The Seville Expert Workshop for Progress in Posttransplant Lymphoproliferative Disorders

Posttransplant lymphoproliferative disorders (PTLDs) are associated with significant morbidity and mortality among solid-organ transplant patients, but approaches to diagnosis and management vary considerably. An international multidisciplinary panel evaluated current understanding of risk factors and classification systems and developed recommendations to aid in PTLD prevention. We considered evidence on PTLD risk factors including Epstein- Barr virus serostatus and immunosuppression and identified knowledge gaps for future research. Recommendations address prophylactic and preemptive strategies to minimize PTLD development, including modulation of immunosuppression and antiviral drug regimens. Finally, new classification criteria were outlined that may help facilitate standardized reporting and improve our understanding of PTLD.

Lupus anticoagulant: a marker for stroke and venous thrombosis in primary Sjogren's syndrome

Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) have been described in primary Sjogren's syndrome (pSS) with controversial findings regarding aPL prevalence and their association with thrombotic events. We evaluated 100 consecutive pSS patients (American-European criteria) and 89 age-gender-ethnicity-matched healthy controls for IgG/IgM anticardiolipin (aCL), IgG/IgM anti-beta2-glycoprotein-I (a beta 2GPI), and lupus anticoagulant (LA) (positivity according to APS Sydney's criteria). Clinical analysis followed standardized interview and physical examination assessing thrombotic and nonthrombotic APS manifestations and thrombosis risk factors. aPLs were detected in 16 % patients and 5.6 % controls (p = 0.035). LA was the most common aPL in patients (9 %), followed by a beta 2GPI (5 %) and aCL (4 %). Thrombotic events occurred in five patients [stroke in two, myocardial infarction in one and deep-vein thrombosis (DVT) in four], but in none of controls (p = 0.061). Mean age at time of stroke was 35 years. Three patients with thrombotic events (including the two with stroke) had APS (Sydney's criteria) and were positive exclusively for LA. Comparison of patients with (n = 16) and without (n = 84) aPL revealed similar mean age, female predominance, and ethnicity (p > =0.387). Frequencies of livedo reticularis (25 vs. 4.8 %, p = 0.021), stroke (12.5 vs. 0 %, p = 0.024), and DVT (18.8 vs. 1.2 %, p = 0.013) were significantly higher in APL + patients. Conversely, frequencies of hypertension, dyslipidemia, diabetes, obesity, smoking, sedentarism, and hormonal contraception were similar in patients with or without aPL (p a parts per thousand yenaEuro parts per thousand 0.253). Our study identified LA as an important marker for APS in pSS, particularly for stroke in young patients, warranting routine evaluation of these antibodies and rigorous intervention in modifiable risk factors.

Comparison of the Clinical Expression of Patients with Ankylosing Spondylitis from Europe and Latin America

Objective. To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA). Methods. We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration >= 10 years. A descriptive and comparative analysis of variables of both groups was carried out. Results. There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations. Conclusion. The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group. (First Release Nov 15 2012; J Rheumatol 2012;39:2315-20; doi:10.3899/jrheum.110687)

Kawasaki disease and juvenile systemic lupus erythematosus

Kawasaki disease (KD) is a common vasculitis in childhood. To the authors' knowledge, only one case of juvenile systemic lupus erythematosus (JSLE)-like onset mimicking KD and another case of KD and JSLE association have previously been described. However, the prevalence of this association of the two diseases was not reported. Therefore, over 27 consecutive years, 5419 patients were followed at the Pediatric Rheumatology Unit and 271 (5%) of them met the ACR classification criteria for JSLE. Two (0.7%) of them were female. These also had KD according to European League against Rheumatism / Paediatric Rheumatology European Society (EULAR/PReS) consensus criteria and are described in this report. One case was a 13-year-old who presented all six KD criteria. Echocardiogram showed pericardial effusion, dilatation and tortuosity of right and left coronary, and her symptoms promptly improved after treatment with intravenous immunoglobulin (IVIG). Lupus diagnosis was established a few days later. Another case was a 4-year-old who had also met all six KD criteria, with improvement after IVIG, and lupus diagnosis was made 1 year later. In conclusion, the frequency of the association between these two autoimmune diseases was rare. The occurrence of a second autoimmune systemic disease in a patient with a history of KD should also be considered. Furthermore, the initial presentation of lupus may mimic KD. Lupus (2012) 21, 89-92.

Effect of age at disease onset in the clinical profile of spondyloarthritis: a study of 1424 Brazilian patients

Objectives To analyse demographic and clinical variables in patients with disease onset before and after 40, 45 and 50 years in a large series of Brazilian SpA patients. Methods A common protocol of investigation was prospectively applied to 1424 SpA patients in 29 centres distributed through the main geographical regions in Brazil. The mean age at disease onset was 28.56 +/- 12.34 years, with 259 patients (18.2%) referring disease onset after 40 years, 15.1 (10.6%) after 45 years and 81 (5.8%) after 50 years. Clinical and demographic variables and disease indices (BASDAI, BASFI, BASRI, MASES, ASQoL) were investigated. Ankylosing spondylitis was the most frequent disease (66.3%), followed by psoriatic arthritis (18%), undifferentiated SpA (6.7%), reactive arthritis (5.5%), and enteropathic arthritis (3.5%). Results Comparing the groups according to age of disease onset, those patients with later onset presented statistical association with female gender, peripheral arthritis, dactylitis, nail involvement and psoriasis, as well as negative statistical association with inflammatory low hack pain, alternating buttock pain, radiographic sacroiliitis, hip involvement, positive familial history, HLA-B27 and uveitis. BASDAI, BASFI and quality of life, as well as physicians and patient's global assessment, were similar in all the groups. Radiographic indices showed worse results in the younger age groups. Conclusion There are two different clinical patterns in SpA defined by age at disease onset: one with predominance of axial symptoms in the group with disease onset <= 40 years and another favouring the peripheral manifestations in those with later disease onset.

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Objective. To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population. Method's. A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated. Results. Age was comparable in patients and controls (14.8 +/- 3.0 vs 14.6 +/- 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant. Conclusion. This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644. (First Release Nov 15 2011; J Rheumatol 2012;39:167-73; doi:10.3899/jrheum.110721)

Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data

OBJECT: In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors. METHODS: Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors. CONCLUSIONS: The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.

WOCAT - World Overview of Conservation Approaches and Technologies - Preliminary results from Eastern and Southern Africa

The World Overview of Conservation Approaches and Technologies (WOCAT) is a program of the World Association of Soil and Water Conservation (WASWC), organized as a consortium of several international institutions. The overall goal of WOCAT is to contribute to sustainable utilization of soil and water. WOCAT collects and analyzes information on soil and water conservation (SWC) technologies and approaches world-wide, and presents the collected information in computer databases and decision support systems, and in the form of handbooks, reports and maps readily accessible to SWC specialists and policy-makers world-wide. WOCAT has prepared a framework for the evaluation of soil and water conservation and has started data collection. The paper presents preliminary results with promising SWC technologies and approaches used in Eastern and Southern Africa. The first finding is that hardly any promising SWC activities could be found on common grazing lands. Analysis of the cropland shows some of the bio-physical and socioeconomic conditions under which certain SWC technologies and approaches are used, including land use types, climatic zones and land tenure, and looks at issues such as participation and costs. Furthermore, classification criteria for SWC technologies and approaches are discussed.

[Polymyalgia rheumatica: What is the current status?]

The diagnosis of polymyalgia rheumatica (PMR) is based on the typical clinical symptoms and elevated inflammatory markers in blood; however, both are unspecific and the differential diagnosis of the disease still represents a challenge for clinicians. The new consensus classification criteria of the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) established in 2012 have a high sensitivity (92.6 %) and specificity (91.2 %) and therefore contribute to improved diagnostics. Glucocorticoids are still the standard treatment with methotrexate and as an alternative and possibly anti-interleukin (anti-IL) 6 therapy in the future.

Análisis de los factores de adopción de comercio electrónico en segmentos de consumidores finales. Aplicación al caso español

El comercio electrónico ha experimentado un fuerte crecimiento en los últimos años, favorecido especialmente por el aumento de las tasas de penetración de Internet en todo el mundo. Sin embargo, no todos los países están evolucionando de la misma manera, con un espectro que va desde las naciones pioneras en desarrollo de tecnologías de la información y comunicaciones, que cuentan con una elevado porcentaje de internautas y de compradores online, hasta las rezagadas de rápida adopción en las que, pese a contar con una menor penetración de acceso, presentan una alta tasa de internautas compradores. Entre ambos extremos se encuentran países como España que, aunque alcanzó hace años una tasa considerable de penetración de usuarios de Internet, no ha conseguido una buena tasa de transformación de internautas en compradores. Pese a que el comercio electrónico ha experimentado importantes aumentos en los últimos años, sus tasas de crecimiento siguen estando por debajo de países con características socio-económicas similares. Para intentar conocer las razones que afectan a la adopción del comercio por parte de los compradores, la investigación científica del fenómeno ha empleado diferentes enfoques teóricos. De entre todos ellos ha destacado el uso de los modelos de adopción, proveniente de la literatura de adopción de sistemas de información en entornos organizativos. Estos modelos se basan en las percepciones de los compradores para determinar qué factores pueden predecir mejor la intención de compra y, en consecuencia, la conducta real de compra de los usuarios. Pese a que en los últimos años han proliferado los trabajos de investigación que aplican los modelos de adopción al comercio electrónico, casi todos tratan de validar sus hipótesis mediante el análisis de muestras de consumidores tratadas como un único conjunto, y del que se obtienen conclusiones generales. Sin embargo, desde el origen del marketing, y en especial a partir de la segunda mitad del siglo XIX, se considera que existen diferencias en el comportamiento de los consumidores, que pueden ser debidas a características demográficas, sociológicas o psicológicas. Estas diferencias se traducen en necesidades distintas, que sólo podrán ser satisfechas con una oferta adaptada por parte de los vendedores. Además, por contar el comercio electrónico con unas características particulares que lo diferencian del comercio tradicional –especialmente por la falta de contacto físico entre el comprador y el producto– a las diferencias en la adopción para cada consumidor se le añaden las diferencias derivadas del tipo de producto adquirido, que si bien habían sido consideradas en el canal físico, en el comercio electrónico cobran especial relevancia. A la vista de todo ello, el presente trabajo pretende abordar el estudio de los factores determinantes de la intención de compra y la conducta real de compra en comercio electrónico por parte del consumidor final español, teniendo en cuenta el tipo de segmento al que pertenezca dicho comprador y el tipo de producto considerado. Para ello, el trabajo contiene ocho apartados entre los que se encuentran cuatro bloques teóricos y tres bloques empíricos, además de las conclusiones. Estos bloques dan lugar a los siguientes ocho capítulos por orden de aparición en el trabajo: introducción, situación del comercio electrónico, modelos de adopción de tecnología, segmentación en comercio electrónico, diseño previo del trabajo empírico, diseño de la investigación, análisis de los resultados y conclusiones. El capítulo introductorio justifica la relevancia de la investigación, además de fijar los objetivos, la metodología y las fases seguidas para el desarrollo del trabajo. La justificación se complementa con el segundo capítulo, que cuenta con dos elementos principales: en primer lugar se define el concepto de comercio electrónico y se hace una breve retrospectiva desde sus orígenes hasta la situación actual en un contexto global; en segundo lugar, el análisis estudia la evolución del comercio electrónico en España, mostrando su desarrollo y situación presente a partir de sus principales indicadores. Este apartado no sólo permite conocer el contexto de la investigación, sino que además permite contrastar la relevancia de la muestra utilizada en el presente estudio con el perfil español respecto al comercio electrónico. Los capítulos tercero –modelos de adopción de tecnologías– y cuarto –segmentación en comercio electrónico– sientan las bases teóricas necesarias para abordar el estudio. En el capítulo tres se hace una revisión general de la literatura de modelos de adopción de tecnología y, en particular, de los modelos de adopción empleados en el ámbito del comercio electrónico. El resultado de dicha revisión deriva en la construcción de un modelo adaptado basado en los modelos UTAUT (Unified Theory of Acceptance and Use of Technology, Teoría unificada de la aceptación y el uso de la tecnología) y UTAUT2, combinado con dos factores específicos de adopción del comercio electrónico: el riesgo percibido y la confianza percibida. Por su parte, en el capítulo cuatro se revisan las metodologías de segmentación de clientes y productos empleadas en la literatura. De dicha revisión se obtienen un amplio conjunto de variables de las que finalmente se escogen nueve variables de clasificación que se consideran adecuadas tanto por su adaptación al contexto del comercio electrónico como por su adecuación a las características de la muestra empleada para validar el modelo. Las nueve variables se agrupan en tres conjuntos: variables de tipo socio-demográfico –género, edad, nivel de estudios, nivel de ingresos, tamaño de la unidad familiar y estado civil–, de comportamiento de compra – experiencia de compra por Internet y frecuencia de compra por Internet– y de tipo psicográfico –motivaciones de compra por Internet. La segunda parte del capítulo cuatro se dedica a la revisión de los criterios empleados en la literatura para la clasificación de los productos en el contexto del comercio electrónico. De dicha revisión se obtienen quince grupos de variables que pueden tomar un total de treinta y cuatro valores, lo que deriva en un elevado número de combinaciones posibles. Sin embargo, pese a haber sido utilizados en el contexto del comercio electrónico, no en todos los casos se ha comprobado la influencia de dichas variables respecto a la intención de compra o la conducta real de compra por Internet; por este motivo, y con el objetivo de definir una clasificación robusta y abordable de tipos de productos, en el capitulo cinco se lleva a cabo una validación de las variables de clasificación de productos mediante un experimento previo con 207 muestras. Seleccionando sólo aquellas variables objetivas que no dependan de la interpretación personal del consumidores y que determinen grupos significativamente distintos respecto a la intención y conducta de compra de los consumidores, se obtiene un modelo de dos variables que combinadas dan lugar a cuatro tipos de productos: bien digital, bien no digital, servicio digital y servicio no digital. Definidos el modelo de adopción y los criterios de segmentación de consumidores y productos, en el sexto capítulo se desarrolla el modelo completo de investigación formado por un conjunto de hipótesis obtenidas de la revisión de la literatura de los capítulos anteriores, en las que se definen las hipótesis de investigación con respecto a las influencias esperadas de las variables de segmentación sobre las relaciones del modelo de adopción. Este modelo confiere a la investigación un carácter social y de tipo fundamentalmente exploratorio, en el que en muchos casos ni siquiera se han encontrado evidencias empíricas previas que permitan el enunciado de hipótesis sobre la influencia de determinadas variables de segmentación. El capítulo seis contiene además la descripción del instrumento de medida empleado en la investigación, conformado por un total de 125 preguntas y sus correspondientes escalas de medida, así como la descripción de la muestra representativa empleada en la validación del modelo, compuesta por un grupo de 817 personas españolas o residentes en España. El capítulo siete constituye el núcleo del análisis empírico del trabajo de investigación, que se compone de dos elementos fundamentales. Primeramente se describen las técnicas estadísticas aplicadas para el estudio de los datos que, dada la complejidad del análisis, se dividen en tres grupos fundamentales: Método de mínimos cuadrados parciales (PLS, Partial Least Squares): herramienta estadística de análisis multivariante con capacidad de análisis predictivo que se emplea en la determinación de las relaciones estructurales de los modelos propuestos. Análisis multigrupo: conjunto de técnicas que permiten comparar los resultados obtenidos con el método PLS entre dos o más grupos derivados del uso de una o más variables de segmentación. En este caso se emplean cinco métodos de comparación, lo que permite asimismo comparar los rendimientos de cada uno de los métodos. Determinación de segmentos no identificados a priori: en el caso de algunas de las variables de segmentación no existe un criterio de clasificación definido a priori, sino que se obtiene a partir de la aplicación de técnicas estadísticas de clasificación. En este caso se emplean dos técnicas fundamentales: análisis de componentes principales –dado el elevado número de variables empleadas para la clasificación– y análisis clúster –del que se combina una técnica jerárquica que calcula el número óptimo de segmentos, con una técnica por etapas que es más eficiente en la clasificación, pero exige conocer el número de clústeres a priori. La aplicación de dichas técnicas estadísticas sobre los modelos resultantes de considerar los distintos criterios de segmentación, tanto de clientes como de productos, da lugar al análisis de un total de 128 modelos de adopción de comercio electrónico y 65 comparaciones multigrupo, cuyos resultados y principales consideraciones son elaboradas a lo largo del capítulo. Para concluir, el capítulo ocho recoge las conclusiones del trabajo divididas en cuatro partes diferenciadas. En primer lugar se examina el grado de alcance de los objetivos planteados al inicio de la investigación; después se desarrollan las principales contribuciones que este trabajo aporta tanto desde el punto de vista metodológico, como desde los punto de vista teórico y práctico; en tercer lugar, se profundiza en las conclusiones derivadas del estudio empírico, que se clasifican según los criterios de segmentación empleados, y que combinan resultados confirmatorios y exploratorios; por último, el trabajo recopila las principales limitaciones de la investigación, tanto de carácter teórico como empírico, así como aquellos aspectos que no habiendo podido plantearse dentro del contexto de este estudio, o como consecuencia de los resultados alcanzados, se presentan como líneas futuras de investigación. ABSTRACT Favoured by an increase of Internet penetration rates across the globe, electronic commerce has experienced a rapid growth over the last few years. Nevertheless, adoption of electronic commerce has differed from one country to another. On one hand, it has been observed that countries leading e-commerce adoption have a large percentage of Internet users as well as of online purchasers; on the other hand, other markets, despite having a low percentage of Internet users, show a high percentage of online buyers. Halfway between those two ends of the spectrum, we find countries such as Spain which, despite having moderately high Internet penetration rates and similar socio-economic characteristics as some of the leading countries, have failed to turn Internet users into active online buyers. Several theoretical approaches have been taken in an attempt to define the factors that influence the use of electronic commerce systems by customers. One of the betterknown frameworks to characterize adoption factors is the acceptance modelling theory, which is derived from the information systems adoption in organizational environments. These models are based on individual perceptions on which factors determine purchase intention, as a mean to explain users’ actual purchasing behaviour. Even though research on electronic commerce adoption models has increased in terms of volume and scope over the last years, the majority of studies validate their hypothesis by using a single sample of consumers from which they obtain general conclusions. Nevertheless, since the birth of marketing, and more specifically from the second half of the 19th century, differences in consumer behaviour owing to demographic, sociologic and psychological characteristics have also been taken into account. And such differences are generally translated into different needs that can only be satisfied when sellers adapt their offer to their target market. Electronic commerce has a number of features that makes it different when compared to traditional commerce; the best example of this is the lack of physical contact between customers and products, and between customers and vendors. Other than that, some differences that depend on the type of product may also play an important role in electronic commerce. From all the above, the present research aims to address the study of the main factors influencing purchase intention and actual purchase behaviour in electronic commerce by Spanish end-consumers, taking into consideration both the customer group to which they belong and the type of product being purchased. In order to achieve this goal, this Thesis is structured in eight chapters: four theoretical sections, three empirical blocks and a final section summarizing the conclusions derived from the research. The chapters are arranged in sequence as follows: introduction, current state of electronic commerce, technology adoption models, electronic commerce segmentation, preliminary design of the empirical work, research design, data analysis and results, and conclusions. The introductory chapter offers a detailed justification of the relevance of this study in the context of e-commerce adoption research; it also sets out the objectives, methodology and research stages. The second chapter further expands and complements the introductory chapter, focusing on two elements: the concept of electronic commerce and its evolution from a general point of view, and the evolution of electronic commerce in Spain and main indicators of adoption. This section is intended to allow the reader to understand the research context, and also to serve as a basis to justify the relevance and representativeness of the sample used in this study. Chapters three (technology acceptance models) and four (segmentation in electronic commerce) set the theoretical foundations for the study. Chapter 3 presents a thorough literature review of technology adoption modelling, focusing on previous studies on electronic commerce acceptance. As a result of the literature review, the research framework is built upon a model based on UTAUT (Unified Theory of Acceptance and Use of Technology) and its evolution, UTAUT2, including two specific electronic commerce adoption factors: perceived risk and perceived trust. Chapter 4 deals with client and product segmentation methodologies used by experts. From the literature review, a wide range of classification variables is studied, and a shortlist of nine classification variables has been selected for inclusion in the research. The criteria for variable selection were their adequacy to electronic commerce characteristics, as well as adequacy to the sample characteristics. The nine variables have been classified in three groups: socio-demographic (gender, age, education level, income, family size and relationship status), behavioural (experience in electronic commerce and frequency of purchase) and psychographic (online purchase motivations) variables. The second half of chapter 4 is devoted to a review of the product classification criteria in electronic commerce. The review has led to the identification of a final set of fifteen groups of variables, whose combination offered a total of thirty-four possible outputs. However, due to the lack of empirical evidence in the context of electronic commerce, further investigation on the validity of this set of product classifications was deemed necessary. For this reason, chapter 5 proposes an empirical study to test the different product classification variables with 207 samples. A selection of product classifications including only those variables that are objective, able to identify distinct groups and not dependent on consumers’ point of view, led to a final classification of products which consisted on two groups of variables for the final empirical study. The combination of these two groups gave rise to four types of products: digital and non-digital goods, and digital and non-digital services. Chapter six characterizes the research –social, exploratory research– and presents the final research model and research hypotheses. The exploratory nature of the research becomes patent in instances where no prior empirical evidence on the influence of certain segmentation variables was found. Chapter six also includes the description of the measurement instrument used in the research, consisting of a total of 125 questions –and the measurement scales associated to each of them– as well as the description of the sample used for model validation (consisting of 817 Spanish residents). Chapter 7 is the core of the empirical analysis performed to validate the research model, and it is divided into two separate parts: description of the statistical techniques used for data analysis, and actual data analysis and results. The first part is structured in three different blocks: Partial Least Squares Method (PLS): the multi-variable analysis is a statistical method used to determine structural relationships of models and their predictive validity; Multi-group analysis: a set of techniques that allow comparing the outcomes of PLS analysis between two or more groups, by using one or more segmentation variables. More specifically, five comparison methods were used, which additionally gives the opportunity to assess the efficiency of each method. Determination of a priori undefined segments: in some cases, classification criteria did not necessarily exist for some segmentation variables, such as customer motivations. In these cases, the application of statistical classification techniques is required. For this study, two main classification techniques were used sequentially: principal component factor analysis –in order to reduce the number of variables– and cluster analysis. The application of the statistical methods to the models derived from the inclusion of the various segmentation criteria –for both clients and products–, led to the analysis of 128 different electronic commerce adoption models and 65 multi group comparisons. Finally, chapter 8 summarizes the conclusions from the research, divided into four parts: first, an assessment of the degree of achievement of the different research objectives is offered; then, methodological, theoretical and practical implications of the research are drawn; this is followed by a discussion on the results from the empirical study –based on the segmentation criteria for the research–; fourth, and last, the main limitations of the research –both empirical and theoretical– as well as future avenues of research are detailed.

Método de Rorscharch em adultos: evidências psicométricas da Escola Francesa

O Método de Rorschach é internacionalmente utilizado e reconhecido como instrumento de avaliação psicológica em processos de investigação da personalidade. Para embasar seu adequado uso no contexto do Brasil, contínuos estudos sobre suas evidências psicométricas fazem-se necessários, sobretudo sobre seus indicadores de validade, precisão e referenciais normativos. Nesse contexto, este trabalho objetivou: a) verificar indicadores de precisão e validade do Rorschach (Escola Francesa ou de Paris), por meio da reavaliação de adultos não pacientes do estudo normativo de Pasian (1998), para checagem da estabilidade temporal (estrutural e funcional) das características de personalidade examinadas pelo método (ESTUDO 1); b) revisar e atualizar padrões normativos e atlas da Escola Francesa do Rorschach em adultos, avaliando-se eventuais especificidades de produção associadas ao sexo, à idade e à escolaridade (ESTUDO 2). No primeiro estudo foram reavaliados 88 adultos do estudo de Pasian (1998), com idade entre 34 a 69 anos, de ambos os sexos e de diferentes níveis de escolaridade (baixa, média e alta). No segundo estudo compôs-se nova amostra com 102 adultos, entre 18 e 65 anos, com sinais de desenvolvimento típico, distribuídos equitativamente em relação ao sexo e com diferentes graus de escolaridade (baixa, média e alta). Para elaboração dos dados normativos foram incluídos 66 adultos do Estudo 1, totalizando 168 casos nessa nova amostra (86 mulheres e 82 homens). Os participantes residiam no interior do Estado de São Paulo e foram avaliados, individualmente, por: a) instrumento de rastreamento de saúde mental (SRQ-20) - no estudo 1, utilizado para caracterização da amostra e no estudo 2 como critério de seleção dos participantes; b) instrumento de avaliação intelectual (Teste de Inteligência Não Verbal - INV, forma C - apenas no Estudo 2) para controle cognitivo da amostra; c) critério de classificação econômica Brasil (ABEP) e d) Método de Rorschach (Escola de Paris). Cada instrumento de avaliação psicológica foi aplicado, codificado e sistematizado conforme seus respectivos manuais técnicos. Especificamente o Método de Rorschach foi avaliado pelas diretrizes da Escola Francesa, sendo cada protocolo (de cada um dos dois estudos) examinado independentemente por dois avaliadores, chegando-se a uma classificação final dos casos. Calculou-se o índice de concordância entre examinadores pelo coeficiente Kappa para as quatro categorias de classificação das respostas do Rorschach (localização, determinante/qualidade formal, conteúdo e banalidades). Os resultados foram sistematizados inicialmente em termos descritivos (média, desvio-padrão, mediana, valor mínimo e máximo), realizando-se análises inferenciais específicas para as amostras de cada estudo em função de seus objetivos centrais. No Estudo 1, os achados relativos aos índices de correlação entre as duas avaliações dos 88 voluntários variaram entre 0,72 a -0,005, evidenciando estabilidade em um conjunto das características de personalidade dos adultos examinados após 15 anos, configurando evidências empíricas de precisão e de validade de método projetivo. Houve variáveis do Rorschach que não apresentaram resultados estáveis entre os dois momentos avaliativos (fórmulas vivenciais), sugerindo se tratarem de indicadores técnicos relativos ao funcionamento da personalidade, mais do que componentes estruturais. As análises do Estudo 2 apontaram reduzida influência dos fatores relacionados ao sexo, à escolaridade e à idade sobre as variáveis do Rorschach, não indicando a necessidade de normas específicas para grupos em termos desses fatores. Por fim, foi elaborado novo atlas de referência do Método de Rorschach (Escola de Paris) no contexto brasileiro, seguindo-se as diretrizes técnicocientíficas nacionais e internacionais da área. Os dados fortalecem a relevância dos estudos de natureza psicométrica para embasar adequadas análises interpretativas desse instrumento de avaliação psicológica (FAPESP e CAPES/PDSE).

Sobrecarga de cuidadores familiares de idosos em cuidados paliativos

O adoecimento de um membro familiar costuma acarretar inúmeras alterações em toda a estrutura e dinâmica familiar. Com a progressão e o agravamento da doença, quando a pessoa se encontra sem possibilidade de tratamento modificador da doença, aumenta o sofrimento tanto da pessoa adoecida quanto de sua família. O cuidador familiar de pessoas idosas em cuidados paliativos sofre junto ao enfermo, podendo enfrentar sobrecarga física, emocional e social decorrente da tarefa de cuidar e da possibilidade da morte. Entretanto, são escassos os estudos que avaliam a sobrecarga desta população. O objetivo deste estudo é identificar e analisar a percepção de sobrecarga por parte do cuidador familiar de idosos em cuidados paliativos. Trata-se de uma pesquisa do tipo transversal, exploratório, de metodologia quantitativa, não probabilística, com uma casuística total composta por 100 pessoas. Essa casuística foi estratificada de acordo com escore obtido por meio da aplicação do protocolo Karnofsky Performance Scale (KPS) com os idosos (com 60 anos ou acima) em cuidados paliativos oncológicos: um grupo com 25 cuidadores familiares de idosos com KPS abaixo de 40%; um grupo com 25 cuidadores de idosos em cuidados paliativos oncológicos com KPS de 70%, 60% ou 50%; um grupo controle com 50 cuidadores familiares de idosos em cuidados paliativos oncológicos, com KPS maior ou igual a 80%. Durante a coleta de dados, além do KPS, foram aplicados o questionário de caracterização clínica e sociodemográfica e os protocolos: Questionário de Classificação Socioeconômica Brasil e o Caregiver Burden Scale (CBScale), validado no Brasil. Para análise dos dados, foi realizada estatística descritiva e as comparações com os grupos foram feitas por meio do Teste Exato de Fisher e de um modelo de regressão quantílica. As análises foram feitas pelo software SAS 9.0 e Stata versão 13. Os resultados indicaram que os cuidadores familiares são, em sua maioria, mulheres, filhas ou esposas, de meia idade a idade mais avançada, predominantemente, na faixa etária de 56 a 71 anos, com baixa escolaridade, pertencentes a classes sociais C e que não realizam nenhuma atividade remunerada. Os maiores índices de sobrecarga foram percebidos em cuidadores do sexo feminino e em cuidadores de idosos os quais apresentam menores escores relativos à capacidade funcional (avaliados pelo KPS). Conclui-se que o agravamento da doença, o declínio funcional do idoso e a possibilidade da sua morte mais próxima fazem aumentar a sobrecarga dos cuidadores, com impactos na sua saúde e qualidade de vida, o que indica a necessidade de oferecimento de serviços de apoio a essa população o mais precocemente possível

Qualidade de vida relacionada à saúde e uso de tecnologia de comunicação alternativa por pessoas com câncer de cabeça e pescoço

O tratamento do câncer de cabeça e pescoço e a dificuldade de comunicação decorrente da laringectomia interferem de maneira significativa na qualidade de vida das pessoas acometidas, principalmente quanto aos aspectos funcionais, psicológicos e sociais. Este estudo teve como o objetivo avaliar a qualidade de vida relacionada à saúde (QVRS) de pessoas com câncer de cabeça e pescoço. Trata-se de um estudo exploratório com metodologia quantitativa, do tipo transversal. A coleta de dados foi realizada no período de maio a setembro de 2015, com 100 pessoas com câncer de cabeça e pescoço, divididas em dois grupos: G1: pessoas laringectomizadas, G2: pessoas não laringectomizadas. Para isto, foi utilizado um aplicativo de comunicação alternativa instalado em tablet e foram aplicados o Critério de Classificação Econômica Brasil (CCEB) e a escala Functional Assessment Cancer Therapy (FACT-H&N). Para a análise dos dados foram utilizados o teste exato de Fisher, teste de Kruskal-Wallis, Ancova e estatística descritiva. Como resultados observou-se a prevalência de pessoas do sexo masculino, com faixa etária entre 59 e 74 anos , casadas, aposentadas não ativas, com baixa escolaridade e baixo nível socioeconômico. Os sujeitos participantes de ambos os grupos avaliaram sua qualidade de vida global, de um modo geral, como satisfatória sendo que as funções mais acometidas foram: bem estar emocional e bem estar funcional. Quanto às comparações dos escores finais da escala, observa-se que os participantes do G1 apresentaram melhor QVRS do que os do G2 no escore FACT-G total score, o G1 apresentou melhor QVRS do que o G2, enquanto no FACT-H&N Total score e TOI o G2 apresentou resultados ligeiramente melhores, porém sem significância estatística. Quanto ao uso do LIVOX, todos os participantes que apresentaram alguma dificuldade no seu uso tinham mais de 58 anos e se declararam aposentados não ativos (p=0,04). Conclui-se que é importante o oferecimento, tanto no pré quanto no pós operatório, de cuidados que possam avaliar e melhorar a qualidade de vida relacionada à saúde das pessoas com câncer de cabeça e pescoço

A massive association around the obscured open cluster RSGC3

Context. Four clusters of red supergiants have been discovered in a region of the Milky Way close to base of the Scutum-Crux Arm and the tip of the Long Bar. Population synthesis models indicate that they must be very massive to harbour so many supergiants. If the clusters are physically connected, this Scutum Complex would be the largest and most massive star-forming region ever identified in the Milky Way. Aims. The spatial extent of one of these clusters, RSGC3, has not been investigated. In this paper we explore the possibility that a population of red supergiants could be located in its vicinity. Methods. We utilised 2MASS JHKS photometry to identify candidate obscured luminous red stars in the vicinity of RSGC3. We observed a sample of candidates with the TWIN spectrograph on the 3.5-m telescope at Calar Alto, obtaining intermediate-resolution spectroscopy in the 8000−9000 Å range. We re-evaluated a number of classification criteria proposed in the literature for this spectral range and found that we could use our spectra to derive spectral types and luminosity classes. Results. We measured the radial velocity of five members of RSGC3, finding velocities similar to the average for members of Stephenson 2. Among the candidates observed outside the cluster, our spectra revealed eight M-type supergiants at distances <18′ from the centre of RSGC3, distributed in two clumps. The southern clump is most likely another cluster of red supergiants, with reddening and age identical to RSGC3. From 2MASS photometry, we identified four likely supergiant members of the cluster in addition to the five spectroscopically observed. The northern clump may be a small cluster with similar parameters. Photometric analysis of the area around RSGC3 suggests the presence of a large (>30) population of red supergiants with similar colours. Conclusions. Our data suggest that the massive cluster RSGC3 is surrounded by an extended association, which may be very massive ( ≳ 105 M⊙). We also show that supergiants in the Scutum Complex may be characterised via a combination of 2MASS photometry and intermediate-to-high-resolution spectroscopy in the Z band.

A new survey of cool supergiants in the Magellanic Clouds

Aims. In this study we conduct a pilot program aimed at the red supergiant population of the Magellanic Clouds. We intend to extend the current known sample to the unexplored low end of the brightness distribution of these stars, building a more representative dataset with which to extrapolate their behaviour to other Galactic and extra-galactic environments. Methods. We select candidates using only near infrared photometry, and with medium resolution multi-object spectroscopy, we perform spectral classification and derive their line-of-sight velocities, confirming the nature of the candidates and their membership in the clouds. Results. Around two hundred new red supergiants have been detected, hinting at a yet to be observed large population. Using near- and mid-infrared photometry we study the brightness distribution of these stars, the onset of mass-loss, and the effect of dust in their atmospheres. Based on this sample, new a priori classification criteria are investigated, combining mid- and near-infrared photometry to improve the observational efficiency of similar programs to this.