A systematic literature review of surgical interventions for limbal stem cell deficiency in humans

PURPOSE: To evaluate the relative benefits and to identify any adverse effects of surgical interventions for limbal stem cell deficiency (LSCD).

DESIGN: Systematic literature review.

METHODS: We searched the following electronic databases from January 1, 1989 through September 30, 2006: MEDLINE, EMBASE, Science citation index, BIOSIS, and the Cochrane Library. In addition, reference lists were scanned to identify any additional reports. The quality of published reports was assessed using standard methods. The main outcome measure was improvement in vision of at least two Snellen lines of best-corrected visual acuity (BCVA). Data on adverse outcomes also were collected.

RESULTS: Twenty-six studies met the inclusion criteria. There were no randomized controlled studies. All 26 studies were either prospective or retrospective case series. For bilateral severe LSCD, keratolimbal allograft was the most common intervention with systemic immunosuppression. Other interventions included eccentric penetrating keratolimbal allografts and cultivated autologous oral mucosal epithelial grafts. An improvement in BCVA of two lines or more was reported in 31% to 67% of eyes. For unilateral severe LSCD, the most common surgical intervention was contralateral conjunctival limbal autograft, with 35% to 88% of eyes gaining an improvement in BCVA of two lines or more. The only study evaluating partial LSCD showed an improvement in BCVA of two lines or more in 39% of eyes.

CONCLUSIONS: Studies to date have not provided strong evidence to guide clinical practice on which surgery is most beneficial to treat various types of LSCD. Standardized data collection in a multicenter LSCD register is suggested.

The reduction of serum soluble Flt-1 in patients with neovascular age-related macular degeneration

PURPOSE: To evaluate serum soluble Flt-1 (sFlt-1) in age-related degeneration (AMD) patients.

DESIGN: Case control study.

METHODS: Fifty-six non-AMD participants, fifty-three early AMD patients and ninety-seven neovascular AMD patients from Belfast in Northern Ireland. Serum samples were collected from each patient. Serum sFlt-1 was measured by human sVEGFR1/sFlt-1 ELISA kit. The results were analyzed by Excel and SPSS.

RESULTS: Serum sFlt-1 concentration of non-AMD, early AMD, and neovascular AMD were 90.8±2.9 pg/mL (±SEM), 88.2±2.6 pg/mL and 79.9±2.2 pg/mL. sFlt-1 from neovascular AMD patients was significantly decreased compared to non-AMD and early AMD patients (ANOVA, p<0.01). For each 10 point increase in sFlt-1, the odds for having neovascular AMD compared with non-AMD and neovascular AMD decreases by 27.8% OR=0.722 (95% CI: 0.588-0.888, p=0.002) and 27.0% OR=0.730 (95% CI: 0.594-0.898, p=0.003), respectively. In patients over 73 years of age, serum sFlt-1 <80 pg/mL was associated with a >6-fold higher risk of neovascular AMD.

CONCLUSIONS: Reduced serum sFlt-1 differentiates those patients with neovascular AMD from both early AMD and non-AMD participants. In those aged over 73, serum sFlt <80 pg/mL seems to indicate a particularly high risk of neovascular AMD. Our results indicate serum sFlt-1 could be a biomarker for development of neovascular AMD.

Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial.

Purpose: To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children. Design: Cluster-randomized controlled trial. Methods: Children with VA <= 6/12 in either eye due to refractive error in 94 randomly-chosen primary schools underwent randomization by school to receive free glasses, education on their use and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if >= 80% of children given glasses wore them during un-announced visits 6 weeks and 6 months (main outcome) after intervention. Results: Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% versus 23.9%, Adjusted Odds Ratio [OR]=11.5, 95% Confidence Interval [CI] 5.91-22.5, P<0.001; Self-reported: 90.6% versus 32.1%, OR = 43.7, 95% CI = 21.7-88.5, P < 0.001). Other predictors of observed wear at 6 months included baseline spectacle wear (P<0.001), uncorrected VA<6/18 (P=0.01) and parental spectacle wear (P=0.02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives. Conclusions: Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions.

Safety of Spectacles for Children's Vision: A Cluster-Randomized Controlled Trial.

Purpose: To study safety of children’s glasses in rural China, where fear that glasses harm vision is an important barrier for families and policy-makers. Design: Exploratory analysis from a cluster-randomized, investigator-masked, controlled trial.Methods: Among primary schools (n=252) in western China, children were randomized by school to one of three interventions: free glasses provided in class, vouchers for free glasses at a local facility or glasses prescriptions only (Control group). The main outcome of this analysis is uncorrected visual acuity after 8 months, adjusted for baseline acuity.Results: Among 19,934 children randomly selected for screening, 5852 myopic (spherical equivalent refractive error <= -0.5 D) eyes of 3001 children (14.7%, mean age 10.5 years) had VA <= 6/12 without glasses correctable to > 6/12 with glasses, and were eligible. Among these, 1903 (32.5%), 1798 (30.7%), and 2151 (36.8%) were randomized to Control, Voucher and Free Glasses respectively. Intention-to-treat analyses were performed on all 1831 (96.2%), 1699 (94.5%), and 2007 (93.3%) eyes of children with follow-up in Control, Voucher and Free Glasses groups. Final visual acuity for eyes of children in the treatment groups (Free Glasses and Voucher) was significantly better than for Control children, adjusting only for baseline visual acuity (difference of 0.023 logMAR units [0.23 vision chart lines, 95% CI: 0.03, 0.43]) or for other baseline factors as well (0.025 logMAR units [0.25 lines, 95% CI 0.04, 0.45]). Conclusion: We found no evidence that spectacles promote decline in uncorrected vision with aging among children.

Alcohol use and positive screening results for depression and anxiety are highly prevalent among chinese children with strabismus

Purpose: To study associations between strabismus and alcohol use, anxiety, and depression among 10- to 17-year-old children in Guangdong, southern China. Design: Cross-sectional, population-based study. Methods: Among 7537 children aged 6-17 years from 9 randomly selected primary and middle schools, ocular alignment was assessed with the Hirschberg light reflex, cover-uncover testing, and alternate cover testing at distance (6 m) and near (40 cm). Additionally, 4000 children (53.1%) aged 10+ years received self-administered questionnaires containing screening questions on alcohol use, anxiety, and depression. Results: Examinations were completed on 7464 of 7537 subjects (99.0%), including 3928 boys (52.6%), with a mean age of 11.1 ± 1.8 years. The prevalence of any strabismus, including exotropia (2.7%), esotropia (0.2%), and intermittent exotropia (3.9%), was 6.8%. Strabismus was more prevalent in urban students (7.3%) and female subjects (7.4%) compared to rural students (6.0%) and male subjects (6.2%) (all P <.05). In multivariate regression models, any strabismus was associated with older age and rural vs urban residence. Among 3903 children (97.6%) answering questionnaires, history of alcohol use (62.3% vs 36.3%) and positive screening responses for depression (26.0% vs 11.6%) and anxiety (10.3% vs 4.9%) were significantly (P <.01 for all) more common among children with strabismus. Conclusion: These Chinese children with strabismus had a significantly higher prevalence of alcohol use and possible markers of emotional problems than children without strabismus. Further research should focus on the appropriateness of classifying surgical treatment for strabismus as "cosmetic" (ineligible for reimbursement) under China's rural health insurance.

Reply (Correspondence)

We appreciate the interest of Galvis and associates in our work.1 It has been suggested that undercorrection of children's refractive error might retard myopia progression. Previous studies,2,3 limited by size, have generally not been consistent with this. We performed a post hoc analysis on data from our large trial of spectacle provision in China and found no evidence of worsening visual acuity (VA) among children randomized to receive glasses compared to controls. In fact, the final uncorrected VA of Treatment Group children was significantly better than that of controls.

Estudio de Factibilidad para la creación de una empresa dedicada a la Producción y Comercialización de Yogur de Uvilla bajo en Calorias, ubicada e el Cantón Cayambe con Mercado objetivo la Ciudad de Quito

En el mundo, las empresas y países que han incursionado en la industria láctea se han especializado en la elaboración de algún producto específico. Dentro de los principales productos derivados de leche podemos mencionar: leche fluida o fresca, leche en polvo, quesos y otros productos lácteos. Según la Organización de las Naciones Unidas para la Agricultura y la Alimentación (FAO) la producción mundial de leche entera en el 2008 alcanzó un volumen de 693,2 millones de toneladas equivalentes en leche, lo que representa un crecimiento de 2,5% respecto al 2007.1

The effect of conservation measures on the spatial and temporal variation of rocky fish assemblages in the Arrábida Marine Park

Marine protected areas (MPAs) have been widely proposed for conservation purposes and as a tool for fisheries management. The Arrábida Marine Park is the first MPA in continental Portugal having a management plan, fully implemented since 2009. The main objective of this study was to evaluate the effect of protection measures on rocky reef fish assemblages and target invertebrates through before-after and control-effect (no-take vs. fished areas) underwater visual surveys and analysis of landings trends. Second, we used surveys before, during and after implementation of the management plan to understand fishers‟ preferences for fishing grounds and adaptation to the new rules, and evaluated the reserve effect through analysis of both ecological responses and fishing effort density. Third, we identified the main oceanographic drivers influencing the structure of reef fish assemblages and predicted the community structure for the last 50 years, in light of climatic change. Overall results suggest positive responses in biomass but not yet in numbers of some commercial species, with no effects on non-target species. The reserve effect is reinforced by the increase in landings of commercial species, despite increased fishing effort density in some areas, especially with octopus traps. Fishing grounds are mainly chosen based on the distribution of target species and associated habitats, but distance to port, weather conditions and safety also influence fishers‟ choices. Moreover, different fisheries respond differently to the protection measures, and within each fishery, individual fishers show distinct strategies, with some operating in a broader area whereas others keep preferred territories. Our results also show that wind stress and temperature are the main oceanographic drivers for rocky reef fish assemblages, with tropicalization of assemblages and polewards movements of species over the last 50 years consistent with temperature trends. We believe this study provides significant lessons for marine conservation and management of coastal systems.

Study of the expression of different genes of long-chain polyunsaturated fatty acids (LC-PUFA) metabolism during the early paralarval development of the common octopus (Octopus vulgaris)

Dissertação de mestrado, Aquacultura e Pescas, Faculdade de Ciências e Tecnologias, Universidade do Algarve, 2015

Ecology of the common octopus "Octopus vulgaris" (Cuvier, 1797) in the Atlantic Iberian coast : life cycle strategies under different oceanographic regimes

Tese de doutoramento, Biologia (Biologia Marinha e Aquacultura), Universidade de Lisboa, Faculdade de Ciências, 2015

Metodologias na banda desenhada : realização de um álbum de BD

This dissertation is an explanation of a methodology applied to the making of a comic book, with all that implies. The various stages of this process will be described, from the time when there was the decision to have ideas for the script to its finalization and subsequent publication of the album "Deixa-me Entrar". With this we intend to scrutinize how the inherent problems were solved in all these steps, either in the narrative construction method, as the visual part, such as drawing, coloring and subtitling were performed always seeking quality, not compromising the quality of the work. The time frame of the book was short since it was aimed for release during the twenty-fifth International Comics Festival of Amadora 2014, one of the main events of this kind in comic book releases. It can be said that this is one of the many events that are part of the context in which the practical component of this work fits, and so it is indispensable to context Comics in Portugal, specifically in a time window since the early twenty-first century, talking about relevant authors in recent years. In this explanation were also described some contractual bureaucracies that had to comply with the publisher "Polvo" and how the dialogue between author and publisher was done. Were also exposed advertising strategies through various platforms as well as how the book was received and concluded how the applied methodology resulted in this case study

Esto es amor: trabalho de projeto

Mestrado Teatro, especialização em artes performativas, teatro música

Valtatie 21 Kolari - Kilpisjärvi : Toimenpideselvitys

Tehtävänä oli laatia toimenpideselvitys valtatielle 21 välille Kolari - Kilpisjärvi. Noin 280 kilometrin mittainen tarkastelujakso sijoittuu Suomi-neidon käsivarteen Kolarin, Muonion ja Enontekiön kuntien alueelle. Valtatie 21 osana kansainvälistä E8 -tietä on Pohjois-Kalotin ja Länsi-Lapin merkittävin pohjois-etelä -suuntainen pääväylä, jolla on suuri merkitys alueen väestölle, elinkeinoelämälle ja matkailulle. Tie palvelee nykyään erityisesti kalottialueen kuljetuksia Tromssan ja Finnmarkin talousalueille sekä Norjan kalateollisuuden kuljetuksia, jotka ovat voimakkaasti kasvavassa roolissa tien käyttäjinä. Tarkasteluvälille on ominaista valtatien kapeus ja laatutason voimakas vaihtelu. Nykyinen tie ei vastaa leveydeltään, geometrialtaan tai kunnoltaan valtatielle asetettuja minimivaatimuksia. Ajo-olosuhteet ovat erityistä tarkkaavaisuutta vaativat, talviaikaan jopa erittäin vaativat. Keskimääräinen vuorokausiliikennemäärä vaihtelee tarkasteluvälillä 350 - 1500 ajon./vrk, josta raskaan liikenteen osuus on 13 - 20 %. Liikenteen kausivaihtelu on erittäin suurta. Viikkokausivaihtelukäyrissä erottuvat selvästi hiihto-, pääsiäis- ja kesälomat sekä ruska-aika. Vuosina 2005- 2014 tarkastelujaksolla tapahtui yhteensä 121 poliisin tietoon tullutta onnettomuutta, joista 60 % johti henkilövahinkoihin. Tarkastelujakson henkilövahinko-onnettomuusaste on varsin korkea ja ylittää valtakunnallisen ja Lapin valtateiden keskiarvon selvästi. Rekkojen tieltä suistumisia tapahtuu talvikaudella paljon. Porokolarit ovat yleisiä. Tarkasteluosuudella valtatie 21 sijoittuu kolmelle metsäkasvillisuusvyöhykkeelle, joten luonnonympäristön ominaisuudet muuttuvat voimakkaasti etelä-pohjois-suunnassa. Käsivarren alueen ilmasto ja kallioperä poikkeaa muusta Pohjois-Lapista. Valtatien ympäristössä on pohjoiselle Lapille tyypillisesti aapasoita ja niiden paikallisia muunnoksia palsasoita, joiden jääsydän säilyy sulamatta yli kesän. Suunnittelualueella on runsaasti luontoarvoja ja laajaalaisia luonnonsuojelualueita. Laajimmat suojelualueet koostuvat erämaa-alueista ja luonnonpuistoista. Alueella on myös paljon soidensuojelualueita. Selvitysalueen koko vesistöalue on Natura 2000 -aluetta lukuun ottamatta kolmen laskujoen vesistöaluetta. Tunturi-Lapin alueella on runsaasti pohjavesialueita, joita valtatie 21 risteää useassa kohtaa. Valtatien tuntumassa on useita sekä valtakunnallisesti arvokkaita että maakunnallisesti arvokkaita maiseman ja kulttuuriperinnön kohteita. Suuri osa näistä kohteista on pieniä pistemäisiä kohteita. Valtatien 21 kehittämiselle asetettiin tavoitetila vuodelle 2045. Tällöin valtatie on kotimaisen ja kansainvälisen liikenteen pääkulkuväylä seudulla ja osa korkealuokkaista Eurooppatie-verkostoa. Liikenne on sujuvaa ja liikkuminen on turvallista kaikilla liikkumismuodoilla ja kaikkina vuodenaikoina. Tien leveys, geometria ja rakenne on kunnostettu ja kohtaamistilanteet ovat turvallisia. Matka-ajat ovat kohtuulliset ja hyvin ennakoitavissa. Olosuhteista ja häiriötilanteista tiedotetaan reaaliajassa. Taajamissa liikkuminen on turvallista kaikilla kulkumuodoilla. Valtatie 21 tunnetaan nykyistä paremmin Revontultentienä, joka tarjoaa laadukkaan matkailutie-elämyksen palveluineen matkailijoille. Valtatie 21 esitetään Kolarin ja Kilpisjärven välillä parannettavaksi suurelta osin nykyisellä paikallaan. Tie ja sillat levennetään ja tien rakennetta vahvistetaan tai rakenne uusitaan käytännössä lähes koko matkalla aiemmin rakennettuja taajamakohtia lukuun ottamatta. Kokonaan uutta tietä tehdään Muotkatakka-Kilpisjärvi -välillä nykyisen tien viereen rakentaen. Kinostumista ehkäistään loiventamalla luiskia, jolloin ei muodostu kinostavaa taitetta. Ongelmaiset palsasuokohteet rakennetaan niin, etteivät routavauriot uusiudu. Taajamissa toimenpiteinä ovat turvallisten tien ylityspaikkojen rakentaminen huolella valittuihin kohteisiin ja systemaattinen ajonopeuksien hillintä. Taukopaikkoja rakennetaan lisää ja nykyisiä kunnostetaan. Tieympäristö kohennetaan raivaamalla umpeen kasvaneita kohtia tien varressa ja avaamalla tiellä kulkijalle jokinäkymiä. Taukopaikkojen ympäristöt raivataan ja siistitään. Poronhoidon ja liikenteen ristiriitoja vähennetään mm. ottamalla käyttöön digitaalinen porovaroitusjärjestelmä.

Principales transformaciones en la vida cotidiana de la cabecera municipal de Chiriguaná, Cesar, producidas por la explotación del carbón a partir de la década de los 90. Estudio de Caso

En el centro del departamento del Cesar, se encuentra un municipio que podría ser una perfecta analogía del Macondo de García Márquez. Cuenta la historia de cómo se transforman sus humildes casas en ¿mansiones¿, sus viejas bicicletas en carros últimos modelo, las calles llenas de polvo en grandes avenidas pavimentadas, donde se cambió el ¿sancocho¿ por comidas sofisticadas, la estadía en la casa de un amigo por un hotel. Donde la iglesia, la devoción por la virgen de Chiquinquirá, un hospital municipal a medio dotar, un notario único, la Caja Agraria y un juzgado hacían parte de la estructura social del pueblo. Luego vinieron las regalías, contratos, y burocracia. Un pueblo que cuenta la historia de cómo existen grandes duchas en sus nuevas casas, pero no hay agua. Donde existen grandes televisores para ver películas, pero no hay luz, donde se han adjudicado millonarios contratos para la construcción de un alcantarillado que no ha sido terminado. Una mega biblioteca a punto de caerse, los estancos llenos, las cantinas llenas, dónde todo extranjero es costeño en carnavales o en las fiestas del ocho de septiembre. Los campesinos aún trabajan en parcelas, los pescadores aún venden desde la madrugada, un mercado que sigue funcionando desde las 3 de la mañana, un comercio de tiendas paisas. Un pueblo lleno de contrastes, pero sobre todo, con la responsabilidad de tener dentro de su jurisdicción uno de los proyectos mineros más rentables del país. Este municipio Macondiano se llama: Chiriguaná.

PREVALENCIA DE SINTOMATOLOGÍA MÚSCULO ESQUELÉTICAS DE CUELLO, HOMBRO Y ESPALDA LUMBAR EN LOS TRABAJADORES DE MINAS SUBTERRÁNEAS DE CARBÓN EN EL DEPARTAMENTO DE BOYACÁ, COLOMBIA, 2013

Introducción. Trabajo de investigación realizado dentro del proyecto “EVALUACIÓN DE LA EXPOSICIÓN A POLVO DE CARBÓN EN MINERÍA SUBTERRÁNEA EN TRES DEPARTAMENTOS DE COLOMBIA” liderado por el grupo Salud Ocupacional y del Ambiente, con la participación de la Universidad del Rosario, la Universidad de los Andes, el Ministerio de Trabajo, la Administradora de Riesgos Laborales Positiva. Inmerso en este proyecto se determinará en el departamento de Boyacá la prevalencia de sintomatología músculo esquelética Objetivo. Determinar la sintomatología músculo esquelética en cuello, hombros y espalda lumbar, en trabajadores de minas de carbón subterráneas del departamento de Boyacá, mediante la aplicación del Cuestionario Nórdico Estandarizado específico y su relación con variables sociodemográficas y ocupacionales. Metodología. Estudio de corte transversal que se realizó en una población de minería subterránea del departamento mediante la aplicación del Cuestionario Nórdico Estandarizado específico. Resultados. La sintomatología en cuello, hombros y espalda reportada fue de 44,1%, 37,1% y 68,2% respectivamente por los trabajadores. La antigüedad laboral en promedio fue de 17,06 (DS 7,93), la media de edad fue 40,46 (DS 11,12 años). De los 170 trabajadores encuestados el 74,7% (127) se desempeñan como picadores, seguidos por cocheros 10,6% (18), malacatero 5,3% (9), el restante se desempeña en otras labores de minería. Conclusiones. Este estudio encontró un alta prevalencia de sintomatología músculo esquelética en los trabajadores de minería de carbón subterránea, lo que sugiere la necesidad de generar estudios ergonómicos y estrategias de prevención para evitar un aumento en la cifras de enfermedades profesionales como desordenes músculo esqueléticos.