Daily living activities in Parkinson's disease patients underwent to stereotactic surgery

OBJECTIVE: To evaluate the impact of stereotactic surgery on daily activities of Parkinson's disease (PD) patients. METHOD: Thirty patients with idiopathic PD were evaluated before surgery and one, three, six and twelve months after surgery. Patients were evaluated with the UPDRS - part II (Unified Parkinson's Disease Rating Scale) and the Schwab & England scales. Nine of the patients had also been evaluated after twenty four months. RESULTS: We performed nine posteroventral pallidotomies (PVP), two on the left hemisphere and seven on the right; 17 ventrolateral thalamotomies (VLT), 12 on the left and five on the right; two VLT on the left associated with PVP on the right at the same surgical procedure. The mean off phase scores of Schwab & England scale were: 60.6 before surgery, 74 after the first, 76.6 after the third, 75.6 after the sixth, 72.3 after the twelfth and 71.1 after the twenty fourth months after surgery. The mean off phase scores of UPDRS - part II scale were: 21 before surgery, 12.3 after the first, 14.7 after the third, 15.27 after the sixth, 17.1 after the twelfth and 17.5 after the twenty fourth months after surgery. CONCLUSION: VTL and PVP are useful procedures to improve daily living activities of the PD patients and the best results are seen by six months after surgery.OBJETIVO: Avaliar o impacto da cirurgia estereotáxica sobre a realização das atividades da vida diária dos paciente com doença de Parkinson (DP). MÉTODO: Foram avaliados 30 pacientes com DP forma idiopática submetidos a cirurgia estereotáxica nos períodos pré-operatório, 1º, 3º, 6º e 12º mês pós-operatório, segundo as escala UPDRS - Item II (escala unificada para DP), Schwab & England e Hoehn & Yahr. Destes, nove pacientes foram também avaliados no 24º mês pós-operatório. RESULTADOS: Foram realizadas nove palidotomias póstero-ventrais (PPV), sendo duas à esquerda e sete à direita; duas PPV bilaterais no mesmo tempo cirúrgico; 17 talamotomias ventro-laterais (TVL), sendo 12 à esquerda e cinco à direita; duas TVL à esquerda com PPV à direita no mesmo tempo cirúrgico. Os escores médios, na fase off, das escalas utilizadas foram: 65,6 no pré-operatório,74 no 1º mês, 76,6 no 3º mês, 75,6 no 6º mês e 72,3 no 12º mês pós-operatório (Schwab & England); 21 no pré-operatório, 12,3 no 1º mês, 14,7 no 3º mês, 15,27 no 6º mês e 17,1 no 12º mês pós-operatório (UPDRS); 3,1 no pré-operatório, 2,8 no 1º mês, 2,7 no 3º mês, 2,8 no 6º mês e 2,85 no 12º mês pós-operatório (Hoehn & Yarh). CONCLUSÃO: A TVL e a PPV são procedimentos capazes de melhorar a independência dos pacientes para realização das atividades cotidianas, sendo constatado benefício maior nos seis primeiros meses de pós-operatório.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de NeurologiaUNIFESP, EPM, Depto. de NeurologiaSciEL

Desempenho motor após palidotomia póstero-ventral e talamotomia ventro-lateral na doença de Parkinson: acompanhamento de um ano

Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in on and off periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the off period, except for 2 patients. The on period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed permanent complications, but none was severe.Vinte e três pacientes portadores de doença de Parkinson foram submetidos a cirurgia estereotáxica para tratamento da doença. Com o objetivo de estudar o desempenho motor a longo prazo, os pacientes foram avaliados clinicamente no período pré-operatório, no 1°, 3°, 6°, e 12° mês pós-operatório, com as seguintes escalas: Escala Unificada para Doença de Parkinson (Unified Parkinson's Disease Rating Scale-UPDRS), item III, escore motor e com a Escala de Larsen para Discinesias. Os pacientes que utilizavam levodopa foram avaliados nos estados off e on. Foram realizadas 14 talamotomias ventro-laterais (TVL) unilaterais, 4 palidotomias póstero-ventrais (PPV) unilaterais, 2 PPV bilaterais; 3 TVL associadas à PPV contralateral. O benefício motor foi observado de forma significante no estado off, e manteve-se a longo prazo na maioria dos pacientes, exceto em 2. Houve melhora da qualidade do período on, devido ao controle das discinesias. A melhora das discinesias se manteve a longo prazo na maioria dos pacientes. As cirurgias não promoveram um decréscimo significante na dose de levodopa.Três pacientes tiveram complicações permanentes, mas nenhuma delas foi considerada grave e nem houve prejuízo funcional importante em decorrência das mesmas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Neurology and NeurosurgeryHospital do Servidor Público Estadual Francisco Morato OliveiraUNIFESP, EPM, Department of Neurology and NeurosurgerySciEL

Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)

Funding The project was funded by the National Institute for Health Research Health Technology Assessment Programme (Project Number 07/60/18). The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Acknowledgements The authors wish to thank the women who participated in the PROSPECT study. We also thank Margaret MacNeil for her secretarial support and data management; Dawn McRae and Lynda Constable for their trial management support; the programming team in CHaRT, led by Gladys McPherson; members of the Project Management Group for their ongoing advice and support of the study; and the staff at the recruitment sites who facilitated the recruitment, treatment and follow up of study participants.Peer reviewedPublisher PD

Hidden Markov Models for Visual Speech Synthesis in Limited Data

This work presents a new approach for estimating control points (facial locations that control movement) to allow the artificial generation of video with apparent mouth movement (visual speech) time-synced with recorded audio. First, Hidden Markov Models (HMMs) are estimated for each visual speech category (viseme) present in stored video data, where a category is defined as the mouth movement corresponding to a given sound and where the visemes are further categorized as trisemes (a viseme in the context of previous and following visemes). Next, a decision tree is used to cluster and relate states in the HMMs that are similar in a contextual and statistical sense. The tree is also used to estimate HMMs that generate sequences of visual speech control points for trisemes not occurring in the stored data. An experiment is described that evaluates the effect of several algorithm variables, and a statistical analysis is presented that establishes appropriate levels for each variable by minimizing the error between the desired and estimated control points. The analysis indicates that the error is lowest when the process is conducted with three-state left-to right no skip HMMs trained using short-duration dynamic features, a high log-likelihood threshold, and a low outlier threshold. Also, comparisons of mouth shapes generated from the artificial control points and the true control points (estimated from video not used to train the HMMs) indicate that the process provides accurate estimates for most trisemes tested in this work. The research presented here thus establishes a useful method for synthesizing realistic audio-synchronized video facial features

The Changing Nature of Catastrophe: A History of Semantic Shift

Catastrophe, and the reporting of catastrophe, is prevalent in the present age, and catastrophic events are a part of the cultural memory. For America, events such as 9/11, the assassination of John F. Kennedy, Hurricane Katrina, and the Challenger explosion, along with many other events, have filled newspapers and books, inspired documentaries and memorials, and, in many ways, reshaped the country. This paper investigated the changing nature of the word catastrophe and discovered the context of and the reasons for the shift in its meaning in 1748, as recorded by the Oxford English Dictionary. The Greek roots of the word, dictionary and encyclopedia entries, books, and newspapers were consulted to create a framework for an investigation of the scholarly, social, cultural, and political use of catastrophe in both England and America

Three Removes from Truth: The Motif of Representation in Literature

This paper explores the motif of representation in a variety of texts to better understand the power that these representations have as a social force. The use of representation in literature has changed throughout history, and the paper analyzes the role of representation in six different fictional texts and in several different critical theories. It gives further consideration to the changing nature of photography in a postmodern world where a true original is never created due to the proliferation of cell phone cameras, digital photograph sharing, and photography-specific social networking websites. In an increasingly visually literate world, photography is a common lens through which individuals choose to see and experience the world around them, and the proliferation and ease of photography is shaping the way society uses and understands representations. Ultimately, the paper investigates portraiture and photography from literary and historical lenses and proves, if not the value of representations in themselves, the importance of representations for society

Predator Prey Models in Competitive Corporations

Predator prey models have been used for years to model animal populations. In recent years they have begun to be applied to economic situations. However, the stock market has remained largely untouched. We examine whether the success of competitive corporations such as Target and Walmart, as measured by the indicators of price per share, market share, and volume, can be modeled by various predator prey models. We consider the basic Lotka-Volterra model and the two-predator, one-prey model, as well as a ratio-dependent model. We discuss the use of numerical techniques and regression analysis as tools to estimate model parameters. For Target and Walmart, the predator prey models mentioned above do not accurately fit the stock market data. In order to more fully explore the use of predator prey models in the stock market, we have examined several other competing companies using a simple Lotka-Volterra model, and found that critical model parameters were not statistically significant. While not statistically significant, these results help reinforce the unpredictability and complexity of markets and provide insight for future research

The Changing Nature of Catastrophe: A History of Semantic Shift

Catastrophe, and the reporting of catastrophe, is prevalent in the present age, and catastrophic events are a part of the cultural memory. For America, events such as 9/11, the assassination of John F. Kennedy, Hurricane Katrina, and the Challenger explosion, along with many other events, have filled newspapers and books, inspired documentaries and memorials, and, in many ways, reshaped the country. This paper investigated the changing nature of the word catastrophe and discovered the context of and the reasons for the shift in its meaning in 1748, as recorded by the Oxford English Dictionary. The Greek roots of the word, dictionary and encyclopedia entries, books, and newspapers were consulted to create a framework for an investigation of the scholarly, social, cultural, and political use of catastrophe in both England and America

A Two-Phase Damped-Exponential Model for Speech Synthesis

It is well known that there is room for improvement in the resultant quality of speech synthesizers in use today. This research focuses on the improvement of speech synthesis by analyzing various models for speech signals. An improvement in synthesis quality will benefit any system incorporating speech synthesis. Many synthesizers in use today use linear predictive coding (LPC) techniques and only use one set of vocal tract parameters per analysis frame or pitch period for pitch-synchronous synthesizers. This work is motivated by the two-phase analysis-synthesis model proposed by Krishnamurthy. In lieu of electroglottograph data for vocal tract model transition point determination, this work estimates this point directly from the speech signal. The work then evaluates the potential of the two-phase damped-exponential model for synthetic speech quality improvement. LPC and damped-exponential models are used for synthesis. Statistical analysis of data collected in a subjective listening test indicates a statistically significant improvement (at the 0.05 significance level) in quality using this two-phase damped-exponential model over single-phase LPC, single-phase damped-exponential and two-phase LPC for the speakers, sentences, and model orders used. This subjective test shows the potential for quality improvement of synthesized speech and supports the need for further research and testing

Community-based framework for influence maximization problem in social networks

Given a social graph, the influence maximization problem (IMP) is the act of selecting a group of nodes that cause maximum influence if they are considered as seed nodes of a diffusion process. IMP is an active research area in social network analysis due to its practical need in applications like viral marketing, target advertisement, and recommendation system. In this work, we propose an efficient solution for IMP based on the social network structure. The community structure is a property of real-world graphs. In fact, communities are often overlapping because of the involvement of users in many groups (family, workplace, and friends). These users are represented by overlapped nodes in the social graphs and they play a special role in the information diffusion process. This fact prompts us to propose a solution framework consisting of three phases: firstly, the community structure is discovered, secondly, the candidate seeds are generated, then lastly the set of final seed nodes are selected. The aim is to maximize the influence with the community diversity of influenced users. The study was validated using synthetic as well as real social network datasets. The experimental results show improvement over baseline methods and some important conclusions were reported