Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Long-term effect of volcanic forcing on ocean heat content

Explosive volcanic eruptions cause episodic negative radiative forcing of the climate system. Using coupled atmosphere-ocean general circulation models (AOGCMs) subjected to historical forcing since the late nineteenth century, previous authors have shown that each large volcanic eruption is associated with a sudden drop in ocean heat content and sea-level from which the subsequent recovery is slow. Here we show that this effect may be an artefact of experimental design, caused by the AOGCMs not having been spun up to a steady state with volcanic forcing before the historical integrations begin. Because volcanic forcing has a long-term negative average, a cooling tendency is thus imposed on the ocean in the historical simulation. We recommend that an extra experiment be carried out in parallel to the historical simulation, with constant time-mean historical volcanic forcing, in order to correct for this effect and avoid misinterpretation of ocean heat content changes

Dual semiosis analysis model managing customer-focused service innovation

Customers will not continue to pay for a service if it is perceived to be of poor quality, and/or of no value. With a paradigm shift towards business dependence on service orientated IS solutions [1], it is critical that alignment exists between service definition, delivery, and customer expectation, businesses are to ensure customer satisfaction. Services, and micro-service development, offer businesses a flexible structure for solution innovation, however, constant changes in technology, business and societal expectations means an iterative analysis solution is required to i) determine whether provider services adequately meet customer segment needs and expectations, and ii) to help guide business service innovation and development. In this paper, by incorporating multiple models, we propose a series of steps to help identify and prioritise service gaps. Moreover, the authors propose the Dual Semiosis Analysis Model, i.e. a tool that highlights where within the symbiotic customer / provider semiosis process, requirements misinterpretation, and/or service provision deficiencies occur. This paper offers the reader a powerful customer-centric tool, designed to help business managers highlight both what services are critical to customer quality perception, and where future innovation

Time-lapse geophysical investigations over known archaeological features using electrical resistivity imaging and earth resistance

Electrical methods of geophysical survey are known to produce results that are hard to predict at different times of the year, and under differing weather conditions. This is a problem which can lead to misinterpretation of archaeological features under investigation. The dynamic relationship between a ‘natural’ soil matrix and an archaeological feature is a complex one, which greatly affects the success of the feature’s detection when using active electrical methods of geophysical survey. This study has monitored the gradual variation of measured resistivity over a selection of study areas. By targeting difficult to find, and often ‘missing’ electrical anomalies of known archaeological features, this study has increased the understanding of both the detection and interpretation capabilities of such geophysical surveys. A 16 month time-lapse study over 4 archaeological features has taken place to investigate the aforementioned detection problem across different soils and environments. In addition to the commonly used Twin-Probe earth resistance survey, electrical resistivity imaging (ERI) and quadrature electro-magnetic induction (EMI) were also utilised to explore the problem. Statistical analyses have provided a novel interpretation, which has yielded new insights into how the detection of archaeological features is influenced by the relationship between the target feature and the surrounding ‘natural’ soils. The study has highlighted both the complexity and previous misconceptions around the predictability of the electrical methods. The analysis has confirmed that each site provides an individual and nuanced situation, the variation clearly relating to the composition of the soils (particularly pore size) and the local weather history. The wide range of reasons behind survey success at each specific study site has been revealed. The outcomes have shown that a simplistic model of seasonality is not universally applicable to the electrical detection of archaeological features. This has led to the development of a method for quantifying survey success, enabling a deeper understanding of the unique way in which each site is affected by the interaction of local environmental and geological conditions.

A cautionary note on the use of Ornstein Uhlenbeck models in macroevolutionary studies

Phylogenetic comparative methods are increasingly used to give new insights into the dynamics of trait evolution in deep time. For continuous traits the core of these methods is a suite of models that attempt to capture evolutionary patterns by extending the Brownian constant variance model. However, the properties of these models are often poorly understood, which can lead to the misinterpretation of results. Here we focus on one of these models – the Ornstein Uhlenbeck (OU) model. We show that the OU model is frequently incorrectly favoured over simpler models when using Likelihood ratio tests, and that many studies fitting this model use datasets that are small and prone to this problem. We also show that very small amounts of error in datasets can have profound effects on the inferences derived from OU models. Our results suggest that simulating fitted models and comparing with empirical results is critical when fitting OU and other extensions of the Brownian model. We conclude by making recommendations for best practice in fitting OU models in phylogenetic comparative analyses, and for interpreting the parameters of the OU model.

Cross-entropy optimizer: a new tool to study precession in astrophysical jets

Evidence of jet precession in many galactic and extragalactic sources has been reported in the literature. Much of this evidence is based on studies of the kinematics of the jet knots, which depends on the correct identification of the components to determine their respective proper motions and position angles on the plane of the sky. Identification problems related to fitting procedures, as well as observations poorly sampled in time, may influence the follow-up of the components in time, which consequently might contribute to a misinterpretation of the data. In order to deal with these limitations, we introduce a very powerful statistical tool to analyse jet precession: the cross-entropy method for continuous multi-extremal optimization. Only based on the raw data of the jet components (right ascension and declination offsets from the core), the cross-entropy method searches for the precession model parameters that better represent the data. In this work we present a large number of tests to validate this technique, using synthetic precessing jets built from a given set of precession parameters. With the aim of recovering these parameters, we applied the cross-entropy method to our precession model, varying exhaustively the quantities associated with the method. Our results have shown that even in the most challenging tests, the cross-entropy method was able to find the correct parameters within a 1 per cent level. Even for a non-precessing jet, our optimization method could point out successfully the lack of precession.

Oxford movement: its themes and their significance

In retrospective, the Oxford movement of nineteenth century England provides one with an interesting study of the struggles between the spiritual and secular worlds. However, repeated abstraction in an interpretation of its significance has tended to distort accurate understanding of its historical development. Often this also has resulted n a misinterpretation of the nature of its major themes and their significance to the world. For these reasons, this study has attempted to describe the origin, maturity, and dissolution of the series of events which strictly speaking may be considered to be the Oxford movement. In conclusion, liberty has been taken to comment on the nature of the Movement's themes and their significance in their own age and to man today.

Acompanhamento das ouvidorias do governo do estado de São Paulo

Trabalho elaborado de acordo com o termo de referência acordado entre FGV e Secretaria de Gestão Pública, cujo objetivo é analisar e propor melhorias ao relatório semestral das Ouvidorias Públicas do Estado de São Paulo. O relatório semestral é uma compilação das informações de todas as ouvidorias de todos os órgãos públicos estaduais, contempla as reclamações e manifestações recebidas por cada um dos órgãos e é elaborado pela Secretaria de Gestão Pública (SGP). O trabalho contempla a análise do relatório e dos processos relacionados à sua elaboração. Procurou-se entender: o papel institucional das Ouvidorias Públicas como representantes do cidadão, apesar da falta de independência frente aos Poder Executivo; os tipos de análise feitos no relatório semestral, que contemplam apresentações e comparações quantitativas que não consideram as realidades de órgãos e períodos distintos; o fluxo da informação, desde a manifestação do cidadão até a confecção do relatório, com diferentes e pouco integrados canais de entrada, sistema de TI subutilizado, e alta incidência de cidadãos que utilizam a ouvidoria como fonte de informação; os ouvidores, coordenados informalmente pela SGP e com percepções diferentes de sua função. A partir da análise, foram feitas sugestões para a Secretaria de Gestão Pública melhorar relatório semestral das ouvidorias, envolvendo uma melhor forma da apresentação das informações, a padronização de formas de contato, o incentivo à participação, a orientação por meio dos sites institucionais do Governo do Estado, a melhoria dos sistemas de TI, de coordenação e de governança.

O Instituto das Súmulas Vinculantes e sua cogente alteração legislativa: a análise do verbete nº 13

O Supremo Tribunal Federal entregou ao ordenamento jurídico brasileiro, em 21 de agosto de 2008, a súmula vinculante nº 13. O referido verbete trata da vedação a nomeações de cônjuge, companheiro ou parente em linha reta, colateral ou por afinidade até o terceiro grau, no âmbito da administração pública direta e indireta, em todas as esferas. Antes da vigência da súmula vinculante nº 13, o nepotismo era praticado de forma nebulosa, tendo em vista a ausência de uma fiscalização eficaz e eficiente. Os Estados e Municípios, através de legislação própria, buscaram o combate a essa prática em momento anterior à edição do verbete, o país carecia de uma regra geral. A partir do início da vigência da súmula vinculante nº 13, o que se verificou, no âmbito da administração pública brasileira, como será demonstrado adiante, foram diversas exonerações de servidores por simples suposição de que determinada situação jurídica configuraria nepotismo, cenário totalmente contrário àquele então proposto.. O STF manifesta-se face aos casos concretos apenas em sede de reclamação. Têm-se, atualmente, uma situação de grave insegurança jurídica, onde servidores públicos não sabem se podem ou não ser nomeados ou se podem continuar exercendo suas funções. O presente exame, pautado no direito comparado e em estudo de casos, analisou algumas situações hipotéticas que, supostamente, configurariam nepotismo, e outras já decididas pela Suprema Corte e propõe uma alteração de natureza legislativa ao instituto das súmulas vinculantes: a criação de incisos a incluídos no corpo do enunciado após cada decisão em sede de reclamação, cujos efeitos não possuem efeito vinculante. Dessa forma, a administração pública direta e indireta poderá aplicar a súmula vinculante nº 13 de forma eficaz, sem interpretações equivocadas, de modo a permitir uma sintonia entre a segurança jurídica e a moralidade.

Estudos de adsorção de tetraciclina em partículas de quitosana

Due to its physico-chemical and biological properties, related to the abundance and low cost of raw material, chitosan has been recognized as a material of wide application in various fields, such as in drug delivery systems. Many of these properties are associated with the presence of amino groups in its polymer chain. A proper determination of these amino groups is very important, in order to properly specify if a given chitosan sample can be used in a particular application. Thus, in this work, initially, a comparison between the determination of the deacetylation degree by conductometry and elemental analysis was carried out using a detailed analysis of error propagation. It was shown that the conductometric analysis resulted in a simple and safe method for the determining the degree of deacetylation of chitosan. Subsequently, experiments were performed to monitor and characterize the adsorption of tetracycline on chitosan particles through kinetic and equilibrium studies. The main models of kinetics and adsorption isotherms, widely used to describe the adsorption on wastewater treatment systems and the drug loading, were used to treat the experimental data. Firstly, it was shown that an apparent linear t/q(t) × t relationship did not imply in a pseudo-second-order adsorption kinetics, differently of what has been repeatedly reported in the literature. It was found that this misinterpretation can be avoided by using non-linear regression. Finally, the adsorption of tetracycline on chitosan particles was analyzed using insights obtained from theoretical analysis, and the parameters generated were used to analyze the kinetics of adsorption, the isotherm of adsorption and to ropose a mechanism of adsorption

Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Um estudo das condições de percolação e estabilidade em barragens de terra mediante métodos geofísicos: caso do dique de Sant Llorenç de Montgai - Espanha

The monitoring of Earth dam makes use of visual inspection and instrumentation to identify and characterize the deterioration that compromises the security of earth dams and associated structures. The visual inspection is subjective and can lead to misinterpretation or omission of important information and, some problems are detected too late. The instrumentation are efficient but certain technical or operational issues can cause restrictions. Thereby, visual inspections and instrumentation can lead to a lack of information. Geophysics offers consolidated, low-cost methods that are non-invasive, non-destructive and low cost. They have a strong potential and can be used assisting instrumentation. In the case that a visual inspection and strumentation does not provide all the necessary information, geophysical methods would provide more complete and relevant information. In order to test these theories, geophysical acquisitions were performed using Georadar (GPR), Electric resistivity, Seismic refraction, and Refraction Microtremor (ReMi) on the dike of the dam in Sant Llorenç de Montgai, located in the province of Lleida, 145 km from Barcelona, Catalonia. The results confirmed that the geophysical methods used each responded satisfactorily to the conditions of the earth dike, the anomalies present and the geological features found, such as alluvium and carbonate and evaporite rocks. It has also been confirmed that these methods, when used in an integrated manner, are able to reduce the ambiguities in individual interpretations. They facilitate improved imaging of the interior dikes and of major geological features, thus inspecting the massif and its foundation. Consequently, the results obtained in this study demonstrated that these geophysical methods are sufficiently effective for inspecting earth dams and they are an important tool in the instrumentation and visual inspection of the security of the dams

Imuno-histoquímica para identificação de células neoplásicas no infiltrado ativo de melanomas finos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Methods for assessing physical activity: a systematic review focused on older adults

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A thermoporometry and small-angle x-ray scattering study of wet silica sonogels as the pore volume fraction is varied

Silica sonogels with different porosities were prepared by acid sono-hydrolysis of tetraethoxysilane. Wet sonogels were studied using small-angle x-ray scattering (SAXS) and differential scanning calorimetry (DSC). The DSC shows a broad thermal peak below the normal water melting point associated with the melting of confined ice nanocrystals, or nanoporosity. The nanopore size distribution was determined from the Gibbs-Thomson equation. As the porosity is increased, a second sharp DSC thermal peak with onset temperature at the water melting point is apparent, which was associated with the melting of ice macrocrystals, or macroporosity. The DSC result could be causing misinterpretation of the macroporosity because water may not be exactly confined in very feeble silica network regions in sonogels with high porosity. The structure of the wet gels can be described fairly well as mutually self-similar mass fractal structures with characteristic length. increasing from similar to 1.8 to similar to 5.4 nm and mass fractal dimension D diminishing discretely from similar to 2.6 to similar to 2.3 as the porosity increases in the range studied. More specifically, such a structure could be described using a two-parameter correlation function gamma(r) similar to r(D-3) exp(-r/xi), which is limited at larger scale by the cut-off distance xi but without a well-defined small scale cut-off distance, at least up to the maximum angular domain probed using SAXS in the present study.