Efficacy and safety of UT-DSAEK combined with Carlevale's sutureless scleral fixation IOL.

PURPOSE: To evaluate a novel surgical combination of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and sutureless scleral fixation for Carlevale intraocular lens (SSF-Carlevale IOL) implantation to manage corneal endothelial decompensation when there is a concomitant need for secondary IOL fixation. METHODS: Clinical data collected from 10 eyes of 9 patients with bullous keratopathy (BK) who underwent combined UT-DSAEK and SSF-Carlevale IOL implantation in a single procedure were retrospectively analyzed. Anterior chamber IOL (4 cases), aphakia (4 cases, 1 of which associated with PEX), and previous trauma (2 cases) were the conditions responsible for BK. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), graft thickness (GT) and complications were recorded over a 12-month follow-up period. RESULTS: In 90% (9/10) of eyes graft clarity was maintained during follow-up. The mean CDVA improved significantly (p < 0.0001) from 1.78 ± 0.76 logMAR preoperatively to 0.53 ± 0.3 logMAR at 12 months. ECD on average decreased from 2575 ± 125.3 cells/mm2 (donor tissue) to 1697 ± 133.3 cells/mm2 in 12 months. The mean CCT decreased from 870 ± 200 µm to 650 µm ± 9 at 12 months (ANOVA, p = 0.0005). CONCLUSIONS: Combined UT-DSAEK and SSF-Carlevale IOL implantation was associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a practical option for patients requiring both treatment for corneal endothelial dysfunction and secondary IOL implantation.

A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

Citizenship, Social Justice and Collective Empowerment: Living Outside Mental Illness.

Citizenship is emerging as one of the world's leading models to shift mental health care from artificial psychiatric settings into more natural community settings by incorporating human rights. This paper describes a four-session roundtable series entitled Citizenship, Social Justice, and Collective Empowerment: Living Outside Mental Illness. These roundtables were part of the New England Mental Health Technology Transfer Center Network (MHTTC). They were built on the conviction that people who have lived experiences of mental health challenges and engaged in making community connections should be at the center of teaching about those experiences. Presenters shared their experiences about how they navigated stigma and discrimination on their way to community inclusion, belonging, and empowerment. The common theme across the series was the citizenship framework. The citizenship framework has inspired people to become involved in an individual and collective dynamic experience that connects them with the 5R's of rights, responsibilities, roles, resources, relationships, and a sense of belonging in society. The outcomes from the discussion on the webinars demonstrated that peer support could be a promising intervention to increase the sense of belonging in the community.

Pediatric Use of Recombinant Human Nerve Growth Factor 20 µg/mL Eye Drops (Cenegermin) for Bilateral Neurotrophic Keratopathy in Congenital Corneal Anesthesia.

PURPOSE: This study aimed to present the efficacy and safety of cenegermin eye drop (Oxervate; Dompè Farmaceutici, Milan, Italy) treatment in a pediatric patient affected by neurotrophic keratopathy (NK) with Goldenhar syndrome. METHODS: This case reports an infant presenting ulceration and a small central opacity in the cornea of the right and left eyes, respectively. The NK bilaterally worsened despite the use of therapeutic contact lenses and temporary partial tarsorrhaphy. Magnetic resonance imaging showed absence and hypoplasia of the right and left trigeminal nerves, respectively. Cenegermin eye drops were administered 1 drop/each eye, 6 times daily for 8 weeks to promote corneal healing. RESULTS: Complete healing was achieved in both eyes after treatment. During the 16-month follow-up period, no epithelial defect, recurrence, or complications were noticed, whereas corneal opacities progressively became clearer, although insignificant improvements in corneal sensitivity or in the reflex tearing were observed. CONCLUSIONS: Cenegermin was effective in treating NK in an infant with Goldenhar syndrome.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities.

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities / Implementação de um protocolo para um estudo piloto randomizado e controlado sobre uma intervenção voltada para a recuperação em pessoas com psicoses em duas cidades latino-americanas / Implementando un protocolo para una prueba piloto controlada aleatorizada en una intervención orientada a la recuperación de personas con psicosis en dos ciudades latinoamericanas

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Diversos países latino-americanos já alcançaram avanços notáveis na oferta de assistência em saúde mental para pessoas com psicoses. No entanto, as clínicas de saúde mental geralmente realizam atividades de extensão muito limitadas dentro das comunidades, tendem a ter vínculos fracos com a assistência primária, raramente envolvem os próprios pacientes nos cuidados e poucas vezes prestam serviços orientados para a recuperação. O artigo descreve um estudo piloto randomizado e controlado sobre a Critical Time Intervention-Task Shifting (CTI-TS), que teve como objetivo analisar essas limitações. O estudo piloto foi realizado em Santiago (Chile) e no Rio de Janeiro (Brasil). Teve como meta a inclusão de 110 pessoas com psicose, recrutadas no momento da entrada em clínicas comunitárias de saúde mental. Os participantes foram randomizados para o CTI-TS ou para os cuidados usuais. Aqueles alocados ao grupo da intervenção receberam os cuidados usuais e os serviços de CTI-TS ao longo de 9 meses. Os desfechos primários incluíram a qualidade de vida (WHO Quality of Life Scale - Brief Version) e as necessidades não atendidas (Camberwell Assessment of Needs) no acompanhamento aos 18 meses. Os desfechos primários aos 18 meses serão analisados com a técnica de Equações de Estimação Generalizadas (GEE), com as observações agrupadas dentro dos locais do estudo. Serão utilizados modelos em três níveis para examinar as tendências temporais nos desfechos primários. Procedimentos semelhantes serão utilizados para analisar os resultados secundários. Espera-se que o estudo forneça uma base para planejar um estudo randomizado e controlado em grande escala e em múltiplos locais para estabelecer a eficácia da intervenção orientada para a recuperação, a exemplo da CTI-TS, na América Latina.

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[Peers as fellow workers: understanding and respecting their roles]. / Pares como compañeros de trabajo: entendiendo y respetando sus funciones.

The literature reveals that peer support in mental health services is growing around the world. In the context of peer support, a "peer" is a person with lived experienced of mental illness and choose to share his or her recovery experience in an effective manner. However, tensions between traditional mental health professionals and peer supporters have arisen in the U.S. as what are the roles of peers within mental health systems. This article aims to review the integration of peers in the existing mental health systems, the values of peer support and to discuss training implications.

Pares como compañeros de trabajo: entendiendo y respetando sus funciones / [Peers as fellow workers: understanding and respecting their roles].

The literature reveals that peer support in mental health services is growing around the world. In the context of peer support, a "peer" is a person with lived experienced of mental illness and choose to share his or her recovery experience in an effective manner. However, tensions between traditional mental health professionals and peer supporters have arisen in the U.S. as what are the roles of peers within mental health systems. This article aims to review the integration of peers in the existing mental health systems, the values of peer support and to discuss training implications.

Recovery narratives: 'see how far i've come' / Narrativas de recuperação: 'veja onde cheguei'

As the paradigm shift towards a recovery-oriented mental health system becomes more prominent, individuals with lived experience of mental illness will continue to write and speak their narratives of mental illness and recovery. This article discusses the social reality of people with mental illness: how they are stigmatized by the media and how competing narratives within the mental health system afflict people with this disability. It also discusses the empowering process of constructing a narrative that enables the narrator/speaker to find meaning in her/his experience while putting a realistic 'face' on mental illness and recovery for the general public. It further describes how telling a narrative to diverse audiences, including a college class of 'people in recovery' enhances the author's personal recovery by giving his life new meaning and purpose.

Na medida em que a mudança de paradigma para um sistema de saúde mental orientado à recuperação se torna mais proeminente, indivíduos com experiências de vivência de doença mental continuarão a escrever e contar suas historias de doença mental e recuperação. Este artigo discute a realidade social das pessoas com doenças mentais: como elas são estigmatizadas pela imprensa e como outras linhas discursivas dentro do sistema de saúde mental as afetam. O artigo também discute o processo de capacitação que a construção da narrativa oferece ao narrador/palestrante, possibilitando-o a encontrar um significado para sua experiência ao mesmo tempo em que fornece uma 'face' realista à doença mental e recuperação para o público em geral. O artigo também descreve como o processo de contar a narrativa a audiências variadas, inclusive uma turma de faculdade de 'pessoas em recuperação', acentua a recuperação pessoal do autor na medida em que dá à sua vida um novo sentido e propósito.

Patrón de variación axial y radial del peso específico en la madera de erisma uncinatum warm / Axial and radial variation pattern in the specific gravity of the wood of erisma uncinatum warm / Padrão de variação axial e radial do peso específico na madeira de erisma uncinatum warm

La variabilidad natural de la madera es producto de su heterogeneidad celular, evidenciada tanto en su anatomía como en su composición química, las cuales a su vez, se reflejan en sus propiedades físicas y mecánicas. Se realizó la caracterización del patrón de variación axial y radial del peso específico seco en la madera de Erisma uncinatum (mureillo), procedente de la región Guayana, Venezuela. La evaluación se realizó empleando una muestra de seis árboles. Las muestras de madera se tomaron a tres niveles de altura (1,30m, 30% y 60% de la altura comercial). La evaluación radial se realizó sobre cinco puntos equidistantes en la dirección radial médula-corteza (0, 25, 50, 75, 90%). El análisis estadístico señaló que la variación entre árboles no fue estadísticamente significativa en comparación con el efecto distancia radial dentro de cada individuo. El peso específico de la madera, presentó un valor promedio de 0,52 ±0,7. La variación radial mostró un incremento lineal positivo médula-corteza (R²=0,68), con una variación de 22%, evidenciándose una demarcación preliminar entre madera juvenil y adulta, a partir del 50% de la dirección de los radios celulares. La variación axial disminuye con la altura del árbol y es menos consistente que la radial, apenas un 13%. La edad fisiológica de las células del cambium vascular es un factor importante que determina la variación del peso específico en la madera de E. uncinatum.

The natural variability of wood is a product of its cellular heterogeneity, evidenced in its anatomy as well as in its chemical composition, which in turn are reflected upon its physical and mechanical properties. A characterization of the axial and radial variation pattern in the dry specific gravity was carried out on wood of the species Erisma uncinatum ("mureillo"), from a forest in the Guayana region, Venezuela. The evaluation was carried out using a sample of six trees. Samples were taken at three different height levels (1.30m, 30% and 60% of commercial height). The radial evaluation was performed on five equidistant points in a pith-bark radial direction (0, 25, 50, 75, 90%). The statistical analysis indicated that the variation between trees was not statistically significant compared to the effect of radial distance in each individual. The specific gravity of the wood presented a mean value of 0.52 ±0.7. The radial variation showed a positive linear increase from pith to bark (R²=0.68), with a 22% variation, evidencing a preliminary boundary between juvenile and adult wood, beginning at 50% of the direction of cellular radii. The axial variation decreases with tree height and is less consistent than the radial variation, barely 13%. The physiological age of the vascular cambium is an important factor that determines the variation in the specific gravity of Erisma uncinatum wood.

A variabilidade natural da madeira é produto de sua heterogeneidade celular, evidenciada tanto em sua anatomia como em sua composição química, as quais por sua vez, são refletidas em suas propriedades físicas e mecânicas. Realizou-se a caracterização do padrão de variação axial e radial do peso específico na madeira de Erisma uncinatum (cedrinho), procedente da região Guayana, Venezuela. A avaliação foi realizada empregando uma amostra de seis árvores. As amostras de madeira foram colhidas em três níveis de altura (1,30m, 30% e 60% da altura comercial). A avaliação radial foi realizada sobre cinco pontos equidistantes na direção radial medula-crosta (0, 25, 50, 75, 90%). A análise estatística apontou que a variação entre árvores não foi estatisticamente significativa em comparação com o efeito distância radial dentro de cada indivíduo. O peso específico na madeira, apresentou um valor médio de 0,52 ±0,7. A variação radial mostrou um incremento linear positivo medula-crosta (R²=0,68), com uma variação de 22%, evidenciando-se uma demarcação preliminar entre madeira juvenil e adulta, a partir do 50% da direção dos raios celulares. A variação axial diminui com a altura da árvore e é menos consistente que a radial, apenas em 13%. A idade fisiológica das células do câmbio vascular é um fator importante que determina a variação do peso específico na madeira de E. uncinatum.

Differential absorption of metals from soil to diverse vine varieties from the Valley of Tulum (Argentina): consequences to evaluate wine provenance.

We report the effect of vine variety on the absorption of metals from soil and follow the variety from wine through juice, verifying which metals could be used to assess wine provenance. Eleven metals were determined by atomic absorption spectroscopy in 32 soils, 16 grapes juices, and 18 wines sampled from a single vineyard having four red grape varieties (Cabernet Sauvignon, Bonarda, Malbec, and Syrah). The K nearest neighbor method allows us to distinguish among different soils, juices, and wines. Linear discriminant analysis affords descriptors to point out differences, mainly Mg, Mn, Ca, K, and Na. Data analysis evidenced that some elements have equivalent concentrations in soil, juice, and wine, while others did not. Canonical analysis shows good correlation between grape juice and wine with their provenance soil. We suggest using Mg as a marker of wine provenance, while Mn could be used to evaluate differences between wine varieties associated with plant physiology.