970 resultados para KARNOFSKY PERFORMANCE STATUS


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Objective: To examine the performance of the Norwegian version of the AUSCAN Index as a disease-specific health status measure in patients with hand osteoarthritis (OA). Methods: One hundred and ninety-nine patients with clinical hand OA (mean (SD) age 61.7 (5.7) years, 18 (9%) males) underwent a comprehensive examination including joint status, examination of grip strength and completion of several self-reported health status questionnaires. The Australian/Canadian OA hand index (AUSCAN) captures three different dimensions of hand OA: pain (5 items), stiffness (1 item), and difficulties with daily activities (9 items). Our pre-study hypothesis was to identify AUSCAN as a specific hand measure with strong correlations to hand measures and lower correlations to other general measures of health. Results: Patient completion of the AUSCAN Index was similar or better than other measures. The internal consistency of the AUSCAN was excellent. The pain and physical dimension of AUSCAN correlated substantially to, each other and moderately to the stiffness scale. The AUSCAN physical scale correlated moderately to substantially to other measures, the highest correlation being seen with the Arthritis Impact Measurement Scale (AIMS) 2 hand and finger function scale (r= 0.73). The standardised differences between patients with and without radiographic abnormalities were numerically larger for the AUSCAN pain and physical scales than for other measures. Conclusion: The Norwegian version of the AUSCAN has an acceptable clinimetric performance and is a suitable tool for assessment of hand OA. (C) 2005 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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Data from an Australian national survey (1996 to 1997) are used to examine domestic labor patterns among de facto and married men and women. The results show that women spend more time on housework and do a greater proportion of housework than men. However, the patterns are most traditional among married men and women. Women in de facto relationships spend less time doing housework and do a smaller proportion of indoor activities than married women. Men in de facto relationships do a larger proportion of indoor activities and a lower proportion of outdoor tasks than married men. The data also show that couples who have cohabited prior to marriage have more egalitarian divisions of labor than those who have not cohabited prior to marriage. This article concludes by arguing that the incompleteness of the de facto relationship provides a period of relative freedom in which to negotiate more equal roles.

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An increase in the production of palm kernel meal (PKM) coupled with the concern for continued availability of conventional feedstuffs in some parts of the world has led to research to establish the maximum inclusion level of palm kernel meal in broiler diets. The results suggested that palm kernel meal has no anti-nutritional properties and thus its inclusion is safe up to at least 40% in the diet, provided the diet is balanced in amino acids and metabolisable energy. Although feed digestibility is decreased due to high dietary fibre when PKM is included in the diet, the feed intake is increased. This makes total digestible nutrient intake relatively high. beta-mannan is the main component of palm kernel meal non-starch polysaccharide (NSP). Both mannose and manno-oligosaccharides have been reported to act as prebiotics. The inclusion of palm kernel meal in the diet improves the immune system of birds and reduces pathogenic bacteria and increases the population of nonpathogenic bacteria in the intestine. These two benefits should be considered as strong recommendations for using palm kernel meal in broiler diets, particularly in palm kernel meal producing countries, not only for increasing bird productivity but also to improve chicken health. Selective enzyme addition increases feed efficiency and digestibility as well as decreasing the moisture content of faeces.

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Methods of analysing and optimising flotation circuits have improved significantly over the last 15 years. Mineral flotation is now generally better understood through major advances in measuring and modelling the sub-processes within the flotation system. JKSimFloat V6 is a user-friendly Windows-based software package incorporating simulation, mass balancing, and, currently under development, liberation data viewing and model fitting. This paper presents an overview of the development of the program up to its current status, and the plans established for the future. The application of the simulator, in particular, at various operations is also discussed with emphasis on the use of the program in improving flotation circuit performance.

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Ready to eat pasta meals are an important segment of convenience food, but these products are subjected to significant changes in physico-chemical properties during storage, which reduce their acceptability at the time of consumption. A deep understanding of the properties of the single phases, their dependence upon formulation, and the changes they undergo during storage is very important to intelligently intervene on products properties to improve their quality at the time of consumer’s consumption. This work has focused on the effect of formulation on physico-chemical properties of pasta and tomato sauce with a special focus on mechanical/rheological attributes and water status. Variable considered in pasta formulation were gluten, glycerol and moisture content and their effect was studied in both freshly cooked or shelf-stable cooked pasta. The effect of multiple hydrocolloids (at different levels) was considered in the case of tomato sauce. In the case of pasta, it was found that water content was indeed a very important variable in defying pasta mechanical properties and water status. Higher moisture contents in pasta resulted in softer samples and reduced the changes in physico-chemical parameters during storage. Glycerol was found to favor water uptake and to soften the pasta matrix, acting as plasticizer and increasing molecular mobility. The addition of gluten hardened pasta but did not affect the water status. The combination of higher amount of gluten (15%, g gluten / 100 g product) with higher moisture content (59-65%, g water / 100 g product) were found to minimize the physico-chemical changes occurring in RTE pasta meals during storage, improving quality at longer storage times. Hydrocolloids added into tomato sauce modulated its mechanical attributes and water status in very different manner, depending on hydrocolloid type and concentration. This may allow to produce tomato sauce for different applications and that are expected to have different performance if placed in contact with pasta in a RTE meal. Future work should include an investigation of how the interaction between the two phases (pasta and sauce) can be modulated and controlled by controlling the properties of the single phases with the goal of obtaining highly acceptable products also at longer storage times.

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Visual perception is dependent not only on low-level sensory input but also on high-level cognitive factors such as attention. In this paper, we sought to determine whether attentional processes can be internally monitored for the purpose of enhancing behavioural performance. To do so, we developed a novel paradigm involving an orientation discrimination task in which observers had the freedom to delay target presentation--by any amount required--until they judged their attentional focus to be complete. Our results show that discrimination performance is significantly improved when individuals self-monitor their level of visual attention and respond only when they perceive it to be maximal. Although target delay times varied widely from trial-to-trial (range 860 ms-12.84 s), we show that their distribution is Gaussian when plotted on a reciprocal latency scale. We further show that the neural basis of the delay times for judging attentional status is well explained by a linear rise-to-threshold model. We conclude that attentional mechanisms can be self-monitored for the purpose of enhancing human decision-making processes, and that the neural basis of such processes can be understood in terms of a simple, yet broadly applicable, linear rise-to-threshold model.

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Rolls-Royce fuel cell systems is developing megawatt scale power systems based on solid oxide fuel cell technology. The hybrid design promises to meet challenging energy efficiency, cost and performance targets in a grid friendly fashion. Analysis and testing to date indicate that those targets can be met and enable a wealth of fuel cell applications to meet customer and existing grid and modern grid requirements. Working with a global development team, a series of laboratory tests and evaluations are completed and future field test and evaluation and demonstration planned.

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The diagnosis and monitoring of ocular disease presents considerable clinical difficulties for two main reasons i) the substantial physiological variation of anatomical structure of the visual pathway and ii) constraints due to technical limitations of diagnostic hardware. These are further confounded by difficulties in detecting early loss or change in visual function due to the masking of disease effects, for example, due to a high degree of redundancy in terms of nerve fibre number along the visual pathway. This thesis addresses these issues across three areas of study: 1. Factors influencing retinal thickness measures and their clinical interpretation As the retina is the principal anatomical site for damage associated with visual loss, objective measures of retinal thickness and retinal nerve fibre layer thickness are key to the detection of pathology. In this thesis the ability of optical coherence tomography (OCT) to provide repeatable and reproducible measures of retinal structure at the macula and optic nerve head is investigated. In addition, the normal physiological variations in retinal thickness and retinal nerve fibre layer thickness are explored. Principal findings were: • Macular retinal thickness and optic nerve head measurements are repeatable and reproducible for normal subjects and diseased eyes • Macular and retinal nerve fibre layer thickness around the optic nerve correlate negatively with axial length, suggesting that larger eyes have thinner retinae, potentially making them more susceptible to damage or disease • Foveola retinal thickness increases with age while retinal nerve fibre layer thickness around the optic nerve head decreases with age. Such findings should be considered during examination of the eye with suspect pathology or in long-term disease monitoring 2. Impact of glucose control on retinal anatomy and function in diabetes Diabetes is a major health concern in the UK and worldwide and diabetic retinopathy is a major cause of blindness in the working population. Objective, quantitative measurements of retinal thickness. particularly at the macula provide essential information regarding disease progression and the efficacy of treatment. Functional vision loss in diabetic patients is commonly observed in clinical and experimental studies and is thought to be affected by blood glucose levels. In the first study of its kind, the short term impact of fluctuations in blood glucose levels on retinal structure and function over a 12 hour period in patients with diabetes are investigated. Principal findings were: • Acute fluctuations in blood glucose levels are greater in diabetic patients than normal subjects • The fluctuations in blood glucose levels impact contrast sensitivity scores. SWAP visual fields, intraocular pressure and diastolic pressure. This effect is similar for type 1 and type 2 diabetic patients despite the differences in their physiological status. • Long-term metabolic control in the diabetic patient is a useful predictor in the fluctuation of contrast sensitivity scores. • Large fluctuations in blood glucose levels and/or visual function and structure may be indicative of an increased risk of development or progression of retinopathy 3. Structural and functional damage of the visual pathway in glaucomatous optic neuropathy The glaucomatous eye undergoes a number of well documented pathological changes including retinal nerve fibre loss and optic nerve head damage which is correlated with loss of functional vision. In experimental glaucoma there is evidence that glaucomatous damage extends from retinal ganglion cells in the eye, along the visual pathway, to vision centres in the brain. This thesis explores the effects of glaucoma on retinal nerve fibre layer thickness, ocular anterior anatomy and cortical structure, and its correlates with visual function in humans. Principal findings were: • In the retina, glaucomatous retinal nerve fibre layer loss is less marked with increasing distance from the optic nerve head, suggesting that RNFL examination at a greater distance than traditionally employed may provide invaluable early indicators of glaucomatous damage • Neuroretinal rim area and retrobulbar optic nerve diameter are strong indicators of visual field loss • Grey matter density decreases at a rate of 3.85% per decade. There was no clear evidence of a disease effect • Cortical activation as measured by fMRI was a strong indicator of functional damage in patients with significant neuroretinal rim loss despite relatively modest visual field defects These investigations have shown that the effects of senescence are evident in both the anterior and posterior visual pathway. A variety of anatomical and functional diagnostic protocols for the investigation of damage to the visual pathway in ocular disease are required to maximise understanding of the disease processes and thereby optimising patient care.

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Using 394 pairs of employees and their immediate supervisors working in the Information and Communication Technology (ICT) sector in three northern European countries, this study examined the effect of workplace moderators on the link between relational demography and supervisor ratings of performance. Directional age differences between superior and subordinate (i.e., status incongruence caused when the supervisor is older or younger than his/her subordinate) and non-directional age differences were used as predictors of supervisor ratings of occupational expertise. The quality of the supervisor-subordinate relationship and the existence of positive age-related supervisory practices were examined as moderators of this relationship. The results provide no support for a relationship between directional age differences and age-related stereotyping by supervisors in ratings of performance, neither for the effects of age-related supervisory practices. However, high quality supervisor-subordinate relationships did moderate the effects of age dissimilarity on supervisory ratings. The implications of these findings for performance appraisal methodologies and recommendations for further research are discussed.

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Addressing inconsistencies in relational demography research, we examine the relationship between cultural dissimilarity and individual performance through the lens of social self-regulation theory, which extends the social identity perspective in relational demography with the analysis of social self-regulation. We propose that social self-regulation in culturally diverse teams manifests itself as performance monitoring (i.e., individuals' actions to meet team performance standards and peer expectations). Contingent on the status associated with individuals' cultural background, performance monitoring is proposed to have a curvilinear relationship with individual performance and to mediate between cultural dissimilarity and performance. Multilevel moderated mediation analyses of time-lagged data from 316 members of 69 teams confirmed these hypotheses. Cultural dissimilarity had a negative relationship with performance monitoring for high cultural-status members, and a positive relationship for low cultural-status members. Performance monitoring had a curvilinear relationship with individual performance that became decreasingly positive. Cultural dissimilarity thus was increasingly negatively associated with performance for high culturalstatus members, and decreasingly positively for low cultural-status members. These findings suggest that cultural dissimilarity to the team is not unconditionally negative for the individual but, in moderation, may in fact have positive motivational effects.

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Purpose - Despite many Maintenance Repair and Overhaul (MRO) organisations alluding their positive business performances to the adoption Lean initiatives, there is a paucity of direct literature that validates this assertion. Thus, the purpose of this paper is to study empirically via the use of an industry-wide survey to establish and extent of Lean adoption and to verify its suitability in mitigating prevalent MRO challenges. Design/methodology/approach - The empirical study contained in this paper is facilitated by an industry-wide survey to collect data from several firms across the MRO spectrum. The analysed responses from industry leaders, professionals and executives synthesised with existing literature was used in ascertaining the extent of Lean adoption within the operational framework of the industry. Findings - The empirical study helped in validating the suitability of Lean in MRO context. However, it was also observed that the focus of its application was skewed towards its production-orientated functions more than its service-orientated functions. Nonetheless, this paper presents results of the positive influence of Lean in MRO context. Research limitations/implications - This empirical study presented in this paper was carried out within a framework of key characteristics of operation. Although this approach is sufficient in assessing the industry's Lean status, further assessment can also be achieved within the context of relevant performance metrics which was not included in this paper. Practical implications - By exploring the industry's Lean status within the context of operational characteristics of operation, this study provides MRO practitioners with more awareness into some of the critical factors required for successful holistic Lean realisation. Social implications - The state-of-the-art of Lean within the aviation MRO context established through this research also contributes to the wider product-centric service environment by providing a platform that facilitates strategy development which ensures Lean success within this environment. Originality/value - Apart from validating the suitability of Lean in MRO contexts, by establishing the extent of Lean adoption within the context of the operational framework, this paper provides a clearer insight as to how successful Lean implementation can be achieved via a holistic implementation strategy balanced between the product-centric and service-centric aspects of the industry.

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This study compared the performance of students who earned GED credentials in Florida with that of graduates of Florida high schools, when members of both groups enrolled for the first time in fall 1992 at an urban multicultural community college in south Florida. GED's and HSD's were matched on gender, race, age range, placement levels, and enrollment in college preparatory courses (reading, English, mathematics). The paired samples t-test compared course grades, first semester GPA, and total college GPA for the groups and subgroups of matched students at a probability level of .05. The McNemar test compared how many students in each group and subgroup re-enrolled for a second and third term, or ever; how many were placed on special academic status during their college enrollment; and how many graduated within 16 semesters. Differences between groups were found only for placement on probation—with HSD's on probation in significantly higher proportion than GED's. ^ Additional findings among subgroups revealed that male and Caucasian HSD subjects earned higher math grades than their GED counterparts. Male HSD's were more likely than male GED's to return to the college at some point after the first term. However, male HSD's were placed on probation in greater proportion than the GED's with whom they were matched. ^ Female GED's earned higher English grades and higher first semester and cumulative GPA's and returned to the college in greater proportion than their HSD counterparts. Black GED's earned higher first-semester GPA's, re-enrolled in terms 2 and 3 and graduated from the college in higher percentages than Black HSD's. Black HSD's were placed on probation in higher proportion than Black GED's. Lastly, greater percentages of HSD than GED subjects in the lowest age range (16–19) were placed on probation. ^ Results connected to the performance of Black GED subjects are likely to have been affected by the fact that 50% of Black study subjects had been born in Jamaica. The place of the GED in the constellation of methods for earning credit by examination is explored, future implications are discussed, and further study is recommended. ^

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The most fundamental and challenging function of government is the effective and efficient delivery of services to local taxpayers and businesses. Counties, once known as the “dark continent” of American government, have recently become a major player in the provision of services. Population growth and suburbanization have increased service demands while the counties' role as service provider to incorporated residents has also expanded due to additional federal and state mandates. County governments are under unprecedented pressure and scrutiny to meet citizens' and elected officials' demands for high quality, and equitable delivery of services at the lowest possible cost while contending with anti-tax sentiments, greatly decreased state and federal support, and exceptionally costly and complex health and public safety problems. ^ This study tested the reform government theory proposition that reformed structures of county government positively correlate with efficient service delivery. A county government reformed index was developed for this dissertation comprised of form of government, home-rule status, method of election, number of government jurisdictions, and number of elected officials. The county government reform index and a measure of relative structural fragmentation were used to assess their impact on two measures of service output: mean county road pavement condition and county road maintenance expenditures. The study's multi-level design triangulated results from different data sources and methods of analysis. Data were collected from semi-structured interviews of county officials, secondary archival sources, and a survey of 544 elected and appointed officials from Florida's 67 counties. The results of the three sources of data converged in finding that reformed Florida counties are more likely than unreformed counties to provide better road service and to spend less on road expenditures. The same results were found for unfragmented Florida counties. Because both the county government reform index and the fragmentation variables were specified acknowledging the reform theory as well as elements from the public-choice model, the results help explain contradicting findings in the urban service research. ^ Therefore, as suggested by the corroborated findings of this dissertation, reformed as well as unfragmented counties are better providers of road maintenance service and do so in a less costly manner. These findings hold although the variables were specified to capture theoretical arguments from the consolidated as well as the public-choice theories suggesting a way to advance the debate from the consolidated-fragmented dichotomy of urban governance. ^

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The purpose of this study was to investigate which affective factors of adolescent high school readers were related to high-level readers, middle-level readers and low-level readers. The research problem was to determine the relationship between adolescent high school students' self-perceived reading self-efficacy factors and the students' reading performance on a standardized reading assessment considering demographic factors of age, gender and socio-economic status as covariates. The research design was ex post facto making inferences without direct intervention. The sample was obtained from one large, diverse, urban high school, consisting of 9th and 10th grade adolescent students (N = 176). Students voluntarily completed a self-report, reading self-efficacy survey. School records were used to obtain standardized reading level scores, age, gender, and socio-economic status data. An exploratory factor analysis of the self-efficacy survey responses resulted in the identification of 7 underlying factors. The striving (low-level) readers had significantly lower self-perceptions on 5 of the 7 affective factors than the middle-level readers, and strong (high-level) readers, p < .05. The 5 affective factors on which the striving readers had significantly lower self-perceptions were: (a) Observational Comparison, (b) Progress, (c) Lack of Progress, (d) Lack of Anxiety, and (e) Positive Social Feedback. The 2 affective factors which were not significantly different for reader level were Anxiety and Negative Social Feedback. Girls had significantly less anxiety than boys for both of the factors in the Anxiety category. Statistical results showed that none of the demographic covariates tested; age, gender, or socio-economic status, moderated the relationship between affective reader self-efficacy factors and reader level. This study concluded that there were distinguishable differences for striving, middle, and strong readers' self-efficacy factors. Determining affective factors related to reading can be used to create better instructional environments and instruction for adolescent students.