844 resultados para Difficulties in the intervention
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Dissertação de mestrado integrado em Psicologia
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Fields of murundus (FM) are wetlands that provide numerous ecosystem services. The objectives of this study were to evaluate the chemical [organic carbon (OC), P, K+, Ca2+, Mg2+, Al3+ and H+Al] and physical [texture and bulk density (Bd)] soil attributes and calculate the organic matter (OM) and nutrient stock (P, Ca, Mg, and K) in soils of FM located in the Guapore River basin in Mato Grosso. Thirty-six sampling points were selected, and soil samples were collected from two environments: the murundu and plain area surrounding (PAS). At each sampling point, mini trenches of 0.5 × 0.5 × 0.4 m were opened and disturbed and undisturbed soil samples were collected at depths of 0-0.1, 0.1-0.2, and 0.2-0.4 m. In the Principal Component Analysis the variables H+Al (49%) and OM (4%) were associated with the F1 component and sand content (47%) with the F2 component. The FM had lower pH values and higher concentrations of K+, P, and H+Al than PAS at all depths (p < 0.05). Additionally, FM stocked up to 433, 360, 205, and 11 kg ha-1 of Ca, Mg, K, and P, respectively, for up to a depth of 0.2 m. The murundu stored two times more K and three times more P than that in the PAS. Our results show that the FM has high sand content and Bd greater than 1.5 Mg m-3, high acidity, low OC content, and low nutrient concentrations. Thus, special care must be taken to preserve FM such that human intervention does not trigger environmental imbalances.
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In humans the importance of biofilms in disease processes is now widely recognised together with the difficulties in treating such infections once established. One of the earliest and certainly most studied biofilm in humans is that of dental plaque which is responsible for two of the most prevalent human infections, namely dental caries and periodontal disease. However, comparable studies of dental plaque in animals are relatively limited, despite the fact that similar infections also occur, and in the case of farm animals there is an associated economic impact. In addition, biofilms in the mouths of animals can also be detrimental to human health when transferred by animal bites. As a result, an understanding of both the microbial composition of animal plaque biofilms together with their role in animal diseases is important. Through the use of modern molecular studies, an insight into the oral microflora of animals is now being obtained and, to date, reveals that despite differences in terms of microbial species and relative proportions occurring between humans and animals, similarities do indeed exist. This information can be exploited in our efforts to both manage and treat infections in animals arising from the presence of an oral biofilm. This Chapter describes our current understanding of the microbial composition of animal plaque, its role in disease and how oral hygiene measures can be implemented to reduce subsequent infection.
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OBJECTIVE: To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS: We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or = 8.5mg/dL and women > or = 7.5mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150mg/day titrated up to 300mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36(M4) after the study was completed. RESULTS: Fifty-five patients participated in the study, 31 women, mean age 54.4±10.6 years, body mass index 28.6±3.9kg/m². A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION: Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study.
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Esta propuesta de investigación se enmarca en los encuentros y discusiones que se están realizando en la Escuela de Artes de la Facultad de Filosofía y Humanidades (CEPIA, CIFFyH y SeCyT, de la U.N.C), en relación a las problemáticas de la investigación en Artes. Los encuentros llevados a cabo en diversas ocasiones y a lo largo de 2009, demuestran la necesidad de establecer un campo particular de la investigación y su relación con la práctica artística. Este proyecto nace de estas inquietudes y establece ciertos ejes de trabajo que permiten poner en práctica ciertos esbozos imaginados. En este sentido, nuestra propuesta se centra en definir la misma construcción escénica como objeto de estudio, delimitando sobre éste la problemática de lo real en el trabajo de la ficción, proponiendo además un equipo que permita investigar en su propio desarrollo creativo las diversas variables que entran en juego. De este modo, se trabajará en una propuesta de laboratorio escénico donde los planteos de orden teórico atraviesen la práctica y, a su vez, la observación de ésta permita una reelaboración y profundización del pensamiento contemporáneo sobre la problemática ejecución/representación, desde los diversos órdenes en que ésta interviene. La idea de representación teatral que planteaba Aristóteles señala que las acciones devienen necesariamente en la definición del carácter de los personajes. Este concepto es clave en el desarrollo del teatro occidental y por ende en las diferentes concepciones de actor. La definición de acción dada por Aristóteles es problemática para parte del teatro contemporáneo ya que supone que toda acción es mimética. También da por supuesto que en el teatro se conforman personajes, y que la unidad narrativa está dada por una programática, que es definida por la acción.La presente investigación se propone indagar en la relación entre la ejecución de la acción y su representación en el desarrollo de un laboratorio teatral. Esto implica que necesariamente es aplicada al trabajo escénico. Nuestra hipótesis de partida es que la relación conflictiva entre acción, ejecución de la misma y representación, se produce a partir de la operación material sobre lo real . Estas intersecciones podrían ser pensadas como una teoría del montaje donde la corporalidad es el principio necesario e irreductible de la construcción. La intersección de lo real es una problemática que permite ahondar sobre los procedimientos por los cuales se construye la escena. La idea de un teatro material, obliga a pensar con qué procedimientos se construye ficción. Un teatro que intenta recalar en lo “real” como modo de señalar la cosa misma, se propone, desde la perspectiva de la realización, indagar en los mecanismos de su construcción (procedimientos), por lo cual supone que la actividad teatral puede dar cuenta de los procesos por los cuales se realiza. La realización de una acción, puede remitir a sí misma y genera una relación “extraña” y ambigua con el mundo de referencia. La acción en sí misma, pone en cuestión la idea de modelo y da cuenta de una crisis en la representación. La teoría ha intentado dividir y sistematizar de manera binaria la manifestación teatral: Teatro de Representación/ Teatro Performático, para distinguir un teatro vinculado a la creación de personajes o para relacionarlo a un teatro de ejecución. Sin embargo, pensamos que es posible encontrar en la producción escénica, intersecciones de lo real que median el mundo de la representación y el de la performance para la construcción de ficción. Nuestra hipótesis de base es que si intervenimos el plano de la ejecución en el actor, la representación varía sustancialmente sus mecanismos de producción de sentido. Este primer planteo no es conflictivo hasta que se pone de manifiesto lo real. This research’s proposal is framed into the meetings and discussions that have been taking place in the School of Arts of the Faculty of Philosophy and Humanities (CEPIA, CIFFyH y SeCyT, of the National University of Cordoba), concerning the difficulties of research in Arts. The meetings carried out along 2009, demonstrate the need to establish a particular field of research and its relation to the practice of arts. This project is born from these concerns and it establishes central axis for the work, that enables us to put on practice some sketches imagined. In this regard, our proposal focuses on defining the construction of the scene as object of study, in itself, delimiting the issue of “the real” in the work of fiction. Proposing, furthermore, a team for researching the many variables that comes into play, in their own creative development. Consequently, the work will be developed in the method of a scenic laboratory, where the theoretical proposals cross over the practice and, in turn, these observations allow a reworking and deepen of contemporary thinking about the problematic of performance / representation, from the diverse orders in which it intervene. The idea of theatrical performance proposed by Aristotle, indicate that actions necessarily turn into the definition of the nature of the characters. This concept is key to the development of Western theaterand consequently on the different conceptions of actor. The definition of action given by Aristotle is problematic for a part of the contemporary theater, because it assumes that every action is mimetic. Also presumes that in the theatre the characters are formed, and narrative unit is given by a programmatic, which is defined by the action. This research proposes to explore the relationship between implementation of the action and its representation in the development of a theatrical laboratory. This implies that it is applied necessarily to the scenic practice. Our preliminary hypothesis is that the co.
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Background: Drug-eluting stents have been used in daily practice since 2002, with the clear advantages of reducing the risk of target vessel revascularization and an impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a late thrombosis can compromise long-term results, particularly if the risks of this event were sustained. In this context, a registry of clinical cases gains special value. Objective: To evaluate the efficacy and safety of drug-eluting stents in the real world. Methods: We report on the clinical findings and 8-year follow-up parameters of all patients that underwent percutaneous coronary intervention with a drug-eluting stent from January 2002 to April 2007. Drug-eluting stents were used in accordance with the clinical and interventional cardiologist decision and availability of the stent. Results: A total of 611 patients were included, and clinical follow-up of up to 8 years was obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal infarctions occurred in 4.3% of the cases. Target vessel revascularization occurred in 12.4% of the cases, and target lesion revascularization occurred in 8% of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed no outcome differences between the different types of stents used, including Cypher®, Taxus®, and Endeavor®. Conclusion: These findings indicate that drug-eluting stents remain safe and effective at very long-term follow-up. Patients in the "real world" may benefit from drug-eluting stenting with excellent, long-term results.
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Background:Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.Objective:To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.Methods:We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.Results:Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.Conclusions:Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.
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Today, usability testing in the development of software and systems is essential. A stationary usability lab offers many different possibilities in the evaluation of usability, but it reaches its limits in terms of flexibility and the experimental conditions. Mobile usability studies consider consciously outside influences, and these studies require a specially adapted approach to preparation, implementation and evaluation. Using the example of a mobile eye tracking study the difficulties and the opportunities of mobile testing are considered.
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BACKGROUND: Multiple interventions were made to optimize the medication process in our intensive care unit (ICU). 1 Transcriptions from the medical order form to the administration plan were eliminated by merging both into a single document; 2 the new form was built in a logical sequence and was highly structured to promote completeness and standardization of information; 3 frequently used drug names, approved units, and fixed routes were pre-printed; 4 physicians and nurses were trained with regard to the correct use of the new form. This study was aimed at evaluating the impact of these interventions on clinically significant types of medication errors. METHODS: Eight types of medication errors were measured by a prospective chart review before and after the interventions in the ICU of a public tertiary care hospital. We used an interrupted time-series design to control the secular trends. RESULTS: Over 85 days, 9298 lines of drug prescription and/or administration to 294 patients, corresponding to 754 patient-days were collected and analysed for the three series before and three series following the intervention. Global error rate decreased from 4.95 to 2.14% (-56.8%, P < 0.001). CONCLUSIONS: The safety of the medication process in our ICU was improved by simple and inexpensive interventions. In addition to the optimization of the prescription writing process, the documentation of intravenous preparation, and the scheduling of administration, the elimination of the transcription in combination with the training of users contributed to reducing errors and carried an interesting potential to increase safety.
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This paper assesses the impact of official central bank interventions (CBIs) on exchange rate returns, their volatility and bilateral correlations. By exploiting the recent publication of intervention data by the Bank of England, this study is able to investigate fficial interventions by a total number of four central banks, while the previous studies have been limited to three (the Federal Reserve, Bundesbank and Bank of Japan). The results of the existing literature are reappraised and refined. In particular, unilateral CBI is found to be more successful than coordinated CBI. The likely implications of these findings are then discussed.
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In line with global changes, the UK regulatory regime for audit and corporate governance has changed significantly since the Enron scandal, with an increased role for audit committees and independent inspection of audit firms. UK listed company chief financial officers (CFOs), audit committee chairs (ACCs) and audit partners (APs) were surveyed in 2007 to obtain views on the impact of 36 economic and regulatory factors on audit quality. 498 usable responses were received, representing a response rate of 36%. All groups rated various audit committee interactions with auditors among the factors most enhancing audit quality. Exploratory factor analysis reduces the 36 factors to nine uncorrelated dimensions. In order of extraction, these are: economic risk; audit committee activities; risk of regulatory action; audit firm ethics; economic independence of auditor; audit partner rotation; risk of client loss; audit firm size; and, lastly, International Standards on Auditing (ISAs) and audit inspection. In addition to the activities of the audit committee, risk factors for the auditor (both economic and certain regulatory risks) are believed to most enhance audit quality. However, ISAs and the audit inspection regime, aspects of the ‘standards-surveillance compliance’ regulatory system, are viewed as less effective. Respondents commented that aspects of the changed regime are largely process and compliance driven, with high costs for limited benefits, supporting psychological bias regulation theory that claims there is overconfidence that a useful regulatory intervention exists.
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This paper describes the construction of monthly income from employment and self employment in the Swiss Household Panel (SHP). It documents the assumptions that have to be taken and addresses possibilities and difficulties when relating monthly income variables with the number of working hours. Finally, some descriptive statistics of the monthly wages are provided from 1999 to 2008. These show a high correlation of wages across the years, which is higher than correlation from yearly wages. This underlies the suitability of these variables on monthly wages for labour market research with the SHP. Median and average hourly wages have increased slightly from 2002 to 2008. The inequality of wages has remained stable for the total population.
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Countries specialised in tourism tend to face two problems with contradictory effects: the commons and the anti-commons, which lead to tourism over- and under-production, respectively. This paper develops a two-period model to analyse the joint effects of both problems on a small and remote tourism economy. Congestion and the complementariness between foreign transport and local tourism services are key features in this type of markets. As a result, direct selling and the presence of foreign tour-operators emerge as possible market arrangements with different implications in terms of welfare and public intervention. Four main results are obtained. First, in the direct selling situation the optimal policy depends on the relative importance of the problems. Second, the existence of tour-operators always leads to tourism over-production. Third, the presence of a single tour-operator does not solve the congestion problem. Lastly, the switch from several tour-operators to a single one is welfare reducing.
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BACKGROUND: Psychomental stress is a major source of illness and reduced productivity. Data objectifying physiological stress responses are scarce. We studied salivary cortisol levels in a highly stressful environment, the pediatric critical care unit. The aim was to identify targets for organizational changes, to implement these changes and to assess their impact on cortisol levels. DESIGN: Repeated measurements observational cohort study (before and after intervention). SUBJECTS: 84 nurses working in two independent teams (A and B) in a 19 bed pediatric intensive care unit. Between study periods team A experienced a major exchange of experienced staff while the turnover rate in team B remained average. MEASUREMENTS AND INTERVENTIONS: Salivary cortisol samples were collected every 2 h and after stressful events. Nurses in study period I showed elevated cortisol levels at the beginning of the late shift, interpreted as an anticipatory stress reaction. To ease conditions during the early part of the late shift (conflicting tasks, noise and crowding), we postponed the afternoon ward round, limited non-urgent procedures and introduced a change in visiting hours. The early shift, which was not affected by the intervention, served as control. MAIN RESULTS: Both crude and adjusted analysis revealed a decrease of cortisol levels at the beginning of the late shift in team B (p = 0.0009), but not in team A (p = 0.464). The control situation showed no difference between teams and study periods. INTERPRETATION: We demonstrated reduced cortisol secretions in one team following organizational changes, which was probably overridden by the disruption of social coherence in the second team.
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BACKGROUND: Among young people, about one in three females and one in five males report experiencing emotional distress but 65-95% of them do not receive help from health professionals. AIM: To assess the differences among young people who seek help and those who do not seek help for their psychological problems, considering the frequency of consultations to their GP and their social resources. DESIGN OF STUDY: School survey. SETTING: Post-mandatory school. METHOD: Among a Swiss national representative sample of 7429 students and apprentices (45.6% females) aged 16-20 years, 1931 young people reported needing help for a problem of depression/sadness (26%) and were included in the study. They were divided into those who sought help (n = 256) and those who did not (n = 1675), and differences between them were assessed. RESULTS: Only 13% of young people needing help for psychological problems consulted for that reason and this rate was positively associated with the frequency of consultations to the GP. However, 80% of young people who did not consult for psychological problems visited their GP at least once during the previous year. Being older or a student, having a higher depression score, or a history of suicide attempt were linked with a higher rate of help seeking. Moreover, confiding in adults positively influenced the rate of help seeking. CONCLUSION: The large majority of young people reporting psychological problems do not seek help, although they regularly consult their GP. While young people have difficulties in tackling issues about mental health, GPs could improve the situation by systematically inquiring about this issue.