Tracheocutaneous fistula in patients undergoing supracricoid partial laryngectomy: the role of chronic aspiration

The aim of the present retrospective controlled study was to analyse and compare risk factors for tracheocutaneous fistula in patients who received tracheostomy after supracricoid partial laryngectomy with those who received tracheostomy for other causes. We enrolled 39 patients with tracheocutaneous fistulas who were divided into two groups. The first received temporary tracheostomy for supracricoid partial laryngectomies (n = 21), while the control group consisted of patients who received temporary tracheostomy for other causes (n = 18). Risk factors believed to play a role in the pathogenesis of tracheocutaneous fistula were examined including advanced age, cardiopathy, local infections, radiotherapy, elevated body mass index, malnutrition, decannulation time and aspiration grade. The Leipzig and Pearson scale score was significantly higher in the supracricoid partial laryngectomy group (p = 0.006 and 0.031 for univariate and multivariate analyses, respectively). The penetration/aspiration scale score was significantly higher in the supracricoid partial laryngectomy group as determined by univariate analysis (p = 0.014). The decannulation time was significantly lower in the supracricoid partial laryngectomy group (p = 0.004 and 0.0004 for univariate and multivariate analyses, respectively). The number of surgical closures for tracheocutaneous fistula was significantly higher in the supracricoid partial laryngectomy group by univariate analysis (p = 0.027). These results suggest that chronic aspiration and related cough may be important pathogenic factors for tracheocutaneous fistula and could be responsible for the significantly higher rates of closure failure in patients after supracricoid partial laryngectomy

REPLACEMENT IN THE WORK MARKET. BARRIERS AND SILENCE IN THE COPING OF THE EXCLUSION FOR PEOPLE WITH HIV/AIDS

The people who live with HIV/AIDS, besides facing the resulting difficulties of the infection for the virus, have that to deal with problems of economic order as the exclusion of the work market. Such exclusion brings as consequences the material difficulties and the removal of the carrier of the social conviviality, harming auto-esteem and some psychosocial resources for the confrontation to the HIV/AIDS. Despite the transmission being little probable in the workstations, this fact has been used for employers as excuse for the resignation or the refusal of these people. This research had as objective to identify difficulties found for the replacement of HIV-positive patients in the work market. Half-structuralized interviews with 10 people had been carried through, of both the sexes, with average time of 5 years for HIV-seropositive status, average of 34 years of age and minimum of basic education. The interviews had been made in accordance with mandate procedures of evocation/articulation/verification aiming at to eliminate the effect of induction of answers. The results indicate that absenteeism, stigma, delays, damages to the health provoked by opportunist illnesses and collateral medicine effect are strong determinants of the difficulties for the replacement in the work market. Also, the fear of stigma or rejection hinders the socialization of the HIV-seropositive status to the fellow workers and commands, determining a lack of perspective how much to the chances to obtain a new job. Such results constitute important subsidiary elements for the conception of programs that aims the replacement and orientation of these people in the work market.As pessoas que vivem com HIV/aids, além de enfrentar as dificuldades decorrentes da infecção pelo vírus, têm que lidar com problemas de ordem econômica, como a exclusão do mercado de trabalho. Tal exclusão traz como conseqüências as dificuldades materiais e o afastamento do portador do convívio social, prejudicando a auto-estima e o acesso a alguns recursos psicossociais para o enfrentamento ao HIV/aids. Apesar da transmissão ser pouco provável nos locais de trabalho, esse fato tem sido usado por empregadores como pretexto para demissão ou recusa destas pessoas. Esta pesquisa teve como objetivo identificar dificuldades encontradas para a reinserção de pessoas soropositivas ao HIV no mercado de trabalho. Foram realizadas entrevistas semi-estruturadas com 10 pessoas, de ambos os sexos, com tempo médio de 5 anos de soropositividade ao HIV, média de 34 anos de idade e escolaridade mínima de ensino fundamental. As entrevistas foram feitas de acordo com procedimentos de evocação/enunciação/verificação, visando eliminar os efeitos de indução de respostas. Os resultados indicam que absenteísmo, estigmatização, atrasos, danos à saúde provocados por doenças oportunistas e efeitos colaterais de medicamentos são fortes determinantes das dificuldades para a reinserção no mercado de trabalho. Também, o medo de estigmatização ou rejeição impede a socialização do status de soropositividade para com os colegas de trabalho e chefias, determinando uma falta de perspectiva quanto às oportunidades para conseguir um novo emprego. Tais resultados constituem elementos subsidiários importantes para a concepção de programas que visam a recolocação e orientação dessas pessoas no mercado de trabalho

Regular and complex singularities of the generalized thin film equation in two dimensions

A20We use a generalized version of the equation of motion for a thin film of liquid on a solid, horizontal substrate as a model system to study the formation of singularities in space dimensions greater than one. Varying both the exponent controlling long-ranged forces, as well as the exponent of the nonlinear mobility, we predict the structure of the singularity as the film thickness goes to zero. The spatial structure of rupture may be either ‘pointlike’ (approaching axisymmetry) or ‘quasi-one-dimensional’, in which case a one-dimensional singularity is unfolded into two or higher space dimensions. The scaling of the profile with time may be either strictly self-similar (the ‘regular’ case) or discretely self-similar and perhaps chaotic (the ‘irregular’ case). We calculate the phase boundaries between these regimes, and confirm our results by detailed comparisons with time-dependent simulations of the nonlinear thin film equation in two space dimensions.Junta de Andalucía P18-FR-3623Ministerio de Economía y Competitividad (MINECO). España 108278-RB-C3

Spontaneous symmetry breaking in amnestically induced persistence

We investigate a recently proposed non-Markovian random walk model characterized by loss of memories of the recent past and amnestically induced persistence. We report numerical and analytical results showing the complete phase diagram, consisting of 4 phases, for this system: (i) classical nonpersistence, (ii) classical persistence (iii) log-periodic nonpersistence and (iv) log-periodic persistence driven by negative feedback. The first two phases possess continuous scale invariance symmetry, however log-periodicity breaks this symmetry. Instead, log-periodic motion satisfies discrete scale invariance symmetry, with complex rather than real fractal dimensions. We find for log-periodic persistence evidence not only of statistical but also of geometric self-similarity.Comment: 4 pages, 2 color fig

Amnestically induced persistence in random walks

We study how the Hurst exponent $\alpha$ depends on the fraction $f$ of the total time $t$ remembered by non-Markovian random walkers that recall only the distant past. We find that otherwise nonpersistent random walkers switch to persistent behavior when inflicted with significant memory loss. Such memory losses induce the probability density function of the walker's position to undergo a transition from Gaussian to non-Gaussian. We interpret these findings of persistence in terms of a breakdown of self-regulation mechanisms and discuss their possible relevance to some of the burdensome behavioral and psychological symptoms of Alzheimer's disease and other dementias.Comment: 4 pages, 3 figs, subm. to Phys. Rev. Let

Histochemical Characterization, Distribution and Morphometric Analysis of NADPH Diaphorase Neurons in the Spinal Cord of the Agouti

We evaluated the neuropil distribution of the enzymes NADPH diaphorase (NADPH-d) and cytochrome oxidase (CO) in the spinal cord of the agouti, a medium-sized diurnal rodent, together with the distribution pattern and morphometrical characteristics of NADPH-d reactive neurons across different spinal segments. Neuropil labeling pattern was remarkably similar for both enzymes in coronal sections: reactivity was higher in regions involved with pain processing. We found two distinct types of NADPH-d reactive neurons in the agouti's spinal cord: type I neurons had large, heavily stained cell bodies while type II neurons displayed relatively small and poorly stained somata. We concentrated our analysis on type I neurons. These were found mainly in the dorsal horn and around the central canal of every spinal segment, with a few scattered neurons located in the ventral horn of both cervical and lumbar regions. Overall, type I neurons were more numerous in the cervical region. Type I neurons were also found in the white matter, particularly in the ventral funiculum. Morphometrical analysis revealed that type I neurons located in the cervical region have dendritic trees that are more complex than those located in both lumbar and thoracic regions. In addition, NADPH-d cells located in the ventral horn had a larger cell body, especially in lumbar segments. The resulting pattern of cell body and neuropil distribution is in accordance with proposed schemes of segregation of function in the mammalian spinal cord

Ruolo della chirurgia endovascolare nelle rotture aortiche del politraumatizzato con lesioni polidistrettuali di pertinenza chirurgica

Nel politraumatizzato con gravi lesioni polidistrettuali di interesse chirurgico il trattamento endovascolare (TEV) della rottura posttraumatica dell’ aorta toracica (RPAT) rappresenta oggi una valida alternativa terapeutica al trattamento chirurgico convenzionale. Nella nostra esperienza (ottobre 2001-novembre 2004) abbiamo osservato 5 casi di RPAT (3 rotture istmiche, 2 rotture aorta toracica discendente) in gravi politraumatizzati, tutti di sesso maschile, di età compresa fra i 23 ed i 42 anni (media 32,4), trattate con successo con TEV. Il Glasgow Coma Score (GCS) era compreso fra 5 e 13. Tutti i pazienti sono stati sottoposti, dopo adeguata stabilizzazione del quadro clinico-emodinamico, ad angio-TC total body al fine di valutare la lesione aortica ed identificare le altre lesioni associate. In 4 casi erano coinvolti più distretti corporei di pertinenza chirurgica (3 casi: trauma osseo, addominale e neurochirurgico; 1 caso: trauma osseo, addominale, neurochirurgico e toracico). Il TEV è stato eseguito sempre in sala operatoria previa arteriografia digitale. La durata media della procedura angio-radiologica è stata di 105 minuti (range 80 - 125). Non si è verificata nessuna complicanza né immediata né a distanza (follow-up = medio 24 mesi; range 12-36). In conclusione il TEV delle RPAT offre in pazienti ‘critici’ una valida opzione terapeutica alla chirurgia tradizionale in grado di stabilizzare il quadro clinico e trattare successivamente ‘in sicurezza’ le altre gravi lesioni chirurgiche associate

Física en la enseñanza secundaria : qué trabajo experimental?

En las dos últimas décadas, han surgido diversas propuestas enfocadas a mejorar la contribución del TE en el aprendizaje de los alumnos, y sugieren, que éste tenga un carácter de actividad de resolución de problemas, donde el alumno desempeñe un papel central tanto en la planificación como en la ejecución ejecución Los resultados presentados se basen en una investigación con alumnos de Física y Química de la Enseñanza Secundaria de dos escuelas portuguesas. Se hace una comparación entre las características del TE implementado en las aulas de estos alumnos y las características de TE que, en su opinión, favorecerían el aprendizaje

Trainee-environment interactions that stimulate motivation:A rich pictures study

Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees' aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees' motivation and how they are intertwined. We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results. Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees' motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus. Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account54324225