Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.

Subtypes of adolescents with substance use disorders and psychiatric comorbidity using cluster and discriminant analysis of MMPI-A profiles

The main aim of this study was to replicate and extend previous results on subtypes of adolescents with substance use disorders (SUD), according to their Minnesota Multiphasic Personality Inventory for adolescents (MMPI-A) profiles. Sixty patients with SUD and psychiatric comorbidity (41.7% male, mean age = 15.9 years old) completed the MMPI-A, the Teen Addiction Severity Index (T-ASI), the Child Behaviour Checklist (CBCL), and were interviewed in order to determine DSMIV diagnoses and level of substance use. Mean MMPI-A personality profile showed moderate peaks in Psychopathic Deviate, Depression and Hysteria scales. Hierarchical cluster analysis revealed four profiles (acting-out, 35% of the sample; disorganized-conflictive, 15%; normative-impulsive, 15%; and deceptive-concealed, 35%). External correlates were found between cluster 1, CBCL externalizing symptoms at a clinical level and conduct disorders, and between cluster 2 and mixed CBCL internalized/externalized symptoms at a clinical level. Discriminant analysis showed that Depression, Psychopathic Deviate and Psychasthenia MMPI-A scales correctly classified 90% of the patients into the clusters obtained.

Multicomutação e amostragem binária em análise química em fluxo: determinação espectrofotométrica de ortofosfato em águas naturais

A flow system based on multicommutation and binary sampling process was developed to implement the sample zone trapping technique in order to increase the spectrophotometric analytical range and to improve sensitivity. The flow network was designed with active devices in order to provide facilities to determine sequentialy analyte with a wide concentration range, employing a single pumping channel to propel sample and reagents solutions. The procedure was employed to determine ortophosphate ions in water samples of river and waste. Profitable features such as an analytical throughput of 60 samples determination per hour, relative standard deviation (r.s.d.) of 2% (n = 6) for a typical sample with concentration of 2.78 mg/L were achieved. By applying the paired t-test no significant difference at 95% confidence level was observed between the results obtained with the proposed system and those of the usual flow injection system.

A Forwarding Cooperation Protocol for Plain and Cluster-based Ad Hoc Networks

Peer-reviewed

Determinação espectrofotométrica de ácido ascórbico em fármacos empregando amostragem binária em fluxo

A flow system procedure for spectrophotometric determination of ascorbic acid in drugs based on [Fe3+(SCN-)n]+3-n complex decomposition by reduction is described. The flow network was constituted by a set of three-way solenoid valves, controlled by a microcomputer running a software wrote in QuickBasic 4.5 language. The feasibility of the procedure was ascertained by determining ascorbic acid in drug samples with mass ranging from 0.0018 up to 0.0180 g. The results showed an agreement of about 7% when compared with recommended method. Other profitable features such as a standard deviation of 1.5% (n = 7) and a throughput of 120 determinations per hour was also achieved.

Emergence and development of a financial cluster: the evolution of Andorra’s banking deposits in the long-term, 1931-2007

This paper explores the origins of Andorra’s financial cluster. It shows that the free movement of currency, the protection of infant industry, and geographical concentration lie at the foundation of the cluster’s competitive advantage. Drawing on a new set of data, the paper also provides for the first time an estimate of the total deposits held by Andorra’s banks between 1931 and 2007. Based on this new information, the paper reaches the conclusion that the development of the cluster went through four distinct phases in which large companies, acting as leaders, played an important role in enhancing the cluster’s business capabilities.

Gotas suspensas: uma proposta para amostragem e análise de gases traços da atmosfera

In the present paper, we report on the analytical use of a dynamic droplet based gas collection and an analysis system. A droplet formed at the tip of a tube represents a sampling approach that provides an indefinitely renewable surface and uses very little reagent. Sample gas flows past the droplet at a low flow rate. After the gas was sampled , the analysis can be carried out by different methodologies. The feasibility of the sensor is demonstrated by continuos determination of gaseous as: NO2, Cl2 and SO2.

Comparação de dois tipos de amostragem de chuva: deposição total e deposição apenas úmida em àrea costeira tropical

In a tropical coastal area. During 6 months the composition of rain samples collected simultaneously over 24h with an open collector and with an automatic opened collector (KFA - J¸lich Type) at 500m of the Atlantic coastline of Salvador were compared. All average concentrations were higher for the "total" samples than for the "wet only" samples, except for hydrogen ions, nitrate and ammonium.

Amostragem de suspensões: Emprego da técnica na análise direta de amostras

This review presents some characteristics related to slurry sampling in trace analysis in terms of its advantages, limitations and applications, as well as the latest advance in this area, such as mechanization, chemical modifiers, stabilization agents and others. The reviewed applications include foods, biological and geological materials.

La ramaderia de muntanya sota el canvi climàtic : estudi sobre la vulnerabilitat i la capacitat adaptativa de les explotacions ramaderes convencionals del Pallars Sobirà

La continuïtat de la ramaderia a les zones muntanyoses es troba en risc sever. El canvi climàtic és un fenomen que es suma a la ja precària situació de la ramaderia al Pallars Sobirà, castigada pel despoblament, l’envelliment de la població i la crisi econòmica. En aquest context, les entrevistes realitzades mostren com els ramaders, tot i ser conscients dels creixents fenòmens climàtics extrems, com les sequeres, a la zona, la seva capacitat adaptativa es veu reduïda per causa d’aquests estressos socioeconòmics. Entre ells, el procés d’envelliment posa en risc el manteniment del coneixement tradicional que és un dels aspectes clau en l’adaptació. Tanmateix, les estratègies d’adaptació a estressos climàtics posades en pràctica actualment pels ramaders són limitades i tenen un marcat caràcter reactiu.

Emprego da amostragem de suspensão na determinação de Cu e Zn em lapa antártica e Ni em sedimento de rio por espectrometria de absorção atômica com chama

In order to demonstrate the feasibility of slurry sampling for environmental studies, different methodologies were developed for Cu and Zn in antarctic limpets and Ni in river sediment with FAAS detection. Studies focusing particle size, acid concentration, slurry stability, selectivity, among others were carried out in order to define the better conditions for slurry analysis. A study related to the depth profile for Ni in the Atibaia River sediment was made after optimization conditions for this element. For accuracy check, certified reference material was used as well as decomposition with microwave oven.

Amostragem passiva de poluentes atmosféricos: aplicação ao SO2

The passive sampling technique has been widely used for many years in the measurement of personal exposure to pollutantes in the workplace. In recent years the technique has been used too for measurements in ambient air. In the specific case of SO2 a variety of passive samplers have been described in the literature. The great number are diffusive samplers and some few are permeation samplers. They are basically of two types: badge and tube-type. However there are more than 10 variations in relation to the sampler dimensions, diffusion barriers and pollutant sorption medium. The technique trend to be very used in the near future with samplers able to reach very low detection limits, proposing a viable option for monitoring specific species at urban, regional and global scales.

Development a distributed simulation environment on a cluster of workstations

Simulation has traditionally been used for analyzing the behavior of complex real world problems. Even though only some features of the problems are considered, simulation time tends to become quite high even for common simulation problems. Parallel and distributed simulation is a viable technique for accelerating the simulations. The success of parallel simulation depends heavily on the combination of the simulation application, algorithm and message population in the simulation is sufficient, no additional delay is caused by this environment. In this thesis a conservative, parallel simulation algorithm is applied to the simulation of a cellular network application in a distributed workstation environment. This thesis presents a distributed simulation environment, Diworse, which is based on the use of networked workstations. The distributed environment is considered especially hard for conservative simulation algorithms due to the high cost of communication. In this thesis, however, the distributed environment is shown to be a viable alternative if the amount of communication is kept reasonable. Novel ideas of multiple message simulation and channel reduction enable efficient use of this environment for the simulation of a cellular network application. The distribution of the simulation is based on a modification of the well known Chandy-Misra deadlock avoidance algorithm with null messages. The basic Chandy Misra algorithm is modified by using the null message cancellation and multiple message simulation techniques. The modifications reduce the amount of null messages and the time required for their execution, thus reducing the simulation time required. The null message cancellation technique reduces the processing time of null messages as the arriving null message cancels other non processed null messages. The multiple message simulation forms groups of messages as it simulates several messages before it releases the new created messages. If the message population in the simulation is suffiecient, no additional delay is caused by this operation A new technique for considering the simulation application is also presented. The performance is improved by establishing a neighborhood for the simulation elements. The neighborhood concept is based on a channel reduction technique, where the properties of the application exclusively determine which connections are necessary when a certain accuracy for simulation results is required. Distributed simulation is also analyzed in order to find out the effect of the different elements in the implemented simulation environment. This analysis is performed by using critical path analysis. Critical path analysis allows determination of a lower bound for the simulation time. In this thesis critical times are computed for sequential and parallel traces. The analysis based on sequential traces reveals the parallel properties of the application whereas the analysis based on parallel traces reveals the properties of the environment and the distribution.

Aspectos técnicos envolvidos na construção de um "cluster beowulf"

Beowulf cluster is perhaps the cheapest way to construct a high performance computers. The strategy of reaching a high power computing isn't so difficult, but buying and configurating should be done carefully. Technical aspects of hardware components and message-passing libraries are considered, with some results given as examples.