The evaluation of an instrument for pediatric oncology patient classification

The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.

Qualifying instrument for evaluation of food and nutritional care in hospital

Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal management dietitian activities." (Nutr Hosp. 2012;27:1170-1177) DOI:10.3305/nh.2012.27.4.5868

Construction and validation of an instrument that breaks the silence: the impact of domestic and/or sexual violence on women's health, as shown during climacterium

Objective: The aim of this study was to construct and to validate a measure of the consequences of domestic violence on women's health during climacterium. Methods: A questionnaire was administered at the Outpatient Climacterium Clinic to 124 women aged 40 to 65 years who were the victims of domestic and/or sexual violence (experimental group). They were divided into three groups: (1) those who were victims of violence exclusively during childhood/adolescence, (2) those who were victims of violence exclusively during adulthood, and (3) those who were victims of violence throughout their lives. The instrument included 34 items evaluating the beginning, frequency, and type of violence; the search for health assistance and reporting of the violence; the violence and the number of comorbidities; and violence and the Kupperman Menopausal Index. We also included a control group composed of perimenopausal and postmenopausal women who did not experience any violence (n = 120). Results: The instrument presented a Cronbach alpha = 0.82, good reliability among the examiners (+0.80), and a good possibility of reproducibility. The mean age of menopause was 45.4 years, and the mean age in the control group was 48.1 years. Group 1 showed a mean of 5.1 comorbidities, Group 2 had 4.6, and Group 3 had 4.4. Sexual violence (43.5%) and other types of violence both presented average comorbidities (4.60) but represented a significant impairment in the victim's sexual life. There were significant associations in group 3 and a high Kupperman Menopausal Index score. In the experimental group, 80.6% did not seek health services for the violence they experienced. Conclusions: The questionnaire presented good internal consistency and a validated construction. It can be easily reproduced and is indicated to evaluate the consequences of domestic and/or sexual violence on women's health during climacterium.

Adaptation and validation of the Patient Expectations and Satisfaction with Prenatal Care instrument among Brazilian pregnant women

Objective: to adapt and validate the Patient Expectations and Satisfaction with Prenatal Care instrument for use in Brazil. It contains 41 items divided into two dimensions: expectations and satisfaction. The adapted version was submitted to analysis for stability, convergent construct validity, and internal consistency (Cronbach’s alpha) for distinct groups and dimensions. Method: 119 pregnant women receiving prenatal care were interviewed and 26 of these women answered the instrument twice (retest). Internal consistency was appropriate (Cronbach’s alpha ≥ 0.70); test-retest presented strong correlation (r=0.82; p<0.001) for the domain expectations and moderate correlation (r=0.66; p<0.001) for the satisfaction domain. The analysis confirmed that the instrument’s adapted version is valid in the studied group. Results: there is strong evidence for the validity and reliability of the instrument’s adaptation. Conclusion: the instrument needs to be tested in groups of pregnant women with different social characteristics.

Effect of infill panels on the seismic response of a typical R.C. frame

Three structural typologies has been evaluated based on the nonlinear dynamic analysis (i.e. Newmark's methods for MDFs: average acceleration method with Modified Newton-Raphson iteration). Those structural typologies differ each other only for the infills presence and placement. In particular, with the term BARE FRAME: the model of the structure has two identical frames, arranged in parallel. This model constitutes the base for the generation of the other two typologies, through the addition of non-bearing walls. Whereas with the term INFILLED FRAME: the model is achieved by adding twelve infill panels, all placed in the same frame. Finally with the term PILOTIS: the model has been generated to represent structures where the first floor has no walls. Therefore the infills are positioned in only one frame in its three upper floors. All three models have been subjected to ten accelerograms using the software DRAIN 2000.

Climate change and the tourism sector: the clean development mechanism, a market instrument under the Kyoto Protocol to achieve multiple objectives

The main objective of this research is to demonstrate that the Clean Development Mechanism (CDM), an instrument created under a global international treaty, can achieve multiple objectives beyond those for which it has been established. As such, while being already a powerful tool to contribute to the global fight against climate change, the CDM can also be successful if applied to different sectors not contemplated before. In particular, this research aimed at demonstrating that a wider utilization of the CDM in the tourism sector can represent an innovative way to foster sustainable tourism and generate additional benefits. The CDM was created by Article 12 of the Kyoto Protocol of the United Nations Framework Convention on Climate Change (UNFCCC) and represents an innovative tool to reduce greenhouse gases emissions through the implementation of mitigation activities in developing countries which generate certified emission reductions (CERs), each of them equivalent to one ton of CO2 not emitted in the atmosphere. These credits can be used for compliance reasons by industrialized countries in achieving their reduction targets. The logic path of this research begins with an analysis of the scientific evidences of climate change and its impacts on different economic sectors including tourism and it continues with a focus on the linkages between climate and the tourism sector. Then, it analyses the international responses to the issue of climate change and the peculiar activities in the international arena addressing climate change and the tourism sector. The concluding part of the work presents the objectives and achievements of the CDM and its links to the tourism sector by considering case studies of existing projects which demonstrate that the underlying question can be positively answered. New opportunities for the tourism sector are available.

Development of human visual system analysis for the implementation of a new instrument for flicker measurement

Flicker is a power quality phenomenon that applies to cycle instability of light intensity resulting from supply voltage fluctuation, which, in turn can be caused by disturbances introduced during power generation, transmission or distribution. The standard EN 61000-4-15 which has been recently adopted also by the IEEE as IEEE Standard 1453 relies on the analysis of the supply voltage which is processed according to a suitable model of the lamp – human eye – brain chain. As for the lamp, an incandescent 60 W, 230 V, 50 Hz source is assumed. As far as the human eye – brain model is concerned, it is represented by the so-called flicker curve. Such a curve was determined several years ago by statistically analyzing the results of tests where people were subjected to flicker with different combinations of magnitude and frequency. The limitations of this standard approach to flicker evaluation are essentially two. First, the provided index of annoyance Pst can be related to an actual tiredness of the human visual system only if such an incandescent lamp is used. Moreover, the implemented response to flicker is “subjective” given that it relies on the people answers about their feelings. In the last 15 years, many scientific contributions have tackled these issues by investigating the possibility to develop a novel model of the eye-brain response to flicker and overcome the strict dependence of the standard on the kind of the light source. In this light of fact, this thesis is aimed at presenting an important contribution for a new Flickermeter. An improved visual system model using a physiological parameter that is the mean value of the pupil diameter, has been presented, thus allowing to get a more “objective” representation of the response to flicker. The system used to both generate flicker and measure the pupil diameter has been illustrated along with all the results of several experiments performed on the volunteers. The intent has been to demonstrate that the measurement of that geometrical parameter can give reliable information about the feeling of the human visual system to light flicker.

Static analysis of functionally graded cylindrical and conical shells or panels using the generalized unconstrained third order theory coupled with the stress recovery

A 2D Unconstrained Third Order Shear Deformation Theory (UTSDT) is presented for the evaluation of tangential and normal stresses in moderately thick functionally graded conical and cylindrical shells subjected to mechanical loadings. Several types of graded materials are investigated. The functionally graded material consists of ceramic and metallic constituents. A four parameter power law function is used. The UTSDT allows the presence of a finite transverse shear stress at the top and bottom surfaces of the graded shell. In addition, the initial curvature effect included in the formulation leads to the generalization of the present theory (GUTSDT). The Generalized Differential Quadrature (GDQ) method is used to discretize the derivatives in the governing equations, the external boundary conditions and the compatibility conditions. Transverse and normal stresses are also calculated by integrating the three dimensional equations of equilibrium in the thickness direction. In this way, the six components of the stress tensor at a point of the conical or cylindrical shell or panel can be given. The initial curvature effect and the role of the power law functions are shown for a wide range of functionally conical and cylindrical shells under various loading and boundary conditions. Finally, numerical examples of the available literature are worked out.

Structural verification of the ESEO spacecraft: from launch loads analysis to composite panels verification

The present thesis work was performed in the frame of ESEO (European Student Earth Orbiter) project. The activities that are described in this document were carried out in the Microsatellites and Space Micro systems Lab led by Professor Paolo Tortora and in ALMASpace company facilities. The thesis deals with ESEO structural analysis, at system and unit level, and verification: after determining the design limit loads to be applied to the spacecraft as an envelope of different launchers load profiles, a finite element structural analysis was performed on the model of the satellite in order to ensure the capability to withstand the loads encountered during the launch; all the analyses were performed according to ESA standards and using the software MSC NASTRAN SIMXPERT. Amplification factors were derived and used to determine loads to be considered at unit level. In particular structural analyses were carried out on the GPS unit, the payload developed for ESEO by students of University of Bologna and results were used in the preparation of GPS payload design definition file. As for the verification phase a study on the panels and inserts to be used in the spacecraft was performed: different designs were created exploiting methods to optimize weight and mechanical behavior. The configurations have been analyzed and results compared to select the final design.

Assessment of the resilience of coral reefs to natural and human disturbances by means of recruitment panels in Indo-Pacific

Indo-Pacific region encompasses about 75% of world's coral reefs, but hard coral cover in this region experienced a 32% region-wide decline since 1970s. This great change is primarily ascribable to natural and anthropogenic pressures, including climate change and human activities effects. Coral reef conservation requires management strategies oriented to maintain their diversity and the capacity to provide ecosystem goods and services. Coral reef resilience, i.e. the capacity to recover after disturbances, is critical to their long-term persistence. The aims of the present study were to design and to test field experiments intended to measure changes in recruitment processes, as a fundamental aspect of the coral reef resilience. Recruitment experiments, using artificial panels suspended in the water column, were carried out in two Indo-Pacific locations affected by different disturbances: a new mine in Bangka Island (Indonesia), and the increased sedimentation due to coastal dynamics in Vavvaru Island (Maldives). One (or more) putatively disturbed site(s) was selected to be tested against 3 randomly selected control sites. Panels��� arrangement simulates 2 proximities to living corals, i.e. the sources of propagules: few centimetres and 2 meters over. Panels were deployed simultaneously at each site and left submerged for about five months. Recruits were identified to the lowest possible taxonomic level and recruited assemblages were analysed in terms of percent cover. In general it was not possible to detect significant differences between the benthic assemblages recruited in disturbed and control sites. The high variability observed in recruits assemblages structure among control sites may be so large to mask the possible disturbance effects. Only few taxa showed possible effects of the disturb they undergo. The field tests have highlighted strengths and weaknesses of the proposed approach and, based on these results, some possible improvements were suggested.

DensiProbe Spine: a novel instrument for intraoperative measurement of bone density in transpedicular screw fixation

STUDY DESIGN.: Cadaver study. OBJECTIVE.: To determine bone strength in vertebrae by measuring peak breakaway torque or indentation force using custom-made pedicle probes. SUMMARY OF BACKGROUND DATA.: Screw performance in dorsal spinal instrumentation is dependent on bone quality of the vertebral body. To date no intraoperative measuring device to validate bone strength is available. Destructive testing may predict bone strength in transpedicular instrumentations in osteoporotic vertebrae. Insertional torque measurements showed varying results. METHODS.: Ten human cadaveric vertebrae were evaluated for bone mineral density (BMD) measurements by quantitative computed tomography. Peak torque and indentation force of custom-made probes as a measure for mechanical bone strength were assessed via a transpedicular approach. The results were correlated to regional BMD and to biomechanical load testing after pedicle screw implementation. RESULTS.: Both methods generated a positive correlation to failure load of the respective vertebrae. The correlation of peak breakaway torque to failure load was r = 0.959 (P = 0.003), therewith distinctly higher than the correlation of indentation force to failure load, which was r = 0.690 (P = 0.040). In predicting regional BMD, measurement of peak torque also performed better than that of indentation force (r = 0.897 [P = 0.002] vs. r = 0.777 [P = 0.017]). CONCLUSION.: Transpedicular measurement of peak breakaway torque is technically feasible and predicts reliable local bone strength and implant failure for dorsal spinal instrumentations in this experimental setting.

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.