Induced higher-order aberrations after laser in situ keratomileusis (LASIK) performed with wavefront-guided IntraLase femtosecond laser in moderate to high astigmatism

Background Wavefront-guided Laser-assisted in situ keratomileusis (LASIK) is a widespread and effective surgical treatment for myopia and astigmatic correction but whether it induces higher-order aberrations remains controversial. The study was designed to evaluate the changes in higher-order aberrations after wavefront-guided ablation with IntraLase femtosecond laser in moderate to high astigmatism. Methods Twenty-three eyes of 15 patients with moderate to high astigmatism (mean cylinder, −3.22 ± 0.59 dioptres) aged between 19 and 35 years (mean age, 25.6 ± 4.9 years) were included in this prospective study. Subjects with cylinder ≥ 1.5 and ≤2.75 D were classified as moderate astigmatism while high astigmatism was ≥3.00 D. All patients underwent a femtosecond laser–enabled (150-kHz IntraLase iFS; Abbott Medical Optics Inc) wavefront-guided ablation. Uncorrected (UDVA), corrected (CDVA) distance visual acuity in logMAR, keratometry, central corneal thickness (CCT) and higher-order aberrations (HOAs) over a 6 mm pupil, were assessed before and 6 months, postoperatively. The relationship between postoperative change in HOA and preoperative mean spherical equivalent refraction, mean astigmatism, and postoperative CCT were tested. Results At the last follow-up, the mean UDVA was increased (P < 0.0001) but CDVA remained unchanged (P = 0.48) and no eyes lost ≥2 lines of CDVA. Mean spherical equivalent refraction was reduced (P < 0.0001) and was within ±0.50 D range in 61 % of eyes. The average corneal curvature was flatter by 4 D and CCT was reduced by 83 μm (P < 0.0001, for all), postoperatively. Coma aberrations remained unchanged (P = 0.07) while the change in trefoil (P = 0.047) postoperatively, was not clinically significant. The 4th order HOAs (spherical aberration and secondary astigmatism) and the HOA root mean square (RMS) increased from −0.18 ± 0.07 μm, 0.04 ± 0.03 μm and 0.47 ± 0.11 μm, preoperatively, to 0.33 ± 0.19 μm (P = 0.004), 0.21 ± 0.09 μm (P < 0.0001) and 0.77 ± 0.27 μm (P < 0.0001), six months postoperatively. The change in spherical aberration after the procedure increased with an increase in the degree of preoperative myopia. Conclusions Wavefront-guided IntraLASIK offers a safe and effective option for vision and visual function improvement in astigmatism. Although, reduction of HOA is possible in a few eyes, spherical-like aberrations are increased in majority of the treated eyes.

Therapeutic hypothermia after cardiac arrest : Studies on neurological and cardiological outcome and prediction of outcome in hypothermia-treated patients resuscitated from out-of-hospital cardiac arrest

The outcome of the successfully resuscitated patient is mainly determined by the extent of hypoxic-ischemic cerebral injury, and hypothermia has multiple mechanisms of action in mitigating such injury. The present study was undertaken from 1997 to 2001 in Helsinki as a part of the European multicenter study Hypothermia after cardiac arrest (HACA) to test the neuroprotective effect of therapeutic hypothermia in patients resuscitated from out-of-hospital ventricular fibrillation (VF) cardiac arrest (CA). The aim of this substudy was to examine the neurological and cardiological outcome of these patients, and especially to study and develop methods for prediction of outcome in the hypothermia-treated patients. A total of 275 patients were randomized to the HACA trial in Europe. In Helsinki, 70 patients were enrolled in the study according to the inclusion criteria. Those randomized to hypothermia were actively cooled externally to a core temperature 33 ± 1ºC for 24 hours with a cooling device. Serum markers of ischemic neuronal injury, NSE and S-100B, were sampled at 24, 36, and 48 hours after CA. Somatosensory and brain stem auditory evoked potentials (SEPs and BAEPs) were recorded 24 to 28 hours after CA; 24-hour ambulatory electrocardiography recordings were performed three times during the first two weeks and arrhythmias and heart rate variability (HRV) were analyzed from the tapes. The clinical outcome was assessed 3 and 6 months after CA. Neuropsychological examinations were performed on the conscious survivors 3 months after the CA. Quantitative electroencephalography (Q-EEG) and auditory P300 event-related potentials were studied at the same time-point. Therapeutic hypothermia of 33ºC for 24 hours led to an increased chance of good neurological outcome and survival after out-of-hospital VF CA. In the HACA study, 55% of hypothermia-treated patients and 39% of normothermia-treated patients reached a good neurological outcome (p=0.009) at 6 months after CA. Use of therapeutic hypothermia was not associated with any increase in clinically significant arrhythmias. The levels of serum NSE, but not the levels of S-100B, were lower in hypothermia- than in normothermia-treated patients. A decrease in NSE values between 24 and 48 hours was associated with good outcome at 6 months after CA. Decreasing levels of serum NSE but not of S-100B over time may indicate selective attenuation of delayed neuronal death by therapeutic hypothermia, and the time-course of serum NSE between 24 and 48 hours after CA may help in clinical decision-making. In SEP recordings bilaterally absent N20 responses predicted permanent coma with a specificity of 100% in both treatment arms. Recording of BAEPs provided no additional benefit in outcome prediction. Preserved 24- to 48-hour HRV may be a predictor of favorable outcome in CA patients treated with hypothermia. At 3 months after CA, no differences appeared in any cognitive functions between the two groups: 67% of patients in the hypothermia and 44% patients in the normothermia group were cognitively intact or had only very mild impairment. No significant differences emerged in any of the Q-EEG parameters between the two groups. The amplitude of P300 potential was significantly higher in the hypothermia-treated group. These results give further support to the use of therapeutic hypothermia in patients with sudden out-of-hospital CA.

Efecto del asocio de frijol común (Phaseolus vulgaris L.) en el crecimiento, desarrollo y rendimiento del cafe (Coffea arabica L) y su influencia sobre las malezas

Este trabajo experimental fue llevado a cabo con el objetivo de evaluar crecimiento, desarrollo y rendimiento del cultivo del café (Coffea arábica L.) sembrando frijol (Phasheolus vulgaris L.) en las calles de café, al mismo tiempo determinar el efecto que tengan las malezas de dicho cultivo sobre el café, y que el frijol sirva de cobertura viva para el café y coma fuente de ingreso económico y alimenticio para el agricultor. El trabajo fue realizado en el Centro Experimental de café del Pacifico (C.E.C.P.) jardín Botánico (Masatepe) durante las dos épocas de siembra para el frijol, y la cosecha anual de café (Dic-Ene) de 1992. Este ensayo se estableció con las variedades. Rev-81 para frijol y catuai amarillo para el café, este tiene una edad de 5 años. El frijol fue sembrado en las calles de café de manera tradicional con el propósito de aprovechar esa área disponible. No hubo diferencia estadística significativa en cuanto al crecimiento, desarrollo y rendimiento del café, por lo que se deduce que el frijol (P. vulgaris) no ejerce efecto negativo alguno sobre el café, lo cual indica que el cultivo en asocio no perjudica la cosecha del café por lo que se recomienda llevar a cabo esta práctica en los primeros alias de edad del café ya que no perjudica el espaciamiento de siembra.

Del sueño cartesiano a la muerte encefálica

Resumen: Entre el sueño y la muerte hay “sólo una distancia”. El dormir encierra un misterio que se aviva con los sueños y, al parecer, habrían prefigurado al mismo método científico moderno. Descartes pensó que en sus sueños se transmitía el espíritu de la verdad. El alma soñadora e inmortal adquirió notoriedad en su dualismo, al tiempo que dejó de asociársela con la muerte. Tres siglos después, la medicina permitió identificar individuos que estaban muertos, aunque pareciesen dormidos (coma dépassé). Así reapareció la asociación sueño-muerte, pero ahora con médicos provistos del “diagnóstico anátomo-clínico” que, por su herencia cartesiana, demandará evidencias. La duda metódica integrada al pensamiento científico, aportaría incertidumbre a las formulaciones cerebrales de la muerte. Este trabajo repasa el valor de los sueños para el pensamiento occidental, busca al “hombre-máquina” dentro de los criterios neurológicos del fallecido y, con la ayuda de la Filosofía, intenta comprender algunas objeciones en torno a la licitud del diagnóstico de “muerte encefálica”. Se propone una revisión sucinta de la obra del filósofo francés y su reflejo en aspectos del debate ofrecido por la literatura médica.

Tratamientos proporcionados y desproporcionados en el estado vegetativo persistente

Los pacientes en estado vegetativo permanente representan un dilema ético en términos de atención médica. El problema está instalado en la sociedad desarrollando un importante dilema que implica la justicia, la religión, la economía y la familia. En el presente trabajo se analiza esta problemática de acuerdo con el “principio de lo éticamente adecuado en el uso de los medios de conservación de la vida”, desarrollado por el profesor M. Calipari. Se presentarán varios casos clínicos que serán analizados a través de esta teoría complementada con aspectos médicos y judiciales, según la legislación argentina.

As instituições formadoras e a identidade profissional da enfermagem : mimetismo ou metamorfose

O objeto do presente estudo consiste nos papéis exercidos pelas instituições formadoras de profissionais de enfermagem, pelo mercado de trabalho e pelas entidades de classe da enfermagem no processo de profissionalização e de construção de sua identidade profissional. Este estudo tem por objetivo reescrever o processo de construção da identidade profissional da enfermagem a partir das discussões travadas pelos profissionais, nas instituições formadoras, acerca de sua especialização, a luz dos fatos sócio-históricos que desencadearam, ao longo do tempo, a passagem de uma enfermagem generalista para outra especialista. O trabalho discute o processo de profissionalização da enfermagem nas instituições formadoras tendo como pano de fundo as idéias clássicas da sociologia das profissões. Para ela, a enfermagem é vista coma uma semiprofissão, uma vez que não possui os quatro atributos fundamentais de uma verdadeira profissão: autonomia, corpo esotérico de conhecimentos, ideal de serviço e monopólio de saber e do fazer. Na tentativa de conquistar estes quatro atributos, ou alguns deles, para, então, ascender ao patamar de profissão, a enfermagem hoje vive um momento de transição na formação de seus profissionais: generalistas (tradicionais) ou especialistas (modernos). Em um outro aspecto, concluímos que, até o momento, o processo de legitimação, ou melhor, de construção social da identidade profissional da enfermagem especializada ainda não se consolidou, ou seja, as instituições formadoras, construtoras sociais do campo profissional da enfermagem, ainda não se definiram pela figura de um só perfil - generalista ou especialista - e, por isso, esta construção ainda encontra-se inacabada.

Aberration measurement of projection optics in lithographic tools by use of an alternating phase-shifting mask

As a critical dimension shrinks, the degradation in image quality caused by wavefront aberrations of projection optics in lithographic tools becomes a serious problem. It is necessary to establish a technique for a fast and accurate in situ aberration measurement. We introduce what we believe to be a novel technique for characterizing the aberrations of projection optics by using an alternating phase-shifting mask. The even aberrations, such as spherical aberration and astigmatism, and the odd aberrations, such as coma, are extracted from focus shifts and image displacements of the phase-shifted pattern, respectively. The focus shifts and the image displacements are measured by a transmission image sensor. The simulation results show that, compared with the accuracy of the previous straightforward measurement technique, the accuracy of the coma measurement increases by more than 30% and the accuracy of the spherical-aberration measurement increases by approximately 20%. (c) 2006 Optical Society of America.

基于双线空间像线宽不对称度的彗差测量技术

在高数值孔径、低工艺因子的光刻技术中，投影物镜彗差对光刻质量的影响变得越来越突出，因而需要一种快速、高精度的彗差原位测量技术。为此提出了一种新的基于双线空间像线宽不对称度的彗差测量技术，利用国际上公认的半导体行业光刻仿真软件PROLITH对该方法的测量精度进行了仿真分析。结果表明，与基于硅片曝光的彗差测量方法相比，基于空间像的彗差测量技术速度上的优势十分明显。其测量精度优于1．4nm，较国际前沿的多照明设置空间像测量技术（TAMIS）提高30％以上，测量速度提高1／3左右。在ASML公司的PAS5500型

基于套刻误差测试标记的彗差检测技术

为了满足光刻机投影物镜彗差测量精度的要求，提出一种基于套刻误差测试标记的彗差检测技术，分析了彗差对套刻误差测试标记空间像的影响，详细叙述了该技术的测量原理，并利用PROLITH光刻仿真软件对不同数值孔径与部分相干因子设置下套刻误差相对于彗差的灵敏度系数进行了仿真实验。结果表明，与目前国际上通常使用的投影物镜彗差检测技术相比，该技术在传统照明条件下灵敏度系数Kz7与Kz14的变化范围分别增加了27．5％和34．3％，而在环形照明条件下则分别增加了20．4％和22．1％，因此彗差的测量精度可提高20％以上。

Co-incineração de pneus com resíduos sólidos urbanos

O aumento da população, o crescimento das grandes cidades, da industrialização e do consumo, tem trazido preocupação com relação a sustentabilidade quanto à disponibilidade energética e quanto à destinação dos resíduos sólidos urbanos gerados. Dessa forma, é fundamental realizarem-se os estudos visando novas formas de reutilização dos resíduos gerados pelas atividades industriais. Os resíduos sólidos urbanos e os pneus inservíveis gerados trazem conseqüências ao meio ambiente e às populações quando destinados inadequadamente. A destinação final dos resíduos sólidos urbanos é complexa, sendo sempre um grande desafio para as administrações públicas. Com a Política Nacional de Resíduos Sólidos (instituída pela Lei n 12.305/2010), tem-se um marco da preservação ambiental, coma a gestão e gerenciamento de resíduos sólidos, com a ordem de prioridade: não geração, redução, reutilização, reciclagem, tratamento dos resíduos sólidos e disposição final ambientalmente adequada dos rejeitos e prevê, de forma inteligente, a atribuição aos fabricantes de responsabilidade pelo retorno de produtos descartados pelos consumidores. Uma alternativa para minimizar estes aspectos e impactos ambientais é o tratamento térmico com aproveitamento energético. Este processo contribui para mais uma solução de destinação dos resíduos, proporcionado uma redução das áreas a serem utilizadas nos aterros sanitários e contribuindo como uma fonte de geração de energia elétrica

Natural Variation In Recovery From A Short Period Of Anoxia Due To A cGMP-Dependent Protein Kinase in Drosophila melanogaster

[EN] Protein Kinase G (PKG) or cGMP-dependent protein kinases (PKG) have been shown to play an important role in resistance to abiotic stressors such as high temperatures or oxygen deprivation in Drosophila melanogaster. In Drosophila, the foraging gene encodes a PKG; natural variants for this gene exist, which differ in the level of expression of PKG: rovers (forR allele) which express high PKG levels, and sitters (forS allele) which express lower PKG levels. This project explores the differences in recovery from short periods of anoxia between natural variants (focusing on forS2, flies with a sitter gene in a rover background), as well as mutants with insertions in the foraging gene and RNAi recombinants that show a reduced PKG expression. The parameters measured were time to recovery and level of activity after anoxia. The results showed lower activity after anoxia in sitters than in rovers, reflecting a worse recovery from the anoxic coma in flies with lower PKG levels.

Mecanismos de variabilidade de pressão arterial batimento-a-batimento e desempenho cognitivo em idosos

O objetivo deste estudo foi investigar os mecanismos de variabilidade da pressão arterial sistólica batimento-a-batimento através da análise espectral do componente de baixa frequência da variabilidade da pressão arterial sistólica, de medidas de velocidade da onda de pulso e de análise da pressão de incremento em idosos normotensos e hipertensos em tratamento anti-hipertensivo. Adicionalmente, investigamos a associação da variabilidade da pressão arterial com a espessura médio-intimal carotídea. Também investigamos a associação entre variabilidade da pressão arterial batimento-a-batimento e da frequência cardíaca com desempenho cognitivo. A pressão arterial foi medida continuamente através de fotopletismografia em posição supina e semi-ereta passiva. A variabilidade da pressão arterial foi estimada pelo desvio padrão das medidas batimento-a-batimento. Medidas de velocidade de onda de pulso, de pressão de incremento e ultrassonografia das artérias carótidas para medidas da espessura médio-intimal foram realizadas. O componente de baixa frequência da variabilidade da pressão arterial sistólica em posição supina e semi-ereta apresentou uma associação positiva independente coma variabilidade nos modelos de regressão linear múltipla ajustado pela velocidade de onda de pulso ou pela pressão de incremento.O componente de baixa frequência do barorreflexo em posição supina apresentou uma associação negativa independente com a variabilidade da pressão arterial sistólica e nos mesmos modelos. Não foi demonstrada associação entre a variabilidade da pressão arterial sistólica com espessura médio-intimal das artérias carótidas. Não foi demonstrada associação da variabilidade da pressão arterial sistólica batimento-a-batimento ou da frequência cardíaca com desempenho cognitivo global. Foi demonstrada associação positiva e independente do componente de baixa frequência do espectro de variabilidade da pressão arterial e da frequência cardíaca com domínios cognitivos relacionados ao lobo frontal. Em conclusão, a modulação simpática do tono vascular arterial, a função vascular miogênica e a desregulação do barorreflexo correlacionam-se com a variabilidade da pressão arterial batimento-a-batimento, o que não foi observado em relação `a rigidez arterial,pressão de incremento eespessura médio-intimal carotídea. A variabilidade da pressão arterial sistólica e da frequência cardíaca não apresentaram correlação com o desempenho cognitivo global, mas apresentaram associação positiva e independente com escores de função executiva.

Moisture conditions in timber cladding: field trial data for Sitka spruce.

Exposure trials on timber cladding are valuable for informing facade designers. This paper describes a trial using Sitka spruce (Picea sitchensis). Sitka spruce is the only UK-grown timber available in sufficient volume to supply the growing cladding market, but its suitability is unclear. Data indicated that the moisture content range in timber cladding was wider than generally accepted. The minimum of around 10% moisture content appeared to be similar for all details tested. The maximum was influenced by construction detailing but was around 30%. From a theoretical standpoint, the range, and rate, of moisture content fluctuation observed meant that the commonly quoted average value was largely irrelevant. The mode was a more representative statistic; most of the data were skewed towards the wood's fibre saturation point. Sitka spruce is, therefore, at risk of fungal decay and is only suitable as external cladding in the UK if treated with preservative

Estimulação cognitiva em idosos institucionalizados após Acidente Vascular Cerebral

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para a obtenção do grau de Mestre em Psicologia, ramo de Psicologia Clínica e da Saúde

Living long-term with acquired brain injury in Ireland: towards a counter discourse

Irish literature on Acquired Brain Injury (ABI) is very scant and is mainly deficits and/or needs based. The focus is generally on how to manage the short term needs of the younger population with ABI. The starting position of my thesis is that people living long-term with ABI are important participants in developing knowledge about this social phenomenon, living with ABI while accepting that their brain injury does not determine them. Six mature adults with ABI and their six significant others participated in this longitudinal study. Using a narrative approach in interviews, over twenty months, five repeat individual interviews with each of the twelve participants was held. From this I gained an understanding of their lived experiences, their life-world and their experiences of our local public ABI/disability services, systems and discourse. Along with this new empirical data, theoretical developments from occupational therapy, occupational science, sociology, and disability studies were also used within a meta-narrative informed by critical theory and critical realism to develop a synthesis of this study. Social analysis of their narratives co-constructed with me, allowed me generate nuanced insights into tendencies and social processes that impacted and continues to impact on their everyday-everynight living. I discuss in some depth here, the relational attitudinal, structural, occupational and environmental supports, barriers or discrimination that they face(d) in their search for social participation and community inclusion. Personal recognition of the disabled participants by their family, friends and/or local community, was generally enhanced after much suffering, social supports, slow recovery, and with some form of meaningful occupational engagement. This engagement was generally linked with pre-injury interests or habits, while Time itself became both a major aid and a need. The present local ABI discourse seldom includes advocacy and inclusion in everyday/every night local events, yet most participants sought both peer-support or collective recognition, and social/community inclusion to help develop their own counter-discourse to the dominant ABI discourse. This thesis aims to give a broad social explanation on aspects of their social becoming, 'self-sameness' and social participation, and the status of the disabled participants wanting to live 'the slow life'. Tensions and dialectical issues involved in moving from the category of a person in coma, to person with a disability, to being a citizen should not demote the need for special services. While individualized short-term neuro-rehabilitation is necessary, it is not sufficient. Along with the participants, this researcher asks that community health and/or social care planners and service-providers rethink how ABI is understood and represented, and how people with ABI are included in their local communities