BIOMEDICAL LANGUAGE UNDERSTANDING AND EXTRACTION (BLUE-TEXT): A MINIMAL SYNTACTIC, SEMANTIC METHOD

Clinical text understanding (CTU) is of interest to health informatics because critical clinical information frequently represented as unconstrained text in electronic health records are extensively used by human experts to guide clinical practice, decision making, and to document delivery of care, but are largely unusable by information systems for queries and computations. Recent initiatives advocating for translational research call for generation of technologies that can integrate structured clinical data with unstructured data, provide a unified interface to all data, and contextualize clinical information for reuse in multidisciplinary and collaborative environment envisioned by CTSA program. This implies that technologies for the processing and interpretation of clinical text should be evaluated not only in terms of their validity and reliability in their intended environment, but also in light of their interoperability, and ability to support information integration and contextualization in a distributed and dynamic environment. This vision adds a new layer of information representation requirements that needs to be accounted for when conceptualizing implementation or acquisition of clinical text processing tools and technologies for multidisciplinary research. On the other hand, electronic health records frequently contain unconstrained clinical text with high variability in use of terms and documentation practices, and without commitmentto grammatical or syntactic structure of the language (e.g. Triage notes, physician and nurse notes, chief complaints, etc). This hinders performance of natural language processing technologies which typically rely heavily on the syntax of language and grammatical structure of the text. This document introduces our method to transform unconstrained clinical text found in electronic health information systems to a formal (computationally understandable) representation that is suitable for querying, integration, contextualization and reuse, and is resilient to the grammatical and syntactic irregularities of the clinical text. We present our design rationale, method, and results of evaluation in processing chief complaints and triage notes from 8 different emergency departments in Houston Texas. At the end, we will discuss significance of our contribution in enabling use of clinical text in a practical bio-surveillance setting.

Understanding Dropout and Prolonged Engagement in Adolescent Competitive Sport

Objectives: The purpose of this study is to gain understanding of training patterns and roles of significant others (i.e. coaches, parents, peers, and siblings) in adolescent swimmers’ sport participation patterns. Design: The developmental model of sport participation [Côté, J., Baker, J., & Abernethy, B. (2003). From play to practice: A developmental framework for the acquisition of expertise in team sport. In J. Starkes, & K. A. Ericsson (Eds.), Recent advances in research on sport expertise (pp. 89–114). Champaign, IL: Human Kinetics; Côté, J., & Fraser-Thomas, J. (2007). Youth involvement in sport. In P. R. E. Crocker (Ed.), Introduction to sport psychology: A Canadian perspective (pp. 266–294). Toronto: Pearson Prentice Hall] was used as a framework. Method: Ten dropout and 10 engaged swimmers, matched on key demographic variables participated in a semi-structured qualitative interview. Results: Groups had many similar experiences (e.g. early training, supportive and unsupportive coaches, involved parents). However, only dropouts spoke of early peak performances, limited one-on-one coaching, pressuring parents during adolescence, lack of swimming peers during adolescence, and sibling rivalries. In contrast, only engaged athletes spoke of clubs’ developmental philosophies, coaches’ and parents’ open communication, school friends’ support, and siblings’ general positive influences. Conclusions: Findings highlight the importance of appropriately structured programs and the fragility of athletes’ relationships with significant others during the adolescent years. Implications for sport programmers, coaches, and parents are discussed.

Audit of selective and non-selective non-steroidal anti-inflammatory drug use in rural general practice

Aim: To identify the demographics and risk factors in a selected patient population prescribed non-selective and cyclo-oxygenase-2 (COX- 2) selective non-steroidal anti-inflammatory drugs (NSAIDs). Method: A structured clinical self-audit form was distributed in January to March 2001 to 155 interested general practitioners (GPs) in rural Queensland. Results: Seventy one GPs participated in the audit and contributed 1417 patient records - 790 patients had received nonselective NSAIDs and 627 had received COX-2 inhibitors (celecoxib or rofecoxib). Patients who received COX-2 inhibitors were significantly older, more likely to have clinically important concomitant illness, and more likely to be taking medication known to interact with NSAIDs. They were also twice as likely to have two or more risk factors for adverse effects. The most common reasons for switching from an NSAID to a COX-2 inhibitor were reported to be a previous side effect from an NSAID (primarily related to gastrointestinal effects) or the doctor's perception of the superior efficacy of COX-2 inhibitor therapy. Conclusions: This study has shown that COX-2 inhibitors were used in a distinctly different patient population compared to non-selective NSAIDs. There were significant variations in the demographics and number of risk factors - for example, cardiovascular and renal - between the two identified populations. These differences may be due to doctors selecting COX-2 inhibitors for patients at high risk of gastrointestinal complications. However, the prescribing pattern may also be partly due to misconceptions about the relative safety and efficacy of COX-2 inhibitor drugs.

Greene Climacteric Scale: norms in an Australian population in relation to age and menopausal status

Objectives The aim of this study was two-fold: to assess climacteric symptoms and provide normative data for the Greene Climacteric Scale during the menopause transition, and to investigate the prevalence of climacteric symptoms in a representative sample of postmenopausal Australian women. Method A cohort of 500 premenopausal, perimenopausal and postmenopausal women aged 40-80 years participated in the Longitudinal Study of Ageing in Women (LAW study) at the Royal Brisbane and Women's Hospital, Brisbane, Australia. In year 1 of the study (2001), all participants completed the Greene Climacteric Scale and information regarding their menopausal status and the use of hormone therapy (HT) was obtained through a clinical interview with a qualified medical practitioner. Results The 50-59-year age group achieved the highest scores on the vasomotor and the depression scales in comparison to other age groups. Significant differences were also evident on the vasomotor and the depression scales on the basis of menopausal status, especially in perimenopausal women. Approximately 10% of women in the 60-79-year age group continued to experience vasomotor symptoms. Conclusion Vasomotor symptoms, as assessed by the Greene Climacteric Scale, are common during the menopause transition and remain elevated for some years in a minority of older postmenopausal women. The norms presented in this study are appropriate for use in an Australian population.

Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

EFICÁCIA ADAPTATIVA E SITUAÇÕES DE CRISE EM PORTADORES DO VÍRUS HIV IMUNODEFICIÊNCIA HUMANA / AIDS.

O objetivo desta pesquisa foi investigar a eficácia adaptativa e situações de crise de indivíduos portadores do vírus HIV do Programa Municipal DST/AIDS de Aparecida SP. O instrumento utilizado foi a Entrevista Clínica Preventiva - EDAO (Escala Diagnóstica Adaptativa Operacionalizada). Participaram do estudo 5 homens e 5 mulheres que freqüentavam o serviço de saúde. Os resultados do trabalho revelaram que ser portador de uma doença crônica carregada de estigmas como a AIDS é um fator desestruturante para o diagnóstico. Foi percebida na população estudada o comprometimento dos setores afetivo-relacional e produtividade, seguido do sóciocultural. Foram observados alguns aspectos importantes como: a crise do impacto diagnóstico como sendo algo marcante em todos os participantes, bem como o uso de drogas, comportamentos vulneráveis que possivelmente levaram à infecção pelo vírus HIV, dificuldades de resolução de conflitos e nas relações interpessoais, perdas vivenciadas durante toda a vida e também no decorrer da infecção e o fenômeno da feminização do vírus HIV através das mulheres entrevistadas, que foram infectadas por seus parceiros sexuais estáveis. No setor orgânico de funcionamento, a população estudada mostrou adesão ao tratamento A maioria da população estudada foi diagnosticada com adaptação ineficaz severa. Este estudo trouxe questionamentos importantes sobre a maneira com a qual o indivíduo portador do vírus HIV mantém seu equilíbrio psíquico e suas relações com o trabalho que executa, chamando atenção para a necessidade de outros estudos que contemplem diferentes instrumentos para a compreensão do tema.

AVALIAÇÃO DA EFICÁCIA ADAPTATIVA DE ATLETAS DE BASQUETEBOL

O objetivo deste estudo foi de analisar e descrever a eficiência adaptativa dos atletas de basquetebol sub19, e verificar se o resultado obtido apresenta implicações no desempenho dos mesmos nos jogos, assim como, de alguma forma, classificá-los a partir da qualidade de adaptação. Método: levantou-se a qualidade da eficácia adaptativa de oito atletas de basquetebol da categoria sub19 com idades entre 18 e 19 anos, todos do gênero masculino e ensino médio completo, por meio de entrevista clínica preventiva e da EDAO (Escala Diagnóstica Adaptativa Operacionalizada). Os índices de desempenho foram verificados a partir dos Índices de Eficácia Técnica da Federação Paulista de Basquete, em sete jogos. Os resultados indicaram um equilíbrio considerável em relação às qualidades adaptativas mostradas pelos atletas no momento da entrevista clínica preventiva, dentre os oito entrevistados dois tiveram como resultado adaptação eficaz; dois obtiveram classificação em adaptação ineficaz leve e quatro em adaptação ineficaz moderada. A análise da EDAO indicou prognóstico bom e ótimo a 50% da amostra e prognóstico regular a 50% da amostra. Os resultados desse estudo em relação à qualidade de adaptação e implicação no desempenho dos atletas (eficiência técnica) mostraram possíveis relações. Concluímos que por meio da EDAO pode-se investigar as demandas de atletas e comissões técnicas para o planejamento de programas de intervenção psicológica eficazes, adequando o instrumento ao contexto desportivo.

DIABETES MELLITUS TIPO1: EVOLUÇÃO DA EFICÁCIA ADAPTATIVA E PSICOTERAPIA BREVE OPERACIONALIZADA

O objetivo deste trabalho foi avaliar a eficácia adaptativa, antes e após intervenção em Psicoterapia Breve Operacionalizada em um paciente portador de Diabetes Mellitus tipo1. Os instrumentos utilizados foram a Entrevista Clínica Preventiva, a Escala Diagnóstica Adaptativa Operacionalizada EDAO e a Psicoterapia Breve Operacionalizada PBO. O delineamento desta pesquisa se deu pelo método clínico combinado ao método descritivo observacional. Foi realizado um estudo de caso com um paciente diagnosticado com Diabetes Mellitus tipo1, que foi submetido a oito entrevistas diagnósticas para a obtenção do diagnóstico clínico e em seguida a doze sessões de Psicoterapia Breve Operacionalizada. Após seis meses do término das sessões o paciente participou de uma entrevista de Follow up. O diagnóstico adaptativo, após as primeiras entrevistas foi: Adaptação Ineficaz Severa, no qual foram detectadas as situações-problemas a serem abordadas na PBO e foi organizado o planejamento desta intervenção. Finalizada a PBO e após seis meses o paciente foi submetido a uma entrevista de Follow up, no qual a classificação diagnóstica foi: Adaptação Ineficaz Leve. Conclui-se que neste estudo de caso que houve uma evolução no diagnóstico adaptativo após a intervenção em PBO, mostrando a importância do atendimento em Psicoterapia Breve Operacionalizada.

A relação entre transtorno da insônia e funções executivas em adultos

The insomnia disorder is defined as a difficulty initiating or maintaining sleep or waking up earlier than expected unable to return to sleep, followed by a feeling of nonrestorative and poor quality sleep, present for at least three months, with consequences on daytime functioning. Studies have shown that insomnia affects cognitive function, especially executive functions. However, researches that sought to investigate the relationship between primary insomnia and executive functioning were quite inconsistent from a methodological point of view, especially in regard to the variability of the used methods, the heterogeneity of diagnostic criteria for insomnia and the control of sleep altering drugs. In this sense, the present study aimed to investigate the relationship between insomnia and executive functions in adults. The participants were 29 people, from both genders, aged 20-55 years old. Participants were divided into three groups, one composed of 10 people with primary insomnia who used sleep medication (GIM), nine people with primary insomnia who did not use medication (GInM) and 10 healthy people who composed the control group (CG). The research was conducted in two stages. The first one involved a diagnostic evaluation for insomnia disorder through a clinical interview and the application of the following protocols: the Athens Insomnia Scale, the Insomnia Severity Index, Sleep Journal (for 14 days), Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Test, depression and anxiety Beck inventories, and Lipp’s Iventory of stress symptoms for adults. After this stage, the evaluation of executive functions was performed by applying a battery of neuropsychological tests composed by the following tests: Wisconsin, Stoop Test, Colored trails Test, the Tower of London Test, Iowa Gambling Task (IGT) and WAIS III subtest digit span, which measured selective attention, inhibitory control, cognitive flexibility, planning, problem solving, decision making and working memory, respectively. The results showed that insomniacs (GIM and GInM) showed higher sleep latency, shorter sleep duration and lower sleep efficiency compared to the CG. In regard to the performance in executive functions, no statistically significant difference between groups was observed in the evaluated modalities. However, the data show evidence that, compared to GInM and GC, the performance of GIM was lower on tasks that required quick responses and changes in attention focus. On the other hand, GInM, when compared to GIM and GC, showed a better performance on tasks involving cognitive flexibility. Furthermore, impaired sleep measures were correlated with the worst performance of insomniacs in all components evaluated. In conclusion, people with the insomnia disorder showed a performance similar to healthy people’s in components of the executive functioning. Thus, one can infer that there is a relationship between primary insomnia and executive functions in adults.

Ser gestora da educação infantil: quais sentidos atribuídos na cultura profissional?

This research has been the aim understanding the senses that managers attribute to school management of the Child Education from his owner teacher high degree formation and his professional culture. The need to research about the sense attributed to the school management of the Child Education by the managers could be considered as contribute to school management studies in the manager team perspective itself. It depart from idea that attributed senses reveal the reinvention process of the professional culture those escape from a regard less attentive and take divers forms, been construct and reconstruct in the social interactions in the live quotidian of school community. The empirical investigation has developed in the Centro Municipal de Educação Infantil (CMEI) Marilanda Bezerra, located in Natal city (RN), during the years of 2012-2013. The methodology is endorsed in the qualitative approach with character of an ethnography type research in education having as main information’s construction tools the semi structured comprehensive interview. This permit (by the interlocutor’s oral discourse) the interpretation of the senses and values selfattributed to hers actions, the personal notebook of ground registers, the record of the interpretative analysis, the evolutionary plans and the participant observation. It distinguish auteurs as Jean-Claude Kaufmann, Adir Ferreira, Sônia Kramer, Álvaro Marchesi, Júlia Oliveira-Formosinho, Maurice Tardif, Telmo Caria, Andy Hargreaves; those supported this paper theoretically and methodologically. The analysis and the experience interpretation point to the possibilities of sharing actions of the Child Education unity with the community, featuring the importance of a participant and collaborative school management practice of the CMEI, highlight the value of this school management possibilities more horizontal and interactive in an essay of constitute a democratic and critical space to the professional culture, with a decisive participation of the managers team. This educational manager form has demonstrated sensibility, creativity, innovation and the possibility of social transformation through institutional action and Child Education teacher’s practices, cohabiting with the challenges, the dilemmas and the problems of work quotidian and the lacunas of a fragmentary formation.

Atividade de formação interprofissional em urgência pré-hospitalar

To acting in emergencies it is important that health professionals develop specific and differentiated skills, which shows us the importance of training in emergency planning. So undergraduate courses in medicine and nursing should encourage the development of these skills and evaluate them through various instruments targeted to the different fields. The aim of this study was to implement an optional and interprofessional curricular component, focusing on interprofessional education in pre-hospital emergency for medical and nursing courses Federal University of Rio Grande do Norte (UFRN). This is an exploratory descriptive study, with 24 medical and nursing graduates of last year undergraduate of supervised training, who underwent theoretical and practical training in the care of pre-hospital emergency services. There were theoretical and practical lessons per week for one school semester, taught by doctors and nurses of the Emergency Medical Service (EMS), where the topics discussed were: basic and advanced life support, safe transport in clinical emergencies, trauma, gynecological, obstetric, pediatric and psychiatric diseases, and have been carried out practical activities in ambulances. The students were evaluated by pre-test, post-test and practical stations made through the Objective Structured Clinical Evaluation (OSCE), in the skills laboratory of the Health Sciences Center. During the activities the students were encouraged to critical and reflective thinking, highlighting the importance of integration between the various health care professionals. It was observed that 88% of the students had a score increase over the pre-test. In the evaluation process carried out by medical students and nursing UFRN have similar expectations regarding the essential skills acquired during the training activity. The results of this study will form the basis for the organization of interprofessional education activity in pre-hospital emergency medical students and nursing, as well as helped to organize practices stations, identifying basic clinical skills, and implementing student assessment tools UFRN.

Global Mental Health: Five Areas for Value-Driven Training Innovation.

OBJECTIVE: In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training. METHODS: Participants (n = 48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation. RESULTS: Priority values included humility, ethical awareness of power differentials, collaborative action, and "deep accountability" when working in low-resource settings in low- and middle-income countries and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language training, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors in addition to medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds. CONCLUSIONS: Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists.

Contribuição do Estágio Curricular para a Formação Académica e Profissional dos Estagiários: estudo de caso numa instituição de ensino superior

O estágio curricular, quando bem fundamentado, estruturado e orientado, configura-se como um importante componente do processo de formação académica e profissional, no qual o aluno se prepara para a inserção no mercado de trabalho mediante a participação em situações reais de trabalho podendo o aluno pode exercer de forma inicial a sua profissão e as funções inerentes à mesma. A presente dissertação parte de uma investigação qualitativa, realizada a dezasseis alunos da licenciatura de Marketing de uma instituição de ensino portuguesa em particular, bem como aos restantes intervenientes do processo de estágios (coordenador de estágios da instituição e gerentes de uma empresa acolhedora), tendo como objectivos analisar a importância do estágio curricular para o desenvolvimento profissional e académico dos estagiários; verificar se o estágio possibilita a aplicação prática dos conhecimentos adquiridos no curso; e entender quais são as contribuições que o estágio oferece à vida académica e profissional dos estudantes. A pesquisa exploratória realizada envolveu, inicialmente, um levantamento biográfico, apresentado por meio de uma revisão da literatura, e um estudo de caso, onde o instrumento utilizado para a recolha de dados foi a entrevista semi-estruturada. Os resultados apontam que, de uma maneira geral, os estágios contribuem para o desenvolvimento académico e profissional dos estudantes, na medida em que funcionam como uma útil ferramenta de preparação prática do estudante onde o mesmo pode aplicar os conhecimentos teóricos numa esfera prática e assim experimentar pela primeira vez a sua futura profissão. Contudo, verificou-se que o estágio, ao contrário das expetativas dos estagiários, não se traduziu em emprego efectivo na empresa acolhedora e não funcionou como uma ferramenta de inserção profissional evidenciando o facto de que o estágio curricular está, por vezes, a ser usado pelas empresas como forma de flexibilização do trabalho e contratação de mão-de-obra qualificada a baixo custo. Verificou-se ainda que existem muitas lacunas no processo de estágio, nomeadamente, ao nível do acompanhamento e supervisão prestado aos estagiários, tanto pela instituição de ensino como pela empresa acolhedora, o que empobrece a experiência vivenciada pelos alunos e diminui a sua satisfação. Espera-se que esta pesquisa possa contribuir para algumas reflexões ou futuras pesquisas que demonstrem qual a perceção destes factos nas demais instituições e, assim, refletir sobre a realidade do ensino superior português e dos estágios curriculares como um todo. / When well organized, structured and supervised the traineeship becomes one of the major components in the professional and academia training. In the traineeship, the student is trained for his first contact with the real work world by facing and dealing with real work situations in a certain company, being able to apply his former knowledge and performing the required work tasks. The present Master’s thesis resulting from an executed qualitative analysis by interviewing sixteen students with the 1st Degree in Marketing, at a certain portuguese teaching institution, as well as those involved in the whole process taking place during the traineeship of a student such as the host academia coordinator and those from the working institution (companies) where the traineeship takes place. The enquiry mainly consisted in the role and importance of the traineeship in the final academia and starting professional life of the students. This exploratory research was firstly based in a carefully elaborated state-of-the-art (literature review) as well as in a case-study in which data was collected using a semi-structured oral interview. Generally, the results appear to point out that the traineeship is very important and effectively contributes to the final academia and starting professional improvement of the students since the traineeship is a most useful tool in the practical training and effective application of the students knowledge in order to face and cope with their first job. Nevertheless, it was also verified that, against the expectations of the students, the traineeship carried out at a certain company did not result in their first effective job experience at the same place, i.e., the traineeship did not become their way of getting their first job at the same company where the traineeship was carried out. The students also revealed, at that time, their frustration since they were hoping that the traineeship would be an effective tool for them acquire professional placing to get their first job in the same place where it was carried out, sometimes accusing the companies of using it as low-cost unqualified hand labour. Finally, a few gaps in the whole process of the traineeship were also identified namely the lack of proper advisement and/or supervision of the students by the host institution itself as well as by the companies where the traineeship takes place. Therefore, this gap is the basis for the traineeship becoming a very poor experience and resulting in the students low degree of satisfaction. Hopefully, this thesis will contribute for further reflections and/or future researches demonstrating the reality of the Portuguese Academia Institutions and the aims of their traineeship.

Cultural influences on positive affect and reward processing in depressed youth

Thesis (Ph.D.)--University of Washington, 2016-07

O controlo do corpo… O controlo da vida autonomia em adolescentes com anorexia nervosa

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica