Reliability and validity of the interactive observation scale for psychiatric inpatients applied by nursing aides in daily ward practice

The main characteristic of the nursing Interactive Observation Scale for Psychiatric Inpatients (IOSPI) is the necessity of interaction between raters and patients during assessment. The aim of this study was to evaluate the reliability and validity of the scale in the "real" world of daily ward practice and to determine whether the IOSPI can increase the interaction time between raters and patients and influence the raters' opinion about mental illness. All inpatients of a general university hospital psychiatric ward were assessed daily over a period of two months by 9 nursing aides during the morning and afternoon shifts, with 273 pairs of daily observations. Once a week the patients were interviewed by a psychiatrist who filled in the Brief Psychiatric Rating Scale (BPRS). The IOSPI total score was found to show significant test-retest reliability (interclass correlation coefficient = 0.83) and significant correlation with the BPRS total score (r = 0.69), meeting the criteria of concurrent validity. The instrument can also discriminate between patients in need of further inpatient treatment from those about to be discharged (negative predictive value for discharge = 0.91). Using this scale, the interaction time between nursing aides and patients increased significantly (t = 2.93, P<0.05) and their opinion about the mental illness changed. The "social restrictiveness" factor of the opinion scale about mental illness showed a significant reduction (t = 4.27, P<0.01) and the "interpersonal etiology" factor tended to increase (t = 1.98, P = 0.08). The IOSPI was confirmed as a reliable and valid scale and as an efficient tool to stimulate the therapeutic attitudes of the nursing staff.

Screening for mutations in human alpha-globin genes by nonradioactive single-strand conformation polymorphism

Point mutations and small insertions or deletions in the human alpha-globin genes may produce alpha-chain structural variants and alpha-thalassemia. Mutations can be detected either by direct DNA sequencing or by screening methods, which select the mutated exon for sequencing. Although small (about 1 kb, 3 exons and 2 introns), the alpha-globin genes are duplicate (alpha2 and alpha1) and highy G-C rich, which makes them difficult to denature, reducing sequencing efficiency and causing frequent artifacts. We modified some conditions for PCR and electrophoresis in order to detect mutations in these genes employing nonradioactive single-strand conformation polymorphism (SSCP). Primers previously described by other authors for radioactive SSCP and phast-SSCP plus denaturing gradient gel electrophoresis were here combined and the resultant fragments (6 new besides 6 original per alpha-gene) submitted to silver staining SSCP. Nine structural and one thalassemic mutations were tested, under different conditions including two electrophoretic apparatus (PhastSystem™ and GenePhor™, Amersham Biosciences), different polyacrylamide gel concentrations, run temperatures and denaturing agents, and entire and restriction enzyme cut fragments. One hundred percent of sensitivity was achieved with four of the new fragments formed, using the PhastSystem™ and 20% gels at 15ºC, without the need of restriction enzymes. This nonradioactive PCR-SSCP approach showed to be simple, rapid and sensitive, reducing the costs involved in frequent sequencing repetitions and increasing the reliability of the results. It can be especially useful for laboratories which do not have an automated sequencer.

Developing purchase invoice processing through workflow automation

The aim of this master’s thesis is to research and analyze how purchase invoice processing can be automated and streamlined in a system renewal project. The impacts of workflow automation on invoice handling are studied by means of time, cost and quality aspects. Purchase invoice processing has a lot of potential for automation because of its labor-intensive and repetitive nature. As a case study combining both qualitative and quantitative methods, the topic is approached from a business process management point of view. The current process was first explored through interviews and workshop meetings to create a holistic understanding of the process at hand. Requirements for process streamlining were then researched focusing on specified vendors and their purchase invoices, which helped to identify the critical factors for successful invoice automation. To optimize the flow from invoice receipt to approval for payment, the invoice receiving process was outsourced and the automation functionalities of the new system utilized in invoice handling. The quality of invoice data and the need of simple structured purchase order (PO) invoices were emphasized in the system testing phase. Hence, consolidated invoices containing references to multiple PO or blanket release numbers should be simplified in order to use automated PO matching. With non-PO invoices, it is important to receive the buyer reference details in an applicable invoice data field so that automation rules could be created to route invoices to a review and approval flow. In the beginning of the project, invoice processing was seen ineffective both time- and cost-wise, and it required a lot of manual labor to carry out all tasks. In accordance with testing results, it was estimated that over half of the invoices could be automated within a year after system implementation. Processing times could be reduced remarkably, which would then result savings up to 40 % in annual processing costs. Due to several advancements in the purchase invoice process, business process quality could also be perceived as improved.

Fuzzy expert system in the prediction of neonatal resuscitation

In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.

Prevalence of diphtheria and tetanus antibodies and circulation of Corynebacterium diphtheriae in São Paulo, Brazil

The introduction of routine vaccination against tetanus and diphtheria in Brazil has decreased the incidence and changed the epidemiology of both diseases. We then investigated the prevalence of Corynebacterium diphtheriae carrier status and diphtheria and tetanus immunity in São Paulo, Brazil. From November 2001 to March 2003, 374 individuals were tested for the presence of C. diphtheriae in the naso-oropharynx and of serum diphtheria and tetanus antibodies. Participants were all healthy individuals without acute or chronic pathologies and they were stratified by age as follows: 0-12 months and 1-4, 5-9, 10-14, 15-24, 25-39, 40-59, and ³60 years. Antibodies were assessed using a double-antigen ELISA. C. diphtheriae species were identified by biochemical analysis and toxigenicity was assessed by the Elek test. For diphtheria, full protection (antibodies ³0.1 IU/mL) was present in 84% of the individuals, 15% had basic protection (antibodies ³0.01 and <0.1 IU/mL) and 1% were susceptible (antibodies <0.01 IU/mL). Full tetanus protection (antibodies ³0.1 IU/mL) was present in 79% of the participants, 18% had basic protection (antibodies ³0.01 and <0.1 IU/mL) and 3% were susceptible (antibodies <0.01 IU/mL). The geometric mean of diphtheria and tetanus antibodies reached the highest values at 5-9 years and decreased until the 40-59-year age range, increasing again in individuals over 60 years. Three participants (0.8%) were carriers of C. diphtheriae, all non-toxigenic strains. The present results demonstrate the clear need of periodic booster for tetanus and diphtheria vaccine in adolescents and adults after primary immunization in childhood.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

Stability of fruit bases and chocolate fillings

Syrups with high sugar content and dehydrated fruits in its composition can be added to chocolate fillings to reduce the need of artificial flavor and dyes attributing a natural appeal to the product. Fruit bases were produced with lyophilized strawberry, passion fruit, and sliced orange peel. Rheological dynamic oscillatory tests were applied to determine the products stability and tendency of shelf life. Values of G´< G´´ were observed for strawberry and passion fruit flavor, whereas values of G´ > G´´ were found for orange flavor during the 90 days of storage. It was observed that shear stress values did not vary significantly suggesting product stability during the studied period. For all fillings, it was found a behavior similar to the fruit base indicating that it has great influence on the filling behavior and its stability. The use of a sugar matrix in fillings provided good shelf life for the fruit base, which could be kept under room temperature conditions for a period as long as one year. The good stability and storage conditions allow the use of fruit base for handmade products as well as for industrialized products.

Salted lamb meat blanket of Petrolina-Pernambuco, Brazil: process and quality

Salted lamb meat blanket, originated from boning, salting, and drying of whole lamb carcass, was studied aiming at obtaining information that support the search for guarantees of origin for this typical regional product from the city of Petrolina-Pernambuco-Brazil. Data from three processing units were obtained, where it was observed the use of a traditional local technology that uses salting, an ancient preservation method; however, with a peculiar boning technique, resulting in a meat product with great potential for exploitation in the form of meat blanket. Based on the values of pH (6.22 ± 0.22), water activity (0.97 ± 0.02), and moisture (69.86 ± 2.26) lamb meat blanket is considered a perishable product, and consequently it requires the use of other preservation methods combined with salt, which along with the results of the microbiological analyses (absence of Salmonella sp, score <10 MPN/g of halophilic bacteria, total coliforms between 6.7 × 10³ and 5.2 × 10(6) FUC/g, and Staphylococcus from 8.1 × 10³ CFU/g at uncountable) reinforce the need of hygienic practices to ensure product safety. These results, together with the product notoriety and the organization of the sector are important factors in achieving Geographical Indication of the Salted lamb Meat blanket of Petrolina.

Measurement of social value creation with non-financial measures

This research examines the concept of social entrepreneurship which is a fairly new business model. In the field of business it has become increasingly popular in recent years. The growing awareness of the environment and concrete examples of impact created by social entrepreneurship have encouraged entrepreneurs to address social problems. Society’s failures are tried to redress as a result of business activities. The purpose of doing business is necessarily no longer generating just profits but business is run in order to make a social change with the profit gained from the operations. Successful social entrepreneurship requires a specific nature, constant creativity and strong desire to make a social change. It requires constant balancing between two major objectives: both financial and non-financial issues need to be considered, but not at the expense of another. While aiming at the social purpose, the business needs to be run in highly competitive markets. Therefore, both factors need equally be integrated into an organization as they are complementary, not exclusionary. Business does not exist without society and society cannot go forward without business. Social entrepreneurship, its value creation, measurement tools and reporting practices are under discussion in this research. An extensive theoretical basis is covered and used to support the findings coming out of the researched case enterprises. The most attention is focused on the concept of Social Return on Investment. The case enterprises are analyzed through the SROI process. Social enterprises are mostly small or medium sized. Naturally this sets some limitations in implementing measurement tools. The question of resources requires the most attention and therefore sets the biggest constraints. However, the size of the company does not determine all – the nature of business and the type of social purpose need to be considered always. The mission may be so concrete and transparent that in all cases any kind of measurement would be useless. Implementing measurement tools may be of great benefit – or a huge financial burden. Thus, the very first thing to carefully consider is the possible need of measuring value creation.

Plantability and moisture content of naked and pelleted seeds of supersweet (Sh2) corn during cold storage conditions

The supersweet (Sh2) corn seeds have a thin tegument and an irregular shape, which hinder the sowing procedure. As a function of those factors, the significance of using the pelleting process to improve sowing and standardize the stand of plants in the field without the need of thinning within the row is emphasized. Although this technique has already been known for many years, little has been studied on the effect of such procedure on the plantability and on the moisture content of the supersweet corn seeds. Therefore, this research work aimed at evaluating the effects of pelleting on the moisture content of the seeds along the storing process, on the occurrence of gaps on seed deposition and on the dropping of double seeds, with the aid of a testing seeder. Other physical attributes of seeds and pellets were also evaluated through tests of fragmentation, screen retention, mass of a thousand seeds and apparent volume. Results have shown an increase on the mass and on the volume of the pelleted seeds that presented highly resistance to cracks and breaking. The pelleting was efficient on the reduction of gaps and on the deposition of double seeds at sowing, thus providing highly satisfactory results for these attributes. An increase on the seed moisture content was also observed as a function of storage with a significant reduction on this factor after the pelleting procedure. Results allow concluding that the pelleting process reduces seed moisture content and improves plantability, positively affecting the efficiency of the sowing process.

Prospects of Bitcoin diffusion

Currency is something people deal with every day in their lives. The contemporary society is very much revolving around currencies. Even though technological development has been rapid, the principle of currency has stayed relatively unchanged for a long time. Bitcoin is a digital currency that introduced an alternative to other digital currencies, and to the traditional physical currencies. Bitcoin is peer-to-peer, open source, and it erases the need of a third party in transactions. Bitcoin has since inception gained certain fame, but it has not established itself as a common currency in the world. The purpose of this study was to analyse what kind of potential does Bitcoin have to become a widely accepted currency in day-to-day transactions. The main research question was divided into three sub questions: • What kind of a process is the diffusion of new innovations? • What kinds of factors speak for the wider adoption of Bitcoin? • What kinds of factors speak against the wider adoption of Bitcoin? The purpose of the study was approached by having diffusion of innovations as the theoretical framework. The four elements in diffusion of innovations are, innovation, communication, time, and social system. The theoretical framework is applied to Bitcoin, and the research questions answered by analysing Bitcoin’s potential diffusion prospects. The body of research data consisted of media texts and statistics. In this study, content analysis was the research method. The main findings of the study are that Bitcoin has clear strengths, but it faces a large amount of uncertainty. Bitcoin’s strong areas are the transactions. They are fast, easy, and cheap. From the innovation diffusion perspective Bitcoin is still relatively unknown, and the general public’s attitudes towards it are sceptical. The research findings purport that Bitcoin has potential demand especially when the financial system of a region is dysfunctional, or when there is a financial crisis. Bitcoin is not very trusted, and the majority of people do not see a reason to start using Bitcoin in the future. A large number of people associate it with illegal activities. In general people are largely unaware of what Bitcoin is or what are the strengths and weaknesses. Bitcoin is an innovative alternative currency. However, unless people see a major need for Bitcoin due to a financial crisis, or dysfunctionality in the financial system, Bitcoin will not become much more widespread as it is today. Bitcoin’s underlying technology can be harnessed to multiple uses. Developments in that field in the future are something that future researchers could look into.

Understanding the polyvocality of autism discourse : a critical autoethnographic approach

Currently, much of the autism literature supports the notion that Pervasive Developmental Disorder (PDD) is a deviation from what is considered "normal" and, accordingly, that it is in need of early remediation. This thesis explored alternative constructions of autism and pathology by drawing on theorists from other disciplines, such as cultural studies (Deleuze & Guattari, 1987, 1965, 1972, 1975,1980, 2003), critical psychology (Parker, 1995, 2002, 2005, 2007), disability studies (Danforth,1997, 1999, 2000; Skrtic, 1995, 1996) and anti-psychiatry (Basaglia, 1987). In an attempt to show how our accounts of the world encompass constructions rooted in language and our own histories of thinking about topics that interest us, this research took an autoethnographic approach to understanding autism discourse. Instead of denying the researcher's existence and personal investment in the research, the author attempted to implicate "the self in the research by acknowledging her own assumptions, biases and ideologies about autism discourse and practice. Thus, tensions between the self and other, personal and political become woven into the fabric, creating a personal, subjective, and partial account of the phenomenon. This research was intended to explicate and interrogate some of the taken-for-granted Truths which guide our practices with people with autism. This alternative critical framework focused on understanding autism as a discourse and explored the way these dominant autism constructions function in society. Furthermore, positioning "the self in the research was meant to illustrate the fundamental need for self-reflective practice in the social sciences.

Canadian curling coaches' use of psychological skills training

Hom's (2008) model of coaching effectiveness proposes a series of direct relationships between the beliefs and values of coaches, their behaviours, and the perceptions of their athletes. One specific area of coaching behaviour that is in need of more research is their use of psychological skills training (PSn. The purpose of this study was to examine the relationship between the beliefs and behaviours of curling coaches with respect to PST, and the perceptions of their athletes. In collaboration with the Canadian Curling Association, data was collected from a national sample of 115 curling teams with varying levels of competition and experience. One hundred and fifteen coaches completed PST attitude (SPA-RC-revised) and behaviour (MSQ-revised) measures, while 403 athletes completed two perception measures (CCS and S-CI). Interclass correlation coefficients (ICC) were calculated to ensure intra-team consistency. All ICCs were positive, ranging from r =.39 to .56, and significant at the p < .01 level. A series of multiple regressions were performed. Three of the four regression models were significant, with coaches' PST behaviours accounting for 16% of the variance in athletes' evaluation of their coaches' competencies (GeC). The models for athletes' PhysicalSport Confidence (P-SC) and Cognitive-Sport Confidence (C-SC) accounted for 15% and 36% of the variation, with GCC and coaches' PST behaviours both being significant predictors of the models. After statistically controlling the influence of GCC, coaches' PST behaviours accounted for 3% and 26% of the variation in athletes P-SC and C-SC. These results provide partial support for Hom's (2008) model of coaching effectiveness, and offer new insight into the benefits of coaches' use of sport psychology-related training behaviours.

The Perceptions of Kinesiologists of Ethics and Professionalism as Established by the College of Kinesiologists of Ontario

As of April 1, 2013 kinesiology became a regulated health profession in Ontario. With its own governing body, the College of Kinesiologists of Ontario (CKO), there are new ethical and professional standards to which kinesiologists must adhere. The purpose of this study is to investigate kinesiologists’ thoughts and perceptions regarding the CKO’s Practice Standards, Guidelines and Code of Ethics, and their level of ethical knowledge and training. Eleven semi-structured interviews were carried out with kinesiologists. Interview data was analyzed through the development of general themes. Findings revealed that kinesiologists are confident of their ethical decision making skills but are in need of more ethical and professional education and training in order to become respected healthcare professionals in the healthcare community and in the eyes of the public. Furthermore, there were key areas identified in need of improvement regarding the quality of the Practice Standards, Guidelines and Code of Ethics. Additional findings, implications and recommendations for future research were also discussed.

Investigation of Offences against National Security

The study is a close scrutiny of the process of investigation of offences in India along with an analysis of powers and functions of the investigating agency. The offences, which are prejudicial to sovereignty, integrity and security of the nation or to its friendly relations with foreign states, are generally called the offences against national security. Offences against national security being prejudicial to the very existence of the nation and its legal system, is a heinous and terrible one. As early as 1971 the Law Commission of India had pointed out the need of treating the offences relating to national security and their perpetrators on a totally different procedural footing. The recommendation that, all the offences coming under the said category ought to be brought under the purview of a single enactment so as to confront such offences effectively. The discrepancies in and inadequacies of the criminal justice system in India as much as they are related to the investigations of the offences against national security are examined and the reforms are also suggested. The quality of criminal justice is closely linked with the caliber of the prosecution system and many of the acquittals in courts can be ascribed not only to poor investigations but also to poor quality of prosecution.