Hidrogin��stica: benef��cios gerais e seus aspectos did��ticos e metodol��gicos

Atualmente, a hidrogin��stica tornou-se um tipo de atividade f��sica bastante praticada pela popula����o em geral, tendo como p��blico alvo espec��fico �� popula����o idosa. Muitos m��dicos t��m orientado os pacientes a praticarem essa atividade em fun����o dos v��rios benef��cios fisiol��gicos e sociais proporcionados e, principalmente, pelo baixo impacto nas articula����es e ossos. Assim, tem crescido consideravelmente o n��mero de praticantes, tornando-se uma atividade f��sica bastante recomendada a todas faixas et��rias. Objetivos do Estudo:1) analisar os benef��cios da hidrogin��stica sob as perspectivas fisiol��gicas, pedag��gicas, psicol��gicas e sociais; 2) Apontar alguns aspectos relevantes a respeito da organiza����o did��tico-metodol��gica necess��ria ao desenvolvimento de um programa de hidrogin��stica de qualidade e eficiente e 3) apontar os benef��cios gerais, metodologias e did��tica de aulas tamb��m para grupos especiais (idosos, gestantes e deficientes). Metodologia: A metodologia do estudo consistiu em uma revis��o bibliogr��fica na qual foram abordados as tem��ticas de efeitos fisiol��gicos, psicol��gicos, pedag��gicos e sociais e aspectos metodol��gicos e did��ticos em aulas de hidrogin��stica para adultos e grupos especiais. Considera����es finais: Os estudos mostrados na revis��o de literatura comprovaram que a hidrogin��stica proporciona os benef��cios fisiol��gicos, sociais, pedag��gicos e psicol��gicos aos seus praticantes. Al��m do mais, aos professores de Educa����o F��sica que atuam nessa ��rea cabe desenvolverem mais estudos e pesquisas sobre essa atividade f��sica, a fim de proporcionar aos seus alunos aulas bem diferenciadas e prazerosas.

John Gledson reescreve Milton Hatoum: a teoria e a experi��ncia da tradu����o cultural

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Desigualdad en el rendimiento acad��mico de los estudiantes en Colombia

En la presente investigaci��n se busca evaluar que tan desiguales son los resultados acad��micos de los estudiantes del grado 11 en Colombia para el per��odo 2008-2012 -- Para esto se construy�� un Gini de puntajes de las pruebas Saber 11 para cada a��o del per��odo evaluado y se compara con el Gini de nivel socioecon��mico estimado a partir de informaci��n de los estudiantes sobre sus condiciones socioecon��micas tomada del formulario de inscripci��n al examen -- Los resultados obtenidos muestran que la desigualdad en t��rminos de puntaje es menor que la desigualdad en t��rminos socioecon��micos, y aunque es relativamente baja se encuentra acompa��ada de puntajes muy bajos en las poblaciones m��s vulnerables -- Los resultados m��s desiguales y con menor puntaje promedio se dan en el ��rea de matem��ticas en los estratos socioecon��micos 1 y 2 -- Seg��n estos resultados, la pol��tica educativa deber��a estar dirigida a reducir la desigualdad en el rendimiento de los alumnos aumentando el rendimiento promedio de estos y no a costa de puntajes m��s bajos, ya que un sistema educativo que logre menor desigualdad implica una sociedad m��s homog��nea, donde todas las personas puedan tener las mismas oportunidades y se cierren brechas de oportunidades e ingresos

Aportes del movimiento estudiantil a los procesos de movilizaci��n social en Colombia

Tesis (Trabajadora Social).-- Universidad de La Salle. Facultad de Ciencias Econ��micas y sociales. Programa de Trabajo Social, 2014

Revisi��n documental en el acceso a los servicios de salud que afrontan los ni��os y ni��as de 6 a 12 a��os diagnosticados con c��ncer en Colombia 2005-2012

Tesis (Trabajadora Social).-- Universidad de La Salle. Facultad de Ciencias Econ��micas y sociales. Programa de Trabajo Social, 2014

O papel da forma����o docente na efetividade das pol��ticas p��blicas de EPT no Brasil - per��odo 2003-2015 : implica����es pol��ticas e pedag��gicas na atua����o de professores

Tese (doutorado)���Universidade de Bras��lia, Faculdade de Educa����o, Programa de P��s-Gradua����o em Educa����o, 2016.

Cooperaci��n para el desarrollo Espa��a-Colombia, un enfoque de Econom��a Pol��tica

La Tesis Cooperaci��n Espa��a- Colombia: un enfoque de Econom��a Pol��tica, realiza un an��lisis sobre los problemas de agencia existentes en la cooperaci��n al desarrollo, entre pa��ses donantes y receptores, aplicado al caso de Colombia. Teor��as como Elecci��n P��blica, Gobernanza, Econom��a Neo institucional, sirven de marco para contrastar fallos de gobierno, asimetr��as de informaci��n, riesgo moral, selecci��n adversa, buscadores de renta. La investigaci��n aporta las siguientes evidencias: Hay necesidad de impulsar la gobernanza en la cooperaci��n al desarrollo, por que las decisiones sobre cooperaci��n bilateral se toman entre los gobiernos de los pa��ses, sin evidencias reales de procesos de gobernanza que integre en el dise��o de estrategias de desarrollo, la participaci��n de representantes del Estado, sociedad civil y mercado ��� sector privado. Por esta raz��n en los foros de Eficacia de la ayuda como Accra (2008) y Busan (20011), se impuls�� el concepto de apropiaci��n democr��tica, que incluye como actor de cooperaci��n a la sociedad civil. Sin embargo, este proceso no est�� a��n integrado en un claro arreglo institucional. Los principios de eficacia de la ayuda de la declaraci��n de Paris, compromete al pa��s donante a alinearse con el pa��s receptor. Sin embargo otorgar todo este poder discrecional a pa��ses receptores, puede ser m��s dificultoso en naciones con menor fortalecimiento institucional por problemas como corrupci��n, estados fr��giles o conflictos armados. El caso colombiano es un ejemplo de los problemas de agencia por conflicto entre ideas e intereses, que genera la alineaci��n de pa��ses donantes con receptores. Despu��s de la adhesi��n de Colombia a la Declaraci��n de Paris en 2007, el compromiso del gobierno de Colombia era acordar la cooperaci��n de forma bilateral, contando con el alineamiento del pa��s receptor. Por lo tanto el gobierno no vio la necesidad de seguir consensuando sus estrategias de cooperaci��n con la participaci��n de donantes y sociedad civil, como lo hizo en la primera estrategia de cooperaci��n de Colombia 2003 ��� 2006, lo que demuestra como la adhesi��n a la Declaraci��n de Paris desestimul�� procesos de gobernanza...

Caracterizaci��n de trastornos musculo esquel��ticos en trabajadores de dos empresas de servicios en Bogot�� D.C 2015

Objetivo: El objetivo de este estudio fue determinar la prevalencia de los trastornos m��sculoesquel��ticos y la asociaci��n con factores sociodemogr��ficos y h��bitos de vida en trabajadores de las ��reas administrativa y operativa de dos empresas de servicio de la ciudad de Bogot�� 2015. Materiales y M��todos: Se realiz�� un estudio de corte transversal, con informaci��n secundaria, procedente de bases de datos suministrada por las dos empresas con 696 registros de trabajadores de servicios generales, y 943 registros de trabajadores del ��rea administrativa, para un total de 1639 registros, en los cuales se evalu�� la presencia de s��ntomas osteomusculares clasificados por segmento. Adicionalmente se contaba con informaci��n de caracter��sticas sociodemogr��ficas y estilos de vida de estos trabajadores. Se obtuvieron las distribuciones de frecuencias absolutas y relativas para las variables cualitativas, y las medidas de tendencia central y de dispersi��n para las variables cuantitativas. Para establecer la asociaci��n entre factores sociodemogr��ficos con las variables dependientes se utiliz�� la prueba chi2 de asociaci��n. Resultados: La prevalencia de molestia o dolor en los diferentes segmentos corporales fue de 21.5 % (n = 203) en cuello para la poblaci��n administrativa y de 17.5% (n = 148) en mano y mu��eca derecha para la poblaci��n de servicios generales. Vale la pena aclarar que el diagn��stico m��dico m��s frecuente referido por la poblaci��n en estudio fue traumas en musculo, bursa tend��n y/o ligamento con 10.5% en la poblaci��n administrativa y con el 12.4% en la poblaci��n de servicios generales. De las asociaciones significativas entre diagn��sticos presentes y h��bitos de vida y sue��o se encontr�� que sue��o no reparador se asoci�� significativamente con enfermedad general de m��sculos y huesos (p = 0.001), enfermedad o trauma activo de tejidos blandos (p = 0,000) y antecedente o enfermedad actual de columna vertebral (p = 0,000). De manera similar, el consumo de medicamentos para conciliar el sue��o se asoci�� con enfermedad de tejidos blandos (p = 0,000) y enfermedad actual de columna vertebral (p = 0,000). El consumo de caf�� (p = 0.001) y el sedentarismo (p = 0.031) est��n asociados con la enfermedad general de m��sculos y huesos. Conclusiones: Los TME son un factor de alta prevalencia en la poblaci��n trabajadora de Colombia, y como se demostr�� en este estudio, afectan a la poblaci��n de las empresas de servicio. Se evidencia cada vez m��s que los segmentos corporales m��s afectados en la poblaci��n administrativa, son cabeza y cuello, debido a las posturas mantenidas por largos periodos de tiempo, y en la poblaci��n de servicios se encontr�� molestia y dolor en mu��ecas y manos debido a los movimientos repetitivos que deben de realizar durante la jornada laboral. Se hace necesario profundizar m��s en la asociaci��n significativa de los trastornos del sue��o y la presencia de los TME, ya que se encontr�� una relaci��n importante entre estos dos.

Economias de escala em centros hospitalares

RESUMO - Perante o actual contexto de conten����o de gastos no sector da sa��de e consequente preocupa����o com a efici��ncia do sistema, tem���se assistido a mudan��as v��rias no modelo de gest��o e organizacional do sistema de sa��de. Destaca���se a altera����o da estrutura hospitalar, com vista �� racionaliza����o dos seus recursos internos, onde as fus��es hospitalares t��m assumido um papel determinante. Em Portugal, nos ��ltimos 10 anos, assistiu���se a uma significativa redu����o do n��mero de hospitais (de sensivelmente 90 para 50 unidades), exclusivamente atrav��s das fus��es e sem quaisquer altera����es no n��mero de estruturas f��sicas existentes. N��o obstante os argumentos justificativos desta reforma, a avalia����o dos objectivos impl��citos �� insuficiente. Neste ��mbito, pretendeu���se com este estudo contribuir para a an��lise do impacte da cria����o de centros hospitalares na redu����o de gastos, isto ��, verificar se a consolida����o e consequente reengenharia dos processos produtivos teve consequencias ao n��vel da obten����o de economias de escala. Para esta an��lise usou���se uma base de dados em painel, onde se consideraram 75 hospitais durante 7 anos (2003���2009), n��mero que foi reduzindo ao longo do per��odo em an��lise devido ��s in��meras fus��es j�� referidas. Para avaliar os ganhos relativos ��s fus��es hospitalares, ao n��vel da efici��ncia t��cnica e das economias de escala, recorreu���se �� fronteira estoc��stica especificada fun����o custo translog. Estimada a fronteira, foi poss��vel analisar tr��s centros hospitalares espec��ficos, onde se comparou o per��odo pr�����fus��o (2005���2006) com o per��odo ap��s a fus��o (2008���2009). Como vari��veis explicativas, relativas �� produ����o hospitalar, considerou���se o n��mero de casos tratados e os dias de internamento (Vita, 1990; Schuffham et al., 1996), o n��mero de consultas e o n��mero de urg��ncias, sendo estas vari��veis as mais comuns na literatura (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Quanto �� vari��vel dependente usou���se o custo vari��vel total, que compreende o total de custos anuais dos hospitais excepto de imobilizado. Como principais conclus��es da investiga����o, em consequ��ncia da cria����o dos centros hospitalares, s��o de referir os ganhos de escala na fus��o de hospitais de reduzida dimens��o e com mais servi��os complementares. --------ABSTRACT - Driven by the current pressure on resources induced by budgetary cuts, the Portuguese Ministry of Health is imposing changes in the management model and organization of NHS hospitals. The most recent change is based on the creation of Hospital Centres that are a result of administrative mergers of existing hospitals. In less than 10 years the number of hospitals passed from around 90 to around 50, only due to the mergers and without any change in the existing number of physical institutions. According to the political discourse, one of the main goals expected from this measure is the creation of synergies and more efficiency in the use of available resources. However, the merger of the hospitals has been a political decision without support or evaluation of the first experiments. The aim of this study is to measure the results of this policy by looking at economies of scale namely through reductions in the expenditures, as expected and sought by the MoH. Data used covers 7 years (2003���2009) and 75 hospitals, number that has been reduced my the enoumerous mergers during the last decade. This work uses a stochastic frontier analysis through the translog cost function to examine the gains from mergers, which were decomposed into technical efficiency and economies of scale. It was analised these effects by the creation of three specific hospital centers, using a longitudinal approach to compare the period pre���merger (2003���2006) with the post���merger period (2007���09). To measure changes in inpatient hospital production volume and length of stay are going to be considered as done by Vita (1990) and Schuffham et al. (1996). For outpatient services the number of consultations and emergencies are going to be considered (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Total variable cost is considered as the dependent variable explained the aforementioned ones. After a review of the literature results expected point to benefits from the mergers, namely a reduction in total expenditures and in the number of duplicated services. Results extracted from our data point in the same direction, and thus for the existence of some economies of scale only for small hospitals.

Physical activity in 22 African countries: results from the World Health Organization STEPwise approach to chronic disease risk factor surveillance.

BACKGROUND: Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking. PURPOSE: To describe and compare levels and patterns of physical activity among adults across 22 African countries. METHODS: Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003-2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week. RESULTS: Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries. CONCLUSIONS: Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

L'��s de la metodologia CUSUM pel control de qualitat i de l'efecte d'aprenentatge en els procediments endovasculars

El control de qualitat terap��utica i el monitoratge de l���efecte d���aprenentatge constitueixen dues responsabilitats ineludibles durant l���adquisici�� i manteniment de noves modalitats terap��utiques. L���objectiu d���aquest estudi va ser avaluar qualitat terap��utica i efecte d���aprenentatge a partir de corbes CUSUM, associats a la introducci�� i desenvolupament de procediments endovasculars incloent 553 pacients consecutius amb arteriopatia obliterant aorto-il��aca, f��moro-popl��tia o renal, tractats per cirurgians vasculars a l���Hospital del Mar entre 2003-2009, registrant-ne iatrog��nia, no consecuci�� t��cnica i frac��s t��cnic durant el primer mes i realitzant corbes CUSUM per a cada territori, que han acabat constituint un excel���lent sistema d���avaluaci�� de qualitat terap��utica.

Schistosomal glomerulopathy and changes in the distribution of histological patterns of glomerular diseases in Bahia, Brazil

Distinct patterns of glomerular lesions, including membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis, are associated with infection by Schistosoma mansoni or Schistosoma japonicum. Evidence suggests that immune complex deposition is the main mechanism underlying the different forms of schistosomal glomerulonephritis and that immune complex deposition may be intensified by portal hypertension. The relationship between focal segmental glomerulosclerosis and schistosomiasis remains poorly understood. A clinicopathologic classification of schistosomal glomerulopathies was proposed in 1992 by the African Association of Nephrology. In Brazil, mass treatment with oral medications has led to a decrease in the occurrence of schistosomal glomerulopathy. In a survey of renal biopsies performed in Salvador, Brazil, from 2003-2009, only 24 (4%) patients were identified as positive for S. mansoni infection. Among these patients, only one had the hepatosplenic form of the disease. Focal segmental glomerulosclerosis was found in seven patients and membranoproliferative glomerulonephritis was found in four patients. Although retrospective studies on the prevalence of renal diseases based on kidney biopsies may be influenced by many patient selection biases, a change in the distribution of glomerulopathies associated with nephrotic syndrome was observed along with a decline in the occurrence of severe forms of schistosomiasis.

Proposal of three thermodynamic variables to discriminate between storms associated with hail and storms with intense rainfall in Catalonia (Proposta de tres variables termodin��miques per discriminar entre tempestes amb pedregades i tempestes amb pluges intenses)

Between late spring and early fall, the development of storms is common in Catalonia. Despite the fact that they usually produce heavy showers of short duration, they can also involve severe weather with ice pellets or hail. While the latter usually affect inland regions, and there are numerous publications on these cases; the analysis of events affecting the coast and causing damage to public and private properties is not so well developed. The aim of this study is to provide additional thermodynamic indicators that help differentiate storms with hail from storms without hail, considering cases that have affected various regions of Catalonia, mainly coastal areas. The aim is to give more information to improve prognosis and the ability to detail information in these situations. The procedure developed involved the study of several episodes of heavy rainfall and hail that hit Catalonia during the 2003-2009 period, mainly in the province of Girona, and validated the proposal during the campaign of late summer and fall of 2009, as well as 2012. For each case, several variables related to temperature, humidity and wind were analyzed at different levels of the atmosphere, while the information provided by the radio sounding in Barcelona was also taken into account. From this study, it can be concluded that the temperature difference between 500 hPa and 850 hPa, the humidity in the lower layers of the atmosphere and the LI index are good indicators for the detection of storms with associated hail.

Simulated Patient as Co-facilitators: Benefits and Challenges of the Interprofessional Team OSCE (Submission #9350).

Hypothesis: The quality of care for chronic patients depends on the collaborative skills of the healthcare providers.1,2 The literature lacks reports of the use of simulation to teach collaborative skills in non-acute care settings. We posit that simulation offers benefits for supporting the development of collaborative practice in non-acute settings. We explored the benefits and challenges of using an Interprofessional Team - Objective Structured Clinical Examination (IT-OSCE) as a formative assessment tool. IT-OSCE is an intervention which involves an interprofessional team of trainees interacting with a simulated patient (SP) enabling them to practice collaborative skills in non-acute care settings.5 A simulated patient are people trained to portray patients in a simulated scenario for educational purposes.6,7 Since interprofessional education (IPE) ultimately aims to provide collaborative patient-centered care.8,9 We sought to promote patient-centeredness in the learning process. Methods: The IT-OSCE was conducted with four trios of students from different professions. The debriefing was co-facilitated by the SP with a faculty. The participants were final-year students in nursing, physiotherapy and medicine. Our research question focused on the introduction of co-facilitated (SP and faculty) debriefing after an IT-OSCE: 1) What are the benefits and challenges of involving the SP during the debriefing? and 2) To evaluate the IT-OSCE, an exploratory case study was used to provide fine grained data 10, 11. Three focus groups were conducted - two with students (n=6; n=5), one with SPs (n=3) and one with faculty (n=4). Audiotapes were transcribed for thematic analysis performed by three researchers, who found a consensus on the final set of themes. Results: The thematic analysis showed little differentiation between SPs, student and faculty perspectives. The analysis of transcripts revealed more particularly, that the SP's co-facilitation during the debriefing of an IT-OSCE proved to be feasible. It was appreciated by all the participants and appeared to value and to promote patient-centeredness in the learning process. The main challenge consisted in SPs feedback, more particularly in how they could report accurate observations to a students' group rather than individual students. Conclusion: In conclusion, SP methodology using an IT-OSCE seems to be a useful and promising way to train collaborative skills, aligning IPE, simulation-based team training in a non-acute care setting and patient-centeredness. We acknowledge the limitations of the study, especially the small sample and consider the exploration of SP-based IPE in non-acute care settings as strength. Future studies could consider the preparation of SPs and faculty as co-facilitators. References: 1. Borrill CS, Carletta J, Carter AJ, et al. The effectiveness of health care teams in the National Health Service. Aston centre for Health Service Organisational Research. 2001. 2. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010. 3. Issenberg S, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning - a BEME systematic review. Medical Teacher. 2005;27(1):10-28. 4. McGaghie W, Petrusa ER, Gordon DL, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 2010;44(1):50-63. 5. Simmons B, Egan-Lee E, Wagner SJ, Esdaile M, Baker L, Reeves S. Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach. Journal of Interprofessional Care. 2011;25(1):73-74. 6. Nestel D, Layat Burn C, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide Supplement 42.1 - Viewpoint. Medical teacher. 2011;33(12):1027-1029. Disclosures: None (C) 2014 by Lippincott Williams & Wilkins, Inc.

Verenpaineen mittaamisen opettaminen sairaanhoitaja- ja terveydenhoitajaopiskelijoille

<b>Teaching the measurement of blood pressure for both nursing and public health nursing students </b> The purpose of this two-phase study was to develop the teaching of blood pressure measurement within the nursing degree programmes of the Universities of Applied Sciences. The first survey phase described what and how blood pressure measurement was taught within nursing degree programmes. The second intervention phase (2004-2005) evaluated first academic year nursing and public health nursing students��� knowledge and skills results for blood pressure measurement. Additionally, the effect on the Taitoviikko experimental group students��� blood pressure measurement knowledge and skills level. A further objective was to construct models for an instrument (RRmittTest) to evaluate nursing students measurement of blood pressure (2003-2009). The research data for the survey phase were collected from teachers (total sampling, N=107, response rate 77%) using a specially developed RRmittopetus-questionnaire. Quasi-experimental study data on the RRmittTest-instrument was collected from students (purposive sampling, experimental group, n=29, control group, n=44). The RRmittTest consisted of a test of knowledge (Tietotesti) and simulation-based test (TaitoSimk��si and Taitovideo) of skills. Measurements were made immediately after the teaching and in clinical practice. Statistical methods were used to analyse the results and responses to open-ended questions were organised and classified. Due to the small amount of materials involved and the results of distribution tests of the variables, non-parametric analytic methods were mainly used. Experimental group and control group similar knowledge and skills teaching was based on the results of the national survey phase (RRmittopetus) questionnaire results. Experimental group teaching includes the supervised Taitoviikko teaching method. During Taitoviikko students studied blood pressure measurement at the municipal hospital in a real nursing environment, guided by a teacher and a clinical nursing professional. In order to evaluate both learning and teaching the processes and components of blood pressure measurement were clearly defined as follows: the reliability of measurement instruments, activities preceding blood pressure measurement, technical execution of the measurement, recording, lifestyle guidance and measurement at home (self-monitoring). According to the survey study, blood pressure measurement is most often taught at Universities of Applied Sciences, separately, as knowledge (teaching of theory, 2 hours) and skills (classroom practice, 4 hours). The teaching was implemented largely in a classroom and was based mainly on a textbook. In the intervention phase the students had good knowledge of blood pressure measurement. However, their blood pressure measurement skills were deficient and the control group students, in particular, were highly deficient. Following in clinical practice the experimental group and control group students��� blood pressure measurement recording knowledge improve and experimental groups declined lifestyle guidance. Skills did not improve within any of the components analysed. The control groups` skills on the whole, declined statistically.There was a significant decline amongst the experimental group although only in one component measured. The results describe the learning results for first academic year students and no parallel conclusions should be drawn when considering any learning results for graduating students. The results support the use and further development of the Taitoviiko teaching method. The RRmittTest developed for the study should be assessed and the results seen from a negative perspective. This evaluation tool needs to be developed and retested.