Success of referral for alcohol dependent patients from a general hospital: predictive value of patient and process characteristics.

To assess the effectiveness of a multidisciplinary evaluation and referral process in a prospective cohort of general hospital patients with alcohol dependence. Alcohol-dependent patients were identified in the wards of the general hospital and its primary care center. They were evaluated and then referred to treatment by a multidisciplinary team; those patients who accepted to participate in this cohort study were consecutively included and followed for 6 months. Not included patients were lost for follow-up, whereas all included patients were assessed at time of inclusion, 2 and 6 months later by a research psychologist in order to collect standardized baseline patients' characteristics, process salient features and patients outcomes (defined as treatment adherence and abstinence). Multidisciplinary evaluation and therapeutic referral was feasible and effective, with a success rate of 43%for treatment adherence and 28%for abstinence at 6 months. Among patients' characteristics, predictors of success were an age over 45, not living alone, being employed and being motivated to treatment (RAATE-A score < 18), whereas successful process characteristics included detoxification of the patient at time of referral and a full multidisciplinary referral meeting. This multidisciplinary model of evaluation and referral of alcohol dependent patients of a general hospital had a satisfactory level of effectiveness. Predictors of success and failure allow to identify subsets of patients for whom new strategies of motivation and treatment referral should be designed.

Enterprise Architecture Principles in Research and Practice: Insights from an Exploratory Analysis

Even though architecture principles were first discussed in the 1990s, they are still perceived as an underexplored topic in enterprise architecture management research. By now, there is an increasing consensus about EA principles' nature, as well as guidelines for their formulation. However, the extant literature remains vague about what can be considered suitable EA design and evolution guidance principles. In addition, empirical insights regarding their role and usefulness in practice are still lacking. Accordingly, this research seeks to address three questions: (1) What are suitable principles to guide EA design and evolution? (2) What usage do EA principles have for practitioners? (3) Which propositions can be derived regarding EA principles' role and application? Opting for exploratory research, we apply a research process covering critical analysis of current publications as well as capturing experts' perceptions. Our research ontologically distinguishes between principles from nonprinciples, proposes a validated set of meta-principles, and clarifies principles' application, role, and usefulness in practice. The explored insights can be used as guidelines in defining suitable principles and turning them into an effective bridge between strategy and design and a guide in design decisions.

Nonparametric estimation of Value-at-Risk

A method to estimate an extreme quantile that requires no distributional assumptions is presented. The approach is based on transformed kernel estimation of the cumulative distribution function (cdf). The proposed method consists of a double transformation kernel estimation. We derive optimal bandwidth selection methods that have a direct expression for the smoothing parameter. The bandwidth can accommodate to the given quantile level. The procedure is useful for large data sets and improves quantile estimation compared to other methods in heavy tailed distributions. Implementation is straightforward and R programs are available.

Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.

Warning systems in a computerized nursing process for Intensive Care Units

A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

On the throughput-WIP trade-off in queueing systems, diminishing returns and the threshold property: A linear programming approach

We present a new unifying framework for investigating throughput-WIP(Work-in-Process) optimal control problems in queueing systems,based on reformulating them as linear programming (LP) problems withspecial structure: We show that if a throughput-WIP performance pairin a stochastic system satisfies the Threshold Property we introducein this paper, then we can reformulate the problem of optimizing alinear objective of throughput-WIP performance as a (semi-infinite)LP problem over a polygon with special structure (a thresholdpolygon). The strong structural properties of such polygones explainthe optimality of threshold policies for optimizing linearperformance objectives: their vertices correspond to the performancepairs of threshold policies. We analyze in this framework theversatile input-output queueing intensity control model introduced byChen and Yao (1990), obtaining a variety of new results, including (a)an exact reformulation of the control problem as an LP problem over athreshold polygon; (b) an analytical characterization of the Min WIPfunction (giving the minimum WIP level required to attain a targetthroughput level); (c) an LP Value Decomposition Theorem that relatesthe objective value under an arbitrary policy with that of a giventhreshold policy (thus revealing the LP interpretation of Chen andYao's optimality conditions); (d) diminishing returns and invarianceproperties of throughput-WIP performance, which underlie thresholdoptimality; (e) a unified treatment of the time-discounted andtime-average cases.

A gated single-photon avalanche diode array fabricated in a conventional CMOS process for triggered systems

A bidimensional array based on single-photon avalanche diodes for triggered imaging systems is presented. The diodes are operated in the gated mode of acquisition to reduce the probability to detect noise counts interfering with photon arrival events. In addition, low reverse bias overvoltages are used to lessen the dark count rate. Experimental results demonstrate that the prototype fabricated with a standard HV-CMOS process gets rid of afterpulses and offers a reduced dark count probability by applying the proposed modes of operation. The detector exhibits a dynamic range of 15 bits with short gated"on" periods of 10ns and a reverse bias overvoltage of 1.0V.

Nitrate and ammonium in soil solution in tobacco management systems

Tobacco farmers of southern Brazil use high levels of fertilizers, without considering soil and environmental attributes, posing great risk to water resources degradation. The objective of this study was to monitor nitrate and ammonium concentrations in the soil solution of an Entisol in and below the root zone of tobacco under conventional tillage (CT), minimum tillage (MT) and no-tillage (NT). The study was conducted in the small-watershed Arroio Lino, in Agudo, State of Rio Grande do Sul, Brazil. A base fertilization of 850 kg ha-1 of 10-18-24 and topdressing of 400 kg ha-1 of 14-0-14 NPK fertilizer were applied. The soil solution was sampled during the crop cycle with a tension lysimeter equipped with a porous ceramic cup. Ammonium and nitrate concentrations were analyzed by the distillation and titration method. Nitrate concentrations, ranging from 8 to 226 mg L-1, were highest after initial fertilization and decreased during the crop cycle. The average nitrate (N-NO3-) concentration in the root zone was 75 in NT, 95 in MT, and 49 mg L-1 in CT. Below the root zone, the average nitrate concentration was 58 under NT, 108 under MT and 36 mg L-1 under CT. The nitrate and ammonium concentrations did not differ significantly in the management systems. However, the nitrate concentrations measured represent a contamination risk to groundwater of the watershed. The ammonium concentration (N-NH4+) decreased over time in all management systems, possibly as a result of the nitrification process and root uptake of part of the ammonium by the growing plants.

The prognostic value of semi-quantitative i-123 mibg scintigraphy at diagnosis in high risk neuroblastoma: validation of the siopen score method

Purpose: SIOPEN scoring of 123I mIBG imaging has been shown to predict response to induction chemotherapy and outcome at diagnosis in children with HRN.Method: Patterns of skeletal 123I mIBG uptake were assigned numerical scores (Mscore) ranging from 0 (no metastasis) to 72 (diffuse metastases) within 12 body areas as described previously. 271 anonymised, paired image data sets acquired at diagnosis and on completion of Rapid COJEC induction chemotherapy were reviewed, constituting a representative sample of 1602 children treated prospectively within the HR-NBL1/SIOPEN trial. Pre-and post-treatment Mscores were compared with bone marrow cytology (BM) and 3 year event free survival (EFS).Results: Results 224/271 patients showed skeletal MIBG-uptake at diagnosis and were evaluable forMIBG-response. Complete response (CR) on MIBG to Rapid COJEC induction was achieved by 66%, 34% and 15% of patients who had pre-treatment Mscores of <18 (n¼65, 29%), 18-44 (n¼95,42%) and Y ´ 45 (n¼64, 28.5%) respectively (chi squared test p<.0001). Mscore at diagnosis and on completion of Rapid COJEC correlated strongly with BM involvement (p<0.0001). The correlation of pre score with post scores and response was highly significant (p<0.001). Most importantly, the 3 year EFS in 47 children with Mscore 0 at diagnosis was 0.68 (A ` 0.07), by comparison with 0.42 (A` 0.06), 0.35 (A` 0.05) and 0.25 (A` 0.06) for patients in pre-treatment score groups <18, 18-44 and Y ´ 45, respectively (p<0.001). AnMscore threshold ofY ´ 45 at diagnosis was associated with significantly worse outcome by comparison with all other Mscore groups (p¼0.029). The 3 year EFS of 0.53 (A` 0.07) of patients in metastatic CR (mIBG and BM) after Rapid Cojec (33%) is clearly superior to patients not achieving metastatic CR (0.24 (A ` 0.04), p¼0.005).Conclusion: SIOPEN scoring of 123I mIBG imaging has been shown to predict response to induction chemotherapy and outcome at diagnosis in children with HRN.

Pela integração da inteligência competitiva nos Enterprise Information Systems (EIS)

O objetivo deste artigo é evidenciar a importância da integração de um módulo de inteligência competitiva (coleta, organização e difusão da informação externa) nos sistemas de informações para o apoio à decisão das empresas, enriquecendo assim os Enterprise Information Systems (EIS). É a efetividade do gerente na busca da identificação ou da antecipação de problemas ou oportunidades, em um cenário de cada vez maiores pressões internas e principalmente externas. O propósito maior é fornecer amplo ambiente de oferta de informações internas e externas, formais e informais, informações sobre as percepções do mercado, informações envolvidas em análises e simulações, enfim, um ambiente integrador das informações disponíveis e relevantes para o sucesso da organização e que crie condições de proatividade para os usuários.

Properties of a risk measure derived from ruin theory

This paper studies a risk measure inherited from ruin theory and investigates some of its properties. Specifically, we consider a value-at-risk (VaR)-type risk measure defined as the smallest initial capital needed to ensure that the ultimate ruin probability is less than a given level. This VaR-type risk measure turns out to be equivalent to the VaR of the maximal deficit of the ruin process in infinite time. A related Tail-VaR-type risk measure is also discussed.