Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Duke Anticoagulation Satisfaction Scale

Aim. The aim of this study was to evaluate the internal reliability and validity of the BrazilianPortuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. Background. Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. Design. Methodological and cross-sectional research design. Methods. The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The BrazilianPortuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbachs alpha). Results. A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r = -0.47, p < 0.01), Vitality (r = -0.44, p < 0.01) and Mental health (r = -0.42, p < 0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r = -0.375, p < 0.01) (Known groups). The Cronbachs alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)0.46 (psychological impact) among the domains, confirming the internal consistency reliability. Conclusions. The BrazilianPortuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. Relevance to clinical practice. Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

Organization Performance Evaluation Using System Thinking: A Study in Brazilian Chemical Organizations Models

System thinking allows companies to use subjective constructs indicators like recursiveness, cause-effect relationships and autonomy to performance evaluation. Thus, the question that motivates this paper is: Are Brazilian companies searching new performance measurement and evaluation models based on system thinking? The study investigates models looking for system thinking roots in their framework. It was both exploratory and descriptive based on a multiple four case studies strategy in chemical sector. The findings showed organizational models have some characteristics that can be related to system thinking as system control and communication. Complexity and autonomy are deficiently formalized by the companies. All data suggest, inside its context, that system thinking seems to be adequate to organizational performance evaluation but remains distant from the management proceedings.

Prevalence of the BRCA1 founder mutation c.5266dupin Brazilian individuals at-risk for the hereditary breast and ovarian cancer syndrome

About 5-10% of breast and ovarian carcinomas are hereditary and most of these result from germline mutations in the BRCA1 and BRCA2 genes. In women of Ashkenazi Jewish ascendance, up to 30% of breast and ovarian carcinomas may be attributable to mutations in these genes, where 3 founder mutations, c.68_69del (185delAG) and c.5266dup (5382insC) in BRCA1 and c.5946del (6174delT) in BRCA2, are commonly encountered. It has been suggested by some authors that screening for founder mutations should be undertaken in all Brazilian women with breast cancer. Thus, the goal of this study was to determine the prevalence of three founder mutations, commonly identified in Ashkenazi individuals in a sample of non-Ashkenazi cancer-affected Brazilian women with clearly defined risk factors for hereditary breast and ovarian cancer (HBOC) syndrome. Among 137 unrelated Brazilian women from HBOC families, the BRCA1c.5266dup mutation was identified in seven individuals (5%). This prevalence is similar to that encountered in non-Ashkenazi HBOC families in other populations. However, among patients with bilateral breast cancer, the frequency of c.5266dup was significantly higher when compared to patients with unilateral breast tumors (12.1% vs 1.2%, p = 0.023). The BRCA1 c.68_69del and BRCA2 c.5946del mutations did not occur in this sample. We conclude that screening non-Ashkenazi breast cancer-affected women from the ethnically heterogeneous Brazilian populations for the BRCA1 c.68_69del and BRCA2 c.5946del is not justified, and that screening for BRCA1c.5266dup should be considered in high risk patients, given its prevalence as a single mutation. In high-risk patients, a negative screening result should always be followed by comprehensive BRCA gene testing. The finding of a significantly higher frequency of BRCA1 c.5266dup in women with bilateral breast cancer, as well as existence of other as yet unidentified founder mutations in this population, should be further assessed in a larger well characterized high-risk cohort.

Best practice: streaming server for educational videos at Universities

[EN]In this paper we present a video streaming solution. It describes the functionality of streaming server at our university and the workflow to embed videos into the learning platform Moodle. By the server-side role management teachers can get access to upload their recorded lectures to the server. Videos will be converted into different streaming formats and embed into the learning platform with provided embed code. The number of teachers who use this proposal is continuously growing at our university. Beside the lecture scripts the videos watched often by the students what the numbers of video accesses in the Moodle course and the streaming server traffic significantly show.

Is characterization of a single isolate sufficient for valid publication of a new genus or species? Proposal to modify recommendation 30b of the Bacteriological Code (1990 Revision)

From 1990 to 2000, the number of published named taxa based upon new isolates at species and genus levels in International Journal of Systematic and Evolutionary Microbiology, formerly International Journal of Systematic Bacteriology, have increased by approximately four- and sevenfold, respectively. New taxa based upon characterization of only a single isolate remained at around 40% for both categories. The Bacteriological Code (1990 Revision) has no recommendations on the number of strains required for definition of new taxa. For a few groups, a minimum number of 5-10 strains has been suggested in minimal standards. Since an exponential increase in new taxa can be expected in the future, the authors discuss problems related to naming new species and genera based upon descriptions of a single isolate and suggest that this practice is re-evaluated. It is proposed that the following should be added to Recommendation 30b of the Bacteriological Code: 'Descriptions should be based on as many strains as possible (minimum five), representing different sources with respect to geography and ecology in order to be well characterized both phenotypically and genotypically, to establish the centre (from which the type strain could be chosen) and the extent of the cluster to be named. In addition, comparative studies should be performed, including reference strains that represent neighbouring species and/or genera, in order to give descriptions that are sufficiently detailed to allow differentiation from these neighbours.'

Outcomes assessment of a pediatric practice guideline

Objective. This study examines the structure, processes, and data necessary to assess the outcome variables, length of stay and total cost, for a pediatric practice guideline. The guideline was developed by a group of physicians and ancillary staff members representing the services that most commonly provide treatment for asthma patients at Texas Children's Hospital, as a means of standardizing care. Outcomes have needed to be assessed to determine the practice guideline's effectiveness.^ Data sources and study design. Data for the study were collected retrospectively from multiple hospital data bases and from inpatient chart reviews. All patients in this quasi-experimental study had a diagnosis of Asthma (ICD-9-CM Code 493.91) at the time of admission.^ The study examined data for 100 patients admitted between September 15, 1995 and November 15, 1995, whose physician had elected to apply the asthma practice guideline at the time of the patient's admission. The study examined data for 66 inpatients admitted between September 15, 1995 and November 15, 1995, whose physician elected not to apply the asthma practice guideline. The principal outcome variables were identified as "Length of Stay" and "Cost".^ Principal findings. The mean length of stay for the group in which the practice guideline was applied was 2.3 days, and 3.1 days for the comparison group, who did not receive care directed by the practice guideline. The difference was statistically significant (p value = 0.008). There was not a demonstrable difference in risk factors, health status, or quality of care between the groups. Although not showing statistical significance in the univariate analysis, private insurance showed a significant difference in the logistic regression model presenting an elevated odds ratio (odds ratio = 2.2 for a hospital stay $\le$2 days to an odds ratio = 4.7 for a hospital stay $\le$3 days) showing that patients with private insurance experienced greater risk of a shorter hospital stay than the patients with public insurance in each of the logistic regression models. Public insurance included; Medicaid, Medicare, and charity cases. Private insurance included; private insurance policies whether group, individual, or managed care. The cost of an admission was significantly less for the group in which the practice guideline was applied, with a mean difference between the two groups of $1307 per patient.^ Conclusion. The implementation and utilization of a pediatric practice guideline for asthma inpatients at Texas Children's Hospital has a significant impact in terms of reducing the total cost of the hospital stay and length of the hospital stay for asthma patients admitted to Texas Children's Hospital. ^

A practice-based culminating experience with Texas Children's Hospital: A hospital's journey to baby-friendly status

Breastfeeding and the use of human milk are widely accepted as the most complete form of nutrition for infants. Breastfeeding is shown to be associated with many positive health outcomes for both infants and mothers. Healthy People 2000 goals to increase breastfeeding rates in the early postpartum period to 75% fell short, with only 64% of mothers meeting this objective. Lack of support from healthcare providers, and unsupportive hospital policies and practices are noted as barriers to the initiation and duration of breastfeeding. The purpose of this study was to evaluate implementation of the BFHI Ten Steps to Successful Breastfeeding at Texas Children's Hospital. ^ The Baby-Friendly Hospital Initiative (BFHI) was developed in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF) to ensure that healthcare facilities offering maternity services adhere to the Ten Steps of Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, and create legislation to protect the rights of breastfeeding women. The instrument used in this study was the BFHI 100 Assessment Tool created by Dr. Laura Haiek, Director of Public Health in Monteregie, Quebec, and her staff at Health and Social Services Agency of Quebec. The BFHI 100 tool utilizes 100 different indicators of compliance with BFHI through questionnaires administered to staff and administrators, pregnant and postpartum mothers, and an observer. ^ The study concluded that although there is much room for improvement in educating breastfeeding mothers, overall, the mothers interviewed were satisfied with their level of care in regards to breastfeeding support. Areas of improvement include staff training, as some nursing staff admitted to relying on the lactation consultants to provide most of the breastfeeding education for mothers. Only a small percentage of mothers interviewed reported that their baby “roomed-in” on average of 22 hours per day during their hospital stay. Staff encouragement of the rooming-in practice will help to increase the proportion of mothers who allow their babies to room-in. The current breastfeeding policy will also need to be revised and strengthened to be compliant with the Ten Steps. Ideally, Baby-Friendly practices will become the norm after staff are trained and policy revisions are made. Staff training and acceptance of breastfeeding as optimal nutrition for infants are the most critical factors that will ultimately drive change for the organization. ^

Element concentrations and stable isotope record of planktonic foraminifera of sediment cores from the northeastern Brazilian Continental Margin

Detailed 14C AMS data and isotope based stratigraphies from high-resolution paleoceanographic records for the last 22 ka of cores from the upper continental slope off NE Brazil reveal sedimentation rates of up to 100 cm per 1000 yr. Variations in the sediment composition relate to changes in the input of terrigenous material. The sedimentation is controlled by sea level and by the climatic regime of the hinterland. Short-term changes in the tropical wind field may act as a climatic trigger. The zonality of the SE trades was probably increased and the monsoonal activity over Africa reduced during the Younger Dryas period.

Reduced certificates for abstraction-carrying code

Abstraction-Carrying Code (ACC) has recently been proposed as a framework for mobile code safety in which the code supplier provides a program together with an abstraction whose validity entails compliance with a predefined safety policy. The abstraction plays thus the role of safety certifícate and its generation is carried out automatically by a fixed-point analyzer. The advantage of providing a (fixedpoint) abstraction to the code consumer is that its validity is checked in a single pass of an abstract interpretation-based checker. A main challenge is to reduce the size of certificates as much as possible while at the same time not increasing checking time. We introduce the notion of reduced certifícate which characterizes the subset of the abstraction which a checker needs in order to validate (and re-construct) the full certifícate in a single pass. Based on this notion, we instrument a generic analysis algorithm with the necessary extensions in order to identify the information relevant to the checker. We also provide a correct checking algorithm together with sufficient conditions for ensuring its completeness. The experimental results within the CiaoPP system show that our proposal is able to greatly reduce the size of certificates in practice.

On abstraction-carrying code and certificate-size reduction

Abstraction-Carrying Code (ACC) is a framework for mobile code safety in which the code supplier provides a program together with an abstraction (or abstract model of the program) whose validity entails compliance with a predefined safety policy. The abstraction plays thus the role of safety certificate and its generation is carried out automatically by a fixed-point analyzer. The advantage of providing a (fixed-point) abstraction to the code consumer is that its validity is checked in a single pass (i.e., one iteration) of an abstract interpretation-based checker. A main challenge to make ACC useful in practice is to reduce the size of certificates as much as possible, while at the same time not increasing checking time. Intuitively, we only include in the certificate the information which the checker is unable to reproduce without iterating. We introduce the notion of reduced certifícate which characterizes the subset of the abstraction which a checker needs in order to validate (and re-construct) the full certificate in a single pass. Based on this notion, we show how to instrument a generic analysis algorithm with the necessary extensions in order to identify the information relevant to the checker.

Abstraction carrying code and resource-awareness

Proof-Carrying Code (PCC) is a general approach to mobile code safety in which the code supplier augments the program with a certifícate (or proof). The intended benefit is that the program consumer can locally validate the certifícate w.r.t. the "untrusted" program by means of a certifícate checker—a process which should be much simpler, eíñcient, and automatic than generating the original proof. Abstraction Carrying Code (ACC) is an enabling technology for PCC in which an abstract model of the program plays the role of certifícate. The generation of the certifícate, Le., the abstraction, is automatically carried out by an abstract interpretation-based analysis engine, which is parametric w.r.t. different abstract domains. While the analyzer on the producer side typically has to compute a semantic fixpoint in a complex, iterative process, on the receiver it is only necessary to check that the certifícate is indeed a fixpoint of the abstract semantics equations representing the program. This is done in a single pass in a much more efficient process. ACC addresses the fundamental issues in PCC and opens the door to the applicability of the large body of frameworks and domains based on abstract interpretation as enabling technology for PCC. We present an overview of ACC and we describe in a tutorial fashion an application to the problem of resource-aware security in mobile code. Essentially the information computed by a cost analyzer is used to genérate cost certificates which attest a safe and efficient use of a mobile code. A receiving side can then reject code which brings cost certificates (which it cannot validate or) which have too large cost requirements in terms of computing resources (in time and/or space) and accept mobile code which meets the established requirements.

Reduced certificates for abstraction-carrying code

Abstraction-Carrying Code (ACC) has recently been proposed as a framework for mobile code safety in which the code supplier provides a program together with an abstraction (or abstract model of the program) whose validity entails compliance with a predefined safety policy. The abstraction plays thus the role of safety certifícate and its generation is carried out automatically by a fixed-point analyzer. The advantage of providing a (fixed-point) abstraction to the code consumer is that its validity is checked in a single pass (i.e., one iteration) of an abstract interpretation-based checker. A main challenge to make ACC useful in practice is to reduce the size of certificates as much as possible while at the same time not increasing checking time. The intuitive idea is to only include in the certifícate information that the checker is unable to reproduce without iterating. We introduce the notion of reduced certifícate which characterizes the subset of the abstraction which a checker needs in order to validate (and re-construct) the full certifícate in a single pass. Based on this notion, we instrument a generic analysis algorithm with the necessary extensions in order to identify information which can be reconstructed by the single-pass checker. Finally, we study what the effects of reduced certificates are on the correctness and completeness of the checking process. We provide a correct checking algorithm together with sufficient conditions for ensuring its completeness. Our ideas are illustrated through a running example, implemented in the context of constraint logic programs, which shows that our approach improves state-of-the-art techniques for reducing the size of certificates.

Certificate size reduction in abstraction-carrying code

Abstraction-Carrying Code (ACC) has recently been proposed as a framework for mobile code safety in which the code supplier provides a program together with an abstraction (or abstract model of the program) whose validity entails compliance with a predefined safety policy. The abstraction plays thus the role of safety certificate and its generation is carried out automatically by a fixpoint analyzer. The advantage of providing a (fixpoint) abstraction to the code consumer is that its validity is checked in a single pass (i.e., one iteration) of an abstract interpretation-based checker. A main challenge to make ACC useful in practice is to reduce the size of certificates as much as possible while at the same time not increasing checking time. The intuitive idea is to only include in the certificate information that the checker is unable to reproduce without iterating. We introduce the notion of reduced certificate which characterizes the subset of the abstraction which a checker needs in order to validate (and re-construct) the fall certificate in a single pass. Based on this notion, we instrument a generic analysis algorithm with the necessary extensions in order to identify the information relevant to the checker. Interestingly, the fact that the reduced certificate omits (parts of) the abstraction has implications in the design of the checker. We provide the sufficient conditions which allow us to ensure that 1) if the checker succeeds in validating the certificate, then the certificate is valid for the program (correctness) and 2) the checker will succeed for any reduced certificate which is valid (completeness). Our approach has been implemented and benchmarked within the CiaoPP system. The experimental results show t h a t our proposal is able to greatly reduce the size of certificates in practice. To appear in Theory and Practice of Logic Programming (TPLP).

A história do Senhor Bom Jesus da Cana Verde: conflitos e celebrações em torno de uma imagem religiosa (Siqueira Campos PR, 1933)

Essa dissertação abordou os conflitos que ocorreram no espaço geográfico denominado Norte Pioneiro . A imagem do Bom Jesus, de propriedade da família Pinto, foi expropriada pelo vigário da paróquia do Distrito de Salto do Itararé, padre Alfredo Simon, que reuniu cerca de vinte homens aramados para capturar esse santo. Nesse conflito religioso que ocorreu no dia 26/4/1933 duas pessoas foram mortas: o comerciante do Arraial dos Pintos, João Moreira, e o herdeiro do Bom Jesus, José Pinto de Oliveira. Esse último veio a falecer meses depois do conflito. Ao redor dessa imagem foi sendo criada uma história oficial e vigiada pelos donos do poder simbólico, mantenedora da ordem e da tradição. No entanto, a história do Bom Jesus foi compreendida numa concepção mais ampla, pois na esfera religiosa ocorria um fenômeno denominado de romanização. A Igreja Católica seguia o Código de Direito Canônico de 1917, não reconhecendo o Código de Direito Civil do Estado Nacional Brasileiro. Na esfera política, o governo paranaense colocou em prática o sistema de terras devolutas. No setor dos transportes, a estrada de ferro RVPRSC (Rede Viária Paraná Santa Catarina) já se encontrava na região desde 1919. E nesse ínterim, as novas relações sócio-culturais e econômicas foram introduzidas no campo, isto é, o capitalismo agrário.(AU)

A história do Senhor Bom Jesus da Cana Verde: conflitos e celebrações em torno de uma imagem religiosa (Siqueira Campos PR, 1933)

Essa dissertação abordou os conflitos que ocorreram no espaço geográfico denominado Norte Pioneiro . A imagem do Bom Jesus, de propriedade da família Pinto, foi expropriada pelo vigário da paróquia do Distrito de Salto do Itararé, padre Alfredo Simon, que reuniu cerca de vinte homens aramados para capturar esse santo. Nesse conflito religioso que ocorreu no dia 26/4/1933 duas pessoas foram mortas: o comerciante do Arraial dos Pintos, João Moreira, e o herdeiro do Bom Jesus, José Pinto de Oliveira. Esse último veio a falecer meses depois do conflito. Ao redor dessa imagem foi sendo criada uma história oficial e vigiada pelos donos do poder simbólico, mantenedora da ordem e da tradição. No entanto, a história do Bom Jesus foi compreendida numa concepção mais ampla, pois na esfera religiosa ocorria um fenômeno denominado de romanização. A Igreja Católica seguia o Código de Direito Canônico de 1917, não reconhecendo o Código de Direito Civil do Estado Nacional Brasileiro. Na esfera política, o governo paranaense colocou em prática o sistema de terras devolutas. No setor dos transportes, a estrada de ferro RVPRSC (Rede Viária Paraná Santa Catarina) já se encontrava na região desde 1919. E nesse ínterim, as novas relações sócio-culturais e econômicas foram introduzidas no campo, isto é, o capitalismo agrário.(AU)