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Benzodiazepines are commonly used to treat anxiety and panic disorders. White patients are more likely to receive a benzodiazepine prescription than non-White patients in different medical settings. Racial-ethnic disparities have also been found in prescription of opioids from the emergency room. It is not known whether racial disparities in benzodiazepine prescriptions exist at the emergency department level. This study aims to analyze the relationship between benzodiazepine prescriptions for anxiety in an emergency department setting.Data for this cross-sectional study was obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) Years 2009-2018. Patients ≥ 18 years of age presenting to the emergency department with anxiety were identified. Adjusted survey logistic regression was conducted to evaluate the patient characteristics and receipt of benzodiazepines.This study analyzed 1,174,556,119 emergency department (ED) visits out of which 2.8% had a diagnosis of anxiety disorder. Prevalence of anxiety was higher in the following groups: females, younger age range (18-34 years old), and non-Hispanic (NH) White. Rates of benzodiazepine prescription for patients with anxiety were higher for NH-White and Hispanic patients at 29% and 28% respectively than for NH-Black and NH-Other (24% and 21% respectively). Compared to NH-White patients, NH-Black patients were 36% less likely to be prescribed a benzodiazepine (prevalence ratio (PR) = 0.64; 95% confidence interval (CI) = 0.54-0.76) and Hispanic patients were 19% less likely to be prescribed a benzodiazepine (PR = 0.81; 95% CI = 0.68-0.96). Age, sex, or type of insurance did not show a statistically significant influence in the prescription of benzodiazepines.These findings reveal that NH-Black and Hispanic patients with anxiety are significantly less likely to be prescribed benzodiazepines than their NH-White counterparts in the ED. Further studies are needed to determine the root causes of these health disparities and strategies to combat them.

The purpose of this study was to report the 5-year outcomes of treatment-naive eyes with cystoid macular edema secondary to central retinal vein occlusion treated with intravitreal bevacizumab in routine clinical practice. We conducted multicenter retrospective non-comparative case series of 102 eyes. The main outcome measured was the change in best-corrected visual acuity (BCVA) at 5 years. Secondary outcomes included the number of injections and the change in CMT at 5 years. At 5 years, the mean BCVA improved from 1.22 ± 0.58 (Snellen 20/428) at baseline to 1.00 ± 0.68 logMAR (Snellen 20/200; p

To report our experience in non-contact wide-angled visualization with chandelier-assisted scleral buckling (SB) in uncomplicated primary rhegmatogenous retinal detachments (RRD). Retrospective case series of 282 eyes that underwent non-contact wide-angled visualization with chandelier-assisted SB and were followed for a mean of 13.5 months. There were 160 male patients. The average age was 42.6 years old. There were 262 eyes that were phakic, 18 pseudophakic, and 2 aphakic. Two-thirds of eyes presented with the macula detached. Eyes had an average of 1.6 breaks. The single operation anatomic success rate was 85.1% (240/282). The pre-op visual acuity improved from 1.21 to 0.76 logMAR at 6 months (p < 0.0001). Complications included a case of scleral laceration, choroidal hemorrhage, 3 epiretinal membranes, 1 macular fold, and 4 eyes with buckle exposure. Non-contact wide-angled visualization with chandelier-assisted SB compares favorably with conventional SB for primary uncomplicated primary RRD.

To assess the effects of weekly post-operative intravitreal methotrexate injections on eyes with grade C proliferative vitreoretinopathy (PVR) that underwent surgical repair. Retrospective case–control study of 16 eyes with retinal detachment and grade C PVR. Seven eyes received weekly intravitreal MTX injections post-operatively as an adjunct and 9 eyes served as the control. The main outcome measure was the retinal re-attachment rate. In the MTX group, 86% (6/7) of eyes had a complete retinal re-attachment at the end of the follow-up period. In contrast in the no MTX group, only 22.2% (2/9) of eyes had a complete retinal re-attachment (p = 0.0406). The patients in the MTX group received a mean of 6 injections (range 4–8). There were no cases of corneal epitheliopathy. Serial intravitreal MTX as an adjunct to surgical repair holds promise for the management of PVR.

The purpose of this study was to report the 5-year outcomes of treatment-naive eyes with cystoid macular edema secondary to central retinal vein occlusion treated with intravitreal bevacizumab in routine clinical practice.We conducted multicenter retrospective non-comparative case series of 102 eyes. The main outcome measured was the change in best-corrected visual acuity (BCVA) at 5 years. Secondary outcomes included the number of injections and the change in CMT at 5 years.At 5 years, the mean BCVA improved from 1.22 ± 0.58 (Snellen 20/428) at baseline to 1.00 ± 0.68 logMAR (Snellen 20/200; p 0.0001). At 5 years, 48 (47%) eyes had a gain of ≥ 3 lines, 41 (40.2%) eyes remained within 3 lines and 13 (12.7%) eyes had a loss of ≥ 3 lines of BCVA. The CMT improved from 740 ± 243 to 322 ± 179 µm (p 0.0001). At 5 years, 59 (57.8%) eyes had a completely dry SD-OCT. Patients received a total of 10.6 ± 6.1 (range 6-27) injections. Baseline BCVA (p 0.0001) and the duration of symptoms prior to initial anti-VEGF injection (p = 0.0274) were the only predictive factors for BCVA at 5 years.After 5 years with an average of 10.6 injections, there was a mean gain of 0.22 logMAR. In addition, more eyes achieved a BCVA of ≥ 20/40, gained ≥ 3 lines and less patients had a BCVA ≤ 20/200. Eyes with a better baseline BCVA and a shorter duration of symptoms were more likely to achieve better BCVA at 5 years.

Myeloid neoplasms (MN) are usually sporadic late-onset cancers; nevertheless, growing evidence suggests that ∼5% of the cases could emerge as a consequence of inherited predisposition. Distinguishing somatic from germline variants is of vital importance, in order to establish an appropriate individualized management and counsel the patients and their relatives. Since many of the genes associated with myeloid neoplasm germline predisposition (MNGP) are also affected in sporadic MN, we intended to design a strategy to identify potentially inherited variants in a tumor only NGS panel in a cohort of 299 patients with a variety of MN. We considered as indicative of potential inherited origin, variants detected in BM sample at a ∼50% VAF classified as pathogenic, likely pathogenic or of unknown significance detected in MNGP-related genes. A total of 104 suspicious variants from 90 patients were filtered-in in tumor samples. Mutational patterns, follow-up data, and sequencing of a range of non-myeloid tissues were used for narrowing down the list of suspicious variants, and ultimately discriminate their nature. Our data supports the importance of considering variants found upon tumor-only sequencing as potentially of germline origin, and we offer a pipeline to define the nature of the variants.

To compare the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) in central serous chorioretinopathy (CSC).Prospective, randomized, double-masked, non-inferiority, 12-week clinical trial. Patients were randomly assigned 1:1 to SML group or TCL group. Patients in the SML group were treated with 577 nm micropulse laser. The spot size was 160 µm, the duty cycle was 5% and exposure time was 0.2 s. The power was 50% threshold tested. Patients in the TCL group were treated with 577 nm continuous laser. The power was 100% threshold tested. The primary outcome was the mean change in best-corrected visual acuity (BCVA) at week 12, with a non-inferiority limit of five letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts.Eighty-eight patients were enroled. Seventy-seven patients were male. Forty-four patients were in SML group and 44 in TCL group. At week 12, SML was equivalent to TCL with a gain of 6.23 ± 8.59 and 6.61 ± 6.35 letters, respectively, (SML-TCL difference: -0.38 letters; 95% confidence interval (CI):-3.58-2.81; PBoth SML and TCL can improve visual acuity in CSC. SML was non-inferior to TCL in the improvement of BCVA.

The sensitivity of in vivo low-dose high-resolution micro-computed tomography imaging enables monitoring the lung damage caused by tuberculosis. Here, we propose a radiological score integrated in the experimental workflow that enables longitudinal monitoring for prospective efficacy studies in drug development programs. The score is based on an automatic measurement of total unaffected lung volume in vivo normalized for inter-subject comparison. It was validated on well-characterized progression of chronic tuberculosis in Erdman and H37Rv strains in C3HeB/FeJ-based models. We demonstrated that a decrease in the score value indicates increasing adverse effects and vice versa. The colony-forming units count confirmed the variability in the host response suggested by the score values. The correlation between changes in the mice's weight and the score is consistent with disease progression. The classification of disease extent by k-means clustering of the score values provided the definition of the lung damage severity according to the bacillus strain. The proposed score will reduce sources of bias and improve the statistical robustness of studies by the attrition of non-infected subjects or subjects with a weak immune response. Readily available quantifications allow for a fast assessment of the therapeutic potential in drug-resistant tuberculosis strains.

To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT).Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months.There were 168 patients (51 men) with a mean age of 68.8 ± 10.7 years. Patients were followed for a mean of 22.7 ± 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 ± 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 ± 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P = 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 ± 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 ± 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45; P = 0.0372), and the mean central macular thickness improved from 350 ± 132 μm to 323 ± 121 μm.Spontaneous resolution of VMT occurred in 21.4% (36 of 168) of eyes after a mean follow-up of 11.4 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of eyes. The baseline SD-OCT grade may predict the progression to full-thickness macular hole.

This document updates the recommendations made by the Spanish Society of Family and Community Medicine and the Spanish Association of Gastroenterology for the diagnosis and prevention of colorectal cancer (CRC). In order to evaluate the quality of the evidence and determine the recommendation levels of the interventions, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. This document establishes optimal delay intervals based on symptoms and the faecal immunochemical test (FIT) and recommends reducing the barriers for diagnostic confirmation in symptomatic subjects. With regard to CRC screening in the average-risk population, we propose strategies to achieve the universal implementation of organised CRC screening programmes based on biennial FIT and to increase the participation of the target population, including the involvement of Primary Healthcare. This Clinical Practice Guideline recommends universal screening for Lynch syndrome with mismatch repair proteins immunohistochemistry or microsatellite instability in incident CRCs and the use of gene panels in patients with adenomatous polyposis. It also updates the strategies to reduce the incidence and mortality of both CRC and other tumours associated with hereditary syndromes. Regarding non-hereditary familial CRC and surveillance after resection of adenomas, serrated lesions or CRC, we established the recommendations based on the attributable risk and the risk reduction of the proposed intervention. Finally, the document includes recommendations regarding surveillance intervals in inflammatory bowel disease and the attitude towards dysplasia. (C) 2018 Elsevier Espana, S.L.U. All rights reserved.

PurposeTo compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT).MethodsThis is a multicentre, retrospective comparative study of 92 eyes treated with yellow MP laser (duty cycle of 5%, zero spacing between spots, spot size varied from 100 to 200 µm, power varied from 320 to 660 mW, and the pulse burst duration was 200 ms) and 67 eyes treated with PDT (half-dose verteporfin (3 mg/m2) infused over 10 min), followed by laser activation for 83 s. Spot sizes varied from 400 to 2000 µm.ResultsIn the MP group, at 12 months of follow-up, the mean best corrected visual acuity (BCVA) improved from the logarithm of the minimum angle of resolution (logMAR) of 0.41±0.27 at baseline to 0.21±0.26 (PConclusionsBoth PDT and MP are effective in restoring the macular anatomy. In places where PDT is not available, yellow MP laser may be an adequate treatment alternative.

The main purpose of this paper is to show and highlight through an example, the relevance of designing a properly strategic communication model (SCM) in order to improve organizations efficiency standards when a sharing knowledge network is used. This example shows as well that even if this configuration upgrades the competitor s standards it will give as an answer the ontological foundations for the knowledge to be shared that guarantee the best practice involved in the framework of the Knowledge Management (KM process). &nbsp The case of study takes advantage of some lesson from Network Centric Warfare (NCW) and the Network Enable Capability (NEC) systems to developed a Strategic Communication Model that looks for increasing the falcon breeding efficiency which it is a direct function of the falcons flight efficiency which creates a free wild-life area in the most sensitive airport locations and which is a priority concern of nowadays falconer's organizations.

Melanoma is a highly prevalent cancer that is associated with substantial mortality. Although clinical staging procedures can serve as relatively robust prognostic indicators, we aimed to determine whether assessments of the abundance of hypoxia inducible factor-1α (HIF-1α) or vascular endothelial growth factor (VEGF) in postexcisional melanoma tumor tissues may enable more accurate determination of tumor aggressiveness. We carried out a multicenter prospective study, in which we systematically evaluated 376 consecutive patients diagnosed with melanoma, and performed histochemical assessments for both HIF-1α and VEGF immunoreactivity in the tumor biopsies. Multivariate analyses showed that higher HIF-1α expression, but not high VEGF, were associated significantly and independently with increased tumor aggressiveness as derived from several well-established aggressiveness criteria. A limitation of this study was that this was a descriptive prospective study lacking a post-hoc verification arm. Thus, the presence of increased numbers of positively labeled HIF-1α cells in melanoma tumors may potentially serve as an indicator of tumor phenotype and prognosis, and accordingly guide therapy.

Purpose: To report the incidence and clinical features of patients that experienced un-explained visual loss following silicone oil (SO) removal. Methods: Multicenter retrospective study of patients that underwent SO removal during 2000-2012. Visual loss of ≥2 lines was considered significant. Results: A total of 324 eyes of 324 patients underwent SO removal during the study period. Forty two (13%) eyes suffered a significant visual loss following SO removal. Twenty three (7.1%) of these eyes lost vision secondary to known causes. In the remaining 19 (5.9%) eyes, the loss of vision was not explained by any other pathology. Eleven of these 19 patients (57.9%) were male. The mean age of this group was 49.2 ± 16.4 years. Eyes that had an un-explained visual loss had a mean IOP while the eye was filled with SO of 19.6 ± 6.9 mm Hg. The length of time that the eye was filled with SO was 14.8 ± 4.4 months. In comparison, eyes that did not experience visual loss had a mean IOP of 14 ± 7.3 mm Hg (p < 0.0002) and a mean tamponade duration of 9.3 ± 10.9 months (p < 0.0001). Conclusions: An un-explained visual loss after SO removal was observed in 5.9% of eyes. Factors associated with this phenomenon included a higher IOP and longer SO tamponade duration. © The Author(s) 2017.

Purpose: To provide evidence-based recommendations and guidance for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) based on recently published clinical evidence and clinical experience. Methods: A literature search using PubMed and the Cochrane Library was performed with the terms “diabetic macular edema” or “diabetic retinopathy” to identify studies published from January 2008 to November 2013. This was followed by a manual search of references cited in selected papers published in peer-reviewed journals. The references identified in these literature searches were reviewed and presented by members of the Latin America DME expert panel to the entire group during the 2-day consensus meeting. During this meeting,the experts formulated recommendations with consideration of the health benefits, risks, and adverse effects of interventions. References used to support recommendations were assigned a level of evidence based on the Strength of Recommendation Taxonomy (SORT) evidence rating system. Results: Thirty-one consensus recommendations were formulated. These include the recommendation for early glycemic control in diabetic patients in order to reduce the risk of progression of ocular disease. The expert panel also recommended the collection of epidemiological data to further define the prevalence of DR and DME in Latin America and to establish management and treatment algorithms for various stages of the disease. The need for early screening and development of infrastructure to ensure appropriate followup and treatment of those in need is further emphasized. Both fluorescein angiography (FA) and optical coherence tomography (OCT) are needed for proper assessment of disease progression and response to therapy. Based on available high-level evidence, we recommend ranibizumab as the gold standard for the treatment of DME and panretinal photocoagulation (PRP) as the gold standard for proliferative DR. Vitrectomy should be considered in the presence of macular traction or if edema is not responding to pharmacological therapy. As intravitreal steroids provide a reduction in edema, they can be used to ameliorate the effects of other therapies as well as in pseudophakic eyes. Finally, when selecting a therapy for DR and/or DME, it is of particular importance to consider the general health status of a patient. Conclusion: Although these guidelines are not intended to be a replacement for clinical judgment, they should help to streamline the management of DME across Latin America and ensure that patients receive the best available care in a timely manner.

Although CDKN2A is the most frequent high-risk melanoma susceptibility gene, the underlying genetic factors for most melanoma-prone families remain unknown. Using whole-exome sequencing, we identified a rare variant that arose as a founder mutation in the telomere shelterin gene POT1 (chromosome 7, g.124493086C>T; p.Ser270Asn) in five unrelated melanoma-prone families from Romagna, Italy. Carriers of this variant had increased telomere lengths and numbers of fragile telomeres, suggesting that this variant perturbs telomere maintenance. Two additional rare POT1 variants were identified in all cases sequenced in two separate Italian families, one variant per family, yielding a frequency for POT1 variants comparable to that for CDKN2A mutations in this population. These variants were not found in public databases or in 2,038 genotyped Italian controls. We also identified two rare recurrent POT1 variants in US and French familial melanoma cases. Our findings suggest that POT1 is a major susceptibility gene for familial melanoma in several populations.

The COSMO-SkyMed is a low-orbit, dual-use, earth observation satellite system operating in the X-band funded by the Italian Ministry of Research (MIUR) and Ministry of Defense and managed by the Italian Space Agency (ASI). SkyMed will make use of the most advanced remote sensing technology in the construction of four SAR (Synthetic Aperture Radar) satellites and in the realization of a complex and geographically distributed Ground Segment infrastructure manufactured by Italian industries. In the context of the Agreement between ASI and CONAE (National Commission of Spatial activities) two Argentine missions are in progress SAOCOM-1-A & 1-B, two SAR L-band satellites. This set of six SAR satellites comprised the SIASGE (Italian-Argentine System for Emergency Management). The COSMO-SkyMed ground segment includes: A constellation management infrastructure (Mission Control Centres and Satellite Control Centres), a decentralized ground-based user facilities for direct data collection from the satellite...

Failure to address limited English proficiency (LEP) is one of the main reasons leading to health disparities among Latinos. Translators in the clinical setting facilitate communication between providers and patients with LEP. In this chapter we talk about the effect of choosing to utilize a translator or not and its relationship to the quality of communication, patient/physician satisfaction, and health-related outcomes.

Purpose:The purpose of this study was to report the short-term visual and anatomical outcomes after intravitreal injections of two different tumor necrosis factor α inhibitors in eyes with refractory diabetic macular edema.Methods:An interventional, retrospective, multicenter study of 39 eyes with r

The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity after injecting 1.25 mg or 2.5 mg bevacizumab as needed in patients with primary macular edema secondary to central retinal vein occlusion.This is an interventional, retrospective, comparative multicenter study of 86 eyes with macular edema secondary to central retinal vein occlusion that were treated primarily with intravitreal bevacizumab (44 eyes, 1.25 mg; 42 eyes, 2.5 mg). The main outcome measures were the CMT and the change of best-corrected visual acuity at 24 months.All patients completed at least 24 months of follow-up. The mean number of injections per eye were 7.2 for the 1.25-mg dose group and 8.1 for the 2.5-mg dose group (P = 0.4492). At 24 months, in the 1.25-mg dose group, the logarithm of the minimal angle of resolution best-corrected visual acuity improved from baseline 0.35 +/- 0.57 units (P0.0001) versus 0.27 +/- 0.68 units for the 2.5-mg dose group (P0.0001). These differences were not statistically significant between both dose groups. In the 1.25-mg dose group, 25 (56.8%) eyes gainedor=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 6 (13.6%) lostor=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg dose group, 24 (57.1 %) eyes improvedor=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 7 (16.7%) lostor=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg dose group improved from 635 +/- 324 microm to 264 +/- 160 microm (P0.0001) versus 528 +/- microm to 293 +/- 137 microm in the 2.5-mg dose group (P0.0001). There was no statistically significant difference between both dose groups with regard to the CMT reduction.Intravitreal bevacizumab at doses up to 2.5 mg seems to be effective in improving visual acuity and reducing CMT in macular edema secondary to central retinal vein occlusion. There were no statistically significant differences between the two dose groups with regard to the number of injections, CMT, and change in visual acuity.

The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity (BCVA) after injecting 1.25 mg or 2.5 mg of bevacizumab as needed in patients with primary macular edema secondary to branch retinal vein occlusion.An interventional, retrospective, comparative multicenter study was conducted of 63 eyes with macular edema secondary to branch retinal vein occlusion that were treated primarily with intravitreal bevacizumab (38 eyes, 1.25 mg; 25 eyes, 2.5 mg). The main outcome measures were the CMT and the change of BCVA at 24 months.All patients completed at least 24 months of follow-up. The mean number of injections per eye was 3.6 in the 1.25-mg group and 4.3 in the 2.5-mg group (P = 0.4770). At 24 months, in the 1.25-mg group, the logarithm of the minimum angle of resolution BCVA improved from baseline 0.38 +/- 0.63 (P0.0001) units to 0.64 +/- 0.6 units for the 2.5-mg group (P0.0001). In the 1.25-mg group, 26 (68%) eyes gainedor =3 of Early Treatment of Diabetic Retinopathy Study visual acuity and 2 (5%) eyes lostor =3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg group, 18 (72%) eyes improvedor =3 of Early Treatment of Diabetic Retinopathy Study visual acuity, and none of the eyes lostor =3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg group improved from 453 +/- 140 microm to 244 +/- 125 microm (P0.0001) versus 444 +/- 175 microm to 234 +/- 80 microm in the 2.5-mg group (P0.0001). There were no cases of endophthalmitis. No systemic adverse events were reported.Intravitreal bevacizumab at doses up to 2.5 mg seems to be effective in improving BCVA and reducing CMT in macular edema secondary to branch retinal vein occlusion. No statistically significant differences were found between the two dose groups with regard to the number of injections, CMT, and change in BCVA.

PURPOSE: To report the 6-month anatomical and visual outcomes after injecting two different doses of intravitreal bevacizumab in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: An interventional, retrospective multicenter study of 45 eyes that were treated with at least one intravitreal injection (24 eyes, 1.25 mg; 21 eyes, 2.5 mg) of bevacizumab is reported. The main outcome measures were the central 1-mm macular thickness (CMT) and the change in ETDRS lines of best-corrected visual acuity (BCVA) at 6 months. RESULTS: Forty-five eyes were injected on average 26.1 months (range, 3-86 months) after the diagnosis. The average follow-up was 35.2 weeks (range, 24-52 weeks). All patients completed at least 6 months of follow-up. In the 1.25-mg dose group, at 1 month, there was an average gain of 4.5 lines of BCVA; at 3 months, 5.1 lines of BCVA; and at 6 months, 5.1 lines of BCVA (P less than 0.005). In the 2.5-mg dose group, at 1 month, there was an average gain of 2.3 lines of BCVA; at 3 months, 3.8 lines of BCVA; and at 6 months, 4.8 lines of BCVA (P = 0.05). In the 1.25-mg dose group, the mean CMT ± SD decreased from 461 ± 211 ?m at baseline to 321 ± 152 ?m at 1 month, 273 ± 99 ?m at 3 months, and 277 ± 114 ?m at 6 months (P = 0.0002). In the 2.5-mg group, the mean CMT ± SD decreased from 385 ± 168 ?m at baseline to 279 ± 111 ?m at 1 month, 249 ± 97 ?m at 3 months, and 240 ± 93 ?m at 6 months (P = 0.011). CONCLUSION: There were no statistically significant differences between the two dose groups with regard to the number of injections and anatomical and functional outcomes. Intravitreal injection of bevacizumab at doses up to 2.5 mg appears to be effective in improving BCVA and reducing CMT in BRVO in the short term. Multiple injections are needed in a large number of eyes for continued control of macular edema and preservation of visual acuity in the short term. Longer studies are needed to determine what role if any intravitreal injection of bevacizumab may play in the long-term treatment of this condition. © The Ophthalmic Communications Society, Inc.

Fault Locators in general are designed for HV solidly grounded systems because of the importance of fault location detection in the overhead transmission lines. In distribution line fault location there are some developments that are based again on the impedance measurement from one end. Accurate fault location in distribution systems is more difficult to achieve because of the existence of multiple branches and also because system neutral point is usually grounded through the high impedance or is ungrounded. In these conditions, fault current is low and with a high capacitive component.

PURPOSE:: To compare the incident rates of sustained elevation of intraocular pressure (IOP) after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane and the unoperated fellow eye. METHODS:: Retrospective multicenter study of 198 patients who underwent pars plana vitrectomy for an idiopathic epiretinal membrane that was followed for at least 12 months. The diagnosis of sustained IOP elevation was defined as an elevation of IOP ? 24 mmHg or an increase of ? 5 mmHg in the IOP from baseline on 2 separate visits that warranted the initiation of ocular hypotensive therapy. The main outcome measured was the development of sustained IOP elevation as defined above. RESULTS:: Patients were followed for an average of 47.3 ± 24 months (range, 12-106 months). In the vitrectomized eyes, 38 of the 198 (19.2%) patients developed elevated IOP compared with 9 of the 198 (4.5%) unoperated fellow eyes (P less than 0.0001, Fisher exact test; odds ratio, 4.988). Possible risk factors include a family history of open-angle glaucoma (P = 0.0004 Fisher exact test; odds ratio, 7.206) and cataract surgery (P = 0.0270 Fisher exact test; odds ratio, 2.506). CONCLUSION:: Uncomplicated PPV seems to increase the IOP, particularly in those who are pseudophakic and have a family history of open-angle glaucoma. This increase in IOP may lead to glaucomatous damage if not managed appropriately. Patients with a previous PPV need to be followed by an ophthalmologist to monitor the IOP in the vitrectomized eye. Copyright © by Ophthalmic Communications Society, Inc.

The improvement of the capabilities of nowadays X-ray observatories, like Chandra or XMMNewton, offers the possibility to detect both absorption and emission lines and to study the nature of the matter surrounding the neutron star in X-ray binaries and the phenomena that produce these lines. The aim of this work is to discuss the different physical scenarios in order to explain the meaning of the significant absorption feature present in the X-ray spectrum of 4U 1538−52. Using the last available calibrations, we discard the possibility that this feature is due to calibration, gain effects or be produced by the X-ray background or a dust region. Giving the energy resolution of the XMM-Newton telescope we could not establish if the line is formed in the atmosphere of the neutron star or by the dispersion of the stellar wind of the optical counterpart.

Atucha II is a 745 MW Argentine Power Nuclear Reactor constructed by ENACE SA, Nuclear Argentine Company for Electrical Power Generation and SIEMENS AG KWU, Erlangen, Germany. A preliminary modular logic analysis of RPS (Reactor Protection System) signals was performed by means of the well known Swedish professional risk and reliability software named Risk-Spectrum taking as a basis a reference signal coded as JR17ER003 which command the two moderator loops valves. From the reliability and behavior knowledge for this reference signal folloos an estimation of the reliability for the other 97 RPS signals. Because the preliminary character of this analysis Main Important Measures are not performed at this stage. Reliability is by the statistic value named unavailability predicted. The scope of this analysis is restricted from the measurement elements to the RPS buffer outputs. In the present context only one redundancy is analyzed so in the Instrumentation and Control area there no CCF (Common Cause Failures) present for signals. Finally those unavailability values could be introduced in the failure domain for the posterior complete Atucha II reliability analysis which includes all mechanical and electromechanical features. Also an estimation of the spurious frequency of RPS signals defined as faulty by no trip is performed.

A new method for computing software structural complexity based on the entropy evaluation of the random uniform response function associated with the so-called software characteristic function is proposed. The functions, parameters and algorithms to perform this computation are introduced and some applications are given. This complexity metric allows different designs to be compared and was used successfully in the assessment of safety critical redundant software.

To compare the short-term visual and anatomic outcomes after intravitreal injections of 2 different tumor necrosis factor-α inhibitors to continued antivascular endothelial growth factor (VEGF) therapy in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration that responded suboptimally to anti-VEGF agents.Retrospective comparative case series of 26 eyes. Eyes were injected intravitreally with 1 mg infliximab, 2 mg infliximab, 2 mg adalimumab, or 1.25 mg bevacizumab. The main outcomes measured were the best-corrected visual acuity (BCVA) and the central macular thickness (CMT) at 3 months of follow-up.The mean log minimal angle of resolution BCVA changed from 1.04±0.23 at baseline to 1.06±0.51 at 3 months (P=0.9455) in the 1-mg infliximab group; 0.94±0.48 at baseline to 0.85±0.43 in the 2-mg infliximab group (P=0.2802); 1.58±0.50 at baseline to 1.38±0.43 in the adalimumab group (P=0.1116); and 1.08±0.1 at baseline to 1.03±0.16 in the bevacizumab group (P=0.9928). The mean CMT changed from 387±54 μm at baseline to 342±108 μm (P=0.1053) in the 1-mg infliximab group; 301±42 μm at baseline to 284±73 μm (P=0.4854) in the 2-mg infliximab group; remained unchanged at 348±106 μm (P=0.308) in the adalimumab group; and 362±66 μm to 340±27 μm in the bevacizumab group (P=0.4622). Adverse events included uveitis in 37.5% (6/16) of eyes injected with infliximab.Intravitreal infliximab and adalimumab do not appear to benefit eyes with CNV that responded suboptimally to anti-VEGF agents. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.

COORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR Emulsões podem ser usadas como agentes de controle de mobilidade em métodos de recuperação avançada de petróleo com o objetivo de obter uma varredura mais uniforme do reservatório. O uso e otimização desta técnica requer um perfeito entendimento do escoamento de emulsões através de meios porosos. O escoamento macroscópico é função direta do escoamento na escala do poro, na qual emulsões não podem ser tratadas como um fluido não Newtoniano monofásico, já que as gotas são de tamanho semelhante às gargantas dos poros. Na escala microscópica, o escoamento de emulsões deve ser modelado como um escoamento bifásico incluindo efeitos capilares. Para determinar o efeito da tensão interfacial, razão de viscosidades, tamanho de gota e geometria do tubo capilar na relaçãao vazão - diferença de pressão do escoamento, um método do tipo Level Set, incluindo forças de tensão interfacial, foi desenvolvido e incorporado a um programa para solução implícita da equação de Navier - Stokes transiente baseado no método de elementos finitos. Os resultados mostram que o controle de mobilidade é obtido através de dois mecanismos. O primeiro é baseado na simples substituição de um líquido menos viscoso por outro mais viscoso; e o outro baseado as forças capilares associadas a deformação da gota durante a sua passagem pela garganta do capilar. Os resultados podem ser usados na construção de um modelo constitutivo na escala de poro que será incorporado em um modelo de rede de capilares que está sendo desenvolvido para o estudo de escoamento de emulsões através demeios porosos. Emulsion can be used as a mobility control agent in enhanced oil recovery methods in order to achieve a more efficient sweep of the reservoir. The application of such technique requires full understanding of how emulsions flow in a porous material. The macroscopic flow behavior can be determined based on the pore scale flow, at which emulsions cannot be treated as a single phase non Newtonian liquid, since the drop diameters are in the same order of magnitude of the pore throats. In the pore scale, emulsion flow needs to be studied as a two phase flow including capillary effects. In order to determine the effect of interfacial tension, viscosity ratio, drop size and capillary geometry in the pressure drop of the flow of a single oil drop immersed in water through a straight and constricted capillary, a Level Set type method including surface tension forces was incorporated to a fully coupled implicit Navier - Stokes solver using finite element method. The results clearly show that mobility control is achieved by two different mechanisms. One based on the simple substitution of a low viscosity by a high viscosity liquid and the other based on the capillary forces associated with the drop deformation as it flows through the constriction. The results can be used to construct a pore level model that will be incorporated in a capillary network model to study flow of emulsions through porous media.

Inflammation is the major etiologic factor in the development of pseudophakic cystoid macular edema (CME). Several soluble mediators of inflammation such as tumor necrosis factor alpha (TNF-α) have been implicated in the pathogenesis of ocular inflammation. The purpose of this study is to report the short-term visual and anatomic outcomes following intravitreal injections of infliximab in eyes with refractory CME secondary to cataract surgery. An interventional, retrospective study of 7 eyes with refractory CME that were injected with 1 mg of infliximab. The main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 6-month follow-up. At the 6 month follow-up, BCVA improved from 1.14 ± 0.59 logMAR at baseline to 0.51 ± 0.35 logMAR (p = 0.0156). CMT also improved from 584 ± 159 μm at baseline to 327 ± 127 μm at 6 months (p = 0.0111). No systemic adverse events were reported in these patients. There was a single episode of uveitis that responded to topical steroids. Inhibition of TNF-α may be beneficial in the treatment of refractory pseudophakic CME.

Purpose: To determine the incidence of endophthalmitis after 20-, 23-, and 25-gauge pars plana vitrectomies (PPVs). Methods: Retrospective comparative case series of consecutive patients who underwent 20-, 23-, or 25-gauge PPV at 11 centers from Latin America between 2005 to 2009. Pars plana vitrectomy cases were identified through a search of the billing records of each institution. Cases of PPV performed in the management of trauma, endophthalmitis, and combined PPV phacoemulsification cases were excluded. Endophthalmitis was diagnosed by clinical criteria regardless of the microbiologic results. The incidence of post-PPV endophthalmitis was compared between 20-, 23-, and 25-gauge PPVs. Results: A total of 35,427 cases of PPV were identified during the study period (n = 19,865 for 20 gauge, n = 10,845 for 23 gauge, and n = 4,717 for 25 gauge). The 5-year post-PPV endophthalmitis incidence rates were 0.020% (4 of 19,865), 0.028% (3 of 10,845), and 0.021% (1 of 4,717) for 20 gauge, 23 gauge, and 25 gauge, respectively (P = 0.9685). Conclusion: Small-gauge transconjunctival PPV does not appear to increase the rates of post-PPV endophthalmitis. © The Ophthalmic Communications Society, Inc.

BACKGROUND: To evaluate the anatomical and functional outcomes of intravitreal bevacizumab (1.25 or 2.5 mg) in the treatment of inflammatory choroidal neovascularization at 24 months. METHODS: We reviewed the clinical records of 22 consecutive patients (23 eyes) with choroidal neovascularization secondary to chorioretinal inflammatory disease in this interventional retrospective multicenter case series. Sixteen eyes (63.6%) received a dose of 1.25 mg of intravitreal bevacizumab, and 7 eyes (36.4%) received a dose of 2.5 mg of intravitreal bevacizumab. RESULTS: At baseline, the mean best-corrected visual acuity was 0.68 logarithm of minimum angle of resolution (Early Treatment Diabetic Retinopathy Study chart = 20/100). After intravitreal bevacizumab, best-corrected visual acuity improved significantly to 0.41 logarithm of minimum angle of resolution (20/51), 0.42 logarithm of minimum angle of resolution (20/53), and 0.40 logarithm of minimum angle of resolution (20/50) at 6, 12, and 24 months, respectively (P < 0.05). Fourteen eyes (60.8%) received 1 injection. Central macular thickness by optical coherence tomography decreased from 375.3 μm (range: 240-634 μm) at baseline to 241.6 μm (range: 189-306 μm) at 24 months of follow-up (P < 0.0001). CONCLUSION: Intravitreal bevacizumab at doses of 1.25 mg and 2.5 mg seems to provide stability or improvement in best-corrected visual acuity, optical coherence tomography, and fluorescein angiogram in inflammatory choroidal neovascularization at 24 months. All patients were treated after the underlying uveitic condition was controlled.

To determine the feasibility, safety, and clinical effect of intravitreal (IVT) bevacizumab (Avastin; Genentech, Inc., San Francisco, CA) in patients with refractory cystoid macular edema (CME) after cataract surgery.Interventional, retrospective, multicenter study.Thirty-six eyes of 31 patients with refractory CME after cataract surgery and with a mean age of 68.2 years (range, 67-87 years).Patients were treated with at least 1 IVT injection of 1.25 or 2.5 mg bevacizumab. Patients were followed up for 12 months.Best-corrected visual acuity (BCVA) and central macular thickness (CMT) by optical coherence tomography (OCT).Twenty-six eyes (72.2%) demonstrated improvement of BCVA (or =2 Early Treatment Diabetic Retinopathy Study [ETDRS] lines), and no eye experienced worsening of visual acuity (or =2 ETDRS lines). Mean baseline BCVA was 20/200 (0.96 logarithm of the minimum angle of resolution [logMAR] units), and the mean 12-month BCVA was 20/80 (0.62 logMAR units; P0.0001). Optical coherence tomography demonstrated that mean CMT at baseline was 499.9 microm (range, 298-784 microm) and decreased to a mean of 286.1 microm (range, 168-499 microm) at 12 months (P0.0001). Four (11%) eyes received 2 injections, 10 (27.8%) eyes received 3 injections, 10 (27.8%) eyes received 4 injections, 1 (2.8%) eye received 5 injections, and 1 (2.8%) eye received 6 injections. The mean number of injections was 2.7 (range, 1-6), and the mean interval between injections was 15.1 weeks (range, 4-45 weeks). No ocular or systemic adverse events were observed.Short-term results suggest that IVT bevacizumab is well tolerated in patients with refractory pseudophakic CME. Treated eyes had a significant improvement in BCVA and decrease in macular thickness by OCT at 12 months.

OBJECTIVE: To evaluate the complications after radial optic neurotomy (RON) for central retinal vein occlusion (CRVO). METHODS: Seventy-three consecutive patients (73 eyes) with CRVO who were treated with RON participated in a retrospective, uncontrolled, interventional, multicenter case series at 7 institutions from 6 countries. RESULTS: In the ischemic CRVO group (n = 53), 32% of eyes had an improvement in best-corrected visual acuity (BCVA) (mean, 5.5 lines), 35.8% had worse BCVA (mean, 6.4 lines), and 32% had BCVA that remained the same after RON. In the nonischemic CRVO group (n = 20), 50% of eyes had an improvement in BCVA (mean, 6.5 lines), 15% had worse BCVA (mean, 4.3 lines), and 35% had BCVA that remained the same after RON. Complications occurred in 71.2% of cases, including cataract in 17 eyes (23.2%), vitreous hemorrhage in 16 eyes (20.5%), persistent macular edema in 15 eyes (20.5%), neovascular glaucoma in 7 eyes (9.5%), anterior segment neovascularization in 5 eyes (6.8%), retinal detachment in 3 eyes (4.1%), and phthisis bulbi, choroidovitreal neovascularization, central retinal artery perforation, and optic nerve atrophy in 1 eye (1.3%) each. CONCLUSIONS: RON may improve visual acuity in some eyes with CRVO, but complications are common. In our series, surgery by itself did not seem to improve the outcome of CRVO when compared with its natural history. Copyright © 2008 by the Ophthalmic Communication Society Inc.

To determine the feasibility, safety, and clinical effect of primary intravitreal bevacizumab (Avastin) in patients with cystoid macular edema (CME) after cataract surgery.Five institutions in Venezuela, Costa Rica, Puerto Rico, Peru, and Brazil.Twenty-eight eyes of 25 patients treated with at least 1 intravitreal injection of 1.25 mg or 2.50 mg of Avastin participated in this interventional retrospective multicenter study at 5 institutions from 5 countries. Baseline and follow-up visits included Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination.The mean follow-up was 32 weeks (range 24 to 52 weeks). Twenty eyes (71.4%) had improved best corrected visual acuity (BCVA) (or =2 ETDRS lines), and no eye had worse visual acuity (or =2 ETDRS lines). The BCVA remained stable in 8 eyes (28.6%). The mean baseline BCVA was 20/160 (logMAR = 0.92) and the mean final BCVA, 20/63 (logMAR = 0.50); the difference was statistically significant (P.0001). The mean central macular thickness at baseline (466.3 microm; range 208 to 784 microm) decreased significantly (264.5 microm; range 176 to 513 microm) by the end of follow-up (P.0001). Eight eyes (28.6%) required a second injection and 4 (14.3%), a third injection. The mean interval between injections was 13 weeks (range 5 to 26 weeks). No ocular or systemic adverse events were observed.Short-term results suggest that primary intravitreal Avastin is well tolerated in patients with pseudophakic CME. Treated eyes had a significant improvement in BCVA and decrease in macular thickness by OCT.

Recent articles published in CNS Neuroscience and Therapeutics reflect the increasing interest of the scientific community in the therapeutic properties of cannabis[1,2]. However, an aspect that is commonly overlooked is the potential medical side effects of cannabis use, among which severe hyperemesis is an uncommon condition. Cannabinoid hyperemesis syndrome (CHS) occurs in chronic, daily cannabis users and is characterized by cyclic vomiting and compulsive bathing behavior. This clinical manifestation is paradoxical, given the previously identified therapeutic role of cannabis as an antiemetic agent. We report a recent case of CHS associated with organic and psychiatric complications that was diagnosed at our center. A 36-year-old Hispanic woman attended the emergency department of a tertiary hospital presenting with second-degree burns on 20% of her body surface. These had been caused by repeated showers in excessively hot water. She also reported a history of frequent episodes of nausea and vomiting for the previous 24 months, which after several inconclusive assessments had been attributed to anxiety. She denied any medical or surgical history, except diagnosis of gastritis in 2011, treated with omeprazole. She had visited the emergency department on several occasions during the previous 5 years referring anxiety and abdominal pain associated with vomiting and compulsive hot showers which the patient had claimed were aimed at relieving anxiety symptoms, and which were considered to be part of an obsessive–compulsive disorder (OCD). She had been treated with antidepressant and anxiolytic drugs without clear improvement. She admitted to smoking marijuana daily for at least 5 years, while she denied the use of any other illicit substances. The patient was admitted for evaluation and was administered acid-suppressive medications, antiemetics, rehydration, and topical treatment. The patient’s laboratory data at admission were normal, except for hypokalemia and a positive urinary drug screen for cannabis, while the physical examination yielded no additional information. During the length of the patient’s hospital admission, she continued to take hot showers numerous times each day. Taking into account the patient’s clinical presentation and her history of regular cannabis use, she was diagnosed with CHS. The patient was informed of the diagnosis, and of the need to cease her marijuana use. On further questioning, the patient confirmed persistent, daily marijuana use over the past 5 years. Following liaison with her psychiatrist, she was referred to a drug treatment center to address her cannabis use disorder, while her OCD diagnosis was withdrawn and her medication modified. Six months later, she had succeeded in giving up cannabis use entirely, she had not suffered any further episodes of nausea or vomiting, and she showered once daily with mild warm water.