Florianópolis, Brazil
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Golbert M.,University of Sao Paulo | Pereira F.J.,Florianopolis | Garcia D.M.,University of Sao Paulo | Cruz A.A.V.,University of Sao Paulo
Aesthetic Surgery Journal | Year: 2017

Background: Conjunctiva-Muller muscle resection (CMMR) is a simple, effective, and predictable procedure for internal treatment of ptosis. Objectives: The authors determined contour symmetry of the upper eyelid following bilateral CMMR. Methods: Thirty control participants (ie, without ptosis) and 44 patients with acquired bilateral blepharoptosis who underwent CMMR were evaluated in a prospective study. To assess symmetry of lid contour, distances from midpupil to the upper eyelid (ie, MPLDs) were determined radially at intervals of 15° (total, 180°) along the palpebral fissure, and MPLDs at each angle were compared for right and left eyes. Results: For control participants, the mean marginal reflex distance (MRD1; ie, MPLD at 90°) ± standard error (SE) was 4.05 mm ± 0.75 mm, and small contour asymmetries (<10%) were measured for all angles. Medial (9.4% ± 4.7%) and lateral (8.1% ± 4.9 %) asymmetries were not significantly different for these participants. For patients with ptosis, the mean preoperative MRD1 was 2.56 ± 0.1 mm, and mean medial and lateral lid asymmetries (14.3% ± 8.4% and 16.7% ± 9.7%, respectively) were significantly higher than those of controls. Medial and lateral asymmetries correlated significantly with the extent of ptosis and were more pronounced laterally than medially. One month after CMMR, the lateral-medial discrepancy in lid asymmetry was resolved, and mean medial and lateral MPLDs (9.9% ± 7.5% and 8.5% ± 5.3%, respectively) were similar to those of controls. Conclusions: For patients with involutional ptosis, CMMR enables elevation of the lid margin and correction of contour anomalies. © 2017 The American Society for Aesthetic Plastic Surgery, Inc.

The new website leonidasortegaamador.com has been launched to give updates on the work and life of Leonidas Ortega Amador. ​The website www.ortegaamador.com has just been launched which will give updates on the various work, charities, and lifestyle of Leonidas Ortega Amador. Leonidas Ortega Amador is a dynamic business leader, strategist and change agent. He has many years of experience in turning around business operations and improving profitability, especially in the Insurance Business. He has a solid understanding of the Hispanic market in South Florida. His entrepreneurial spirit and sales expertise make him a valued leader and board member. Leonidas Ortega Amador web team is responsible for this press release. Mr. Amador’s areas of expertise include Finance and Investment, Mergers and Acquisitions, Health Care, Insurance, Commercial Development, and the Automotive Industry. His skills include: Mr. Amador is currently the Vice President and Manager of the Inlingua Language School in Miami, one of the leading language schools in Florida. He was recruited by them to turn around their operations and has developed a strategic plan to increase their sales growth in other U.S. states. To accomplish his mission, he: * Coordinated the expansion of the business by obtaining capital from other investors; * Led the Board of Directors and the strategic planning with the company owners; * Promotes sales growth and expansion of other branches; and * Controls the legal and regulatory divisions of the company. He has also worked for several other companies, providing his expert guidance and leadership to increase sales, maximize growth, and improve business and client relationships. He has the experience and knowledge in managing business relationships from other countries and cultures. He is a member of the Board in Banking, Education and Real Estate Business. Mr. Amador is highly educated with several undergraduate degrees, a Law degree and an MBA from Harvard Business School. In his leisure time, Mr. Amador enjoys competing in triathlons. He has competed in the Iron Man Competition Florianopolis Brazil in 2005, the New York Marathon and other triathlon events. He also enjoys rebuilding vintage cars. For further information, please contact:

News Article | December 6, 2016
Site: www.eurekalert.org

BMJ, one of the world's leading healthcare knowledge providers, and its partner the University of Cape Town Lung Institute's Knowledge Translation Unit, have launched the global edition of the Practical Approach to Care Kit (PACK) in eBook and print format - to support and empower primary healthcare workers. The PACK Adult Global guide provides a generic 'framework' that can be customised to meet the needs of primary healthcare systems in individual countries or states. Primary healthcare is key to achieving the United Nations-led Sustainable Development Goals and the broader goal of "health for all" by providing accessible, affordable and effective healthcare. Yet in many low and middle income countries, primary healthcare is constrained by a lack of adequately skilled and supervised health workers. The Knowledge Translation Unit is a health systems research unit that has spent 16 years developing the PACK programme to empower health workers in primary healthcare. The PACK programme consists of 4 pillars: 1) the PACK Guide 2) the PACK training programme, 3) health systems intervention and strengthening and 4) monitoring and evaluation of the PACK implementation. The PACK Guide is a clinical decision tool that enables healthcare practitioners to manage symptoms and diagnose conditions commonly seen in primary care including infectious diseases, non-communicable diseases, women's health, mental health and end-of-life care. Its comprehensive scope promotes delivery of integrated primary care, rather than care through "vertical programmes". PACK is based on WHO guidelines, strengthened with the latest global research evidence as appraised, graded, sourced and synthesised by BMJ Best Practice. BMJ Best Practice content underpins more than 80% of PACK recommendations and its robust updating processes will facilitate an annual update of the PACK Guide. The PACK programme has been implemented and scaled up throughout the nine provinces in South Africa. It is now used in more than 2,000 clinics across the country, by over 20,000 primary care health workers. The Knowledge Translation Unit has conducted formal evaluation of the programme through 4 pragmatic trials and has published the outcomes of this research in 11 papers. There has been considerable interest from countries outside of South Africa in adopting the PACK programme to strengthen primary care service delivery. PACK is designed to be localised to local clinical protocols, policy and practice, and where necessary translated. PACK has previously been localised for Botswana and Malawi and currently pilot implementations are underway in Florianopolis, Brazil and in three states of Nigeria. The Knowledge Translation Unit has developed a mentorship package to support the in-country localisation of PACK. BMJ and the Knowledge Translation Unit partnered in 2015 to address this need, and to enable global use of the PACK programme in keeping with their strongly aligned strategic goals of "improving primary care, especially in underserved communities" and "enabling a Healthier World". It is to this end that we launch PACK Global Adult 2016/17. Dr Tracy Eastman, Director of PACK Global Development at BMJ said: "The growing burden of non-communicable disease and mental illness in low and middle income countries means it is crucial that healthcare workers have access to the latest evidence based recommendations to diagnose and treat patients effectively across the full spectrum of integrated primary care needs and services. We are delighted to be able to provide the global edition of the PACK Adult guide that can be customised to help meet the specific needs of local communities, as part of the BMJ's Global Health outreach programme." Professor Lara Fairall, Head of the KTU, commented: "The KTU team is committed to improving primary healthcare, focusing on the most underserved communities globally. We hope that by launching the PACK Adult Global guide as an eBook this will raise awareness of the PACK programme and how it can empower primary care clinicians. We encourage primary healthcare workers to utilise the PACK principles and approach to support their teams, strengthen their health systems and provide the highest quality, integrated, team based primary healthcare services, no matter where they work." The UCT Lung Institute Knowledge Translation unit is generously supported by the Peter Sowerby Charitable Foundation. BMJ is a healthcare knowledge provider that aims to advance healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value. For a full list of BMJ products and services, please visit: bmj.com. Follow us on Twitter The KTU is a research unit committed to improving the quality of primary healthcare for underserved communities through pragmatic research, evidence-based implementation, evaluation, and engagement of health systems, their planners and providers. Further details are provided at http://www. The Peter Sowerby Foundation was established in 2011 with an endowment from Dr Peter Sowerby, a retired Yorkshire GP and co-founder of Egton Medical Information Systems, which provides database software to around half of the GP practices in the country. The Foundation does not solicit applications, but seeks out projects to support on ways to improve innovation in primary healthcare, as well as work promoting environmental conservation and activities in Peter's native North Yorkshire. For more information see http://www.

Parmi les 20 000 entreprises qui bénéficient chaque année du CIR, les plus nombreuses opèrent dans le secteur des technologies de l'information, et déclarent dans l'assiette de leur CIR une partie des coûts salariaux relatifs à leur personnel technique ou scientifique, c'est-à-dire à leurs ingénieurs et informaticiens. Il n'en demeure pas moins que le cadre législatif du Crédit Impôt Recherche vise à encourager l'ensemble des dépenses de Recherche et Développement, y compris celles liées à des personnels non-techniques qui concourent de manière active aux projets de R & D.  Malgré ce contexte législatif sans ambigüité, l'Administration fiscale a longtemps cherché à reprendre aux entreprises, au fil de ses contrôles, ce que le législateur leur accordait pourtant. Ce n'est que fin 2013 qu'un important Arrêt de la Cour Administrative d'Appel (CAA), a jugé que tous les personnels qui concourent de manière indispensable à la réalisation d'un projet de R & D, y compris en l'espèce les commerciaux, peuvent être valorisés dans l'assiette de calcul du Crédit Impôt Recherche à hauteur du temps qu'ils consacrent au projet, à charge bien entendu pour l'entreprise de pouvoir justifier de leur participation active et indispensable au projet. Le statut des Jeunes Entreprises Innovantes (JEI) s'appuyant directement sur l'éligibilité au CIR, on aurait pu imaginer logiquement que l'URSSAF calque sa position sur celle que cette jurisprudence de la CAA impose à l'Administration fiscale, et que les exonérations de charges sociales liées au statut JEI s'appliquent à tous les personnels valorisés dans l'assiette du Crédit d'impôt Recherche, et en particulier aux personnels non-techniques visés par cet Arrêt. Malheureusement, jusqu'à l'Arrêt du 9 juin 2016 de la Cour d'Appel de Paris, objet de cette chronique, l'URSSAF refusait de s'inspirer de la jurisprudence Administrative de 2013, et s'obstinait à exclure des exonérations de charges sociales les personnels non-techniques ou non-scientifiques. C'est ainsi que GYMGLISH, une Jeune Entreprise Innovante spécialisée dans l'élaboration de logiciels de e-learning, cliente du cabinet NÉVA, s'était vue refuser le bénéfice des exonérations de charges auxquelles elle avait droit au titre de son personnel non-technique, en particulier ses didacticiens, ses commerciaux et son Webmaster, qui avaient pourtant activement participé à son programme de R & D. Défendue par les avocats de son prestataire CIR NÉVA, qui l'accompagne depuis l'origine, GYMGLISH vient d'obtenir un Arrêt favorable de la Cour d'Appel de Paris (Arrêt du 9 juin 2016), qui lui permet enfin de faire valoir ses droits, mettant fin à une incohérence et une injustice qui perdurait depuis des années. Cet Arrêt historique, qui fera jurisprudence, aligne définitivement les règles de droit en matière fiscale (assiette du CIR) et sociale (exonérations Urssaf au titre des JEI) pour les personnels non-techniques ou non-scientifiques qui concourent à un projet de R & D. Après un contentieux qu'a dû endurer GYMGLISH pendant des années, la cour a en effet enfin confirmé que les didacticiens, commerciaux et webmaster concernés par le litige, avaient bien concouru au développement d'un produit innovant et que le redressement infligé à l'entreprise n'était pas justifié. GYMGLISH, qui a su documenter avec précision la contribution de chacun de ses salariés concernés grâce au concours de NÉVA, a emporté l'avis de la cour. Preuve qu'un dossier solidement charpenté finit heureusement par emporter la décision des juges. Ce jugement fera jurisprudence et permettra désormais aux JEI de faire valoir leurs droits sans avoir à batailler avec l'Urssaf devant la justice. À propos de Gymglish Fondée en février 2004, Gymglish est une société indépendante proposant une nouvelle approche de l'auto-apprentissage à distance : des efforts d'apprentissage concis, réguliers et inscrits dans la durée, avec l'objectif de stimuler la motivation et l'assiduité grâce à des contenus personnalisés et ludiques et grâce à une démarche d'ancrage des connaissances sur le long terme. Les formations dispensées comptabilisent à ce jour deux millions et demi d'utilisateurs à travers le monde, et sont déployés dans plus de 6000 entreprises, 110 universités et écoles de langues. L'équipe Gymglish est composée de 25 personnes (9 nationalités) passionnées par les langues et les nouvelles technologies, réparties sur 3 bureaux : Paris (siège), Tel Aviv Israël et Florianopolis Brésil. Pour en savoir plus : http://www.gymglish.com - Gymglish, 16A, Boulevard de Reuilly, 75012 Paris, France. L'auteur : Larry PERLADE, Directeur associé et fondateur de NÉVA Larry PERLADE a créé NÉVA en 1995 pour accompagner les PME dans leurs recherches de financements publics et la mise en oeuvre de leurs CIR. Depuis 21 ans, c'est un expert reconnu du financement de l'innovation et des aides R & D. Auparavant, il a été Vice-Président Directeur Général de FRED Joaillier USA et Secrétaire Général du groupe FRED Joaillier, avant de diriger le Centre d'Art Contemporain ARTCURIAL pour L'ORÉAL. Il a démarré son activité professionnelle chez Elf Aquitaine au Royaume-Uni. Larry PERLADE est diplômé d'HEC (1982), de l'Université de Berkeley (Californie) et de ESADE Business School (Barcelone). A propos de NÉVA Fondé en 1995, NÉVA est l'un des plus anciens cabinets de conseil dédiés à la mise en oeuvre du Crédit Impôt Recherche (CIR) et du statut des Jeunes Entreprises Innovantes (JEI). NÉVA réalise chaque année une cinquantaine de missions, tous secteurs d'activité confondus : à ce jour, après 21 ans d'activité, tous ses dossiers ont été validés in fine par l'Administration. NÉVA est le cabinet de référence auprès de la communauté des Dirigeants diplômés de HEC, du groupement professionnel EUROCLOUD et de PARIS & CO. C'est aussi le partenaire CIR de l'agence gouvernementale AFII (Agence Française pour les Investissements Internationaux), chargée de promouvoir l'attractivité de la France et l'implantation de sociétés étrangères sur notre territoire, en particulier au travers des dispositifs d'aide à l'innovation.  Parmi les entreprises qui ont fait confiance à NÉVA : Empruntis, Findus, MeilleursAgents, Millemercis, Mozilla Firefox, Nextedia, PriceMinister, Stratorg, Synertrade, The Phone House, Virgin Mobile.  Pour en savoir plus : www.neva-net.com

News Article | November 3, 2016
Site: phys.org

Researchers including scientists from Princeton University have developed a system that greatly simplifies the task of managing the software switches used to control traffic across a network. Called Protocol-Independent Switch or PISCES, the new system allows managers to adjust and customize their software switches quickly without sacrificing speed or efficiency. The lead author of the research, Muhammad Shahbaz, said the challenge was to simplify the task for the system administrators and translate those instructions into language that the software switches could implement. "We created PISCES in order to enable rapid development and give the ability to add new features so that an administrator would be able to express their intent without being an expert on the underlying codebase," said Shahbaz, a graduate student in computer science. Data centers are made of ranks of specialized computer processors or servers, and at the most basic level, traffic among the machines can be controlled by physical hardware switches. But because these hardware switches, which are extremely fast and efficient, are not practically adjustable, administrators rely on software to direct and control computer traffic as it moves through the network of machines. In a typical data center, these software switches far outnumber the hardware switches and have much greater control over the traffic moving through the center. A significant problem, the researchers wrote in their paper, was that "modifying these switches requires both intimate knowledge of the switch codebase and extensive expertise in network protocol design, making the bar for customizing these software switches prohibitively high." In an article presented at the ACM SIGCOMM Conference in Florianopolis, Brazil, on Aug. 25, the researchers describe how the PISCES system can be used to allow administrators to alter traffic without intensive knowledge of the code used to control the switches. In general, the researchers said, instructions written in PISCES are 40 times more concise than programs needed to control the software switches directly. "PISCES makes it easy to customize software switches with new functionality," said Nate Foster, an associate professor of computer science at Cornell University, who was not part of the research team. He said the system also provides good performance. Jennifer Rexford, the Gordon Y.S. Wu Professor in Engineering and chair of computer science at Princeton, said the goal of PISCES was to deliver greater flexibility to network administrators and to allow them to innovate and improve their systems. "How do you unshackle the people who run the network to help them do it better?" asked Rexford. "By making things programmable. PISCES is a baby step. It's a platform. It enables people to do reinvention." There have been attempts at simplifying software switching commands. But those tended to add complexity to the switches and compromise the speed of the system. Tests on PISCES indicate that the system avoids these slowdowns. "We demonstrated that, with appropriate compiler optimizations, this drastic reduction in complexity incurs only a small performance overhead compared to the native software switch implementation," the researchers wrote in the article "It is too early to see the effects of PISCES on protocol development, but the resulting code simplicity should make it easier to deploy, implement and maintain custom software switches." The researchers are working with industry to deploy the system into operating networks. They have developed software patches to introduce the system, which are under review by the community of potential users. The researchers are distributing PISCES as an open-source project through their website at Princeton. "By making it open source, people will be able to adopt it much more quickly," Shahbaz said. "They will not only be able to write new programs for themselves, but we hope the open-source platform will enable them to contribute to the project to help the community at large."

News Article | February 23, 2017
Site: www.wired.com

Every day, more than 5,000 people commute to and from Wallacedene, a small settlement on the eastern edge of Cape Town. But you won’t find it on official transit maps. It’s simply a stop in the South African city’s sprawling informal taxi network of more than 7,500 unregulated minibuses that shuttle people between the city’s center and its outskirts on a daily basis. Commuters have for decades navigated this network using only word of mouth. “People don’t really know how it works—they just know the few routes that they’re used to running,” says Madeline Zhu of the South African startup WhereIsMyTransport. Earlier this month, Zhu and her team published a map that visualizes 137 minibus routes alongside official rail and bus networks—a crucial first step in making public transit simpler for citizens to navigate and easier for cities to improve. Informal transportation networks are common outside the US and Europe. People call them matatus in Nairobi, jeepneys in Manila, and peseros in Mexico City. In Cape Town, they’re simply taxis. Whatever they’re called, unofficial transit systems typically stem from income inequality. Cape Town’s system started out as a way of transporting people from poor black communities into the city during apartheid. “The taxis are sort of a self organizing system that has sprung up around people’s unmet need to get from place to place,” Zhu says. For that reason, the buses always circumvented regulation and developed rules and logic based on market demand. They don’t charge set fares or follow fixed routes. Stops can change depending on who’s riding that day, and good luck knowing when to transfer. That creates no end of headaches for anyone trying to use the system, let alone understand it, improve it, or incorporate it into a formal transit network. Researchers from Columbia University and MIT recently mapped Nairobi’s matatu system. Another project mapped most of Mexico City’s peseros network. Similar efforts are underway in Cairo; Accara, Senegal; Santo Domingo, Dominican Republic; and Florianopolis, Brazil. The recent boom in mapping is happening because it can—thank your smartphone’s GPS—and because it must. “For a long time, cities thought they were going to replace these mini buses with formal buses, but there’s a growing recognition that that’s not going to happen,” says Jackie Klopp, a professor at Columbia’s Center for Sustainable Urban Development and co-founder of Digital Matatus, the project behind Nairobi’s matatu map. Instead, experts say cities should integrate them with existing transportation options like rail and Bus Rapid Transit systems. That’s where mapping comes in. “The moment you realize that modern bus rapid transit is not the solution for everything, then the first thing you have to do to improve the informal bus system is to make it visible,” says Shomik Mehndiratta, a transportation analyst at the World Bank who worked on the peseros mapping project in Mexico City. When WhereIsMyTransport started pondering mapping Cape Town’s taxi system more than eight years ago, the technology needed to capture the data needed to build a full-scale map simply didn’t exist. “Now we all have little digital reorders in our hand all the time so it makes it a lot easier to do this,” says Sarah Williams, who leads MIT’s Civic Data Center and worked on the Digital Matatus project. Last fall, WhereIsMyTransport hired 13 data collectors who rode buses for eight hours a day, tracking as many as 10 routes with an app called Collector. The tool gathered data like speed and location, and prompted the user to add information like major stops, wait times, geographic markers, fares, and the number of passengers. After three weeks and more than 5,500 miles, WhereIsMyTransport had tracked more than 1,000 routes, which it uploaded to its open platform alongside Cape Town’s formal transit routes. The company mapped only the routes that flow from the 10 busiest taxi hubs, so the map isn’t comprehensive, even if the data set is. “The real value of this project and projects like it is not in the map—it’s in the data being openly and dynamically available,” Zhu says. That creates its own set of challenges. The key to keeping Cape Town’s data useful is keeping it current. To ensure that, WhereIsMyTransport is exploring turning Collector into a crowdsourcing app or installing tracking devices on the taxis to gather real-time information. Eventually, the company hopes developers will use the data to build projects like Magic Bus, which uses an SMS app to let passengers pre-buy tickets for Nairobi’s matatus. All of the digital mapping projects hope to leverage technology to close the quality gap between the agile-but-flawed minibuses and more refined transit networks. “We’ve treated them as two completely different entities,” Mehndiratta says. “What’s interesting is how just mapping the informal starts bridging the difference between the two.” Ultimately, the systems shouldn’t be in competition—both have plenty to learn from each other.

News Article | October 26, 2016
Site: www.nature.com

Paired with rice or steeped in feijoada stew, beans are an essential feature of Brazilian cuisine. So great is Brazil's love of legumes that demand often outstrips domestic supply, forcing the country to import beans from Argentina, Bolivia and China. But this relationship could face the ultimate test as Brazilian scientists roll out a transgenic pinto bean (Phaseolus vulgaris) engineered to fend off one of the crop's most devastating enemies: the golden mosaic virus. Approved on 15 September by the Brazilian National Technical Commission on Biosafety (CTNBio), the transgenic bean uses RNA interference to shut down replication of the virus (K. Bonfim et al. Mol. Plant Microbe Interact. 20, 717–726; 2007). A product of more than a decade of home-grown research, the bean could begin appearing on tables across the country as early as 2014. "It is an extremely important crop for our small farmers," says Francisco Aragão, a plant geneticist who led the work for the Brazilian Agricultural Research Corporation (EMBRAPA), the research arm of the Ministry of Agriculture, based in Brasilia. The biosafety commission has taken a favourable position towards biotechnology in past years, helping Brazil to become the world's second-largest producer of genetically modified (GM) crops, behind the United States. Farmers have planted vast tracts of GM maize (corn), soya and cotton with little public resistance, but EMBRAPA is now tinkering with a product that people eat in large quantities every day, says Rubens Nodari, a plant geneticist at the Federal University of Santa Catarina in Florianopolis. Environmental groups and a presidential advisory panel, the National Council for Food Security and Nutrition, have called for more transparency in biotechnology science and decision-making, and increased research to rule out health risks stemming from the bean. Nodari, a former member of CTNBio who has long questioned transgenic crops, says that the commission improperly granted EMBRAPA's request for confidentiality regarding key aspects of the genetic engineering. "We don't know what we will be eating tomorrow in Brazil," he says. Current members of the commission have aggressively defended their decision. In a media interview after the decision last month, Edilson Paiva, president of CTNBio, said that Nodari and other opponents of genetic engineering are taking an ideological position aimed at "promoting fear and uncertainty" as they demand that scientists provide the impossible: guarantees of absolute safety. EMBRAPA says that it must keep core information about genetic insertions confidential, to allow it to patent the work. The details will help the agency to develop bean varieties that are resistant to the golden mosaic and similar viruses, says Aragão, who is a member of CTNBio but abstained from the decision on the beans. Aragão notes that safety analyses showed no reason for concern regarding the beans. He says that whereas some other GM crops produce unfamiliar proteins that could in theory cause an allergic reaction when eaten, the GM pinto bean produces only small snippets of RNA, tailored to react with and neutralize RNA from any invading virus. Herve Vanderschuren, a biotechnologist at the Swiss Federal Institute of Technology in Zurich, adds that plants naturally produce similar RNA snippets to defend themselves from viral attack, and there is no evidence that this common molecular warfare is dangerous to humans. With approval secured, EMBRAPA must now conduct a further round of field trials to ensure that the transgenic bean produces yields comparable to those of existing varieties. Aragão hopes that the strain will not only boost yields, but also enable planting on as much as 200,000 hectares of land on which the golden mosaic virus is so prevalent that farmers cannot grow beans at all at present. Brazil produces some 3.5 million tonnes of beans per year already, and Aragão says that the transgenic bean could increase production by 10–20%, enough to offset imports and soften the price spikes that accompany domestic shortages. "The best part of this story is that the bean was developed in Brazil for the Brazilian farmers," says Vanderschuren, who is part of a consortium working with researchers in Kenya, Tanzania and South Africa to apply the same technology to local crops, including cassava. EMBRAPA is already looking to develop other virus-resistant beans, including common black beans and the popular carioca bean. "It's very easy to transfer this gene to any other variety," says Aragão. "That's the next step."

Teixeira G.,Florianopolis | Teixeira G.,Johns Hopkins Medical Institutions | Teixeira T.,University of South Santa Catarina | Gubert F.,Casa de Saude Sao Sebastiao | And 2 more authors.
Surgery | Year: 2011

Background: In papillary thyroid cancer, the incidence of regional lymph node metastasis in the central compartment has been reported to be between 21% and 60%. This study sought to establish the rate of micrometastatic disease in the central neck in patients staged as N0 by preoperative and intraoperative assessment. Methods: We studied 72 consecutive patients with diagnoses of papillary thyroid cancer without preoperative or intraoperative evidence of central neck metastases. They underwent total thyroidectomies and were given elective central compartment neck dissection (CCND) ispsilateral to the lobe harboring the tumor or bilaterally in cases of primary tumor located in the isthmus. Results: Of the patients, 30 underwent right CCND, 30 underwent left CCND, and in 12 cases the dissection was bilateral. The incidence of lymph node micrometastasis was 25%. Male gender and histologic type showed association with lymph node micrometasis. Among these cases, 7% had temporary vocal cord palsy, and 8% had temporary hypoparathyroidism. No cases of definitive vocal cord palsy or definitive hypocalcemia were observed. After the procedure 8 patients were up-staged according to the American Joint Committee on Cancer staging system. Conclusion: Despite being a safe procedure, this relatively low rate of micrometastatic disease emphasizes the need for a careful weighing of the risks and benefits of elective CCND. © 2011 Published by Mosby, Inc.

Chamie F.,INTERCAT Cardiologia IntervencionistaRJ | Maia J.,Catheterisation Laboratory | Giuliano L.C.,Florianopolis
Catheterization and Cardiovascular Interventions | Year: 2016

A failing intracardiac device is traditionally addressed by open-heart surgery. Surgical explantation of the device, although a simple procedure, carries risks that some patients are not able or willing to cope with. Thus, a nonsurgical option seems desirable in selected cases. We report on four cases of early malfunction of the Polyvinyl Alcohol membrane of Ultrasept II™ CARDIA ASD devices. In all cases, transthoracic echo (TTE) surveillance 4–6 months after the index procedure, depicted significant left-to-right atrial shunts through the center portion of the devices. A second nitinol double disk device with a connecting pin (Lifetech CERA™ Multifenestrated ASD device) was implanted over the CARDIA devices, with excellent results. All procedures were uneventful and all patients are asymptomatic with no residual shunts, in short-term follow-up. This device-in-device technique prevents surgical explantation of failing ASD devices, and may become a less invasive option in selected patients. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Carminati A.,Florianopolis | De Oliveira R.S.,Florianopolis
IEEE International Conference on Emerging Technologies and Factory Automation, ETFA | Year: 2012

In this paper we propose and evaluate suspension-based variations of the Multiprocessor Priority Ceiling Protocol (MPCP). The variations are compared with existing protocols for the same system model, which is partitioned and static priority scheduling. We present variations of the MPCP that improve in some cases the system schedulability. Some variations are actually simplifications that favor the implementation in real systems. © 2012 IEEE.

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