818 resultados para Question of use
Resumo:
Trimethylaminuria (TMAU) or Fish odor syndrome is an autosomal recessive disease that is characterized by pungent body odor with subsequent psychosocial complications. There are limited studies of the sequence variants causing TMAU in the literature with most studies describing only one or two patients and lacking genotype-phenotype correlations. Also to date, there is no laboratory in the US or Europe that offers TMA genetic testing on a clinical basis. We have recently validated genetic testing in the University of Colorado DNA Diagnostic Laboratory. We have a database of a few dozen patients with a biochemical diagnosis of TMA at the University of Colorado at Denver Health Sciences Center (UCDHSC) which includes a few patients with the classical form of the disease. We have used the newly established clinical test in our institution to attempt to characterize the genotype (sequence variants including mutations and polymorphisms) of classical TMAU patients and to establish a genotype-phenotype (biochemical and clinical) association. The questionnaire results confirmed most of the previously reported epidemiological findings of TMAU and also indicated that TMAU patients use multiple intervention measures in attempt to control their symptoms with dietary control being most effective. Despite the complexity of intervention, most patients did not have any medical follow up and there was underutilization of specialist care. In a set of our patients, two deleterious mutations were identified in 4/12 patients including a novel T237P sequence variant, while the majority of our patients (8/12) did not reveal any mutations. Some of the latter were double heterozygous for the E158K and E308G polymorphisms which could explain a mild phenotype while others had only the E158K variant which raised the question of undetected mutations. These results indicate that further experiments are needed to further delineate the full mutational spectrum of the FMO3 gene. ^
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Background. Primary liver cancer, the majority of which is hepatocellular carcinoma, is the third most common cause of mortality from cancer. It has one of the worst prognosis outcomes and an overall 5-year survival of only 5-6%. Hepatocellular carcinoma has been shown to have wide variations in geographic distribution and there is a marked difference in the incidence between different races and gender. Previously low-rate countries, including the US, have shown to have doubled the incidence of HCC during the past two decades. Even though the incidence of HCC is higher in males as compared to females, female hormones, especially estrogens have been postulated to have a role in the development of hepatocellular carcinoma on a molecular level. Despite the frequent usage of oral contraceptive pills (OCP) and previously, hormone replacement therapy (HRT), their role on HCC development has not been studied thoroughly. We aim to examine the association between exogenous hormone intake (oral contraceptives and post-menopausal hormone replacement therapy) and the development of HCC. Methods. This study is part of an ongoing hospital-based case-control study which is conducted at the Department of Gastrointestinal Oncology at The University of Texas M. D. Anderson Cancer Center. From January 2005 up to January 2008, a total of 77 women with pathologically confirmed hepatocellular carcinoma (cases) and 277 healthy women (controls) were included in the investigation. Information about the use of hormonal contraceptives, hormone replacement therapy and risk factors of hepatocellular cancer was collected by personal interview. Univariate and multivariate logistic regression analyses were done to estimate the crude odds ratios (OR) and adjusted odds ratios (AOR). Results. We found statistically significant protective effect for the use of HRT on the development of HCC, AOR=0.42 (95% CI, 0.21, 0.81). The significance was observed for estrogen replacement, AOR=0.43 (95% CI, 0.22, 0.83) and not for progesterone replacement, AOR=0.49 (95% CI, 0.10, 2.35). On the other hand, any hormonal contraceptive use, which encompasses oral contraceptive pills, implants and injections, did not show a statistical significance either in the crude OR=0.58 (95% CI, 0.33, 1.01) or AOR=0.56 (95% CI 0.26, 1.18). Conclusions. As corroborated by previous studies, HRT confers 58% HCC risk reduction among American women. The more important question of the association between hormonal contraceptives and HCC remains controversial. Further studies are warranted to explore the mechanism of the protective effect of HRT and the relationship between hormonal contraception and HCC.^
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One of the broad objectives of the Nigerian health service, vigorously being pursued at all levels of government, is to make comprehensive health care available and accessible to the population at the lowest possible cost, within available resources. Some state governments in the federation have already introduced free medical service as a practical way to remove financial barriers to access and in turn to encourage greater utilization of publicly funded care facilities.^ To aid health planners and decision makers in identifying a shorter corridor through which urban dwellers can gain access to comprehensive health care, a health interview survey of the metropolitan Lagos was undertaken. The primary purpose was to ascertain the magnitude of access problems which urban households face in seeking care from existing public facilities at the time of need. Six categories of illness chosen from the 1975 edition of the International Classification of Disease were used as indicators of health need.^ Choice of treatment facilities in response to illness episode was examined in relation to distance, travel time, time of use and transportation experiences. These were graphically described. The overall picture indicated that distance and travel time coexist with transportation problems in preventing a significant segment of those in need of health care from benefitting in the free medical service offered in public health facilities. Within this milieu, traditional medicine and its practitioners became the most preferred alternative. Recommendations were offered for action with regard to decentralization of general practitioner (GP) consultations in general hospitals and integration of traditional medicine and its practitioners into public health service. ^
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The Health Belief Model (HBM) provided the theoretical framework for examining Universal Precautions (UP) compliance factors by Firefighter, EMTs and Paramedics (prehospital care providers). A convenient sample of prehospital care providers (n = 4000) from two cities (Houston and Washington DC), were surveyed to explore the factors related to their decision to comply with Universal Precautions. Eight hundred and sixty-five useable questionnaires were analyzed. The responders were primarily male (95.7%) eight hundred and twenty-eight and thirty-seven were female, prehospital based (100%), EMTs (60.0%) and paramedics (12.8%) who had a mean 13 years of prehospital care experience. ^ Linear regression was used to evaluate the four hypotheses. The first hypothesis evaluating perceived susceptibility and seriousness with reported UP use was statistically significant (p = < .05). Perceived susceptibility, when considered independently, did not make a significant contribution (t = −4.2852; p = 0.0000) to the stated use of Universal precautions. The hypothesis is not supported as stated. The data indicates the opposite effect. Supported is the premise that as perceived susceptibility and perceived seriousness increase the use of Universal Precautions decreases. Hypothesis two tested perceived benefits with internal and external barriers. Both perceived benefits and internal and external barriers as well as the overall regression were significant (F = 112.6, p = 0.0000). The contribution of internal and external barriers was statistically significant (t = 0.0175; p = 0.0000) and (t = 0.0128; p = 0.0000). Hypothesis three which tested modifying factors, cues to action, select demographic variables, and the main effects of the HBM with self reported UP compliance overall was significant. The variables gender, birth, education, job type, EMS certification, years of service, years of experience providing patient care, Universal Precautions training hours, type of apparatus assigned to and the number of EMS related incidents responded to in a month were found to have a significant contribution to the stated use of Universal Precautions. ^ The additive effects were tested by use of a stepwise regression that assessed the contribution of each of the significant variables. Three variables in the equation were statistically significant. Internal barriers (t = −8.5507; p = 0.0000), external barriers (t = −6.2862; p = 0.000) and job type 2 & 3. Job type two (t = −2.8464; p = 0.0045 is titled Engineer/Operator. Job type three (t = −2.5730; p = 0.0103) is titled captain. The overall regression was significant (F = 24.06; p = 0.000). The Hypothesis is supported in the certain demographic variables do influence the stated use of Universal precautions and that as internal and external barriers are decreased, there is an increase in the stated use of Universal Precautions. ^ In summary, this study demonstrated that internal and external barriers have a significant impact on the stated use of Universal Precautions. Internal barriers are those factors within the individual that require an internal change (i.e., forgetfulness, freedom, perception of the urgency of the patient's needs etc.) and external barriers are things in the environment that can be altered (i.e., equipment design, availability of equipment, ease of use). These two model variables explained 23%–30% of the variance. ^
Resumo:
Continental and marine conditions during the last millennium off Porto, Portugal (the southern pole of the North Atlantic Oscillation, NAO), are reconstructed from a sediment archive through a high-resolution multiproxy study and instrumental evidence. Results show multidecadal variability and sea surface temperatures (SSTs) that correlate well with previously published land and sea-based Northern Hemisphere temperature records, and appear to be responding to long-term solar insolation variability. Precipitation was negatively correlated with the NAO, whereas strong flooding events occurred at times of marked climate cooling (AD 1100-1150 and 1400-1470) and transitions in solar activity. AD 1850 marks a major shift in the phytoplankton community associated with a decoupling of d18O records of 3 planktonic foraminifera species. These changes are interpreted as a response to a reduction in the summer and/or annual upwelling and more frequent fall-winter upwelling-like events. This shift's coincidence with a decrease in SST and the increase in coherence between our data and the Atlantic Multidecadal Oscillation (AMO) confirms the connection of the upwelling variability to the North Atlantic Ocean's surface and thermohaline circulation on a decadal scale. The disappearance of this agreement between the AMO and our records beyond AD 1850 and its coincidence with the beginning of the recent rise in atmospheric CO2 supports the hypothesis of a strong anthropogenic effect on the last ~150 yr of the climate record. Furthermore, it raises an important question of the use of instrumental records as the sole calibration data set for climate reconstructions, as these may not provide the best analogue for climate beyond AD 1730.
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The city of Malaga underwent considerable growth in the 19th and 20th centuries. The territorial expansion paired with a massive influx of immigrants occurred in three waves and as a consequence the city of Malaga remains divided into three different parts up to today. The differences between these three neighbourhoods of the city lie in the type of houses, different cultural and industrial activities, socioeconomic level, and very interestingly, also in speech. Thus, the aim of this study is an examination of the interrelation between speech (phonetic features) and urban space in Malaga. A combination of quantitative and qualitative analysis was used, based on two types of data: 1) production data stemming from recordings of 120 speakers; 2) perception data (salience, estimated frequency of use, attitude, spatial and social perception, imitation) which was collected from several surveys with 120 participants each. Results show that the speech production data divides the city of Malaga clearly into three different parts. This tripartition is confirmed by the analysis of the perception data. Moreover, the habitants of these three areas are perceived as different social types, to whom a range of social features is attributed. That is, certain linguistic features, the different neighbourhoods of the city and the social characteristics associated with them are undergoing a process of indexicalization and iconization. As a result, the linguistic features in question function as identity markers on the intraurban level.
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Below are the results of the survey of the Iberian lynx obtained with camera-trapping between 2000 and 2007 in Sierra Morena. Two very important aspects of camera-trapping concerning its efficiency are also analyzed. The first is the evolution along years according to the camera-trapping type used of two efficiency indicators. The results obtained demonstrate that the most efficient lure is rabbit, though it is the less proven (92 trap-nights), followed by camera-trapping in the most frequent marking places (latrines). And, we propose as a novel the concept of use area as a spatial reference unit for the camera-trapping monitoring of non radio-marked animals is proposed, and its validity discussed.
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This study investigates the effect of price and travel mode fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed preferences data collection. The survey was administered among young people in Copenhagen and Lisbon to explore the transit perceptions and use under different economic and transit provision conditions. The survey yielded 499 questionnaires, analyzed by means of structural equation models. Results show that higher perceived fairness relates positively to higher perceived quality of transit service and higher perceived ease of paying for transit use. Higher perceived spatial equity in service provision is associated with higher perceived service quality. Higher perceived service quality relates to higher perceived ease of payment, which links to higher frequency of transit use.
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The study area is La Colacha sub-basins from Arroyos Menores basins, natural areas at West and South of Río Cuarto in Province of Córdoba of Argentina, fertile with loess soils and monsoon temperate climate, but with soil erosions including regressive gullies that degrade them progressively. Cultivated gently since some hundred sixty years, coordinated action planning became necessary to conserve lands while keeping good agro-production. The authors had improved data on soils and on hydrology for the study area, evaluated systems of soil uses and actions to be recommended and applied Decision Support Systems (DSS) tools for that, and were conducted to use discrete multi-criteria models (MCDM) for the more global views about soil conservation and hydraulic management actions and about main types of use of soils. For that they used weighted PROMETHEE, ELECTRE, and AHP methods with a system of criteria grouped as environmental, economic and social, and criteria from their data on effects of criteria. The alternatives resulting offer indication for planning depending somehow on sub basins and on selections of weights, but actions for conservation of soils and water management measures are recommended to conserve the basins conditions, actually sensibly degrading, mainly keeping actual uses of the lands.
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This study investigates the effect of price and travel time fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed preferences data collection. The survey was administered among young people in Copenhagen and Lisbon to explore the transit perceptions and use under different economic and transit provision conditions. The survey yielded 499 questionnaires, analyzed by means of structural equation models. Results show that higher perceived fairness relates positively to higher perceived quality of transit service and higher perceived ease of paying for transit use. Higher perceived spatial equity in service provision is associated with higher perceived service quality. Higher perceived service quality relates to higher perceived ease of payment, which links to higher frequency of transit use.
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PURPOSE The decision-making process plays a key role in organizations. Every decision-making process produces a final choice that may or may not prompt action. Recurrently, decision makers find themselves in the dichotomous question of following a traditional sequence decision-making process where the output of a decision is used as the input of the next stage of the decision, or following a joint decision-making approach where several decisions are taken simultaneously. The implication of the decision-making process will impact different players of the organization. The choice of the decision- making approach becomes difficult to find, even with the current literature and practitioners’ knowledge. The pursuit of better ways for making decisions has been a common goal for academics and practitioners. Management scientists use different techniques and approaches to improve different types of decisions. The purpose of this decision is to use the available resources as well as possible (data and techniques) to achieve the objectives of the organization. The developing and applying of models and concepts may be helpful to solve managerial problems faced every day in different companies. As a result of this research different decision models are presented to contribute to the body of knowledge of management science. The first models are focused on the manufacturing industry and the second part of the models on the health care industry. Despite these models being case specific, they serve the purpose of exemplifying that different approaches to the problems and could provide interesting results. Unfortunately, there is no universal recipe that could be applied to all the problems. Furthermore, the same model could deliver good results with certain data and bad results for other data. A framework to analyse the data before selecting the model to be used is presented and tested in the models developed to exemplify the ideas. METHODOLOGY As the first step of the research a systematic literature review on the joint decision is presented, as are the different opinions and suggestions of different scholars. For the next stage of the thesis, the decision-making process of more than 50 companies was analysed in companies from different sectors in the production planning area at the Job Shop level. The data was obtained using surveys and face-to-face interviews. The following part of the research into the decision-making process was held in two application fields that are highly relevant for our society; manufacturing and health care. The first step was to study the interactions and develop a mathematical model for the replenishment of the car assembly where the problem of “Vehicle routing problem and Inventory” were combined. The next step was to add the scheduling or car production (car sequencing) decision and use some metaheuristics such as ant colony and genetic algorithms to measure if the behaviour is kept up with different case size problems. A similar approach is presented in a production of semiconductors and aviation parts, where a hoist has to change from one station to another to deal with the work, and a jobs schedule has to be done. However, for this problem simulation was used for experimentation. In parallel, the scheduling of operating rooms was studied. Surgeries were allocated to surgeons and the scheduling of operating rooms was analysed. The first part of the research was done in a Teaching hospital, and for the second part the interaction of uncertainty was added. Once the previous problem had been analysed a general framework to characterize the instance was built. In the final chapter a general conclusion is presented. FINDINGS AND PRACTICAL IMPLICATIONS The first part of the contributions is an update of the decision-making literature review. Also an analysis of the possible savings resulting from a change in the decision process is made. Then, the results of the survey, which present a lack of consistency between what the managers believe and the reality of the integration of their decisions. In the next stage of the thesis, a contribution to the body of knowledge of the operation research, with the joint solution of the replenishment, sequencing and inventory problem in the assembly line is made, together with a parallel work with the operating rooms scheduling where different solutions approaches are presented. In addition to the contribution of the solving methods, with the use of different techniques, the main contribution is the framework that is proposed to pre-evaluate the problem before thinking of the techniques to solve it. However, there is no straightforward answer as to whether it is better to have joint or sequential solutions. Following the proposed framework with the evaluation of factors such as the flexibility of the answer, the number of actors, and the tightness of the data, give us important hints as to the most suitable direction to take to tackle the problem. RESEARCH LIMITATIONS AND AVENUES FOR FUTURE RESEARCH In the first part of the work it was really complicated to calculate the possible savings of different projects, since in many papers these quantities are not reported or the impact is based on non-quantifiable benefits. The other issue is the confidentiality of many projects where the data cannot be presented. For the car assembly line problem more computational power would allow us to solve bigger instances. For the operation research problem there was a lack of historical data to perform a parallel analysis in the teaching hospital. In order to keep testing the decision framework it is necessary to keep applying more case studies in order to generalize the results and make them more evident and less ambiguous. The health care field offers great opportunities since despite the recent awareness of the need to improve the decision-making process there are many opportunities to improve. Another big difference with the automotive industry is that the last improvements are not spread among all the actors. Therefore, in the future this research will focus more on the collaboration between academia and the health care sector.
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In this paper I revisit the age-old question of the relationship between philosophy and theology by rejecting the claim that throughout the history of the Christian Church, whenever Christian thinkers have baptized philosophy, they have done so to the detriment of theology. Church history reveals just the opposite, i. e., that sometimes theologians have creatively and fruitfully used philosophical language, concepts, methods, and conclusions to understand and express the faith. In addition, church history records numerous attempts to limit philosophical enquiry for theological reasons that proved unsuccessful and counter-productive. Both types of interaction between philosophy and theology occurred at the University of Paris during the thirteenth century. Despite repeated efforts of some officials to place philosophy under interdict, that is, to ban the reading of particular philosophical works or the teaching of philosophical propositions from the university faculties, a series of university theologians applied Aristotelian tools of enquiry to questions about the Christian faith with positive and constructive results. If academic theology at Paris during the thirteenth century has anything to teach us, it is that interdict cuts both ways. It might protect some theological claims from philosophical contamination or compromise, but it can also insulate theological claims from much needed critical analysis. The thinkers and developments surveyed in this paper suggest that perhaps instead of placing deconstruction under interdict, today’s Christian thinkers should use some of the language, concepts, methods and conclusions of Derrida to further theological understanding.
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We have investigated a light-conditional mutant of Chlamydomonas reinhardtii (J12) that is unable to synthesize chlorophyll in the dark with the aim of characterizing the mitochondrial membrane polypeptides of this alga. A crude membrane fraction derived from etiolated cells was analyzed by gel electrophoresis, immunoblot analysis, and pulse-labeling in the presence of specific protein synthesis inhibitors. This fraction contained both mitochondrial and etioplast membranes, and the latter contained appreciable amounts of subunits of the cytochrome b6f complex. The mitochondria-encoded subunit 1 of cytochrome-c oxidase called COX1 was identified, and its synthesis was detected in this membrane fraction. The redox-difference spectra of mitochondrial cytochromes were studied in whole cells and membrane fractions, in both respiratory-competent and -deficient strains. Mitochondrial membranes could be further purified after sucrose gradient centrifugation. The use of etiolated cells and their membrane extracts, in association with appropriate methodologies, opens ways to study the molecular genetics of mitochondria in C. reinhardtii and allows us to address the question of the cooperation established between the three genetic compartments of a plant cell.
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It has become clear that many organisms possess the ability to regulate their mutation rate in response to environmental conditions. So the question of finding an optimal mutation rate must be replaced by that of finding an optimal mutation schedule. We show that this task cannot be accomplished with standard population-dynamic models. We then develop a "hybrid" model for populations experiencing time-dependent mutation that treats population growth as deterministic but the time of first appearance of new variants as stochastic. We show that the hybrid model agrees well with a Monte Carlo simulation. From this model, we derive a deterministic approximation, a "threshold" model, that is similar to standard population dynamic models but differs in the initial rate of generation of new mutants. We use these techniques to model antibody affinity maturation by somatic hypermutation. We had previously shown that the optimal mutation schedule for the deterministic threshold model is phasic, with periods of mutation between intervals of mutation-free growth. To establish the validity of this schedule, we now show that the phasic schedule that optimizes the deterministic threshold model significantly improves upon the best constant-rate schedule for the hybrid and Monte Carlo models.
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A driving argument behind recent EU treaty reforms was that more qualified majority voting (QMV) was required to reduce the potential dangers of legislative paralysis caused by enlargement. Whilst existing literature on enlargement mostly focuses on the question of what changed in the legislative process after the 2004 enlargement, the question of why these changes occurred has been given far less attention. Through the use of a single veto player theoretical model, this paper seeks to test and explain whether enlargement reduces the efficiency of the legislative process and alters the type of legislation produced, and whether QMV can compensate for these effects. In doing this, it offers a theoretical explanation as to why institutional changes that alter the level of cohesion between actors in the Council have an influence over both the legislative process and its outcomes.