864 resultados para Drug Related Problems
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One of the aims of a broad ethnographic study into how the apportionment of risk influences pricing levels of contactors was to ascertain the significant risks affecting contractors in Ghana, and their impact on prices. To do this, in the context of contractors, the difference between expected and realized return on a project is the key dependent variable examined using documentary analyses and semi-structured interviews. Most work in this has focused on identifying and prioritising risks using relative importance indices generated from the analysis of questionnaire survey responses. However, this approach may be argued to constitute perceptions rather than direct measures of the project risk. Here, instead, project risk is investigated by examining two measures of the same quantity; one ‘before’ and one ‘after’ construction of a project has taken place. Risks events are identified by ascertaining the independent variables causing deviations between expected and actual rates of return. Risk impact is then measured by ascertaining additions or reductions to expected costs due to the occurrence of risk events. So far, data from eight substantially complete building projects indicates that consultants’ inefficiency, payment delays, subcontractor-related problems and changes in macroeconomic factors are significant risks affecting contractors in Ghana.
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A simple relationship is described which connects Buffon's classical needle problem with related problems involving circles, squares and rectangles.
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The construction field is dynamic and dominated by complex, ill-defined problems for which myriad possible solutions exist. Teaching students to solve construction-related problems requires an understanding of the nature of these complex problems as well as the implementation of effective instructional strategies to address them. Traditional approaches to teaching construction planning and management have long been criticized for presenting students primarily with well-defined problems - an approach inconsistent with the challenges encountered in the industry. However, growing evidence suggests that employing innovative teaching approaches, such as interactive simulation games, offers more active, hands-on and problem-based learning opportunities for students to synthesize and test acquired knowledge more closely aligned with real-life construction scenarios. Simulation games have demonstrated educational value in increasing student problem solving skills and motivation through critical attributes such as interaction and feedback-supported active learning. Nevertheless, broad acceptance of simulation games in construction engineering education remains limited. While recognizing benefits, research focused on the role of simulation games in educational settings lacks a unified approach to developing, implementing and evaluating these games. To address this gap, this paper provides an overview of the challenges associated with evaluating the effectiveness of simulation games in construction education that still impede their wide adoption. An overview of the current status, as well as the results from recently implemented Virtual Construction Simulator (VCS) game at Penn State provide lessons learned, and are intended to guide future efforts in developing interactive simulation games to reach their full potential.
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Cognitive theories emphasise the role of dysfunctional beliefs about sleep in the development and maintenance of sleep-related problems (SRPs). The present research examines how parents' dysfunctional beliefs about children's sleep and child dysfunctional beliefs about sleep are related to each other and to children's subjective and objective sleep. Participants were 45 children aged 11 -12 years and their parents. Self-report measures of dysfunctional beliefs about sleep and child sleep were completed by children, mothers and fathers. Objective measures of child sleep were taken using actigraphy. The results showed that child dysfunctional beliefs about sleep were correlated with father (r=.43, p<.05) and mother (r=.43, p<.05) reported child SRPs, and with Sleep Onset Latency (r=.34, p<.05). Maternal dysfunctional beliefs about child sleep were related to child SRPs as reported by mothers (r=.44, p<.05), and to child dysfunctional beliefs about sleep (r=.37, p<.05). Some initial evidence was found for a mediation pathway in which child dyfunctional beliefs mediate the relationship between parent dysfunctional beliefs and child sleep. The results support the cognitive model of SRPs and contribute to the literature by providing the first evidence of familial aggregation of dysfunctional beliefs about sleep.
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This thesis examines three different, but related problems in the broad area of portfolio management for long-term institutional investors, and focuses mainly on the case of pension funds. The first idea (Chapter 3) is the application of a novel numerical technique – robust optimization – to a real-world pension scheme (the Universities Superannuation Scheme, USS) for first time. The corresponding empirical results are supported by many robustness checks and several benchmarks such as the Bayes-Stein and Black-Litterman models that are also applied for first time in a pension ALM framework, the Sharpe and Tint model and the actual USS asset allocations. The second idea presented in Chapter 4 is the investigation of whether the selection of the portfolio construction strategy matters in the SRI industry, an issue of great importance for long term investors. This study applies a variety of optimal and naïve portfolio diversification techniques to the same SRI-screened universe, and gives some answers to the question of which portfolio strategies tend to create superior SRI portfolios. Finally, the third idea (Chapter 5) compares the performance of a real-world pension scheme (USS) before and after the recent major changes in the pension rules under different dynamic asset allocation strategies and the fixed-mix portfolio approach and quantifies the redistributive effects between various stakeholders. Although this study deals with a specific pension scheme, the methodology can be applied by other major pension schemes in countries such as the UK and USA that have changed their rules.
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For tokamak models using simplified geometries and reversed shear plasma profiles, we have numerically investigated how the onset of Lagrangian chaos at the plasma edge may affect the plasma confinement in two distinct but closely related problems. Firstly, we have considered the motion of particles in drift waves in the presence of an equilibrium radial electric field with shear. We have shown that the radial particle transport caused by this motion is selective in phase space, being determined by the resonant drift waves and depending on the parameters of both the resonant waves and the electric field profile. Moreover, we have shown that an additional transport barrier may be created at the plasma edge by increasing the electric field. In the second place, we have studied escape patterns and magnetic footprints of chaotic magnetic field lines in the region near a tokamak wall, when there are resonant modes due to the action of an ergodic magnetic limiter. A non-monotonic safety factor profile has been used in the analysis of field line topology in a region of negative magnetic shear. We have observed that, if internal modes are perturbed, the distributions of field line connection lengths and magnetic footprints exhibit spatially localized escape channels. For typical physical parameters of a fusion plasma, the two Lagrangian chaotic processes considered in this work can be effective in usual conditions so as to influence plasma confinement. The reversed shear effects discussed in this work may also contribute to evaluate the transport barrier relevance in advanced confinement scenarios in future tokamak experiments.
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We consider conditions which allow the embedding of linear hypergraphs of fixed size. In particular, we prove that any k-uniform hypergraph H of positive uniform density contains all linear k-uniform hypergraphs of a given size. More precisely, we show that for all integers l >= k >= 2 and every d > 0 there exists Q > 0 for which the following holds: if His a sufficiently large k-uniform hypergraph with the property that the density of H induced on every vertex subset of size on is at least d, then H contains every linear k-uniform hypergraph F with l vertices. The main ingredient in the proof of this result is a counting lemma for linear hypergraphs, which establishes that the straightforward extension of graph epsilon-regularity to hypergraphs suffices for counting linear hypergraphs. We also consider some related problems. (C) 2009 Elsevier Inc. All rights reserved.
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Många projekt misslyckas och en av anledningarna är dålig styrning av projektet i allmänhet och inom IT branschen i synnerhet. Baserad på kritik av de traditionella metoderna under de senaste åren, så har det uppkommit flera lättrörliga metoder som kallas Agila metoder. Scrum är den mest kända Agila metoden som används idag. Metoden lovar goda resultat, men i en artikel ur tidningen Computer Sweden (feb 2009) står det ”siffror visar att nio av tio Scrumprojekt misslyckas”. Artikeln triggade vårt intresse av att ta reda på vilka problem specifika för Scrum som många har kritiserat och valde därför att rikta in vår studie mot detta. Uppsatsen syftar till att undersöka om lokala IT-företag i Borlänge, Headlight, Sogeti ochstatliga nätkapacitetleverantören Trafikverket ICT lider av det allmänna problem som de andra Scrumanvändarna upplever i samband med användningen av metoden. Denna uppsats har fokus på fyra problemområden: bristfällig dokumentation, sämre effektivitet i arbetsprocessen, sämre effektivitet i arbetsprocessen i stora projekt samt bristande stöd för utvärdering. För vår studie har litteraturstudier och intervjuer genomförts. Intervjuserier gjordes på elva personer hos våra fallföretag. Målgruppen för våra intervjuer är Product Owner (PO) ScrumMaster (SM) och utvecklare. Vi kan efter genomförd studie dra slutsatsen att de allmänna upplevda problem som de andra Scrumanvändaren upplever har vi även kunnat identifiera hos våra fallföretag. Resultaten har bekräftats med insamlade data och vår teoretiska ram. I diskussionen presenterar vi rekommendationer för att undvik relaterade problem med Scrum.
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Time as a welfare factor This article presents the results of an archive study of working time development in Sweden. It investigates how structural policy change is moving from a social discourse closely related to Swedish welfare reforms, towards an economic discourse motivated by financial arguments. By doing so, the political measures to solve working time related problems in today’s flexible working life appear to be contradictory. On one side we find time-poor people on the labour market mainly supported by tax-reductions and private time saving solutions. On the other side we find time-rich people mainly supported by activation programs and/or welfare benefits. This is a system and a policy strategy that obviously disregards the other side of the coin.
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Objective: To investigate whether spirography-based objective measures are able to effectively characterize the severity of unwanted symptom states (Off and dyskinesia) and discriminate them from motor state of healthy elderly subjects. Background: Sixty-five patients with advanced Parkinson’s disease (PD) and 10 healthy elderly (HE) subjects performed repeated assessments of spirography, using a touch screen telemetry device in their home environments. On inclusion, the patients were either treated with levodopa-carbidopa intestinal gel or were candidates for switching to this treatment. On each test occasion, the subjects were asked trace a pre-drawn Archimedes spiral shown on the screen, using an ergonomic pen stylus. The test was repeated three times and was performed using dominant hand. A clinician used a web interface which animated the spiral drawings, allowing him to observe different kinematic features, like accelerations and spatial changes, during the drawing process and to rate different motor impairments. Initially, the motor impairments of drawing speed, irregularity and hesitation were rated on a 0 (normal) to 4 (extremely severe) scales followed by marking the momentary motor state of the patient into 2 categories that is Off and Dyskinesia. A sample of spirals drawn by HE subjects was randomly selected and used in subsequent analysis. Methods: The raw spiral data, consisting of stylus position and timestamp, were processed using time series analysis techniques like discrete wavelet transform, approximate entropy and dynamic time warping in order to extract 13 quantitative measures for representing meaningful motor impairment information. A principal component analysis (PCA) was used to reduce the dimensions of the quantitative measures into 4 principal components (PC). In order to classify the motor states into 3 categories that is Off, HE and dyskinesia, a logistic regression model was used as a classifier to map the 4 PCs to the corresponding clinically assigned motor state categories. A stratified 10-fold cross-validation (also known as rotation estimation) was applied to assess the generalization ability of the logistic regression classifier to future independent data sets. To investigate mean differences of the 4 PCs across the three categories, a one-way ANOVA test followed by Tukey multiple comparisons was used. Results: The agreements between computed and clinician ratings were very good with a weighted area under the receiver operating characteristic curve (AUC) coefficient of 0.91. The mean PC scores were different across the three motor state categories, only at different levels. The first 2 PCs were good at discriminating between the motor states whereas the PC3 was good at discriminating between HE subjects and PD patients. The mean scores of PC4 showed a trend across the three states but without significant differences. The Spearman’s rank correlations between the first 2 PCs and clinically assessed motor impairments were as follows: drawing speed (PC1, 0.34; PC2, 0.83), irregularity (PC1, 0.17; PC2, 0.17), and hesitation (PC1, 0.27; PC2, 0.77). Conclusions: These findings suggest that spirography-based objective measures are valid measures of spatial- and time-dependent deficits and can be used to distinguish drug-related motor dysfunctions between Off and dyskinesia in PD. These measures can be potentially useful during clinical evaluation of individualized drug-related complications such as over- and under-medications thus maximizing the amount of time the patients spend in the On state.
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Objective: To investigate whether advanced visualizations of spirography-based objective measures are useful in differentiating drug-related motor dysfunctions between Off and dyskinesia in Parkinson’s disease (PD). Background: During the course of a 3 year longitudinal clinical study, in total 65 patients (43 males and 22 females with mean age of 65) with advanced PD and 10 healthy elderly (HE) subjects (5 males and 5 females with mean age of 61) were assessed. Both patients and HE subjects performed repeated and time-stamped assessments of their objective health indicators using a test battery implemented on a telemetry touch screen handheld computer, in their home environment settings. Among other tasks, the subjects were asked to trace a pre-drawn Archimedes spiral using the dominant hand and repeat the test three times per test occasion. Methods: A web-based framework was developed to enable a visual exploration of relevant spirography-based kinematic features by clinicians so they can in turn evaluate the motor states of the patients i.e. Off and dyskinesia. The system uses different visualization techniques such as time series plots, animation, and interaction and organizes them into different views to aid clinicians in measuring spatial and time-dependent irregularities that could be associated with the motor states. Along with the animation view, the system displays two time series plots for representing drawing speed (blue line) and displacement from ideal trajectory (orange line). The views are coordinated and linked i.e. user interactions in one of the views will be reflected in other views. For instance, when the user points in one of the pixels in the spiral view, the circle size of the underlying pixel increases and a vertical line appears in the time series views to depict the corresponding position. In addition, in order to enable clinicians to observe erratic movements more clearly and thus improve the detection of irregularities, the system displays a color-map which gives an idea of the longevity of the spirography task. Figure 2 shows single randomly selected spirals drawn by a: A) patient who experienced dyskinesias, B) HE subject, and C) patient in Off state. Results: According to a domain expert (DN), the spirals drawn in the Off and dyskinesia motor states are characterized by different spatial and time features. For instance, the spiral shown in Fig. 2A was drawn by a patient who showed symptoms of dyskinesia; the drawing speed was relatively high (cf. blue-colored time series plot and the short timestamp scale in the x axis) and the spatial displacement was high (cf. orange-colored time series plot) associated with smooth deviations as a result of uncontrollable movements. The patient also exhibited low amount of hesitation which could be reflected both in the animation of the spiral as well as time series plots. In contrast, the patient who was in the Off state exhibited different kinematic features, as shown in Fig. 2C. In the case of spirals drawn by a HE subject, there was a great precision during the drawing process as well as unchanging levels of time-dependent features over the test trial, as seen in Fig. 2B. Conclusions: Visualizing spirography-based objective measures enables identification of trends and patterns of drug-related motor dysfunctions at the patient’s individual level. Dynamic access of visualized motor tests may be useful during the evaluation of drug-related complications such as under- and over-medications, providing decision support to clinicians during evaluation of treatment effects as well as improve the quality of life of patients and their caregivers. In future, we plan to evaluate the proposed approach by assessing within- and between-clinician variability in ratings in order to determine its actual usefulness and then use these ratings as target outcomes in supervised machine learning, similarly as it was previously done in the study performed by Memedi et al. (2013).
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We solve the generalized relativistic harmonic oscillator in 1+1 dimensions, i.e., including a linear pseudoscalar potential and quadratic scalar and vector potentials which have equal or opposite signs. We consider positive and negative quadratic potentials and discuss in detail their bound-state solutions for fermions and antifermions. The main features of these bound states are the same as the ones of the generalized three-dimensional relativistic harmonic oscillator bound states. The solutions found for zero pseudoscalar potential are related to the spin and pseudospin symmetry of the Dirac equation in 3+1 dimensions. We show how the charge conjugation and gamma(5) chiral transformations relate the several spectra obtained and find that for massless particles the spin and pseudospin symmetry-related problems have the same spectrum but different spinor solutions. Finally, we establish a relation of the solutions found with single-particle states of nuclei described by relativistic mean-field theories with scalar, vector, and isoscalar tensor interactions and discuss the conditions in which one may have both nucleon and antinucleon bound states.
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Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.)
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Como parte do projeto GENACIS, este artigo visou estimar a prevalência de depressão em amostra urbana de São Paulo, Brasil, assim como a associação entre depressão e padrão de uso de álcool segundo gênero. Para tanto, foi realizado inquérito epidemiológico com amostra probabilística e por conglomerados, com um total de 2083 adultos. Utilizou-se o CIDI SF para identificação de depressão. A análise estatística utilizou o teste de Rao Scott e regressão logística multivariada. A taxa de resposta foi de 74,9%. Predominaram mulheres (58,8%), menores de 40 anos de idade (52%). A prevalência de depressão foi de 28,3% para as mulheres e 12,7% para os homens. Entre os homens, 61,1% são de bebedores no último ano e a depressão esteve associada ao padrão de consumo de álcool, à maior frequência de binge drinking e à presença de problemas decorrentes do álcool. Entre as mulheres, 69,5% são abstinentes e a depressão se associou à convivência com cônjuge com problemas devidos ao álcool. Os resultados ressaltam que a associação entre depressão e consumo de álcool é distinta entre os gêneros.
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A degradação ambiental vem modificando nosso cenário de forma acelerada e interferindo negativamente no processo saúde-doença de toda a comunidade. No entanto, o meio ambiente vem sendo concebido como um simples cenário, algo externo ao ser humano, não onde estamos inseridos e no qual acontecem suas interações e inter-relações. A complexidade dos problemas ambientais clama pela adoção de medidas que superem práticas assistencialistas, levando à adoção de práticas transdisciplinares que avancem na promoção da saúde. Neste artigo procura-se discutir, nesta perspectiva, a necessidade de inserção nos cursos de graduação em saúde a temática saúde e meio ambiente, adotando como exemplo um curso de enfermagem do interior paulista que inseriu uma disciplina relacionada ao tema. Analisa também o papel do enfermeiro na relação com o meio ambiente segundo a representação social dos alunos, trabalhada a partir do Discurso do Sujeito Coletivo. Nota-se que é fundamental discutir essa temática ambiental entre os profissionais da saúde, a fim de que eles se empoderem desse conhecimento e consigam identificar problemas relacionados à questão ambiental, propondo ações resolutivas e preventivas, juntamente com a comunidade, procurando amenizar os riscos ambientais a que todos estão expostos. Reforça-se a profundidade do papel dos profissionais de saúde diante dos problemas ambientais, buscando a saúde em uma perspectiva ampliada de promoção da saúde.