Outcome Measures in Glaucoma : a systematic review of Cochrane Reviews and Protocols

Peer reviewed

The effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma : a randomized controlled trial (EAGLE)

Medical Research Council (ref G0701604) and administered by the NIHR-EME (ref 09-800-26)

Outcome Measures in Glaucoma : a systematic review of Cochrane Reviews and Protocols

Peer reviewed

A nasalidade no dialeto quilombola do Norte de Minas: uma análise contrastiva baseada em corpus

This research investigated the nasality of vowels in the spontaneous speech of inhabitants of the quilombola communities of Brejo dos Crioulos and Poções (MG). As a theoretical framework, we based on the assumptions of Phonetics and Phonology, in renowned scholars on the investigation of nasality (CAGLIARI, 1977; CÂMARA JR., 1984, 2013; BISOL, 2013; ABAURRE; PAGOTTO, 1996; SILVA, 2015), with subsidies of the Corpus Linguistics. Its general goal was to investigate the occurrence of nasality, in the dialect of these quilombola communities, and their linguistic behavior, considering the linguistic factors that can interfere in the phenomenon. Specifically it was aimed to a) detect the occurrence of nasalized vowels with the help of the resources that the Corpus Linguistics provides (Praat and WorldSmith Tolls); b) discriminate the different types of occurring contexts of nasalized vowels; c) make quantitative and qualitative analyzes of the nasalized vowels in the study corpus; d) describe and analyze the behavior of nasalized vowels and; e) contrast the values of F1 and F2 of the oral and nasalized vowels. It was hypothesized that the nasality happens because it is conditioned by the nasal segment following the nasalized vowel - phonological process of “assimilation” - its position as the primary stress and grammatical category. It was believed that the quilombolas communities of Brejo dos Crioulos and Poções produce nasalized vowels in their speech and this linguistic phenomenon is favored by the adjacent presence of consonants or nasal vowels. Furthermore, it was hypothesized that the values of F1 and F2 of oral and nasalized vowels in these communities are distinct. The following research questions were elaborated: (i) is the presence of nasalized vowels in the speech of these quilombola communities conditioned to the presence of a nasal sound segment? (ii) does the nasal sound segment following the nasalized vowel favor the occurrence of the nasality phenomenon? is there a difference between the values of F1 and F2 of the oral and nasalized vowels in both quilombola communities considered? To compose our corpus, 24 interviews recordings were used (12 female speakers and 12 male speakers), a total of 24 participants. It was found that the following nasal sound segment tends to condition the nasalized vowel. In general, it assimilates the lowering of the soft palate of nasal consonant segment immediately following, but there are cases of nasal vowel segment - regressive assimilation; the stressed syllable tends to favor the nasality, but it occurs in pretonic and postonic position as well; F1 and F2 values of oral and nasalized vowels in the quilombola communities of Poções and Brejo dos Crioulos are distinct: the group of Brejo dos Crioulos tends to produce the F1 of oral and nasalized vowels more lowered than the group of Poções and the F2, in a more anterior position. The nasality tends to occur in verbs and nouns, although it is not specific to a grammatical category. This research found cases of spurious nasalization, confirming previous studies. In turn, it revealed cases of lexical items with favorable context for nasalization, but with its non-occurrence. This last case, considered as the lowering of the uniform soft palate in PB, presented pronounced vowels without the soft palate lowering. That is, it was detected variation in the phenomenon of nasalization in PB. With this work, it was promoted the discussion about nasality, in order to contribute to the linguistic studies about the functioning of Brazilian Portuguese in this geographical context.

Retinal microvascular dysfunction occurs similarly in Alzheimer's disease and primary open angle glaucoma patients

Purpose: The exact nature of the relationship between Alzheimer’s disease (AD) and primary open angle glaucoma (POAG) is still the subject of debate. One factor attributed to the aetiology of both conditions is vascular dysfunction. This study aimed to investigate the similarities and differences in retinal microvascular function between mild AD patients, early stage POAG patients and healthy controls Methods: Retinal vessel reactivity to flickering light was assessed in 10 AD, 19 POAG and 22 healthy age matched control patients by means of dynamic retinal vessel analysis (DVA, IMEDOS, GmbH, Jena, Germany) according to an established protocol. All patients additionally underwent BP measurements and blood analysis for glucose and lipid metabolism markers Results: AD and POAG patients demonstrated comparable alterations in retinal artery reactivity, in the form of an increased arterial reaction time (RT) to flicker light on the final flicker cycle (p=0.014), which was not replicated in the healthy age and cardiovascular risk matched controls (p>0.05). Furthermore, the sequential changes in RT on progressing from flicker one to flicker three were found to differ between healthy controls and the two disease groups (p=0.001) Conclusions: AD and POAG patients demonstrate comparable signs of vascular dysfunction in their retinal arteries at the early stages of their disease process. These comparable signs may reflect similarities in the pathophysiological processes that occur in the development of both conditions

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Background
Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment.

Methods
From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607.

Findings
Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015–0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI –1·99 to –0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events.

Interpretation
Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment.

Síndrome de Sjögren Primário

A Síndrome de Sjögren (SS) é uma das três patologias autoimunes mais frequentes na população mundial, ainda assim frequentemente infradiagnosticada. Esta síndrome é uma doença autoimune crónica que afeta as glândulas exócrinas, particularmente as glândulas salivares e lacrimais. A SS primária (SSp) afeta especificamente as glândulas exócrinas, enquanto que a SS secundária (SSs) aparece associada a outras patologias autoimunes sistémicas. A SS é caracterizada, histopatologicamente, por um infiltrado inflamatório linfocitário que interfere com a função glandular normal. Afeta 0,5% da população mundial, sendo claramente mais predominante em mulheres (9:1 versus homens), principalmente por volta dos 50 anos (após a menopausa), ainda que também possa aparecer depois da menarca (entre os 20 e os 30 anos). Considera se que a etiologia da SS é multifatorial. Fatores genéticos, ambientais, hormonais e virais estão implicados na sua etiopatogénese. É muito importante o papel dos Médicos Dentistas no diagnóstico da SSp, uma vez que na maior parte dos casos são eles quem detetam os primeiros sintomas, mais propriamente a boca seca. Diversos testes auxiliares são utilizados para o diagnóstico desta doença, tais como: o teste de Schimer, o teste de Rosa Bengala, a Sialometria, a Sialografia, a Biópsia das glândulas salivares, entre outros. A SSp, regra geral, tem um curso não doloroso, sendo a boca seca e a secura ocular as suas duas características clínicas mais salientes. A maior parte das manifestações orais que se apresentam nestes pacientes são resultado de hipofunção das glândulas salivares (da boca seca), tais como: a cárie dentária, a doença periodontal, as infeções fúngicas, entre outras. Esta doença também se pode associar a problemas a nível sistémico, que podem ser subdivididos em não viscerais (pele, artralgia, mialgia) e viscerais (pulmão, coração, rim, sistema gastrointestinal, sistema endócrino e sistema nervoso central e periférico). O tratamento é empírico, sintomático e direcionado a tratar as complicações da doença mais inicial, que consiste em limitar os danos da xerostomia e da queratoconjuntivite. A prevenção dos sintomas a nível oral e ocular é fundamental em pacientes com SSp, para assim terem maior qualidade de vida.

SAPO campus: aprendizagem, ensino e pessoas em rede

As escolas portuguesas do ensino não superior estão dotadas com infraestruturas e equipamentos que permitem trazer o mundo para dentro da sala de aula, tornando o processo de ensino e de aprendizagem mais rico e motivador para os alunos. A adoção institucional de uma plataforma que segue os princípios da web social, o SAPO Campus (SC), definida pela abertura, partilha, integração, inovação e personalização, pode ser catalisadora de processos de mudança e inovação. O presente estudo teve como finalidade acompanhar o processo de adoção do SC em cinco escolas, bem como analisar o impacto no processo de ensino e de aprendizagem e a forma como os alunos e professores se relacionam com esta tecnologia. As escolas envolvidas foram divididas em dois grupos: o primeiro grupo, constituído por três escolas onde o acompanhamento teve uma natureza mais interventiva e presente, enquanto que no segundo grupo, composto por duas escolas, foram apenas observadas as dinâmicas que se desenvolveram no processo de adoção e utilização do SC. No presente estudo, que se assume como um estudo longitudinal de multicasos, foram aplicadas técnicas de tratamento de dados como a estatística descritiva, a análise de conteúdo e a Social Network Analysis (SNA), com o objetivo de, através de uma triangulação permanente, proceder a uma análise dos impactos observados pela utilização do SC. Estes impactos podem ser situados em três níveis diferentes: relativos à instituição, aos professores e aos alunos. Ao nível da adoção institucional de uma tecnologia, verificou-se que essa adoção passa uma mensagem a toda a organização e que, no caso do SC, apela à participação coletiva num ambiente aberto onde as hierarquias se dissipam. Verificou-se ainda que deve implicar o envolvimento dos alunos em atividades significativas e a adoção de estratégias dinâmicas, preferencialmente integradas num projeto mobilizador. A adoção do SC foi ainda catalisadora de dinâmicas que provocaram mudanças nos padrões de consumo e de produção de conteúdos bem como de uma atitude diferente perante o papel da web social no processo de ensino e aprendizagem. As conclusões apontam ainda no sentido da identificação de um conjunto de fatores, observados no estudo, que tiveram impacto no processo de adoção como o papel das lideranças, a importância da formação de professores, a cultura das escolas, a integração num projeto pedagógico e, a um nível mais primário, as questões do acesso à tecnologia. Algumas comunidades construídas à volta do SAPO Campus, envolvendo professores, alunos e a comunidade, evoluíram no sentido da autossustentação, num percurso de reflexão sobre as práticas pedagógicas e partilha de experiências.

Um espaço pioneiro de modernidade educacional: Grupo Escolar Augusto Severo -Natal/RN -1908-13

Cette recherche a pour but d analyser l Ecole Augusto Severo, située dans la ville de Natal dont la construction date de 1907,étant le premier établissement d enseignement primaire à l état du Rio Grande do Norte, pendant le processus de restructuration de l enseignement républicain. On cherche à comprendre la représentation de ce milieu scolaire, comme équipement urbain, dans le processus de modernisation de la ville et comme modèle éducationnel pour l état entre 1908 et 1913. En se servant des études historiographes sur le processus de modernisation de quelques villes brésiliennes et des innovations de l enseignement public primaire au pays, à la fin du dix-neuvième siècle et pendant la première décennie du vingtième siècle, comme source pour mieux saisir le contexte général et spécifique. On reconstitue les aspects économiques, sociaux et politiques déterminants des interventions publiques réalisées dans cette ville par les gouvernements républicains ayant comme obectif la construction d une ville embellie,hygiénique et civilisée. Située au quartier Ribeira, principal scénario de la modernité de Natal, l Ecole Augusto Severo est mise em relief comme symbole de civilité du paysage urbain de l époque pour le citoyen du Rio Grande do Norte. Elle disposait de services d énergie et d un tram électrique. Il y avait devant, un grand lac arborisé et une station ferroviaire. A côté, il y avait le théâtre Carlos Gomes (actuellement Alberto Maranhão). Par suíte de son imposante architecture, raffiné style éclectique,on reflète l idéal républicain des elites locales, avec une conception d espace symbolique et éducative de surveillance et contrôle, caractéristiques de l école graduée républicaine

Análises de elementos arquitetônicos de proteção solar em edificações institucionais na cidade de Natal/RN Diretrizes projetuais

The present work concerns the use of shade elements as architectural elements to block sunlight in public buildings. In a city like Natal, (5o South) the incidence of sunrays in any type of design should be a constant concern for all the architects. Besides, this habit of avoiding insolation in the environment is not a common practice. Within this context, the present work has the objective to dig deep into the knowledge of solar control, studying some cases and verifying its function according to the orientation and the original design of the building, having in mind if the shade elements usually used in the region have achieved their purpose of providing protection against the incidence of direct sun rays. This study considers the position of the shade element (horizontal and vertical), the angle formed between them and the respective facades, and the local of the buildings in relation to their orientation during the summer, winter and equinox solstice. As supporting instruments the solar map of the city and the protractor, for measuring shade angles, were used. It was concluded that in all the cases studied, it was not possible to obtain the maximum use of the elements. It was verified that the best type of shade element (more efficient) for the city of Natal is the mixed type (horizontal and vertical) and that the vertical shade elements are more efficient in the early mornings and late afternoon. The horizontal shade elements are used more effective at midday. We intend to present the results of this study to the architects in the region in order to show them the correct ways of using the shade elements according to the possible orientation on the facade, as a supporting tool at the time of designing a project as well as a subsidy for further discussions on the elaboration of the new urban standards for the city of Natal/RN

Automatic Glaucoma Detection Based on Optic Disc Segmentation and Texture Feature Extraction

The use of digital image processing techniques is prominent in medical settings for the automatic diagnosis of diseases. Glaucoma is the second leading cause of blindness in the world and it has no cure. Currently, there are treatments to prevent vision loss, but the disease must be detected in the early stages. Thus, the objective of this work is to develop an automatic detection method of Glaucoma in retinal images. The methodology used in the study were: acquisition of image database, Optic Disc segmentation, texture feature extraction in different color models and classification of images in glaucomatous or not. We obtained results of 93% accuracy

O enigma do modelo por competência no ensino primário de Moçambique

A implementação efectiva do Modelo por Competência nas instituições da educação constitui um dos maiores desafios do Ministério da Educação e Desenvolvimento Humano. Passa mais do que uma década que os currículos baseados em competência estão sendo implementados no Ensino Primário. Contudo, a qualidade de formação dos alunos nos diferentes ciclos de aprendizagem tem sido reclamada e/ou censurada por diferentes grupos sociais, incluindo professores, pais e encarregados de educação. É neste âmbito que o presente artigo pretende analisar o impacto e efeitos do desenvolvimento de competências na organização curricular moçambicana na qualidade de aprendizagens dos alunos do Ensino Primário do país. Para o efeito, foram eleitos os paradigmas quantitativo e qualitativo, a combinação de métodos bibliográficos, documental e de estudo de caso e ainda de técnicas como entrevista, questionário, observação e testes diagnósticos aplicados sobre uma amostra de (N=908) indivíduos (gestores, professores e alunos. O percurso investigativo permitiu que se chegasse à conclusão de que o modelo por competência está longe de ser implementado efectivamente nas escolas moçambicanas, uma vez que apenas 45% dos cerca de n=112 alunos testados é que desenvolveram as competências prescritas nos programas do Ensino Primário. Este facto deve-se à falta ou deficiente apropriação da filosofia e estratégias exigidas pelo currículo pelos dirigentes, gestores, professores e encarregados de educação, exiguidade de recursos infraestruturais, materiais e meios de ensino para efectiva implementação do currículo do Ensino Primário.

Influência do sistema anteoxidante da catalase no ciclo do glioxilato durante o estabelecimento pós-germinativo de cártamo (Carthamus tinctorius L.) e de girassol (Helianthus annuus L.)

Oilseeds are a high-value natural resource, due to its use as a substitute for petroleum. However, the storage time can reduce seed viability and oil quality. Therefore, scientific efforts have been made to provide a increment of storage time, germination rates and plant establishment of high-value oilseeds. The seedling establishment depends of the plant pass over the functional transition stage, characterized by a metabolic change from heterotrophic condition to autotrophic one. The storage oil mobilization is performed by β-oxidation process and the glyoxylate cycle. Also, the functional transition involves acclimation to photosynthetic condition, which generally includes the participation of antioxidant system and the reactive oxygen species, the latter are produced in various reactions of primary and secondary metabolism. In the present study, Catalase was inhibited during the functional transition of sunflower and safflower, after were performed many analyzes to elucidate the effects caused on the SOD and APX antioxidant systems. Also, were checked the changes in expression pattern of the glyoxylate cycle enzymes markers, ICL and MLS. It was observed that after CAT inhibition, the SOD and APX antioxidant systems allow the seedling establishment. Besides, was verified that both oilseeds can be accelerate the reverse mobilization and the photosynthetic establishment when Catalase activity has dramatically decreased

Linfoma primário da vagina – revisão da literatura a propósito de um caso clínico

Os tumores primários malignos da vagina são raros, contribuindo apenas para cerca de 1%-2% dos cancros ginecológicos. O linfoma não-Hodgkin (LNH) primário da vagina é raríssimo (existindo aproximadamente 100 casos descritos na literatura). A sua associação com infecção pelo vírus Epstein Barr (VEB) foi descrita em escassos casos. Os autores pretendem fazer uma revisão da literatura de linfoma primário da vagina, com base num caso clínico de LNH-B de grandes células numa mulher nulípara de 25 anos de idade.

Estabelecimento de um sistema padrão primário para raios X baixas com uma câmara de ionização de ar livre de energias

Dissertação (Mestrado em Tecnologia Nuclear)