Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

Background: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods: Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results: Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion: The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.

Warsaw Conference: “Small steps forward while awaiting major decisions at the 2015 Paris Conference”

6 p.

La Cumbre de Varsovia: “Pequeños avances en espera de decisiones de envergadura en la Cumbre de Paris 2015”

6 p.

Macroscopically Dissipative Systems with Underlying Microscopic Dynamics : Properties and Limits of Measurement

While some of the deepest results in nature are those that give explicit bounds between important physical quantities, some of the most intriguing and celebrated of such bounds come from fields where there is still a great deal of disagreement and confusion regarding even the most fundamental aspects of the theories. For example, in quantum mechanics, there is still no complete consensus as to whether the limitations associated with Heisenberg's Uncertainty Principle derive from an inherent randomness in physics, or rather from limitations in the measurement process itself, resulting from phenomena like back action. Likewise, the second law of thermodynamics makes a statement regarding the increase in entropy of closed systems, yet the theory itself has neither a universally-accepted definition of equilibrium, nor an adequate explanation of how a system with underlying microscopically Hamiltonian dynamics (reversible) settles into a fixed distribution.

Motivated by these physical theories, and perhaps their inconsistencies, in this thesis we use dynamical systems theory to investigate how the very simplest of systems, even with no physical constraints, are characterized by bounds that give limits to the ability to make measurements on them. Using an existing interpretation, we start by examining how dissipative systems can be viewed as high-dimensional lossless systems, and how taking this view necessarily implies the existence of a noise process that results from the uncertainty in the initial system state. This fluctuation-dissipation result plays a central role in a measurement model that we examine, in particular describing how noise is inevitably injected into a system during a measurement, noise that can be viewed as originating either from the randomness of the many degrees of freedom of the measurement device, or of the environment. This noise constitutes one component of measurement back action, and ultimately imposes limits on measurement uncertainty. Depending on the assumptions we make about active devices, and their limitations, this back action can be offset to varying degrees via control. It turns out that using active devices to reduce measurement back action leads to estimation problems that have non-zero uncertainty lower bounds, the most interesting of which arise when the observed system is lossless. One such lower bound, a main contribution of this work, can be viewed as a classical version of a Heisenberg uncertainty relation between the system's position and momentum. We finally also revisit the murky question of how macroscopic dissipation appears from lossless dynamics, and propose alternative approaches for framing the question using existing systematic methods of model reduction.

Properties of α-monoclinic selenium

The growth of bulky and platelet shaped α-monoclinic crystals is discussed. A simple method is devised for identifying and orienting them.

The density, previously in disagreement with the value calculated from x-ray studies, is carefully redetermined, and found to be in good agreement with the latter.

The relative dielectric constant is determined, an effort being made to eliminate errors inherent in previous measurements, which have not been in agreement. A two parameter model is derived which explains the anisotropy in the relative dielectric constant of orthorhombic sulfur, which is also composed of 8-atom puckered ring molecules. The model works less well for α-monoclinic selenium. The relative dielectric constant anisotropy is quite noticeable, being 6.06 along the crystal b axis, and 8.52-8.93 normal to the axis.

Thin crystal platelets of α-monoclinic selenium (less than 1µ thick) are used to extend optical transmission measurements up to 4.5eV. Previously the measurements extended up to 2.1 eV, limited by the thickness of the available crystals. The absorption edge is at 2.20 eV, with changes in slope of the absorption coefficient occurring at 2.85 eV and 3.8 eV. Measurement of transmission through solutions of selenium in CS_2 and trichlorethylene yield an absorption edge of 2.75 eV. There is evidence the selenium exists in solution partly as Se_8 rings, the building block of monoclinic selenium. Transmission is measured at low temperatures (80°K and 10°K) using the platelets. The absorption edge is at 2.38 eV and 2.39 eV, respectively, for the two temperatures. Measurements at low temperatures with polarized and unpolarized light reveal interesting absorption anisotropy near 2.65 eV.

Análise cladística de táxons atribuídos aos peixes euteleósteos basais

Os teleósteos são o grupo mais diversificado entre os vertebrados e seu registro mais antigo data do Jurássico. Sua atual classificação inclui quatro clados, dentre os quais Euteleostei é o mais avançado e variado. Apesar de todos os trabalhos a respeito do grupo, ele ainda não possui diagnose, definição e composição precisas. A discordância entre autores é ilustrada pelas nove diferentes propostas filogenéticas elaboradas nos últimos 30 anos. Muitos fósseis do Cretáceo são classificados como euteleósteos basais por falta de conhecimento morfológico, enquanto outros fósseis possuem classificação sistemática controversa ou compartilham aspectos estruturais com euteleósteos basais. Nesse contexto, os objetivos da presente dissertação são avaliar o monofiletismo de euteleósteos basais e recuperar relações filogenéticas de táxons do Nordeste do Brasil, África, Europa, Ásia e América do Norte atribuídos aos euteleósteos basais. Sete táxons brasileiros (i.e., Beurlenichthys ouricuriensis, Britoichthys marizalensis, Clupavus brasiliensis, Santanasalmo elegans, Santanichthys diasii, Scombroclupeoides scutata e novo euteleósteo da Bacia de Pelotas) e 14 táxons de localidades estrangeiras (i.e., Avitosmerus canadensis, Barcarenichthys joneti, Chanoides macropoma, Clupavus maroccanus, Gaudryella gaudryi, Humbertia operta, Kermichthys daguini, Leptolepides spratiiformis, Lusitanichthys characiformis, Nybelinoides brevis, Orthogonikleithrus leichi, Pattersonella formosa, Wenzichthys congolensis e Tchernovichthys exspectatum) foram analisados através de observação direta, fotografias, desenhos e descrições e submetidos a uma análise de Sistemática Filogenética utilizando o princípio da parcimônia. Três espécies recentes (i.e., Elops saurus, Hoplias malabaricus e Salmo trutta) foram usadas como grupo externo. Sessenta e dois caracteres foram selecionados e, como resultado, seis árvores igualmente parcimoniosas foram obtidas com 325 passos, índice de consistência (CI) de 0,2523 e índice de retenção (RI) de 0,4309. O consenso estrito é representado pela seguinte topologia: ((C. marocanus), (C. brasiliensis, (H. malabaricus + S. diasii))) ((G. gaudryi, (C. macropoma + L. characiformis)), (K. daguini), ((A. canadensis, (novo euteleósteo, (S. elegans + W. congolensis), (B. ouricuriensis + B. marizalensis)), (L. spratiiformis, (S. scutata, (N. brevis + P. formosa))), (B. joneti), (O. leichi), (H. operta + T. exspectatum), indicando que euteleósteos basais não formam um grupo monofilético e que as atuais sinapomorfias propostas são insuficientes para suportar o grupo.

Gestão do trabalho na Estratégia Saúde da Família em municípios do Estado do Rio de Janeiro com mais de 500 mil habitantes: o caso do Rio de Janeiro e Duque de Caxias

Não obstante ao aumento do número de equipes de Saúde da Família no território brasileiro há disparidade na implantação da Estratégia Saúde da Família (ESF) em municípios de grande porte. Outras dificuldades enfrentadas referem-se aos recursos humanos em saúde (RHS). Nesse sentido, esta pesquisa objetivou analisar o cenário atual da gestão do trabalho na ESF nos municípios do Rio de Janeiro e Duque de Caxias. Metodologia: Estudo exploratório, de investigação narrativa, bibliográfica e documental, de abordagem qualitativa. A coleta de dados se deu em duas fases: pesquisa de material bibliográfico nas bases: LILACS, PAHO e WHOLIS, e de editais de processos seletivos e concursos públicos dos anos 2000, com vistas à contratação de profissionais de saúde para a ESF e; entrevistas semiestruturadas com gestores da ESF. O período de coleta perdurou entre agosto de 2010 e dezembro de 2011. Os documentos foram analisados à luz da estatística descritiva e as entrevistas submetidas à análise de conteúdo. Resultados: Escassez de literatura sobre a ESF nos municípios de Duque de Caxias e Rio de Janeiro. As contratações no Rio de Janeiro obedeceram a dois momentos: prefeitura e Organizações Sociais (OS) como contratantes. Em Duque de Caxias a contratação foi exclusividade da Prefeitura. No Rio de Janeiro os salários dos profissionais variaram entre R$ 728,59 (Agentes Comunitários de Saúde - ACS) e R$ 7.773,69 (médicos), contrastando com a isonomia salarial adotada em Duque de Caxias, com vencimentos ao redor de R$ 700,00 para os ACS, R$ 800,00 para nível técnico e; aproximadamente R$ 5.000,00 aos profissionais de nível superior. Os gestores sugerem que a maior rotatividade entre os médicos é motivada por carga horária excessiva; más condições de trabalho e, localização da unidade em áreas de risco social. As estratégias para atração e fixação profissional incluem: processos seletivos; garantia dos direitos trabalhistas e; abonos salariais, no caso do Rio de Janeiro e; flexibilização de carga horária, melhorias em infraestrutura e estratégias de qualificação, em Duque de Caxias. Entrevistas revelaram as maiores dificuldades na gestão da ESF: alta rotatividade, formação médica destoante com o SUS e, infraestrutura precária. Acrescenta-se o baixo salário para médicos em Duque de Caxias e, vínculos e salários distintos entre profissionais que exercem mesma função no Rio de Janeiro. Conclusões: A expansão da ESF nos grandes centros urbanos encontra obstáculos relacionados à gestão do trabalho que fragilizam sua consolidação. O Rio de Janeiro mostra-se mais atraente para os profissionais da ESF. O único diferencial de Duque de Caxias, sobretudo para odontólogos e enfermeiros, refere-se à contratação direta pela Prefeitura com vinculação estatutária, ainda que, eventual aumento salarial esteja atrelado ao de todos os servidores municipais. No Rio de Janeiro, a contratação sob regime da Consolidação das Leis do Trabalho revela-se uma proteção, posto que diante da possibilidade de perda de profissionais as OS elevam seus salários. Dentre as recomendações para fixação profissional incluem-se: incentivos salariais para atuação em regiões vulneráveis, melhorias em infraestrutura e, acoplação entre Instituições de Ensino Superior e rede de saúde.

Os conflitos tributários internacionais e sua possível solução pela via arbitral

O fenômeno da globalização teve o condão de aproximar os diversos povos, cada um com seus interesses e culturas próprios. A existência de um consenso internacional na definição de princípios a serem seguidos quando das relações externas não consegue impedir, contudo, o surgimento de possíveis conflitos e divergências, tendo em vista a pluralidade cultural das diversas nações mundiais, fato que induziu a sociedade internacional a desenvolver meios que pudessem dirimir pacificamente as controvérsias, porventura, surgidas entre elas. A adoção dos meios para solução pacífica dos conflitos internacionais encontra-se incentivada pela Constituição da República Federativa do Brasil (art. 4., incisos VI e VII) e sua utilização não importa qualquer renúncia ao exercício da soberania, nem tampouco à imunidade de jurisdição. Para que se tenha uma eficácia maior da submissão dos conflitos surgidos no âmbito externo aos meios admitidos para resolvê-los, é importante que os países envolvidos no litígio possuam orientação interna no sentido de privilegiar o Direito Internacional frente à sua legislação infraconstitucional doméstica. A eventual primazia do direito interno pode resultar na inocuidade da adoção dos meios pacíficos de solução de controvérsias internacionais, uma vez que as autoridades dos países litigantes poderão se esquivar do cumprimento do acordo ou decisão alegando uma possível contrariedade com os ditames legais domésticos. Nesse contexto, a seara tributária tem despertado constantes divergências internacionais. As diferentes interpretações conferidas pelas diversas nações, dentre elas o Brasil, quando da aplicação dos tratados por elas firmados e que tenham vertente fiscal, em especial aqueles que visam evitar a dupla imposição fiscal da renda, ou garantir o livre trânsito de bens, pessoas e serviços, acaba trazendo grande insegurança àqueles investidores que possuem operações conectadas a dois ou mais sistemas tributários diferentes. Assim, ganham cada vez mais corpo, os debates em torno da extensão dos mecanismos pacíficos para resolução de divergências, também ao âmbito de aplicação de todo e qualquer tratado que verse sobre a matéria tributária. Tal fato propicia a busca de uma possível uniformização dos métodos hermenêuticos aplicáveis àqueles fatos geradores tributáveis que se encontrem vinculados a dois ou mais entes soberanos. É nesse contexto que se apresenta o presente estudo, o qual aborda a possibilidade de a República Federativa do Brasil submeter ao procedimento arbitral aquelas controvérsias de cunho tributário que eventualmente decorram da interpretação divergente das convenções internacionais das quais seja parte e que tratem de matéria fiscal.

Os homens do século XXI no cuidado dos filhos: um papel social em aberto

No século XXI podemos caracterizar as relações por sua complexidade, o que se expressa em diferentes aspectos, como nas relações familiares, sociais, valores, crenças. Sendo assim, fatores como gênero, transgeracionalidade e a coexistência de antigos padrões e novas demandas relacionais, compõem a construção dos papéis contemporâneos. E dentre um dos mais importantes papéis desempenhados pelo homem, podemos citar o de pai, com isto. Dessa forma, com base nas necessidades e na carência de literatura sobre o papel atribuído a este novo pai, o presente trabalho pretendeu investigar os aspectos semelhantes e diferentes nas crenças de homens e mulheres de gerações distintas. Participaram desta pesquisa 100 pessoas residentes na cidade de Magé (estado do Rio de Janeiro), divididas em quatro grupos (25 por contexto: gênero e idade, grupos de 25 a 35 anos e 55 a 65 anos). O estudo incluiu questionário sociodemográfico, questionário sobre Função Paterna, aplicação da Escala sobre Crenças e Práticas Paterna (ECPP) e Escala sobre Crenças e Práticas Paterna Pretéritas (ECPP-P). Os resultados mostraram concordâncias e divergências, tanto entre os gêneros quanto entre as gerações, mas acreditamos que discussões como estas propiciam novos entendimentos acerca das práticas parentais paterna.

Hezkuntza eta kalitatea

[EUS] Ikerketa honen bidez, Euskal Herrian hezkuntza kalitatea bermatzeko dagoen sarearen, hau da, “Kalitatea Hezkuntzan” sarearen ebaluazioa egin nahi izan da. Horretarako, adituek berrikuntza eta hezkuntza kalitatea gaiei buruz adierazten dutenaren inguruan bilaketa bat egin izan da eta ondoren, sei ikastetxe ezberdinetako irakasle batzuei inkesta bat bidali izan zaie. Lortutako emaitzak oso ezberdinak izan dira, izan ere, irakasleen artean ez-adostasunak aztertu izan dira. Bestalde, ondorioetan, adituek azaltzen dutenaren eta irakasleek uste dutenaren artean, alde handia dagoela ondorioztatu izan da, lehenengoek hezkuntza kalitatea nola definitzen duten eta irakasleek nola antzematen duten oso ezberdina izan delako.

Inferring Population Genetic Structure in Widely and Continuously Distributed Carnivores: The Stone Marten (Martes foina) as a Case Study

The stone marten is a widely distributed mustelid in the Palaearctic region that exhibits variable habitat preferences in different parts of its range. The species is a Holocene immigrant from southwest Asia which, according to fossil remains, followed the expansion of the Neolithic farming cultures into Europe and possibly colonized the Iberian Peninsula during the Early Neolithic (ca. 7,000 years BP). However, the population genetic structure and historical biogeography of this generalist carnivore remains essentially unknown. In this study we have combined mitochondrial DNA (mtDNA) sequencing (621 bp) and microsatellite genotyping (23 polymorphic markers) to infer the population genetic structure of the stone marten within the Iberian Peninsula. The mtDNA data revealed low haplotype and nucleotide diversities and a lack of phylogeographic structure, most likely due to a recent colonization of the Iberian Peninsula by a few mtDNA lineages during the Early Neolithic. The microsatellite data set was analysed with a) spatial and non-spatial Bayesian individual-based clustering (IBC) approaches (STRUCTURE, TESS, BAPS and GENELAND), and b) multivariate methods [discriminant analysis of principal components (DAPC) and spatial principal component analysis (sPCA)]. Additionally, because isolation by distance (IBD) is a common spatial genetic pattern in mobile and continuously distributed species and it may represent a challenge to the performance of the above methods, the microsatellite data set was tested for its presence. Overall, the genetic structure of the stone marten in the Iberian Peninsula was characterized by a NE-SW spatial pattern of IBD, and this may explain the observed disagreement between clustering solutions obtained by the different IBC methods. However, there was significant indication for contemporary genetic structuring, albeit weak, into at least three different subpopulations. The detected subdivision could be attributed to the influence of the rivers Ebro, Tagus and Guadiana, suggesting that main watercourses in the Iberian Peninsula may act as semi-permeable barriers to gene flow in stone martens. To our knowledge, this is the first phylogeographic and population genetic study of the species at a broad regional scale. We also wanted to make the case for the importance and benefits of using and comparing multiple different clustering and multivariate methods in spatial genetic analyses of mobile and continuously distributed species.

Comment on 'processing and microstructure of single grain uranium-doped Y-Ba-Cu-O superconductor'

We comment on the paper by N Hari Babu et al. (2002 Supercond. Sci. Technol. 15 104-10) and point out misinterpretations of the chemical composition of U-bearing deposits observed in Y123. The observed small deposits are those of new compounds which do not contain Cu, rather than refined Y211 plus U, as stated by the authors. We further note that extensive literature, not quoted, is in disagreement by nearly an order of magnitude concerning the values of Pt and U doping at which the optimum value of Jc is obtained. Other related information, presently in the literature, which may be helpful to those working with this high temperature superconducting chemical system, is presented.

East African Fisheries Research Organization Annual Report 1955/1956

This report covers the period 1st July, 1955, to 30th June, 1956. As printing has been delayed for various reasons, reference should be made to certain important proposals put forward since the 30th June. Just after the close of the year a meeting of the Lake Victoria Fisheries Board was held at Entebbe on 26th July. At this meeting disagreement arose between the representatives of the three East African Governments on the subject of whether or not existing restrictions on fishing in Lake Victoria should be retained. This organization holds strongly to the view that the existing restrictions on fishing should be retained, Kenya holds similar views, but Uganda and Tanganyika were in favour of a proposal to lift these restrictions. This question was discussed a month earlier by the Director with the Colonial Office Fisheries Advisory Committee and they also advised the Lake Victoria Fisheries Board against lifting the restrictions.

The oxidation of CH2O in the intermediate temperature range (943-995 K)

New atmospheric pressure flow reactor data on the oxidation of formaldehyde in the temperature range 943-995 K and over equivalence ratios from 0.013 to 36.7 are reported and discussed. A detailed mechanism assembled from previously published results produced acceptable agreement with the experimental data for the fuel-lean conditions, but failed to predict results for oxidative pyrolysis. Analysis or the very fuel-lean conditions, but failed to modelling results are principally sensitive to CH2O+HO2→HCO+H2O2 (6) and H2O2 +M→OH+OH+M (33). Whereas the specific rate of each reaction cannot be independently determined, it is found that the product k33.k6 is a well defined function of temperature: (3.4±3.0).1028 exp(-(26,800±400)/T). Inadequacies in the mechanism which may be responsible for the disagreement under fuel-rich conditions are discussed. © 1991 Combustion Institute.

How to avoid the problems of target-setting

Purpose: Advocates and critics of target-setting in the workplace seem unable to reach beyond their own well-entrenched battle lines. While the advocates of goal-directed behaviour point to what they see as demonstrable advantages, the critics of target-setting highlight equally demonstrable disadvantages. Indeed, the academic literature on this topic is currently mired in controversy, with neither side seemingly capable of envisaging a better way forward. This paper seeks to break the current deadlock and move thinking forward in this important aspect of performance measurement and management by outlining a new, more fruitful approach, based on both theory and practical experience. Design/methodology/approach: The topic was approached in three phases: assembling and reading key academic and other literature on the subject of target-setting and goal-directed behaviour, with a view to understanding, in depth, the arguments advanced by the advocates and critics of target-setting; comparing these published arguments with one's own experiential findings, in order to bring the essence of disagreement into much sharper focus; and then bringing to bear the academic and practical experience to identify the essential elements of a new, more fruitful approach offering all the benefits of goal-directed behaviour with none of the typical disadvantages of target-setting. Findings: The research led to three key findings: the advocates of goal-directed behaviour and critics of target-setting each make valid points, as seen from their own current perspectives; the likelihood of these two communities, left to themselves, ever reaching a new synthesis, seems vanishingly small (with leading thinkers in the goal-directed behaviour community already acknowledging this); and, between the three authors, it was discovered that their unusual combination of academic study and practical experience enabled them to see things differently. Hence, they would like to share their new thinking more widely. Research limitations/implications: The authors fully accept that their paper is informed by extensive practical experience and, as yet, there have been no opportunities to test their findings, conclusions and recommendations through rigorous academic research. However, they hope that the paper will move thinking forward in this arena, thereby informing future academic research. Practical implications: The authors hope that the practical implications of the paper will be significant, as it outlines a novel way for organisations to capture the benefits of goal-directed behaviour with none of the disadvantages typically associated with target-setting. Social implications: Given that increased efficiency and effectiveness in the management of organisations would be good for society, the authors think the paper has interesting social implications. Originality/value: Leading thinkers in the field of goal-directed behaviour, such as Locke and Latham, and leading critics of target-setting, such as Ordóñez et al. continue to argue with one another - much like, at the turn of the nineteenth century, proponents of the "wave theory of light" and proponents of the "particle theory of light" were similarly at loggerheads. Just as this furious scientific debate was ultimately resolved by Taylor's experiment, showing that light could behave both as a particle and wave at the same time, the authors believe that the paper demonstrates that goal-directed behaviour and target-setting can successfully co-exist. © Emerald Group Publishing Limited.