884 resultados para Non-compliance situations
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Aim: N-3 fatty acids, especially eicosapentaenoic acid (EPA), may possess anticachectic properties. This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants (experimental: E) with an isocaloric isonitrogenous control supplement (C) for their effects on weight, lean body mass (LBM), dietary intake, and quality of life in cachectic patients with advanced pancreatic cancer. Methods: A total of 200 patients (95 E; 105 C) were randomised to consume two cans/day of the E or C supplement (480 ml, 620 kcal, 32 g protein ± 2.2 g EPA) for eight weeks in a multicentre, randomised, double blind trial. Results: At enrolment, patients' mean rate of weight loss was 3.3 kg/month. Intake of the supplements (E or C) was below the recommended dose (2 cans/day) and averaged 1.4 cans/day. Over eight weeks, patients in both groups stopped losing weight (Δweight E: -0.25 kg/month versus C: -0.37 kg/month; p=0.74) and LBM (ΔLBM E: +0.27 kg/month versus C: +0.12 kg/month; p=0.88) to an equal degree (change from baseline E and C, p<0.001). In view of evident non-compliance in both E and C groups, correlation analyses were undertaken to examine for potential dose-response relationships. E patients demonstrated significant correlations between their supplement intake and weight gain (r=0.50, p<0.001) and increase in LBM (r=0.33, p=0.036). Such correlations were not statistically significant in C patients. The relationship of supplement intake with change in LBM was significantly different between E and C patients (p=0.043). Increased plasma EPA levels in the E group were associated with weight and LBM gain (r=0.50, p<0.001; r=0.51, p=0.001). Weight gain was associated with improved quality of life (p<0.01) only in the E group. Conclusion: Intention to treat group comparisons indicated that at the mean dose taken, enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss. Post hoc dose-response analysis suggests that if taken in sufficient quantity, only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight, lean tissue, and improved quality of life. Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia.
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Self-identity as a careful pedestrian has not been fully considered in previous work on predicting intention to cross the road, or actual crossing behaviour, in non-optimal situations. Evidence suggests that self-identity may be a better predictor than attitudes in situations where decision-making styles have become habitual ways to respond. This study compared contributions of self-identity and attitudes to the prediction of intentions in two situations differing in level of habitual crossing expectation, and to crossing behaviour. Three hundred and sixty-two adults (17–92 years) completed a questionnaire measuring self-identity, attitudes, intentions, experience, social identity variables (e.g. age, gender) and personal limitations (mobility). Two hundred and five participants also completed a road-crossing simulation. Self-identity and attitude were both shown as significant independent predictors of intention in both situations. However, self-identity was less effective as a predictor in the higher risk scenario, where intention to perform the behaviour was lower, and for participants aged >75 years who had lower intention across scenarios. Self-identity strongly predicted intention to cross, which in turn predicted behaviour, but self-identity did not directly predict behaviour. Self-identity was strongly predicted by age. Implications for theories of compensation in older age and for design and targeting of pedestrian safety education are discussed.
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Background: Some Australian pharmacists use continuing education to maintain knowledge and acquire new information. There has been a progression from continuing education to continuing professional development (CPD) - a mandatory requirement for pharmacists in all jurisdictions of Australia. Aim: To identify post-registration learning trends of community pharmacists in Western Australia. Method: A questionnaire was developed and administered by face-to-face interviews with community pharmacists in metropolitan Perth. Pharmacists registered for less than 12 months and pharmacists working in hospitals were excluded. Results: 103 pharmacists were approached with a response rate of 95%. Journals (41%), reference books (23%) and the Internet (18%) were the most commonly used educational resources cited by pharmacists. Keeping scientific information up-to-date (39%) and gathering practical knowledge (22%) were the leading motivators for pharmacists to participate in continuing education. Factors that hindered participation in continuing education included lack of time (34%), family commitments (21%) and business commitments (21%). 79% of pharmacists agreed with the concept of mandatory CPD. 47% of pharmacists suggested that the primary sanction for not complying with mandatory CPD should be counselling to determine reasons for non-compliance. Conclusion: Community pharmacists preferred educational resources that were easily accessible at convenient times. Most pharmacists were able to fulfil the requirements of CPD, however, further educational support and promotion would ensure the successful uptake of CPD by community pharmacists in Western Australia.
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Die vorliegende Studie prüft Zusammenhänge zwischen Arbeitsintensität, Tätigkeitsspielraum, sozialer Arbeitsumgebung (Kooperation/Kommunikation, soziale Unterstützung, soziale Stressoren) und Stresserleben am Arbeitsplatz mit der basalen Cortisolsekretion im Speichel (Tagesprofil, Aufwachreaktion und Variation über den Tag). Insgesamt 46 Erwerbstätige aus dem Bankwesen sammelten an zwei aufeinander folgenden Arbeitstagen je vier Speichelproben (beim Aufwachen, 30 min nach dem Aufwachen, 14 Uhr und unmittelbar vor dem Zubettgehen), aus denen die individuelle Cortisolkonzentration (Mittelwert aus den jeweils zugehörigen Proben) bestimmt wurde. Die Tätigkeitsmerkmale wurden sowohl mittels Fragebögen als auch objektiv, d.?h. unabhängig vom Arbeitsplatzinhaber, erhoben. Alter, Geschlecht, Rauchen, Body-Mass-Index, gesundheitliche Beeinträchtigungen sowie eventuelle Abweichungen bei der Probensammlung wurden als mögliche Drittvariablen berücksichtigt. Im Ergebnis zeigte sich, dass subjektiv erlebte, geringe soziale Unterstützung und hohe soziale Stressoren mit einer erhöhten Aufwachreaktion bzw. mit einer erhöhten Variation über den Tag assoziiert waren. Für die Arbeitsintensität, den Tätigkeitsspielraum sowie für die objektiv erhobene Kooperation/Kommunikation waren keine Effekte nachweisbar. Die Ergebnisse lassen vermuten, dass sowohl die Belastungs- als auch deren Erhebungsart für den Nachweis von Effekten im Hinblick auf die Cortisolsekretion bei Erwerbstätigen von Bedeutung sind. The present study examines associations between job demands, job control, social work environment (cooperation/communication, social support, social stressors), and strain at work with basal salivary cortisol (day profiles, cortisol awakening reaction, diurnal variation). Forty-six employees collected four saliva samples (immediately after waking up, 30 min after waking up, at 2 p.m. and immediately before going to bed) each on two consecutive working days. We computed the mean across the two days for each of the four saliva samples per employee. Job characteristics were assessed by self-reports as well as by objective job analysis. Analyses were controlled for possible confounding effects of age, gender, smoking, body-mass index, health impairments, and non compliance with the cortisol protocol. Results show that subjectively experienced low social support and high social stressors at work were associated with elevated cortisol awakening reaction and elevated diurnal variation. We found no effects for job demands, job control or objectively assessed cooperation/communication. Our results suggest that both the type of job characteristic as well as the type of measurement of job characteristics have to be taken into account when relating them to employees’ cortisol secretion.
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Background and Objective: Medication non-compliance is a considerable obstacle in achievinga therapeutic goal, whichcan result in poorerhealthcare outcomes, increased expenditure, wastage and potential for medication resistance. The UK Government’s Audit Commission’s publication ‘A Spoonful of Sugar’1 addresses these issues and promotes self-medication systems as a possible solution. The self-medication system within the Liver Transplant Unit (LTU) was implemented to induct patients onto new post- transplantation medication regimes ready for discharge. The system involves initial consultations with both the Liver Transplant Pharmacist and Trans- plant Co-ordinator, supported with additional advice as and when necessary. Design: Following ethical approval, evaluation of the self-medication sys- tem for liver transplant patients was conducted between January and March 2004 via two methods: audit and structured post-transplantation interview. The audit enabled any discrepancies between current Hospital guidelines and Liver Transplant Unit (LTU) practices to be highlighted. Patient interviews generated a retrospective insight into patient acceptance of the self-medication system. Setting: LTU, Queen Elizabeth Hospital, Birmingham, England. Main Outcome Measures: LTU compliance with Hospital self-medication guidelines and patient insight into self-medication system. Results: A total of seven patients were audited. Findings illustrated that self- medication by transplant patients is a complex process which was not fully addressed by current Hospital self-medication guidelines. Twenty-three patients were interviewed, showing an overwhelming positive attitude to- wards participating in their own care and a high level of understanding towards their individual medication regimes. Following a drugs counselling session, 100% of patients understood why they were taking their medica- tion, and their doses, 95% understood how to take their medication and 85% were aware of potential side effects. Conclusions: From this pilot evaluation it can be stated that the LTU self-medication system is appreciated by patients and assists them in fully understanding their medication regimes. There appear to be no major defects in the system. However areas such as communication barriers and on-going internet education were illustrated as areas for possible future investigation. References: 1. Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission; 2001.
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Analysis of risk measures associated with price series data movements and its predictions are of strategic importance in the financial markets as well as to policy makers in particular for short- and longterm planning for setting up economic growth targets. For example, oilprice risk-management focuses primarily on when and how an organization can best prevent the costly exposure to price risk. Value-at-Risk (VaR) is the commonly practised instrument to measure risk and is evaluated by analysing the negative/positive tail of the probability distributions of the returns (profit or loss). In modelling applications, least-squares estimation (LSE)-based linear regression models are often employed for modeling and analyzing correlated data. These linear models are optimal and perform relatively well under conditions such as errors following normal or approximately normal distributions, being free of large size outliers and satisfying the Gauss-Markov assumptions. However, often in practical situations, the LSE-based linear regression models fail to provide optimal results, for instance, in non-Gaussian situations especially when the errors follow distributions with fat tails and error terms possess a finite variance. This is the situation in case of risk analysis which involves analyzing tail distributions. Thus, applications of the LSE-based regression models may be questioned for appropriateness and may have limited applicability. We have carried out the risk analysis of Iranian crude oil price data based on the Lp-norm regression models and have noted that the LSE-based models do not always perform the best. We discuss results from the L1, L2 and L∞-norm based linear regression models. ACM Computing Classification System (1998): B.1.2, F.1.3, F.2.3, G.3, J.2.
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This study was a qualitative investigation, with demographic quantitative features, of post-secondary educational access and legal guidelines for individuals with psychological disabilities. Although disability laws have positively influenced post-secondary educational attitudes and practices relative to accommodating many individuals with disabilities, prevailing stigmas regarding mental illness have discouraged the equal access to higher education for individuals with psychological disabilities. Little research concentrating on this area was found.^ Thirty-six relevant legal case decisions, focusing on a variety of realms of higher education, were scrutinized. The policies, procedures, and practices of six Southeastern United States universities were analyzed through official documents and participant responses from disability service providers and other university employees. Comparisons were made between legal cases, and within and between universities. Case findings also provided standards through which participating university practices could be studied.^ The legal analysis revealed that most institutions did not discriminate against individuals with psychological disabilities. Practices of a few of these institutions, however, suggested non-compliance despite favorable decisions on their behalf. Institutions found to have discriminatory practices were cited for inadequate procedures, or for presumptive assessments of the educational functioning levels of individuals with psychological disabilities.^ Participant university practices generally suggested disability law compliance; however, certain campus interventions were determined to be ineffective in identifying, addressing, and communicating about the educational needs of individuals with psychological disabilities. The most effective services for these individuals, who were described as rapidly increasing in number but lagging in self-advocacy and acceptance by others, went beyond legal requirements.^ Recommendations were made for institutional practices concerning disability-related documentation, written standards and operations, and student identification and referral. Directions for future research focused on study skills training for students; exposure of mental health professionals to client educational needs; and expansion of the current research, on a nationwide collegiate level, and a parallel analysis focusing on business and industry. ^
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This dissertation analyses the Brazilian Supreme Court’s judgement in the Non-compliance Action of the Fundamental Precept 132/RJ and in the Direct Action of Unconstitutionality 4277/DF, which created in the country the same-sex civil union. In This decision, the STF interpreted according to the constitution Article 1.723 of the Civil Code, invoking several fundamentals reaffirmed in the Constitution. From all these laws invoked by the Supreme Court to support the pretorian creation, the content of consitutional Law regarding equality is the only that corresponds, and it is sufficient to evidence the necessity of the creation, by legislator, of the institute for civil rights, since the Constitution forbids distinctions that is not expressly provided for in the Constitution (Art. 3º, IV, of Federal Constitution). In this way, Article 226, § 3º is not an exception capable of satisfying the condition of the consitutional foresight because although it protect, according its content only the civil union “between the man and the woman”, it is not able to forbid the creation, by legislator, of another kinds of families, including the same-sex civil union. As such, the reasoning, now legitimate according to the legislator, is not support the creation of institute by Constitutional Court, because the Court may enforce the Law, interpreting in the purviews allowed by the legal text and its constitutionality. In regard to the civil union of individuos of the same sex, the Court could not deduce that such union was implied by Law, like the interpretation according to the Constitution given by judges, on grounds of semantic purviews of the words man and woman, existents in both articles. The Court could not created it either, exceeding the legal system role. So, upon the institute creation, the STF, exceeded two limits: the interpretation and Law enforcement.
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Neophobia, the fear of novelty, is a behavioral trait found across a number of animal species, including humans. Neophobic individuals perceive novel environments and stimuli to have aversive properties, and exhibit fearful behaviors when presented with non-familiar situations. The present study examined how early life exposure to aversive novel stimuli could reduce neophobia in bobwhite quail chicks. Experiment 1 exposed chicks to a novel auditory tone previously shown to be aversive to naïve chicks (Suarez, 2012) for 24 hours immediately after hatching, then subsequently tested them in the presence of the tone within a novel maze task. Postnatally exposed chicks demonstrated decreased fearfulness compared to naïve chicks, and behaved more similarly to chicks tested in the presence of a known attractive auditory stimulus (a bobwhite maternal assembly call vocalization). Experiment 2 exposed chicks to the novel auditory tone for 24 hours prenatally, then subsequently tested them within a novel maze task. Prenatally exposed chicks showed decreased fearfulness to a similar degree as those postnatally exposed, revealing that both prenatal and postnatal exposure methods are capable of decreasing fear of auditory stimuli. Experiment 3 exposed chicks to a novel visual stimulus for 24 hours postnatally, then subsequently tested them within a novel emergence box / T-maze apparatus. Chicks exposed to the visual stimulus showed decreased fearfulness compared to naïve chicks, thereby demonstrating the utility of this method across sense modalities. Experiment 4 assessed whether early postnatal exposure to one novel stimulus could generalize and serve to decrease fear of novelty when chicks were tested in the presence of markedly different stimuli. By combining the methods of Experiments 1 and 3, this experiment revealed that chicks exposed to one type of stimulus (auditory or visual) demonstrated decreased fear when subsequently tested in the presence of the opposite type of novel stimulus. These results suggest that experience with novel stimuli can moderate the extent to which neophobia will develop during early development.
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This survey has to general objective to evaluate the Food Safety Policy implemented by Restaurantes Populares do Rio Grande do Norte. The survey is qualitative of type exploratory and descriptive. The universe of survey is all Units of Food and Nutrition (UAN) of the Restaurantes Populares do Rio Grande do Norte. To collects of data were used two instruments: interview and form. The interviews were intended to analyze the four axes of the Food Safety: access, food quality, production and marketing of food and organizational arrangement. The form was used to check the quality of nutrition and sanitary-hygienic food served. We used two types of forms: a spreadsheet with the weekly menu and the portions served to verify that the meals serve the nutritional needs proposed by the program; and the check-list of ANVISA to verify the sanitary-hygienic conditions in each unit. Through the survey data and analyses made observe that the access category have some problems such as lack of registration, lack of advertising of Restaurants and wastage of public resources, making policy that should be of included in a policy of exclusion. In the nutritional aspect there is neglect on the daily nutritional goal, because it is not accomplished nutritional analysis of menu offered, the nutritionists do not know what should be the nutritional value of meals served; in the hygienic-health aspect trough the problems identified is concludes that there is no guarantee of food quality hygienic-sanitary, committing the program as a Food Safety Program. About the production and marketing of food is observed some problems as: the goal of sale of meals is not achieved in full, the purchase of genres does not stimulate the local economy, nor generates jobs and income, and inefficient performance of the MEIOS's supervision. In the analysis of organizational arrangement is concluded that the partnerships are beneficial, despite some negative points, therefore, are these partnerships the problems of non-compliance, as both the MEIOS and Nutriti of important criteria established in the partnership. Therefore, it is understood that the Programa Restaurantes Populares in its original formulation is proposed to be a food safety policy, but has some problems that impossible to meet its goal, making it unprofitable like Food Safety Policy
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Conventional taught learning practices often experience difficulties in keeping students motivated and engaged. Video games, however, are very successful at sustaining high levels of motivation and engagement through a set of tasks for hours without apparent loss of focus. In addition, gamers solve complex problems within a gaming environment without feeling fatigue or frustration, as they would typically do with a comparable learning task. Based on this notion, the academic community is keen on exploring methods that can deliver deep learner engagement and has shown increased interest in adopting gamification – the integration of gaming elements, mechanics, and frameworks into non-game situations and scenarios – as a means to increase student engagement and improve information retention. Its effectiveness when applied to education has been debatable though, as attempts have generally been restricted to one-dimensional approaches such as transposing a trivial reward system onto existing teaching materials and/or assessments. Nevertheless, a gamified, multi-dimensional, problem-based learning approach can yield improved results even when applied to a very complex and traditionally dry task like the teaching of computer programming, as shown in this paper. The presented quasi-experimental study used a combination of instructor feedback, real time sequence of scored quizzes, and live coding to deliver a fully interactive learning experience. More specifically, the “Kahoot!” Classroom Response System (CRS), the classroom version of the TV game show “Who Wants To Be A Millionaire?”, and Codecademy’s interactive platform formed the basis for a learning model which was applied to an entry-level Python programming course. Students were thus allowed to experience multiple interlocking methods similar to those commonly found in a top quality game experience. To assess gamification’s impact on learning, empirical data from the gamified group were compared to those from a control group who was taught through a traditional learning approach, similar to the one which had been used during previous cohorts. Despite this being a relatively small-scale study, the results and findings for a number of key metrics, including attendance, downloading of course material, and final grades, were encouraging and proved that the gamified approach was motivating and enriching for both students and instructors.
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The National School Feeding Programme (PNAE) is a public policy in Brazil for over 60 years and represents one of the most important programs of feeding and nutrition in the world. The role of family farming as a source of employment in rural areas, food provider and for ensuring much of the Brazil’s food security is constantly present at the government's and social movement’s agendas. Law 11.947 of 2009 marked its integration in the food supply for the National School Feeding Programme. Article 14 of aforementioned law highlights that a minimum of 30% (thirty percent) of the funds transferred by the National Development Fund Education (FNDE) to the Programme must be used for the purchase of food directly from family farmers or their organizations. The national school feeding policy under the responsibility of the FNDE and is subjected to agencies of internal control, such as the General Controllership of the Union (CGU), of external control, such as the Audit Courts of the Union and the of the states, and to the social control of the school feeding councils. Those funds are transferred to the implementing agencies, which are the education offices of the states, municipalities and of the Federal District. These entities must annually present their accountings to the School Feeding Councils, which analyze them and then issue a conclusive report to the FNDE, approving with or without reservations, or rejecting them. In this sense, this research aims to propose parameters that should contribute to the improvement of the social control over purchases from family farming for the National School Feeding Programme. The study was conducted by non parametric sampling alongside the managers of the implementing entities, school feeding councils and Family Farming Organizations all across Brazil, from the databases provided by FNDE and by the National Union of Cooperatives of Family Agriculture and Solidarity Economy (Unicafes). The study points out that the legal framework of PNAE seeks to ensure the participation of family farming in the food supply for the Programme, despite allowing the executing agencies to justify the non-compliance of the minimum required in a number of ways. The survey also signalizes that the school feeding councils follow the implementation of the Programme very shyly, and points out that there is room to expand and enhance the participation of these councils and organizations of family farming in the execution of PNAE. Its effectiveness requires a constant and effective process of training of the agents involved in the Programme.
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Introdução: O recurso ao serviço de urgência (SU) hospitalar motivado por situações não urgentes é frequente e conduz a pior prestação de cuidados, insatisfação dos utentes e profissionais e aumento dos custos. Objectivos: Determinar os motivos para recurso a SU pediátrica hospitalar. Material e métodos: Estudo descritivo, transversal, entre 10/10 e 31/12/2013 em SU pediátrico hospitalar, através de análises de inquéritos preenchidos de forma anónima pelos acompanhantes e complementados com informação clínica pelo médico. Resultados: Foram analisados 481 questionários. O recurso ao SU ocorreu nas primeiras 24 horas de doença em 48% dos casos. Os principais motivos foram: noção de doença grave e urgente (33%), local de atendimento mais próximo (17%), preferência por avaliação por pediatra (17%). A maioria teve alta sem realização de exames complementares de diagnóstico ou tratamento (89%) e os principais diagnósticos de alta foram nasofaringite e gastroenterite agudas. Apenas 19,7% das idas ao SU poderiam ser consideradas como “justificadas” pelo cumprimento dos critérios de OMS para urgência hospitalar ou por orientação prévia por outra entidade de saúde. Não existem diferenças estatisticamente significativas entre as características das crianças que recorreram ao SU de forma “justificada” e “não justificada”. Discussão e conclusão: O reconhecimento de situações clínicas que justifiquem o recurso ao SU hospitalar não parece relacionado com habilitações literárias parentais ou atribuição de médico de família. A percepção de doença grave em situação benigna com recurso precoce e injustificado ao atendimento em contexto de serviço de urgência denota falta de educação para a saúde na população geral.
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This survey has to general objective to evaluate the Food Safety Policy implemented by Restaurantes Populares do Rio Grande do Norte. The survey is qualitative of type exploratory and descriptive. The universe of survey is all Units of Food and Nutrition (UAN) of the Restaurantes Populares do Rio Grande do Norte. To collects of data were used two instruments: interview and form. The interviews were intended to analyze the four axes of the Food Safety: access, food quality, production and marketing of food and organizational arrangement. The form was used to check the quality of nutrition and sanitary-hygienic food served. We used two types of forms: a spreadsheet with the weekly menu and the portions served to verify that the meals serve the nutritional needs proposed by the program; and the check-list of ANVISA to verify the sanitary-hygienic conditions in each unit. Through the survey data and analyses made observe that the access category have some problems such as lack of registration, lack of advertising of Restaurants and wastage of public resources, making policy that should be of included in a policy of exclusion. In the nutritional aspect there is neglect on the daily nutritional goal, because it is not accomplished nutritional analysis of menu offered, the nutritionists do not know what should be the nutritional value of meals served; in the hygienic-health aspect trough the problems identified is concludes that there is no guarantee of food quality hygienic-sanitary, committing the program as a Food Safety Program. About the production and marketing of food is observed some problems as: the goal of sale of meals is not achieved in full, the purchase of genres does not stimulate the local economy, nor generates jobs and income, and inefficient performance of the MEIOS's supervision. In the analysis of organizational arrangement is concluded that the partnerships are beneficial, despite some negative points, therefore, are these partnerships the problems of non-compliance, as both the MEIOS and Nutriti of important criteria established in the partnership. Therefore, it is understood that the Programa Restaurantes Populares in its original formulation is proposed to be a food safety policy, but has some problems that impossible to meet its goal, making it unprofitable like Food Safety Policy
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Mestrado em Contabilidade, Fiscalidade e Finanças Empresariais