Adaptive strategy for the statistical analysis of connectomes.

We study an adaptive statistical approach to analyze brain networks represented by brain connection matrices of interregional connectivity (connectomes). Our approach is at a middle level between a global analysis and single connections analysis by considering subnetworks of the global brain network. These subnetworks represent either the inter-connectivity between two brain anatomical regions or by the intra-connectivity within the same brain anatomical region. An appropriate summary statistic, that characterizes a meaningful feature of the subnetwork, is evaluated. Based on this summary statistic, a statistical test is performed to derive the corresponding p-value. The reformulation of the problem in this way reduces the number of statistical tests in an orderly fashion based on our understanding of the problem. Considering the global testing problem, the p-values are corrected to control the rate of false discoveries. Finally, the procedure is followed by a local investigation within the significant subnetworks. We contrast this strategy with the one based on the individual measures in terms of power. We show that this strategy has a great potential, in particular in cases where the subnetworks are well defined and the summary statistics are properly chosen. As an application example, we compare structural brain connection matrices of two groups of subjects with a 22q11.2 deletion syndrome, distinguished by their IQ scores.

Clinical Learning Environment and Supervision. Development and Validation of the CLES Evaluation Scale

The purpose of the study is: (1) to describe how nursing students' experienced their clinical learning environment and the supervision given by staff nurses working in hospital settings; and (2) to develop and test an evaluation scale of Clinical Learning Environment and Supervision (CLES). The study has been carried out in different phases. The pilot study (n=163) explored the association between the characteristics of a ward and its evaluation as a learning environment by students. The second version of research instrument (which was developed by the results of this pilot study) were tested by an expert panel (n=9 nurse teachers) and test-retest group formed by student nurses (n=38). After this evaluative phase, the CLES was formed as the basic research instrument for this study and it was tested with the Finnish main sample (n=416). In this phase, a concurrent validity instrument (Dunn & Burnett 1995) was used to confirm the validation process of CLES. The international comparative study was made by comparing the Finnish main sample with a British sample (n=142). The international comparative study was necessary for two reasons. In the instrument developing process, there is a need to test the new instrument in some other nursing culture. Other reason for comparative international study is the reflecting the impact of open employment markets in the European Union (EU) on the need to evaluate and to integrate EU health care educational systems. The results showed that the individualised supervision system is the most used supervision model and the supervisory relationship with personal mentor is the most meaningful single element of supervision evaluated by nursing students. The ward atmosphere and the management style of ward manager are the most important environmental factors of the clinical ward. The study integrates two theoretical elements - learning environment and supervision - in developing a preliminary theoretical model. The comparative international study showed that, Finnish students were more satisfied and evaluated their clinical placements and supervision with higher scores than students in the United Kingdom (UK). The difference between groups was statistical highly significant (p= 0.000). In the UK, clinical placements were longer but students met their nurse teachers less frequently than students in Finland. Arrangements for supervision were similar. This research process has produced the evaluation scale (CLES), which can be used in research and quality assessments of clinical learning environment and supervision in Finland and in the UK. CLES consists of 27 items and it is sub-divided into five sub-dimensions. Cronbach's alpha coefficient varied from high 0.94 to marginal 0.73. CLES is a compact evaluation scale and user-friendliness makes it suitable for continuing evaluation.

The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

OBJECTIVE: To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. METHODS: Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the "gold standard measure," chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. RESULTS: The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. CONCLUSION: We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM.

Vemurafenib in patients with BRAF(V600) mutation-positive melanoma with symptomatic brain metastases: final results of an open-label pilot study.

BACKGROUND & AIM: Brain metastases are frequent in patients with metastatic melanoma, indicating poor prognosis. We investigated the BRAF kinase inhibitor vemurafenib in patients with advanced melanoma with symptomatic brain metastases. METHODS: This open-label trial assessed vemurafenib (960mg twice a day) in patients with BRAF(V600) mutation-positive metastatic melanoma with non-resectable, previously treated brain metastases. The primary end-point was safety. Secondary end-points included best overall response rate, and progression-free and overall survival. RESULTS: Twenty-four patients received vemurafenib for a median treatment duration of 3.8 (0.1-11.3) months. The majority of discontinuations were due to disease progression (n=22). Twenty-three of 24 patients reported at least one adverse event (AE). Grade 3 AEs were reported in four (17%; 95% confidence interval [CI], 4.7-37.4%) patients and included cutaneous squamous cell carcinoma in four patients. Median progression-free survival was 3.9 (95% CI, 3.0-5.5) months, and median survival was 5.3 (95% CI, 3.9-6.6) months. An overall partial response (PR) at both intracranial and extracranial sites was achieved in 10 of 24 (42%; 95% CI, 22.1-63.4) evaluable patients, with stable disease in nine (38%; 95% CI, 18.8-59.4) patients. Of 19 patients with measurable intracranial disease, seven (37%) achieved >30% intracranial tumour regression, and three (16%; 95% CI, 3.4-39.6%) achieved a confirmed PR. Other signs of improvement included reduced need for corticosteroids and enhanced performance status. CONCLUSIONS: Vemurafenib can be safely used in patients with advanced symptomatic melanoma that has metastasised to the brain and can result in meaningful tumour regression.

Recognition judgments and the performance of the recognition heuristic depend on the size of the reference class

In a series of three experiments, participants made inferences about which one of a pair of two objects scored higher on a criterion. The first experiment was designed to contrast the prediction of Probabilistic Mental Model theory (Gigerenzer, Hoffrage, & Kleinbölting, 1991) concerning sampling procedure with the hard-easy effect. The experiment failed to support the theory's prediction that a particular pair of randomly sampled item sets would differ in percentage correct; but the observation that German participants performed practically as well on comparisons between U.S. cities (many of which they did not even recognize) than on comparisons between German cities (about which they knew much more) ultimately led to the formulation of the recognition heuristic. Experiment 2 was a second, this time successful, attempt to unconfound item difficulty and sampling procedure. In Experiment 3, participants' knowledge and recognition of each city was elicited, and how often this could be used to make an inference was manipulated. Choices were consistent with the recognition heuristic in about 80% of the cases when it discriminated and people had no additional knowledge about the recognized city (and in about 90% when they had such knowledge). The frequency with which the heuristic could be used affected the percentage correct, mean confidence, and overconfidence as predicted. The size of the reference class, which was also manipulated, modified these effects in meaningful and theoretically important ways.

Stress, coping and presenteeism in nurses assisting critical and potentially critical patients

Objective to verify the associations between stress, Coping and Presenteeism in nurses operating on direct assistance to critical and potentially critical patients. Method this is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010 with 129 hospital nurses. The Inventory of stress in nurses, Occupational and Coping Questionnaire Range of Limitations at Work were used. For the analysis, the Kolmogorov-Smirnov test, correlation coefficient of Pearson and Spearman, Chi-square and T-test were applied. Results it was observed that 66.7% of the nurses showed low stress, 87.6% use control strategies for coping stress and 4.84% had decrease in productivity. Direct and meaningful relationships between stress and lost productivity were found. Conclusion stress interferes with the daily life of nurses and impacts on productivity. Although the inability to test associations, the control strategy can minimize the stress, which consequently contributes to better productivity of nurses in the care of critical patients and potentially critical.


Systematic review of meaning in life assessment instruments.

BACKGROUND: The construct of "meaning in life" (MiL) has raised the interest of clinicians working in psycho-oncology and end-of-life care. It has become a topic of scientific investigation where diverse assessment approaches have been applied. Aims: We present a comprehensive systematic review of existing MiL assessment instruments. METHODS: Electronic searches of articles published in English peer-reviewed journals were performed in Psycinfo, Medline, Embase and Cinahl. Instruments are appraised with regard to ten measurement properties. RESULTS: In total, 59 nomothetic and idiographic MiL instruments were identified. Most instruments were developed in North America and meet basic psychometric criteria. They assess presence of and search for MiL, crisis and sources of MiL, meaning making, meaningful activity, MiL in the context of illness, breadth, depth, and other structural indicators. These aspects are largely consistent with existing MiL definitions. Nine out of 59 instruments included cancer populations in test development. CONCLUSIONS: This overview of available instruments underscores the complexity of the construct and might assist researchers to select an appropriate instrument for their research needs. Finally, it points to the need for more integrative theorizing and research on MiL. Copyright © 2012 John Wiley & Sons, Ltd.

Skin cancer in survivors of childhood and adolescent cancer.

The incidence of basal cell carcinoma (BCC) has been related to ionizing radiation, particularly for exposure occurring at young age. In this study, we considered the incidence of second skin neoplasms in long-term survivors from childhood cancer. We considered second primary cancers occurring among 776 subjects (436 males, 340 females) with first primary cancer diagnosed before age 20 years, between 1974 and 2001, in the Swiss Cantons of Vaud and Neuchâtel (786,000 inhabitants). Five BCC were observed versus 0.43 expected (standardized incidence ratio: 11.6, 95% confidence interval: 3.7-27.1). No case of cutaneous squamous cell carcinoma, nor of malignant melanoma was observed. The estimated radiation doses at 1mm through the skin ranged between 7 and 27 Sv. These data confirm that BCC are strongly related to ionizing radiation exposure in childhood. All the BCC were located within the radiation field, thus indicating that ionizing radiation is the key aetiological factor, even in the absence of any meaningful interaction with UV.

Approaches and Strategies to Improve Writing Skills

I believe and, I hope others believe that writing well is not only a personal accomplishment but also a valuable form of social participation and leadership. After reviewing the literature, this work tries to identify the problem and to identify the key issues to EFL writing so as to suggest a remedial procedure that may help the learners to express themselves better in English. It aims at finding areas of difficulty in the writing skill among the students and to work out remedial procedures to help them overcome their weakness. A survey carried out on 12th grade students, regarding their comprehension, shows that organizing idea on paper is one of the factors which influences their ability to write. It also shows that students feel the need to be instructed on strategies of writing success and consequently improving their writing. There are a lot systematic approaches and methods for discerning which skills and type of writing teacher should focus on and meaningful classroom activities and strategies that teacher can use to help students improving their writing.

Abnormal cortical network activation in human amnesia: A high-resolution evoked potential study.

Little is known about how human amnesia affects the activation of cortical networks during memory processing. In this study, we recorded high-density evoked potentials in 12 healthy control subjects and 11 amnesic patients with various types of brain damage affecting the medial temporal lobes, diencephalic structures, or both. Subjects performed a continuous recognition task composed of meaningful designs. Using whole-scalp spatiotemporal mapping techniques, we found that, during the first 200 ms following picture presentation, map configuration of amnesics and controls were indistinguishable. Beyond this period, processing significantly differed. Between 200 and 350 ms, amnesic patients expressed different topographical maps than controls in response to new and repeated pictures. From 350 to 550 ms, healthy subjects showed modulation of the same maps in response to new and repeated items. In amnesics, by contrast, presentation of repeated items induced different maps, indicating distinct cortical processing of new and old information. The study indicates that cortical mechanisms underlying memory formation and re-activation in amnesia fundamentally differ from normal memory processing.

Spanning tests in return and stochastic discount factor mean-variance frontiers: A unifying approach

We propose new spanning tests that assess if the initial and additional assets share theeconomically meaningful cost and mean representing portfolios. We prove their asymptoticequivalence to existing tests under local alternatives. We also show that unlike two-step oriterated procedures, single-step methods such as continuously updated GMM yield numericallyidentical overidentifyng restrictions tests, so there is arguably a single spanning test.To prove these results, we extend optimal GMM inference to deal with singularities in thelong run second moment matrix of the influence functions. Finally, we test for spanningusing size and book-to-market sorted US stock portfolios.

Increasing Students Vocabulary in Efl Class

After reviewing the literature, this work tries to show the importance of teaching vocabulary fõr students’ literacy skills, especially, reading comprehension. Many researchers suggest that the greatest amount of vocabulary growth occurs through incidental word learning in wide reading, and, research indicates that vocabulary instruction is an important vehicle for vocabulary learning. (Anderson& Nagy, as cited in Harmon, 1992, p.306). Word knowledge is one of the best ways of successful reading and comprehension. “Reading enhancement correlates with reader’s vocabulary” (Im, 1994, p.12). Therefore, today’s language teachers and researchers have realized the important role of vocabulary in reading comprehension. A survey carried out on 10th, 11th and 12th grade students, regarding their reading comprehension, shows that unknown words is one of the factors which influences their ability to read and comprehend a passage. It also shows that students feel the need to be instructed on strategy when encountering new words and consequently improving their vocabulary. This inhibits their understanding of a reading selection. As a result it is crucial that teachers equip students with methodological tools to be employed when they encounter unknown words. There are a lot systematic approaches for discerning which skills and words a teacher should focus on and meaningful classroom activities to reinforce the words and strategies that teachers can use to help students increase their word knowledge. Finally research indicates that developing students’ vocabulary correlates with success in all areas of curriculum (Edger, 1999, p.14). The success of vocabulary development depends on students’ active process of learning and strategies used by teachers.

Revitalização dos Patrimónios Arquitectónicos da Cidade Da Ponta Do Sol – Uma Proposta

O objectivo deste trabalho foi de propor propostas de revitalização dos patrimónios arquitectónicos, históricos e culturais da cidade de Ponta do Sol, no intuito de que essa acção pudesse contribuir, de forma significativa, para a preservação dos patrimónios e um possível crescimento económico de Santo Antão, sobretudo do ponto de vista turístico. A cidade de Ponta do Sol, no passado, teve grande importância no que tange à produção e escoamento de vários produtos a exemplo do café, aguardente e quina, tanto para as outras ilhas como para países europeus. Mantém em seu espaço várias e belas construções dos tempos coloniais, entretanto esquecidas, e muitas delas já destruídas e outras encontrando-se em elevado estado de degradação. Além disso, possui uma grande presença judaica e também uma diversidade de herança histórica e cultural, que precisa continuar existindo para que não se perca a identidade cultural da comunidade, uma vez que há presença de tentativas de homogeneização da cultura, imposta principalmente pelos países desenvolvidos e pela globalização. Sendo assim, a preservação e revitalização dos edifícios, tanto público como privado, como do centro histórico em geral, poderá servir de base promotora para o fortalecimento da actividade turística da cidade. Para isso utilizaram-se como fontes bibliográficas, vários documentos, livros diversos, entrevistas, fotografias e trabalho de campo. Depois, com a recolha de dados foi possível constatar que a cidade de Ponta do Sol está atravessando um processo de degradação e modernização. Apesar de ainda activo e vivo, o centro está-se deteriorando, e se não houver intervenções que revertam esse processo, este perderá muito da sua identidade, da sua história-cultural e principalmente os seus patrimónios. Mas, propostas, projectos intervencionistas e acções executoras podem ainda reverter parte dessa situação e dando soluções ao centro da Cidade. Algumas propostas serão implementadas e até mesmo aglutinadas a novas propostas, podendo ser benéficas tanto para a cidade como também para a população. The aim of this work is to make proposals for the revitalization of the historic, cultural and architectural heritage of the city of Ponta do Sol, hoping that this action could contribute in a meaningful way to preserve the patrimony and the possible economic growth of Santo Antão, an island which is particularly considered for the production and trade of different products, especially coffee, liquor and quinine for other islands as well as for European countries. It displays several beautiful colonial constructions. However, they have been forgotten and some of degradation. Besides, this city hosts a great Judaic presence and also some diversity of the cultural identity, since there is the presence of attempts for the homogenization of the culture, imposed mainly by developed countries and the globalization. Thus, the preservation and revitalization of both public and private buildings as well as of the historic centre in general, can serve of a promotion basis for the strength of the historic activity in this town. That´s why a lot of documents, several books, interviews, photos, and field work as local evidence were used as bibliography. Afterwards, with the collected data it was possible to notice that the city of Ponta do Sol is facing a process of degradation and modernization. In spite of still being active and alive, the center is up deteriorating and if on interventions are made to revert this process, it will lose a lot of its identity, cultural history and mainly its patrimony. But proposals, interventionist projects and executive actions can still revert part of this situation and get solutions for the City centre. Some proposal which will be implemented and even be agglutinated to new proposal can be helpful for the city as well as for the population.

Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study.

Liver transplantation (LT) is currently contraindicated in patients with residual or metastatic alveolar echinococcosis (AE) lesions. We evaluated the long-term course of such patients who underwent LT and were subsequently treated with benzimidazoles. Clinical, imaging, serological, and therapeutic data were collected from 5 patients with residual/recurrent AE lesions who survived for more than 15 years. Since 2004, [(18) F]-2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) images were available, and the levels of serum antibodies (Abs) against Echinococcus multilocularis-recombinant antigens were evaluated. Median survival time after LT was 21 years. These patients were from a prospective cohort of 23 patients with AE who underwent LT: 5 of 8 patients with residual/recurrent AE and 4 of 9 patients without residual/recurrent AE were alive in September 2009. High doses of immunosuppressive drugs, the late introduction of therapy with benzimidazoles, its withdrawal due to side effects, and nonadherence to this therapy adversely affected the prognosis. Anti-Em2(plus) and anti-rEm18 Ab levels and standard FDG-PET enabled the efficacy of therapy on the growth of EA lesions to be assessed. However, meaningful variations in Ab levels were observed below diagnostic cutoff values; and in monitoring AE lesions, images of FDG uptake taken 3 hours after its injection were more sensitive than images obtained 1 hour after its injection. In conclusion, benzimidazoles can control residual/recurrent AE lesions after LT. Using anti-rEm18 or anti-Em2(plus) Ab levels and the delayed acquisition of FDG-PET images can improve the functional assessment of disease activity. The potential recurrence of disease, especially in patients with residual or metastatic AE lesions, should not be regarded as a contraindication to LT when AE is considered to be lethal in the short term.

On some geometry and equivalence classes of normal form games

Equivalence classes of normal form games are defined using the geometryof correspondences of standard equilibiurm concepts like correlated, Nash,and robust equilibrium or risk dominance and rationalizability. Resultingequivalence classes are fully characterized and compared across differentequilibrium concepts for 2 x 2 games. It is argued that the procedure canlead to broad and game-theoretically meaningful distinctions of games aswell as to alternative ways of viewing and testing equilibrium concepts.Larger games are also briefly considered.