Missed appointments in an outpatient clinic for adolescents, an approach to predict the risk of missing.

PURPOSE: To predict the risk of an adolescent patient to miss an appointment, based on the previous appointments and on the characteristics of the patient and the appointment. METHODS: Two thousand one hundred ninety-three (1873 females) patients aged 12 to 20 years having scheduled at least four appointments were included. We assessed the rate of missed nonexcused appointments of each patient. Second, a Markovian multilevel model was used to predict the risk of defaulting. RESULTS: Forty-five percent of the patients have not missed even once, and 14% of females and 17% of males have missed >25% of their appointments. Females show two types of behaviors (an abstract concept that groups individuals based on a combination of their appointment-keeping and their recorded type of healthcare need) depending on the diagnosis. Somatic, gynecology, violence, and counseling diagnoses are mostly grouped together. In this group, having already missed and having an appointment with a paramedical provider increases the risk of missing. In the second group (eating disorders and psychiatric diagnoses) having already missed and a longer delay between appointments influence the risk of missing, although the risk is lower for this latter group. Males only show one type of behavior regarding missed appointments. Having missed a previous appointment, being older, having cancelled the next to last appointment and the type of diagnosis explain the risk of missing. CONCLUSIONS: Patients who have already defaulted have a higher risk of defaulting again. Means of control regarding missed appointments should consequently focus on defaulters, to decrease the associated workload. Reminders could be a solution for the follow-up appointments scheduled with a long delay.

Go-to-market strategy with pharmacies

The purpose of the research is to develop a go-to-market strategy with pharmacies. As it was agreed with the client of the study, Reckitt Benckiser, the focus is solely on non-prescription products. Therefore, prescription medicines are not considered in the study. The main objective of the research is to clarify consumer and pharmacy personnel behavior concerning non-prescription products. These issues are observed with surveys, which are provided to consumers and pharmacy personnel. The go-to-market strategy is based on the survey results and is comprised by utilizing the marketing-mix model. Legislation and the present state & trends are additional minor research problems of the study. The results of the research provide many descriptive insights about consumer and pharmacy personnel behavior. It is concluded that the consumers’ level of involvement with non-prescription products is low and the type of behavior is habitual. It is also demonstrated that several decision-making criteria are very different among different age groups and genders. Concerning pharmacy personnel, the factors that they base their product recommendations are revealed. In addition, the sources of medicine information for both consumers and pharmacy personnel are found out.

Study of adsorption isotherms of green coconut pulp

Brazil is considered one of the largest producers and consumers of tropical fruits. Green coconut (Cocos nucifera L.) stands out not only for its production and consumption, but also for the high amount of waste produced by coconut water industry and in natura consumption. Therefore, there is a need for utilization of this by-product. This study aims to study the adsorption isotherms of green coconut pulp and determine its isosteric heat of sorption. The adsorption isotherms at temperatures of 30, 40, 50, 60, and 70 °C were analyzed, and they exhibit type III behavior, typical of sugar rich foods. The experimental results of equilibrium moisture content were correlated by models present in the literature. The Guggenheim, Anderson and De Boer (GAB) model proved particularly good overall agreement with the experimental data. The heat of sorption determined from the adsorption isotherms increased with the decrease in moisture content. The heat of sorption is considered as indicative of intermolecular attractive forces between the sorption sites and water vapor, which is an important factor to predict the shelf life of dried products.

Prévention de la maladie de Lyme : facteurs sociaux et priorisation des interventions

La maladie de Lyme est la maladie vectorielle la plus fréquente dans les pays tempérés et est en émergence dans plusieurs régions du monde. Plusieurs stratégies de prévention existent et comprennent des interventions qui visent les individus, comme le port de vêtements protecteurs, et d’autres qui sont implantées au niveau collectif, dont des interventions de contrôle des tiques dans l’environnement. L’efficacité de ces stratégies peut être influencée par divers facteurs, dont des facteurs sociaux tels que les connaissances, les perceptions et les comportements de la population ciblée. Elles peuvent également avoir des impacts parallèles non désirés, par exemple sur l’environnement et l’économie, et ces derniers peuvent s’opposer aux bénéfices des interventions jusqu’à remettre en cause la pertinence de leur mise en œuvre. Aussi, ces facteurs sociaux et les impacts des interventions sont susceptibles de varier selon la population ciblée et en fonction du contexte épidémiologique et social. L’objectif de cette thèse était donc d’étudier les principaux facteurs sociaux et enjeux d’importance à considérer pour évaluer l’efficacité et prioriser des interventions de prévention pour la maladie de Lyme dans deux populations exposées à des contextes différents, notamment en ce qui concerne leur situation épidémiologique, soient au Québec, où l’incidence de la maladie de Lyme est faible mais en émergence, et en Suisse, où elle est élevée et endémique depuis plus de trois décennies. L’approche choisie et le devis général de l’étude sont basés sur deux modèles théoriques principaux, soient le modèle des croyances relatives à la santé et celui de l’aide à la décision multicritère. Dans un premier temps, les facteurs associés à la perception du risque pour la maladie de Lyme, c’est-à-dire l’évaluation cognitive d’une personne face au risque auquel elle fait face, ont été étudiés. Les résultats suggèrent que les facteurs significatifs sont différents dans les deux régions à l’étude. Ensuite, l’impact des connaissances, de l’exposition, et des perceptions sur l’adoption de comportements préventifs individuels et sur l’acceptabilité des interventions de contrôle des tiques (acaricides, modifications de l’habitat, contrôle des cervidés) a été comparé. Les résultats suggèrent que l’impact des facteurs varierait en fonction du type du comportement et des interventions, mais que la perception de l’efficacité est un facteur commun fortement associé à ces deux aspects, et pourrait être un facteur-clé à cibler lors de campagnes de communication. Les résultats montrent également que les enjeux relatifs aux interventions de contrôle des tiques tels que perçus par la population générale seraient communs dans les deux contextes de l’étude, et partagés par les intervenants impliqués dans la prévention de la maladie de Lyme. Finalement, un modèle d’analyse multicritère a été développé à l’aide d’une approche participative pour le contexte du Québec puis adapté pour le contexte suisse et a permis d’évaluer et de prioriser les interventions préventives selon les différentes perspectives des intervenants. Les rangements produits par les modèles au Québec et en Suisse ont priorisé les interventions qui ciblent principalement les populations humaines, devant les interventions de contrôle des tiques. L’application de l’aide à la décision multicritère dans le contexte de la prévention de la maladie de Lyme a permis de développer un modèle décisionnel polyvalent et adaptable à différents contextes, dont la situation épidémiologique. Ces travaux démontrent que cette approche peut intégrer de façon rigoureuse et transparente les multiples perspectives des intervenants et les enjeux de la prévention relatifs à la santé publique, à la santé animale et environnementale, aux impacts sociaux, ainsi qu’aux considérations économiques, opérationnelles et stratégiques. L’utilisation de ces modèles en santé publique favoriserait l’adoption d’une approche « Une seule santé » pour la prévention de la maladie de Lyme et des zoonoses en général. Mots-clés : maladie de Lyme, prévention, facteurs sociaux, perception du risque, comportements préventifs, acceptabilité, priorisation des interventions, contrôle des tiques, aide à la décision multicritère, analyse multicritère, Québec, Suisse, « Une seule santé »

Sensitivity of feature-based analysis methods of storm tracks to the form of background field removal

For the tracking of extrema associated with weather systems to be applied to a broad range of fields it is necessary to remove a background field that represents the slowly varying, large spatial scales. The sensitivity of the tracking analysis to the form of background field removed is explored for the Northern Hemisphere winter storm tracks for three contrasting fields from an integration of the U. K. Met Office's (UKMO) Hadley Centre Climate Model (HadAM3). Several methods are explored for the removal of a background field from the simple subtraction of the climatology, to the more sophisticated removal of the planetary scales. Two temporal filters are also considered in the form of a 2-6-day Lanczos filter and a 20-day high-pass Fourier filter. The analysis indicates that the simple subtraction of the climatology tends to change the nature of the systems to the extent that there is a redistribution of the systems relative to the climatological background resulting in very similar statistical distributions for both positive and negative anomalies. The optimal planetary wave filter removes total wavenumbers less than or equal to a number in the range 5-7, resulting in distributions more easily related to particular types of weather system. For the temporal filters the 2-6-day bandpass filter is found to have a detrimental impact on the individual weather systems, resulting in the storm tracks having a weak waveguide type of behavior. The 20-day high-pass temporal filter is less aggressive than the 2-6-day filter and produces results falling between those of the climatological and 2-6-day filters.

A numerical model of the ionospheric signatures of time-varying magnetic reconnection: II. Measuring expansions in the ionospheric flow response

A numerical model embodying the concepts of the Cowley-Lockwood (Cowley and Lockwood, 1992, 1997) paradigm has been used to produce a simple Cowley– Lockwood type expanding flow pattern and to calculate the resulting change in ion temperature. Cross-correlation, fixed threshold analysis and threshold relative to peak are used to determine the phase speed of the change in convection pattern, in response to a change in applied reconnection. Each of these methods fails to fully recover the expansion of the onset of the convection response that is inherent in the simulations. The results of this study indicate that any expansion of the convection pattern will be best observed in time-series data using a threshold which is a fixed fraction of the peak response. We show that these methods used to determine the expansion velocity can be used to discriminate between the two main models for the convection response to a change in reconnection.

Intergranular properties of uniaxially pressed YBa(2)Cu(3)O(7-delta) ceramic samples

We performed measurements of electrical resistivity as a function of temperature, rho(T), in polycrystalline samples of YBa(2)Cu(3)O(7-delta) (Y-123) subjected to different uniaxial compacting pressures. We observed by using X-ray diffractometry that samples have a very similar composition. Most of the identified peaks are related to the superconducting Y-123 phase. Also, from the X-ray diffraction patterns performed, in powder and pellet samples, we estimated the Lotgering factor along the (00l) direction, F((00l)). The results indicate that F((00l)) increases from 0.13 to 0.16. From electrical resistivity measurements as a function of temperature, we were able to separate contributions arising from both the grain misalignment and microstructural defects. We found appreciable degradation in the normal-state transport properties of samples with an increase in uniaxial compacting pressure. It seems that this type of behavior is associated with an increase in the influence of microstructural defects at the intergranular level. The experimental results are analyzed in the framework of a current conduction model of granular samples.

Too Many Bad Cooks Spoiling the Broth? Effectiveness of NGOs in Addressing Child Labour in El Salvador

The reaction of the first world to the persevering plight of a large part of the third world varies. In response to the sometimes glaring disparities, many international organizations and multinational corporations have recently adopted a pro-development rhetoric with relation to the problem of global poverty. However, the rhetoric rarely translates into action. As David Bacon discusses, leaders of corporations and organizations now tend to conclude their speeches by expressing a desire to reduce the suffering of the third world. However, when it comes to agreeing on specific concessions that could indeed improve the world-wide economic situation, first world countries are reluctant to act. A good example of this type of behavior is the current negotiation of the WTO, the “development round of Doha,” in which the United States along with the European Union pressure countries of the developing South to open up their markets, while at the same time refusing to remove or even decrease their own agricultural subsidies. The first world civil society observes the behavior of international organizations and western based multinational corporations as ineffectual. Taking the matter in its own hands, especially in the past couple of decades, this civil society has created a countless number of development-oriented nongovernmental organizations. These are supposed to compensate for the lack of action by international organizations. Development NGOs are believed to be more locally responsive as well as free of business or political considerations in choosing their strategies, and thus generally more efficient than IOs. However, if they really were how they are alleged to be, the problems of the third world would already be ameliorated by a significant amount, if not completely eradicated. Do development-NGOs indeed possess the characteristics that they claim to possess? What is their real affect on human rights? And how effective are they in their work?

Os bancos brasileiros na internet: um estudo de caso sobre os motivadores para a sua forma de atuação neste ambiente

O objetivo deste estudo é propor um modelo de análise integrada para a forma de atuação dos bancos brasileiros no ambiente da Internet. Para tanto foi conduzido um estudo de caso único com o Banco do Brasil. A maioria das entrevistas foi realizada nas sedes administrativa e de tecnologia do banco na cidade de Brasília, DF. Foi proposto um Modelo de Análise Integrada baseado em várias teorias e estruturas da área de estudos organizacionais e sistemas de informação. Entre as descobertas da pesquisa está a constatação de que o fenômeno estudado pode ser satisfatoriamente compreendido com o emprego de todas as teorias selecionadas, comprovando a complexidade do objeto desta pesquisa. O estudo apresentou entre suas limitações o fato de ter sido um estudo de caso único, como também a impossibilidade de se realizar esta pesquisa em amplo espectro, com um número consideravelmente maior de organizações. O ineditismo e a contribuição deste estudo residem no fato de ter proposto um modelo integrado com teorias e estruturas de análise que facilitam a compreensão do fenômeno observado. Em estudos futuros o pesquisador poderia incluir a pesquisa em um número maior de instituições para enriquecer a análise.

Analise epistemológica do processo educacional brasileiro a partir da evolução da maquina

O presente trabalho parte do pressuposto de que o desenvolvimento das ideias e ações humanas é indissociável do processo de evolução da máquina, destacando o aspecto interativo aí existente: a mente que concebe a máquina e que, por sua vez, passa a servir de modelo para, essa mesma mente construir a sua visão de mundo. O objetivo principal consiste em analisar as bases epistemológicas do processo educacional brasileiro a partir do desenvolvimento da própria máquina, o qual, segundo a teoria aqui adotada, subdivide-se em quatro etapas: a máquina Pré-Clássica, a máquina Clássica, a máquina Cibernética e a máquina Informacional. A hipótese aqui apresentada, e no final confirmada, é a de que, apesar de hoje o mundo estar subjugado às propriedades da maquina informacional, na estrutura do processo educacional brasileiro predominam as características epistêmicas da maquina clássica, devido a nossa educação continuar arraigada em aspectos constitutivos dessa máquina: em sua Iógica (linear), em seu ritmo (padrão de comportamento) e em sua morfologia (elementarização). Através desse estudo procura se evidencia que transformações se operaram (ou não) no processo educacional brasileiro e a necessidade de uma redefinição conceitual e metodológica da própria educação, de forma que se minimize a distância entre a mesma e o progresso tecnológico.

Burrows with Chimneys of the Fiddler Crab Uca thayeri: Construction, Occurrence, and Function

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

Estimativa populacional e uso do hábitat do boto-cinza (Sotalia guianensis) no litoral sul do Rio Grande do Norte

Four areas are known as of frequent usage by Guiana dolphins (Sotalia guianensis) in the south coast of Rio Grande do Norte state, northeast Brazil: Tabatinga, Pipa, Lagoa de Guaraíras and Baia Formosa. This extension of 40 km of shoreline is under increasing anthropogenic impacts due to continuous development of the coastal areas and vessel traffic. The objective of this study was to investigate aspects of population biology and habitat use of the population of Sotalia guianensis in the south coast of Rio Grande do Norte. It was applied the photo-identification technique and posterior methods of capture-recapture for population estimation (POPAN extension in MARK). The distribution, movement and site fidelity of the dolphins were analyzed trough the geographic information system (GIS) and group characteristics and behavior trough non-parametric statistics. Field work was conducted on board a 10m motor vessel from March 2008 to March 2009. Photo-identification effort was 329h with 113h of direct observation of the dolphins. The population estimatives for each area: Tabatinga: 75 (63-92); Pipa 105 (88-129); Lagoa de Guaraíras: 27 (18-54) e Baia Formosa: 112 (89-129) individuals. Total population estimative was: 223 (192 a 297). High site fidelity was detected for only part of the population (<15%) as low site fidelity and transients individuals were also detected (>20%). It was observed frequent movements between Tabatinga, Lagoa de Guaraíras and Pipa, but not Baía Formosa. This suggests a division in two communities along this shore extension: one in Pipa and other in Baía Formosa. Group size was small, most groups with up to 10 dolphins. The areas were use intensively, only in Lagoa de Guaraíras dolphins were not seen in all field trips. Lagoa de Guaraíras is an area used by small groups exclusively for foraging. In Tabatinga and Pipa dolphins concentrated close to the shore, in the inner sector of the area and the main activity is also foraging. Significant larger groups were seen in socializing behavior but there was no difference in group size between the inner and external sectors of the area. The presence of calves and juveniles were significant greater in the inner areas of Tabatinga and Pipa, confirming the hypothesis that these beaches are also used for parental care. In Baia Formosa dolphins concentrated in the outer sector and foraging was also predominant. Significant larger groups were seen in the outer sector, mainly engaged in mixed behaviors of travel/foraging, possibly in some kind of group foraging. Calves and juveniles were significant more present in the outer sector where group size was also larger. In general there was no difference in area usage and period of the day. Sotalia guianensis has characteristics that make the species vulnerable to human activities such as small population concentrated in patches of suitable habitats restrict to coastal areas. We hope that this study bring new information for the species and help for the adequate management of the area in order to assure the presence of the dolphins as well as its behavior pattern and gene flow betweencommunities.

Comportamento social de botos-cinza, sotalia guianensis, na praia de Pipa, RN, Brasil: dinâmica, sequência, sincronia e respostas ao turismo de observação

Social behavior of Guiana dolphins, Sotalia guianensis, at Pipa Beach, RN, Brazil: dynamics, sequence, breathing synchrony, and responses to dolphin watching. Social animals form groups that can range from temporary to permanent. Depending on the nature of the social relationships developed between individuals, groups present a particular social organization and the effect of these interactions shapes the activity patterns of these animals. This study investigates: (i) fission-fusion dynamics of Guiana dolphins, through the analysis of three dimensions of the social system (variation in spatial cohesion, variation in size and composition of groups), (ii) sequence, routine and behavioral stability, (iii) breathing intervals in synchronized groups and (iv) behavioral responses of the animals to dolphin watching. Systematic observations of Guiana dolphins were made from a platform located in cliffs about 25 m above sea level that surround Madeiro Bay, Pipa Beach. Sampling occurred from December 2007 to February 2009 between 0600 h and 1600 h, and the groups of Guiana dolphins were investigated according to their size (alone and group) and composition (adults, adults and juveniles, and adults and calves). According to the analysis of fission-fusion dynamics, Guiana dolphin groups frequently changed their composition, modifying their patterns of spatial grouping and cohesion every 20 minutes on average. More than 50% of the individuals maintained a distance of up to 2 m from other group members and new individuals were attracted to the group, especially during feeding, leaving it for foraging. Large groups were more unstable than small, while groups containing only adults were more stable than groups of adults and juveniles. According to the Z-score analysis to investigate the sequence and behavioral routine, lone individuals were more ! .7! ! involved in foraging and feeding, while resting was more common in groups. Foraging and feeding were more common in homogeneous groups (individuals of the same age class), while heterogeneous groups (different age classes) were often involved in socialization, displaying a broader behavioral repertoire. Foraging and resting behavior presented higher stability (continuous duration in minutes) than the other behaviors. The analysis of breathing intervals in synchronized groups showed significant differences depending on type of behavior, composition and area preference. During resting, breathing intervals were of longer duration, and groups with calves showed shorter breathing intervals than groups without calves. Lone individuals also preferred areas called corral , often used for the entrapment of fishes. The Markov chain analysis revealed behavioral changes in the presence of boats, according to the type of group composition. Groups composed of adults presented decreased resting and increased in traveling during the presence of boats. Groups of adults and juveniles showed a massive reduction of socialization, while the behavior transition probability traveling-traveling was higher in groups of adults and calves. In the presence of the boats, stability of resting was reduced by one third of its original duration and traveling more than doubled. The behavioral patterns analyzed are discussed in light of socio-ecological models concerning costs and benefits of proximity between individuals and behavioral optimization. Furthermore, significant changes in behavioral patterns indicate that Guiana dolphins, at Pipa Beach, have suffered the effects of tourism as a result of violation of rules of conduct established for the study area

Structural Characterization of Peruvian Carrot (Arracacia xanthorrhiza) Starch and the Effect of Annealing on Its Semicrystalline Structure

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

Study of adsorption isotherms of green coconut pulp

O Brasil é considerado um dos maiores produtores e consumidores de frutas tropicais. O coco verde (Cocos nucifera L.) se destaca tanto em termos de produção e consumo quanto em quantidade de resíduos gerada por indústrias de água de coco e pelo consumo in natura. Portanto, existe uma necessidade de aproveitamento deste subproduto. Este trabalho teve por objetivo estudar as isotermas de adsorção da polpa de coco verde e determinação do calor isostérico de sorção. As isotermas de adsorção para as temperaturas de 30, 40, 50, 60 e 70 °C foram analisadas e evidenciaram curvas do tipo III, típicas de alimentos ricos em açúcares. Os dados experimentais de umidade de equilíbrio foram correlacionados por modelos da literatura. O modelo de GAB apresentou melhor concordância com os dados experimentais, entre os modelos avaliados. O calor isostérico de sorção é considerado um indicativo de forças atrativas intermoleculares entre os sítios de sorção de vapor de água, consequentemente, um importante fator para predizer a vida de prateleira de produtos desidratados.