941 resultados para Multicriteria approval


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This study investigated the consumer attitude to food irradiation in Sao Paulo, Brazil, through a qualitative research perspective. Three focus groups were conducted with 30 consumers, responsible for food choices and purchases. Both irradiated and nonirradiated food samples were served in the sessions to motivate the discussion and elicit the participants knowledge, opinions, feelings and concerns towards the irradiation process. Reactions were similar among the groups and differences between the irradiated and the nonirradiated samples were hardly perceived. When provided with positive information about irradiation and its benefits to foods and human health, many people still remained suspicious about the safety of the technology. Risk perception seemed to be related to unease and lack of knowledge about nuclear power and its non-defense use. Participants claimed for more transparency in communication about risks and benefits of irradiated foods to the human health, especially with respect to the continued consumption. Industrial relevance: Irradiation is an emerging food processing technology, which has been gaining interest by food technologists, producers and manufacturers all over the world in the last decades. Irradiation is suitable for disinfestation, microorganism load reduction or sterilization, assuring the safety, as well as having benefits in the shelf-life of foodstuffs. Food irradiation is approved in many countries and its use in food processing is endorsed by several reputed authorities, such as FAD and USDA. Despite the approval and recommendation, this technology still remains underutilized not only in Brazil, but also in other countries. The main reason appears to be the consumer concerns and doubts about the use of radiations in food processing. To develop communication strategies in promotion of irradiated foods it is necessary to investigate consumer attitudes, knowledge. opinions, as well as fears, with respect to the use of radiation in food processing. It is well-known that consumer views on technology may vary from a culture to another. So, findings from consumer research in a country may certainly not reflect the consumer views in other countries. In this sense, Brazilian studies focused on consumer views on food irradiation are necessary to gain understanding on how the local market accepts the technology. Brazil is one of the most important food producers in the world and an emerging consumer market with a population of about 184 million people. Food irradiation is regulated in Brazil since 1973, but to date only a few food ingredients are subjected to irradiation. The wide use of irradiation in food processing would favor Brazilian producers in the quality and safety assurance of food products, both for the local market and for exports. (C) 2009 Elsevier Ltd. All rights reserved.

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Objectives. The present study was designed to test the diathesis-stress components of Beck's cognitive theory of depression and the reformulated learned helplessness model of depression in the prediction of postpartum depressive symptomatology. Design and methods. The research used a two-wave longitudinal design-data were collected from 65 primiparous women during their third trimester of pregnancy and then 6 weeks after the birth. Cognitive vulnerability and initial depressive symptomatology were assessed at Time 1, whereas stress and postpartum depressive symptomatology were assessed at Time 2. Results. There was some support for the diathesis-stress component of Beck's cognitive theory, to the extent that the negative relationship between both general and maternal-specific dysfunctional attitudes associated with performance evaluation and Time 2 depressive symptomatology was strongest for women who reported high levels of parental stress. In a similar vein, the effects of dysfunctional attitudes (general and maternal-specific) associated with performance evaluation and need for approval (general measure only) on partner ratings of emotional distress were evident only among those women whose infants were rated as being temperamentally difficult. Conclusion. There was no support for the diathesis-stress component of the reformulated learned helplessness model of depression; however, there was some support for the diathesis-stress component of Beck's cognitive theory.

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Purpose: To evaluate the influence of cross-sectional arc calcification on the diagnostic accuracy of computed tomography (CT) angiography compared with conventional coronary angiography for the detection of obstructive coronary artery disease (CAD). Materials and Methods: Institutional Review Board approval and written informed consent were obtained from all centers and participants for this HIPAA-compliant study. Overall, 4511 segments from 371 symptomatic patients (279 men, 92 women; median age, 61 years [interquartile range, 53-67 years]) with clinical suspicion of CAD from the CORE-64 multi-center study were included in the analysis. Two independent blinded observers evaluated the percentage of diameter stenosis and the circumferential extent of calcium (arc calcium). The accuracy of quantitative multidetector CT angiography to depict substantial (>50%) stenoses was assessed by using quantitative coronary angiography (QCA). Cross-sectional arc calcium was rated on a segment level as follows: noncalcified or mild (<90 degrees), moderate (90 degrees-180 degrees), or severe (>180 degrees) calcification. Univariable and multivariable logistic regression, receiver operation characteristic curve, and clustering methods were used for statistical analyses. Results: A total of 1099 segments had mild calcification, 503 had moderate calcification, 338 had severe calcification, and 2571 segments were noncalcified. Calcified segments were highly associated (P < .001) with disagreement between CTA and QCA in multivariable analysis after controlling for sex, age, heart rate, and image quality. The prevalence of CAD was 5.4% in noncalcified segments, 15.0% in mildly calcified segments, 27.0% in moderately calcified segments, and 43.0% in severely calcified segments. A significant difference was found in area under the receiver operating characteristic curves (noncalcified: 0.86, mildly calcified: 0.85, moderately calcified: 0.82, severely calcified: 0.81; P < .05). Conclusion: In a symptomatic patient population, segment-based coronary artery calcification significantly decreased agreement between multidetector CT angiography and QCA to detect a coronary stenosis of at least 50%.

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Bliacheriene F, Carmona MJC, Barretti CFM, Haddad CMF, Mouchalwat ES, Bortlotto MRFL, Francisco RPV, Zugaib M - Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases. Background and Objectives: Hemodynamic changes are observed during cesarean section under spinal anesthesia. Non-invasive blood pressure (BP) and heart rate (HR) measurements are performed to diagnose these changes, but they are delayed and inaccurate. Other monitors such as filling pressure and cardiac output (CO) catheters with external calibration are very invasive or inaccurate. The objective of the present study was to report the cardiac output measurements obtained with a minimally invasive uncalibrated monitor (LiDCO rapid) in patients undergoing cesarean section under spinal anesthesia. Case report: After approval by the Ethics Commission, four patients agreed to participate in this study. They underwent cesarean section under spinal anesthesia while at the same time being connected to the LiDCO rapid by a radial artery line. Cardiac output, HR, and BP were recorded at baseline, after spinal anesthesia, after fetal and placental extraction, and after the infusion of oxytocin and metaraminol. We observed a fall in BP with an increase of HR and CO after spinal anesthesia and oxytocin infusion; and an increase in BP with a fall in HR and CO after bolus of the vasopressor. Conclusions: Although this monitor had not been calibrated, it showed a tendency for consistent hemodynamic data in obstetric patients and it may be used as a therapeutic guide or experimental tool.

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Aim Stapled haemorrhoidopexy may damage the anorectal musculature and its sensorimotor function. Most studies have not used a barostat for the measurement of compliance. This study aimed to investigate the effect of stapled haemorrhoidopexy on rectal compliance and sensitivity. Method After Ethical Committee approval, we studied 10 male patients (mean age 33.8 years) with third- or fourth-degree haemorrhoids. Rectal compliance and sensitivity were measured with a 600-ml bag and an electronic barostat. Volunteers were submitted to two consecutive rectal distension protocols, including continuous distension at 2, 4 and 6 months after stapled haemorrhoidopexy. Intraluminal volume and pressure were recorded, including the first rectal sensation, desire to defecate and onset of rectal pain. Another group of 10 male control patients (mean age 24.9 years) with pilonidal sinus and no haemorrhoids was also included in the study. Results Two months after stapled haemorrhoidopexy, rectal compliance decreased (7.1 +/- 0.2 vs 5.3 +/- 0.1, 6.4 +/- 0.1 vs 5.1 +/- 0.1 and 5.6 +/- 0.2 vs 4.7 +/- 0.1 ml/mmHg for first rectal sensation, desire to defecate and rectal pain, respectively; P < 0.05). The sensitivity threshold volume did not change for the first sensation but decreased significantly for the desier to defecate and pain (p < 0.05) (116.8 +/- 13.8 vs 148.4 +/- 14.61, 251.1 +/- 8.9 vs 185.8 +/- 8.6 and 293.3 +/- 16.6 vs 221.2 +/- 6.0 ml for first rectal sensation, desire to defecate and rectal pain, respectively). Four and 6 months after surgery, rectal compliance and sensitivity returned to levels similar to those in the basal period. Muscle tissue was found in only three of the 10 resected doughnuts. Controls remained without any change in rectal compliance and sensitivity. Conclusion Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity threshold in young male patients.

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Background: It has been suggested that individuals with social anxiety disorder (SAD) are exaggeratedly concerned about approval and disapproval by others. Therefore, we assessed the recognition of facial expressions by individuals with SAD, in an attempt to overcome the limitations of previous studies. Methods: The sample was formed by 231 individuals (78 SAD patients and 153 healthy controls). All individuals were treatment naive, aged 18-30 years and with similar socioeconomic level. Participants judged which emotion (happiness, sadness, disgust, anger, fear, and surprise) was presented in the facial expression of stimuli displayed on a computer screen. The stimuli were manipulated in order to depict different emotional intensities, with the initial image being a neutral face (0%) and, as the individual moved on across images, the expressions increased their emotional intensity until reaching the total emotion (100%). The time, accuracy, and intensity necessary to perform judgments were evaluated. Results: The groups did not show statistically significant differences in respect to the number of correct judgments or to the time necessary to respond. However, women with SAD required less emotional intensity to recognize faces displaying fear (p = 0.002), sadness (p = 0.033) and happiness (p = 0.002), with no significant differences for the other emotions or men with SAD. Conclusions: The findings suggest that women with SAD are hypersensitive to threat-related and approval-related social cues. Future studies investigating the neural basis of the impaired processing of facial emotion in SAD using functional neuroimaging would be desirable and opportune. (C) 2009 Elsevier Ltd. All rights reserved.

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Background. Play is an indication of a children`s development. Purpose. Organize a culturally adapt the Child-Initiated Pretend Play Assessment to Brazilian population. Method. Translation and cultural adaptation procedures consisted of translation, synthesis, back translation, author`s approval, and pretest of the assessment. For the pretest, 14 typically developing children were assessed. Was evaluated the use of play materials, duration of the assessment, and reliability. Findings. Play materials and duration of the assessment were appropriate for Brazilian children. Analysis of intra-rater reliability showed good agreement ranging from 0.90 to 1.00. Inter-rater reliability showed good to moderate agreement for five items ranging from 0.76 to 0.59. Four items showed chance to poor agreement (rho = -0.13 to 0.50). Implications. Results of the pretest indicate the Brazilian version of the ChIPPA is potentially useful for Brazilian children. ChIPPA training in Portuguese in Brazil with play observation feedback is recommended to improve inter-rater reliability.

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Transforming growth factor-beta (TGF-beta) is a multifunctional growth factor that has several biological effects in vivo including control of cell growth and differentiation, cell migration, lineage determination, motility, adhesion, apoptosis, and synthesis and degradation of extracellular matrix, and TGF-beta plays an important role in regulating tissue repair and regeneration. Our study analyzed the participation of TGF-beta 1, -beta 2, and -beta 3 in the different stages of morphogenesis and differentiation of human developing dental organ using immunobistochemistry. The maxillae and mandibles of 10 human embryos ranging from 8 to 23 weeks of gestation were employed, according to the approval of the ethical committee. Our study revealed that the TGF-beta subunits-beta 1, beta 2, and beta 3 were present in the various stages of tooth development, but the expression varied according to the differentiation stage, tissue, and TGF-beta subunit. Our results indicated that TGF-beta 1 is closely related to differentiation of enamel organ and initiation of matrix secretion, TGF-beta 2 to cellular differentiation, and TGF-beta 3 to mineral maturation matrix.

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Aim. This study examines the extent to which hospital nurses view their working environment in a positive sense, working as a cohesive group. Background. Despite the fact that nursing in Australia is now considered a profession, it has been claimed that nurses are an oppressed group who use horizontal violence, bullying and aggression in their interactions with one and other. Methods. After ethical approval, a random sample of 666 nurses working directly with patients and all 333 critical care nurses employed in three large tertiary Australian hospitals were invited to participate in the study in the late 1990s. A mailed survey examined the perceptions of interaction nurses had with each other. The hypothesis, that level of employment (either Level I bedside nurses or Level II/III clinical leaders) and area of work (either critical care or noncritical care) would influence perceptions of cohesion, as measured by the cohesion amongst nurses scale (CANS) was tested. Results. In total 555 (56%) surveys were returned. Of these, 413 were returned by Level I and 142 by Level II/III nurses. Of this sample, 189 were critical care and 355 noncritical care nurses. There was no difference between Level I and II/III nurses in mean CANS scores. It is interesting to note that the item rated most positively was, 'nurses on the units worked well together', however, the item rated least positive was 'staff can be really bitchy towards each other' for both Level I and II/III nurses. There was no difference in CANS scores between critical care and noncritical care nurses. Conclusions. Nurses working in Australian hospitals perceived themselves to be moderately cohesive but, as would be expected in other work settings, some negative perceptions existed.

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While riparian vegetation can play a major role in protecting land, water and natural habitat in catchments, there are high costs associated with tree planting and establishment and in diverting land from cropping. The distribution of costs and benefits of riparian revegetation creates conflicts in the objectives of various stakeholder groups. Multicriteria analysis provides an appropriate tool to evaluate alternative riparian revegetation options, and to accommodate the conflicting views of various stakeholder groups. This paper discusses an application of multicriteria analysis in an evaluation of riparian revegetation policy options for Scheu Creek, a small sub-catchment in the Johnstone River catchment in north Queensland, Australia. Clear differences are found in the rankings of revegetation options for different stakeholder groups with respect to environmental, social and economic impacts. Implementation of a revegetation option will involve considerable cost for landholders for the benefits of society. Queensland legislation does not provide a means to require farmers to implement riparian revegetation, hence the need for subsidies, tau incentives and moral suasion. (C) 2001 Academic Press.

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Objective. To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and allow clinicians to make informed decisions regarding the risks and benefits of treatment. Methods. Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 27 specialists from academia. governmental agencies, and the pharmaceutical industry participated in a consensus meeting and identified core outcome domains that should be considered in clinical trials of treatments for chronic pain. Conclusions. There was a consensus that chronic pain clinical trials should assess outcomes representing six core domains: (1) pain, (2) physical functioning, (3) emotional functioning, (4) participant ratings of improvement and satisfaction with treatment, (5) symptoms and adverse events, (6) participant disposition (e.g. adherence to the treatment regimen and reasons for premature withdrawal from the trial). Although consideration should be given to the assessment of each of these domains, there may be exceptions to the general recommendation to include all of these domains in chronic pain trials. When this occurs, the rationale for not including domains should be provided. It is not the intention of these recommendations that assessment of the core domains should be considered a requirement for approval of product applications by regulatory agencies or that a treatment must demonstrate statistically significant effects for all of the relevant core domains to establish evidence of its efficacy. (C) 2003 International Association for the Study of Pain.

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We examined the unique relations between the five dimensions of the Attachment Style Questionnaire (ASQ; Feeney, Noller, & Hanrahan, 1994) and depression and agoraphobic behavior (i.e., avoidance of situations where high anxiety is experienced). In addition, we examined mediation models in an attempt to clarify the link between adult attachment and these two dimensions of psychopathology. In testing these models, we administered the ASQ, General Self-Efficacy Scale, Agoraphobic Catastrophic Cognitions Questionnaire, Beck Depression Inventory, and the Mobility Inventory for Agoraphobia (a measure of the degree to which situations are avoided that are typically anxiety provoking for people with agoraphobia) to 122 participants (44 with agoraphobia, 25 with a current major depressive disorder, and 53 with no current psychopathology). The results showed that the insecure attachment dimensions of need for approval, preoccupation with relationships, and relationships as secondary were uniquely associated with depression and that general self-efficacy partly mediated the relationship between need for approval and depression. In contrast, only preoccupation with relationships was uniquely associated with agoraphobic behavior, and catastrophic cognitions about bodily sensations partly mediated this association.

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Se nos estados federais os mecanismos de coopera????o e coordena????o intergovernamental j?? s??o relevantes, no caso brasileiro eles ganham centralidade ainda maior. A Constitui????o Federal de 1988 agregou complexidade ao desenho federativo brasileiro, reconhecendo o munic??pio como ente federado. Esse processo foi acompanhado por intensa descentraliza????o de pol??ticas p??blicas, pelo fortalecimento do poder local e por mecanismos pouco coordenados de rela????o vertical e horizontal entre os entes federativos. Ao mesmo tempo, a aus??ncia de pol??ticas de desenvolvimento regional acentuou as desigualdades locais e regionais observadas historicamente no pa??s. Diferentes experi??ncias de consorciamento foram levadas a cabo por munic??pios no pa??s e ainda hoje esse ?? um instrumento de larga utiliza????o. De forma diversa, as iniciativas de coopera????o entre estados s??o ainda incipientes. As limita????es institucionais e jur??dicas dos desenhos utilizados pelos munic??pios, no entanto, levaram ?? aprova????o da Emenda Constitucional n?? 19/98, que instituiu os cons??rcios p??blicos e a gest??o associada de servi??os p??blicos.

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A necessidade de viabilizar investimentos p??blicos em um contexto de restri????o fiscal impulsionou governos de diversos pa??ses a buscar na parceria com o setor privado a alternativa para a realiza????o de obras e servi??os p??blicos. A experi??ncia paradigm??tica do Reino Unido em programas de parceria p??blico-privada (PPP) norteou a implanta????o de iniciativas semelhantes mundo afora. No Brasil, a aprova????o, em dezembro de 2004, da lei que disciplina as normas para contrata????o de PPP deu in??cio a um processo que passar?? pela defini????o dos projetos priorit??rios e que culminar?? na consolida????o das parcerias como mais um instrumento para a viabiliza????o de obras e servi??os p??blicos de que o pa??s necessita. Esse artigo tem por objetivo elucidar o modelo brasileiro de parcerias p??blico-privadas. Ap??s uma contextualiza????o inicial, s??o discutidos os fundamentos que balizam a implanta????o de um programa de PPP e apresentadas algumas caracter??sticas gerais dos contratos. Por fim, s??o expostos os pontos centrais da lei brasileira.

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O paper estuda o caso da recente reforma da Previd??ncia na It??lia, ilustrando a possibilidade de uma participa????o positiva dos sindicatos ??? tradicionalmente contr??rios ??s reformas ??? no processo de transforma????o do setor p??blico. Ap??s uma revis??o do sistema previdenci??rio italiano, altamente fragmentado e particularista na opini??o dos autores, e o apontamento de suas principais defici??ncias, o estudo concentra-se na an??lise de tr??s propostas de reforma ligadas aos governos de Amato (1992-93), Berlusconi (1994) e Dini (1995), respectivamente. O texto aborda tanto as propostas concretas de mudan??a, trazendo contribui????es sobre uma variedade consider??vel de medidas, seu impacto e aceita????o sociais e por categoria, como os objetivos visados e o processo pol??tico relacionado ?? sua discuss??o e tramita????o. Uma preocupa????o constante dos autores ?? a correla????o entre a postura e a participa????o dos sindicatos em mat??ria de reforma previdenci??ria, por um lado, e o avan??o das propostas governamentais, por outro. Segundo o estudo, a ampla participa????o da for??a sindical na negocia????o do projeto de reforma previdenci??ria do governo Dini representou um fator decisivo para sua aprova????o e implementa????o bem-sucedidas. Ao mesmo tempo, a delibera????o democr??tica para concilia????o de prefer??ncias e interesses (m??ltiplos no caso de assuntos norteados pela dicotomia bem comum/interesse particular) ??? objeto da ??ltima sess??o do estudo ??? ?? vista como uma forma de ampliar a participa????o sindical al??m das lideran??as, passando a incluir os rank-and-file trabalhadores, um procedimento que traz, igualmente, a for??a de uma decis??o majorit??ria. A an??lise da reforma da Previd??ncia italiana ?? ilustrada no paper com tabelas que trazem e comparam dados referentes ?? contribui????o previdenci??ria, ??s categorias de beneficiados e ??s diferentes propostas de reforma formuladas por sucessivos governos italianos.