Improving risk stratification in non-ST-segment elevation myocardial infarction with combined assessment of GRACE and CRUSADE risk scores

BACKGROUND: Risk assessment is fundamental in the management of acute coronary syndromes (ACS), enabling estimation of prognosis. AIMS: To evaluate whether the combined use of GRACE and CRUSADE risk stratification schemes in patients with myocardial infarction outperforms each of the scores individually in terms of mortality and haemorrhagic risk prediction. METHODS: Observational retrospective single-centre cohort study including 566 consecutive patients admitted for non-ST-segment elevation myocardial infarction. The CRUSADE model increased GRACE discriminatory performance in predicting all-cause mortality, ascertained by Cox regression, demonstrating CRUSADE independent and additive predictive value, which was sustained throughout follow-up. The cohort was divided into four different subgroups: G1 (GRACE<141; CRUSADE<41); G2 (GRACE<141; CRUSADE≥41); G3 (GRACE≥141; CRUSADE<41); G4 (GRACE≥141; CRUSADE≥41). RESULTS: Outcomes and variables estimating clinical severity, such as admission Killip-Kimbal class and left ventricular systolic dysfunction, deteriorated progressively throughout the subgroups (G1 to G4). Survival analysis differentiated three risk strata (G1, lowest risk; G2 and G3, intermediate risk; G4, highest risk). The GRACE+CRUSADE model revealed higher prognostic performance (area under the curve [AUC] 0.76) than GRACE alone (AUC 0.70) for mortality prediction, further confirmed by the integrated discrimination improvement index. Moreover, GRACE+CRUSADE combined risk assessment seemed to be valuable in delineating bleeding risk in this setting, identifying G4 as a very high-risk subgroup (hazard ratio 3.5; P<0.001). CONCLUSIONS: Combined risk stratification with GRACE and CRUSADE scores can improve the individual discriminatory power of GRACE and CRUSADE models in the prediction of all-cause mortality and bleeding. This combined assessment is a practical approach that is potentially advantageous in treatment decision-making.

Multiple Imputation of missing values in exploratory factor analysis of multidimensional scales: estimating latent trait scores

ABSTRACT Researchers frequently have to analyze scales in which some participants have failed to respond to some items. In this paper we focus on the exploratory factor analysis of multidimensional scales (i.e., scales that consist of a number of subscales) where each subscale is made up of a number of Likert-type items, and the aim of the analysis is to estimate participants' scores on the corresponding latent traits. We propose a new approach to deal with missing responses in such a situation that is based on (1) multiple imputation of non-responses and (2) simultaneous rotation of the imputed datasets. We applied the approach in a real dataset where missing responses were artificially introduced following a real pattern of non-responses, and a simulation study based on artificial datasets. The results show that our approach (specifically, Hot-Deck multiple imputation followed of Consensus Promin rotation) was able to successfully compute factor score estimates even for participants that have missing data.

Criteria for graphic representation in musical scores: Visual elements in musical scores

A interdisciplinaridade entre a música e as artes visuais tem sido explorado por conceituados teóricos e filósofos, embora não exista muito na área da interpretação visual do grafismo de partituras musicais. Este estudo investiga como os grafismos na notação e símbolos musicais afectam o intérprete na sua transformação em som, com referência especial a partituras contemporâneas, que utilizam notação menos convencional para a criação de uma interpretação por sugestão. Outras relações entre o som e o visual são exploradas, incluindo a sinestesia, a temporalidade e a relação entre obra de arte e público. O objectivo desta dissertação é a de constituir um estudo inovativo sobre partituras musicais contemporâneas, simultaneamente do ponto de vista musical e visual. Finalmente, também vai mais longe, incluindo desenhos da própria autora inspirados e motivados pela música. Estes já não cumprem uma função de notação convencional para o músico, embora existe uma constante possibilidade de uma reinterpretação. ABSTRACT; The inter-disciplinarity between music and visual art has been explored by leading theorists and philosophers, though very little exists in the area of the visual interpretation of graphic musical scores. This study looks at how the graphics of musical notation and symbols affect the performer in transforming them into sound, with particular reference to contemporary scores that use non¬conventional notation to create an interpretation through suggestion. Other sound-visual relationships are explored, including synaesthesia, temporality and the interconnection between work of art and audience or public. This dissertation aims to be an innovative study of contemporary musical scores, from a musical as well as visual perspective. Finally, it takes a step further with drawings of my own, directly inspired and motivated by the music. These no longer fulfil a conventionally notational function for the musician, yet the potential for a re-interpretation is ever-present.

Estimates of genetic parameters for visual scores and their correlation with production and reproductive traits in Brahman cattle

The objective of this study was to evaluate the association of visual scores of body structure, precocity and muscularity with production (body weight at 18 months and average daily gain) and reproductive (scrotal circumference) traits in Brahman cattle in order to determine the possible use of these scores as selection criteria to improve carcass quality. Covariance components were estimated by the restricted maximum likelihood method using an animal model that included contemporary group as fixed effect. A total of 1,116 observations of body structure, precocity and muscularity were used. Heritability was 0.39, 043 and 0.40 for body structure, precocity and muscularity, respectively. The genetic correlations were 0.79 between body structure and precocity, 0.87 between body structure and muscularity, and 0.91 between precocity and muscularity. The genetic correlations between visual scores and body weight at 18 months were positive (0.77, 0.57 and 0.59 for body structure, precocity and muscularity, respectively). Similar genetic correlations were observed between average daily gain and visual scores (0.60, 0.57 and 0.48, respectively), whereas the genetic correlations between scrotal circumference and these scores were low (0.13, 0.02, and 0.13). The results indicate that visual scores can be used as selection criteria in Brahman breeding programs. Favorable correlated responses should be seen in average daily gain and body weight at 18 months. However, no correlated response is expected for scrotal circumference.

Low Test Scores in Latin America: Poor Schools, Poor Families, or Something Else?

Latin American students consistently score low on international tests of cognitive skills. In the PISA 2012 results, students in seven Latin American countries had an average score of 395, or about 100 points lower than the average score of 497 in four Scandinavian countries. We examine why Latin American scores are lower and conclude that 50 points are explained by Latin American families’ lower average educational and socioeconomic characteristics, 25 points are explained by Latin America’s weak cultural orientation toward reading books, and the remaining 25 points are explained by the lower effectiveness of educational systems in teaching cognitive skills.

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

Objective: The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. Method: This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples’ state anxiety scores were re-evaluated after embryo transfer (ET). Results: A significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome. Conclusion: Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

Avoiding staff removal stage in optical music recognition: application to scores written in white mensural notation

Staff detection and removal is one of the most important issues in optical music recognition (OMR) tasks since common approaches for symbol detection and classification are based on this process. Due to its complexity, staff detection and removal is often inaccurate, leading to a great number of errors in posterior stages. For this reason, a new approach that avoids this stage is proposed in this paper, which is expected to overcome these drawbacks. Our approach is put into practice in a case of study focused on scores written in white mensural notation. Symbol detection is performed by using the vertical projection of the staves. The cross-correlation operator for template matching is used at the classification stage. The goodness of our proposal is shown in an experiment in which our proposal attains an extraction rate of 96 % and a classification rate of 92 %, on average. The results found have reinforced the idea of pursuing a new research line in OMR systems without the need of the removal of staff lines.

Examining the Validity of the GRE General Test Scores and Undergraduate GPA for Predicting Success in Graduate School at a Large Racially and Ethnically Diverse Public University in Southeast Florida

The purpose of the study was to determine the degree of relationships among GRE scores, undergraduate GPA (UGPA), and success in graduate school, as measured by first year graduate GPA (FGPA), cumulative graduate GPA, and degree attainment status. A second aim of the study was to determine whether the relationships between the composite predictor (GRE scores and UGPA) and the three success measures differed by race/ethnicity and sex. A total of 7,367 graduate student records (masters, 5,990; doctoral: 1,377) from 2000 to 2010 were used to evaluate the relationships among GRE scores, UGPA and the three success measures. Pearson’s correlation, multiple linear and logistic regression, and hierarchical multiple linear and logistic regression analyses were performed to answer the research questions. The results of the correlational analyses differed by degree level. For master’s students, the ETS proposed prediction that GRE scores are valid predictors of first year graduate GPA was supported by the findings from the present study; however, for doctoral students, the proposed prediction was only partially supported. Regression and correlational analyses indicated that UGPA was the variable that consistently predicted all three success measures for both degree levels. The hierarchical multiple linear and logistic regression analyses indicated that at master’s degree level, White students with higher GRE Quantitative Reasoning Test scores were more likely to attain a degree than Asian Americans, while International students with higher UGPA were more likely to attain a degree than White students. The relationships between the three predictors and the three success measures were not significantly different between men and women for either degree level. Findings have implications both for practice and research. They will provide graduate school administrators with institution-specific validity data for UGPA and the GRE scores, which can be referenced in making admission decisions, while they will provide empirical and professionally defensible evidence to support the current practice of using UGPA and GRE scores for admission considerations. In addition, new evidence relating to differential predictions will be useful as a resource reference for future GRE validation researchers.

CONTINUING EDUCATION TEACHER AND SCORES BASIC EDUCATION DEVELOPMENT: THE PROCESS AND PRODUCT

: The present work has as its theme the continuing education of teachers and their close relationship with the Development Index of Basic Education (IDEB) in the early years. Its main objective is to offer to this level of education professionals and other interested parties, a discussion of ways to a more consistent performance in the classroom. To this end, we have made consideration of the municipal public policies for continuing education of teachers of Portuguese in order to reflect on the importance of planning of actions aimed at continuing education in the municipalities and their reflections in IDEB. The discussion will be subsidized by the propositions of Linguistics of Enunciation based on Bakhtin (1992, 2003) among others. Thus, to sustain the discussion, we selected a town in western Paraná, for which we will launch our eye on the public policy of continuing education and its impact on the teaching of Portuguese. These reflections are connected with the Center for Research Project organized by the Continuing Education for teachers of basic education in the early years: actions for literacy in cities with low IDEB the western Paraná, linked to the Post-graduate studies in Literature and Monitoring Program of Education - CAPES / INEP / SECAD.

A comparative analysis of major ERP lifecycle implementation, management and support issues in Queensland Government

This paper reports on a study of ERP lifecycle major issues from the perspectives of individuals with substantial and diverse involvement with SAP Financials in Queensland Government. A survey was conducted of 117 ERP system project participants in five closely related state government agencies. A modified Delphi technique identified, rationalized and weighed perceived major issues in ongoing ERP life cycle implementation, management and support. The five agencies each implemented SAP Financials simultaneously using a common implementation partner. The three survey rounds of the Delphi technique, together with coding and synthesizing procedures, resulted in a set of 10 major issue categories with 38 sub-issues. Relative scores of issue importance are compared across government agencies, roles (client vs implementation partner) and organizational levels (strategic, technical and operational). Study findings confirm the importance of this finer partitioning of the data, and distinctions identified reflect the circumstances of ERP lifecycle implementation, management and support among the stakeholder groups. The study findings should also be of interest to stakeholders who seek to better understand the issues surrounding ERP systems and to better realise the benefits of ERP.

An Investigation of Cognitive, Emotional and Negative Behavioural Responses to Service Recovery Strategies

Despite the best intentions of service providers and organisations, service delivery is rarely error-free. While numerous studies have investigated specific cognitive, emotional or behavioural responses to service failure and recovery, these studies do not fully capture the complexity of the services encounter. Consequently, this research develops a more holistic understanding of how specific service recovery strategies affect the responses of customers by combining two existing models—Smith & Bolton’s (2002) model of emotional responses to service performance and Fullerton and Punj’s (1993) structural model of aberrant consumer behaviour—into a conceptual framework. Specific service recovery strategies are proposed to influence consumer cognition, emotion and behaviour. This research was conducted using a 2x2 between-subjects quasi-experimental design that was administered via written survey. The experimental design manipulated two levels of two specific service recovery strategies: compensation and apology. The effect of the four recovery strategies were investigated by collecting data from 18-25 year olds and were analysed using multivariate analysis of covariance and multiple regression analysis. The results suggest that different service recovery strategies are associated with varying scores of satisfaction, perceived distributive justice, positive emotions, negative emotions and negative functional behaviour, but not dysfunctional behaviour. These finding have significant implications for the theory and practice of managing service recovery.

Attitudes towards American brands and brand America

A study of 556 students at colleges and universities in Australia, Hong Kong and Singapore explored the relationship between attitude towards the United States and brand attitudes and preferences. Singaporean student attitudes towards both the US Government and US people were higher than were those of the Australian and Hong Kong students. Coke, Nike and McDonald's were among both the most-liked and disliked US brands among the international students, a finding suggesting that brands may possess both a 'lovemark' status, as described in the literature, and its opposite — 'loathemark' status — within the same demographic group. US brand preference scores did not offer support for the belief that international consumers 'vote with their pocketbooks' by refusing to purchase US brands if they have a negative attitude towards the United States. Among Hong Kong and Singaporean students, favourable attitudes towards the purchase of US brands was found to be positively related to favourability towards the US Government.

Investigating the links between muscle strength, sun exposure, dietary vitamin D intake and the vitamin D status of ambulatory older adults in South East Queensland

Vitamin D deficiency and insufficiency are now seen as a contemporary health problem in Australia with possible widespread health effects not limited to bone health1. Despite this, the Vitamin D status (measured as serum 25-hydroxyvitamin D (25(OH)D)) of ambulatory adults has been overlooked in this country. Serum 25(OH)D status is especially important among this group as studies have shown a link between Vitamin D and fall risk in older adults2. Limited data also exists on the contributions of sun exposure via ultraviolet radiation and dietary intake to serum 25(OH)D status in this population. The aims of this project were to assess the serum 25(OH)D status of a group of older ambulatory adults in South East Queensland, to assess the association between their serum 25(OH)D status and functional measures as possible indicators of fall risk, obtain data on the sources of Vitamin D in this population and assess whether this intake was related to serum 25(OH)D status and describe sun protection and exposure behaviors in this group and investigate whether a relationship existed between these and serum 25(OH)D status. The collection of this data assists in addressing key gaps identified in the literature with regard to this population group and their Vitamin D status in Australia. A representative convenience sample of participants (N=47) over 55 years of age was recruited for this cross-sectional, exploratory study which was undertaken in December 2007 in south-east Queensland (Brisbane and Sunshine coast). Participants were required to complete a sun exposure questionnaire in addition to a Calcium and Vitamin D food frequency questionnaire. Timed up and go and handgrip dynamometry tests were used to examine functional capacity. Serum 25(OH)D status and blood measures of Calcium, Phosphorus and Albumin were determined through blood tests. The Mean and Median serum 25-Hydroxyvitamin D (25(OH)D) for all participants in this study was 85.8nmol/L (Standard Deviation 29.7nmol/L) and 81.0nmol/L (Range 22-158nmol/L), respectively. Analysis at the bivariate level revealed a statistically significant relationship between serum 25(OH)D status and location, with participants living on the Sunshine Coast having a mean serum 25(OH)D status 21.3nmol/L higher than participants living in Brisbane (p=0.014). While at the descriptive level there was an apparent trend towards higher outdoor exposure and increasing levels of serum 25(OH)D, no statistically significant associations between the sun measures of outdoor exposure, sun protection behaviors and phenotypic characteristics and serum 25(OH)D status were observed. Intake of both Calcium and Vitamin D was low in this sample with sixty-eight (68%) of participants not meeting the Estimated Average Requirements (EAR) for Calcium (Median=771.0mg; Range=218.0-2616.0mg), while eighty-seven (87%) did not meet the Adequate Intake for Vitamin D (Median=4.46ug; Range=0.13-30.0ug). This raises the question of how realistic meeting the new Adequate Intakes for Vitamin D is, when there is such a low level of Vitamin D fortification in this country. However, participants meeting the Adequate Intake (AI) for Vitamin D were observed to have a significantly higher serum 25(OH)D status compared to those not meeting the AI for Vitamin D (p=0.036), showing that meeting the AI for Vitamin D may play a significant role in determining Vitamin D status in this population. By stratifying our data by categories of outdoor exposure time, a trend was observed between increased importance of Vitamin D dietary intake as a possible determinant of serum 25(OH)D status in participants with lower outdoor exposures. While a trend towards higher Timed Up and Go scores in participants with higher 25(OH) D status was seen, this was only significant for females (p=0.014). Handgrip strength showed statistically significant association with serum 25(OH)D status. The high serum 25(OH)D status in our sample almost certainly explains the limited relationship between functional measures and serum 25(OH)D. However, the observation of an association between slower Time Up and Go speeds, and lower serum 25(OH)D levels, even with a small sample size, is significant as slower Timed Up and Go speeds have been associated with increased fall risk in older adults3. Multivariable regression analysis revealed Location as the only significant determinant of serum 25(OH)D status at p=0.014, with trends (p=>0.1) for higher serum 25(OH)D being shown for participants that met the AI for Vitamin D and rated themselves as having a higher health status. The results of this exploratory study show that 93.6% of participants had adequate 25(OH)D status-possibly due to measurement being taken in the summer season and the convenience nature of the sample. However, many participants do not meet their dietary Calcium and Vitamin D requirements, which may indicate inadequate intake of these nutrients in older Australians and a higher risk of osteoporosis. The relationship between serum 25(OH)D and functional measures in this population also requires further study, especially in older adults displaying Vitamin D insufficiency or deficiency.