual e o uso das tecnologias de informação e de comunicação na produção de páginas para a Internet

Este trabalho relata a atividade do acesso e do uso das tecnologias de informação e de comunicação (TICs), tendo como sujeito uma pessoa com necessidades educacionais especiais (PNEE) na produção de páginas para a Internet. A atividade permitiu a observação das barreiras e dificuldades enfrentadas e superadas, mediante o uso de ambiente de aprendizagem mediado por computador (AAMC). Foram utilizadas várias alternativas, formas de comunicação, tecnologias adequadas para a realização da atividade proposta, resultando em uma postura de compartilhamento no qual cada um tem muito para cooperar, para doar-se na busca de uma construção coletiva e na superação das limitações, sejam estas físicas e/ou tecnológicas. O artigo aponta que, com a educação e o uso das TICs, é possível promover a inclusão social e digital das PNEEs com limitação visual.

Capacitação de bibliotecários com limitação visual pela educação a distância em ambientes virtuais de aprendizagem

Este artigo ressalta a importância da capacitação de bibliotecários, profissionais da informação, por meio da educação aberta e a distância (EAD) mediada por computador, sendo estes videntes ou pessoas com necessidades educacionais especiais (PNEEs) com limitação visual. Apresenta o curso Bibliotec II, realizado pelo DCI/Fabico/UFRGS, ministrado para bibliotecários e com a participação de dois profissionais PNEEs com limitação visual. Aborda temas relacionados à biblioteca escolar, à educação, à acessibilidade e à inclusão social, digital e profissional das PNEEs, e o bibliotecário como educador, sendo um mediador, junto com os professores e os alunos, no uso das TICs, nos processos de interação, colaboração, cooperação em ambientes virtuais de aprendizagem (AVAs).

Tecnologias da informação e da comunicação e a polêmica sobre direito autoral: o caso Google Book Search

Anotamos, neste trabalho, reflexões sobre as conseqüências das Tecnologias da Informação e da Comunicação (TICs) para o direito autoral e sobre os atores do processo informativo. Partimos da lei do direito autoral vigente no Brasil, perguntando-nos como tais normas protegem as obras intelectuais no contexto digital e até que ponto há legalidade e legitimidade na digitalização de livros protegidos, disponibilizados on-line, tomando como exemplo o caso "Google Book Search". Constatamos que a lei atual pouco defende os direitos dos autores e dos leitores, pois se volta para a proteção dos interesses privados comerciais, e que a sociedade civil encontra formas de ampliar o fluxo comunicativo em decorrência da facilidade de reprodução e distribuição de cópias de obras intelectuais proporcionada pelas TICs.

Catalan beauty and the transnational beast: Barcelona on screen

This article explores the case of Barcelona as paradigmatic global city in such transnational productions as Vicky Cristina Barcelona by Woody Allen (2008) and Biutiful by Alejandro González Iñárritu (2010). Allen"s film shows the extreme dilution that national and linguistic identity undergoes under foreign eyes in its rendition of a"hip Barcelona" for tourists"invaded" by transnational subjects in search of bourgeois pleasures. Maybe in pursuit of a more"real" city, Iñárritu"s Biutiful moves to the Barcelona of the immigrants and the undocumented, a transnational and paradoxical location inhabited by those who need to cross borders in order to survive. Through reference to the work of Manuel Castells, Saskia Sassen, Neil Smith and Michel De Certeau among others, we argue that neither of these representations of the city is more real or unreal than the other. In their drastically divergent ways, both films contribute their external perspectives to the imaginary construction of Barcelona as a fascinating global city and can be seen as a dyptich of a transnational Barcelona. Further, they contribute to the ongoing debate about the polarization between the local and the global, the construction of urban boarders inside cities through gentrification, the transformation of the places we (would like to) inhabit, and the translation of all these into visual terms.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Efectos de tipicidad en la percepción visual de escenas naturales

La actuación de las estructuras de conocimiento en el proceso de identificación y codificación de estimulos visuales se ha operativizado frecuentemente mediante conceptos como contexto o tipicidad. Ambos efectos pueden considerarse complementarios y producidos por la actuación de un mecanisrno de tipo atencional. Dicho mecanisrno fue aplicado al procesamiento de escenas por Arnau, Carreras y Salvador (en prensa). A partir de los términos propuestos en dicho modelo se intenta comprobar si la tipicidad es una variable relevante para la identificación de 10s objetos que forman una escena. Los resultados obtenidos en el experimento 1 permiten afirmar que el grado de tipicidad de un objeto respecto a una escena determina el tiempo y exactitud de su identificación. Por otra parte, en el experimento 2 se demuestra que en procesos de memoria a corto plazo el efecto de tipicidad detectado en el experimento 1 se anula. Finalmente se discuten las implicaciones de estos resultados para el estudio de la percepción visual de escenas naturales.

Comparing 'visual' effect size indices for single-case designs

Effect size indices are indispensable for carrying out meta-analyses and can also be seen as an alternative for making decisions about the effectiveness of a treatment in an individual applied study. The desirable features of the procedures for quantifying the magnitude of intervention effect include educational/clinical meaningfulness, calculus easiness, insensitivity to autocorrelation, low false alarm and low miss rates. Three effect size indices related to visual analysis are compared according to the aforementioned criteria. The comparison is made by means of data sets with known parameters: degree of serial dependence, presence or absence of general trend, changes in level and/or in slope. The percent of nonoverlapping data showed the highest discrimination between data sets with and without intervention effect. In cases when autocorrelation or trend is present, the percentage of data points exceeding the median may be a better option to quantify the effectiveness of a psychological treatment.

Factors affecting visual analysis in single-case designs

Visual inspection remains the most frequently applied method for detecting treatment effects in single-case designs. The advantages and limitations of visual inference are here discussed in relation to other procedures for assessing intervention effectiveness. The first part of the paper reviews previous research on visual analysis, paying special attention to the validation of visual analysts" decisions, inter-judge agreement, and false alarm and omission rates. The most relevant factors affecting visual inspection (i.e., effect size, autocorrelation, data variability, and analysts" expertise) are highlighted and incorporated into an empirical simulation study with the aim of providing further evidence about the reliability of visual analysis. Our results concur with previous studies that have reported the relationship between serial dependence and increased Type I rates. Participants with greater experience appeared to be more conservative and used more consistent criteria when assessing graphed data. Nonetheless, the decisions made by both professionals and students did not match sufficiently the simulated data features, and we also found low intra-judge agreement, thus suggesting that visual inspection should be complemented by other methods when assessing treatment effectiveness.

Percutaneous CT-guided treatment of osteochondritis dissecans of the sacroiliac joint.

Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.