Expert opinion on best practice guidelines and competency framework for visual screening in children

PURPOSE: Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. METHODS: A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. RESULTS: According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). CONCLUSIONS: Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

Pictorial health warnings on cigarette packs and the impact on women

OBJECTIVE : To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS : Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS : Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS : Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.

Children, space, and the urban street: an ethnomathematics posture

Dissertation presented for the PhD Degree in Education Science – Curricular Theory and Science Teaching, by Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Virtual Communities of Practice: Design and Development of Support Platforms and Participation Fostering

Mestrado em Engenharia Informática - Área de Especialização em Sistemas Gráficos e Multimédia

“Culture Stops Development!”: Bijagó Youth and the Appropriation of Developmentalist Discourse in Guinea-B

African Studies Review, Volume 52, Number 2, pp. 69–

Innovations in technology: a friendly math project and the learning analytics “challenge”

Currently the world around us "reboots" every minute and “staying at the forefront” seems to be a very arduous task. The continuous and “speeded” progress of society requires, from all the actors, a dynamic and efficient attitude both in terms progress monitoring and moving adaptation. With regard to education, no matter how updated we are in relation to the contents, the didactic strategies and technological resources, we are inevitably compelled to adapt to new paradigms and rethink the traditional teaching methods. It is in this context that the contribution of e-learning platforms arises. Here teachers and students have at their disposal new ways to enhance the teaching and learning process, and these platforms are seen, at the present time, as significant virtual teaching and learning supporting environments. This paper presents a Project and attempts to illustrate the potential that new technologies present as a “backing” tool in different stages of teaching and learning at different levels and areas of knowledge, particularly in Mathematics. We intend to promote a constructive discussion moment, exposing our actual perception - that the use of the Learning Management System Moodle, by Higher Education teachers, as supplementary teaching-learning environment for virtual classroom sessions can contribute for greater efficiency and effectiveness of teaching practice and to improve student achievement. Regarding the Learning analytics experience we will present a few results obtained with some assessment Learning Analytics tools, where we profoundly felt that the assessment of students’ performance in online learning environments is a challenging and demanding task.

Antiretroviral treatment for HIV infection/AIDS and the risk of developing hyperglycemia and hyperlipidemia

A cross-sectional study with internal comparison groups was conducted to describe sociodemographic characteristics, as well as verify the association between the type of antiretroviral treatment used and hyperglycemia and hyperlipidemia, with special attention to the use of HIV protease inhibitors. The data was obtained through an interview questionnaire, as well as blood and urine samples that were collected for the laboratory exams. A total of 418 patients were interviewed. 46 of these, however, met the exclusion criteria. The sample was therefore composed by 372 HIV positive patients, attended at the laboratory of the Correia Picanço State Hospital for the collection of blood, to estimate the HIV viral load and/or TCD4 cell counts from August to November 2000. The association between the variables was tested using the chi-square test and the p-value. A multiple logistic regression analysis was carried out to adjust for potential confounding factors. A greater frequency of patients with high glucose levels was observed among those making use of antiretroviral therapy without protease inhibitors, but the number of patients limited the comparisons. An association was verified between the total serum cholesterol level and the use of HIV protease inhibitors (p = 0.047) even after controlling for age. An association was also observed between the triglyceride levels and the use of HIV protease inhibitors, which remained after adjustment for age, sex and creatinine levels (p < 0.001). The levels of glucose and TSH, the presence of proteinuria and the practice of physical activity were not associated either with the levels of cholesterol or with the levels of tryglicerides thus they were not confounders of the associations described.

Improving tuberculosis control through the partnership between university and the health system

INTRODUCTION: Tuberculosis (TB) control is linked to the availability of qualified methods for microbiological diagnostics; however, microscopy with limited sensitivity is the only method available in many locations. The objective of this study was to evaluate the introduction of culture, drug susceptibility testing (DST), and genotyping in the routine of a Municipal Program of Tuberculosis Control. METHODS: Direct microscopy of sputum and culture in Ogawa-Kudoh were performed on 1,636 samples from 787 patients. DST of positive cultures was performed by resazurin microtiter assay and genotyping by mycobacterial interspersed repetitive units-variable number tandem repeat. RESULTS: A total 91 patients with TB were identified. The culture increased case detection by 32% compared with the microscopy; acquired resistance was 3.3% and the genotyping showed high genetic diversity. CONCLUSIONS: Ogawa-Kudoh contributed significantly to the increase in case detection and is suitable for implementation in poor-resource locations. The acquired resistance rate was lower than that reported in a recent Brazilian survey. The high genetic diversity is possibly related to the high TB prevalence in the population, as well as to early detection and suitable treatment of patients. The interaction between research and health care is important for reorienting the practice, transferring technology, and improving TB control.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

On project finance and the first road concession in Portugal

In broad sense, Project Financing1 as a mean of financing large scale infrastructural projects worldwide has had a steady growth in popularity for the last 20 years. This growth has been relatively unscathed from most economic cycles. However in the wake of the 2007 systemic Financial Crisis, Project Financing was also in trouble. The liquidity freeze and credit crunch that ensued affected all parties involved. Traditional Lenders, of this type of financial instrument, locked-in long-term contractual obligations, were severely hit with scarcity of funding compounded by rapidly increasing cost of funding. All the while, Banks were “rescued” by the concerted actions of Central Banks and other Multi-Lateral Agencies around the world but at the same time “stressed” by upcoming regulatory effort (Basel Committee). This impact resulted in specific changes to this type of long-term financing. Changes such as Commercial Banks’ increased risk aversion; pricing increase and maturities decrease of credit facilities; enforcement of Market Disruption Event clauses; partial responsibility for project risk by Multilateral Agencies; and adoption of utility-like availability payments in other industrial sectors such as transportation and even social infrastructure. To the extent possible, this report is then divided in three parts. First, it begins with a more instructional part, touching academic literature (theory) and giving the Banks perspective (practice), but mostly as an overview of Project Finance for awareness’ sake. The renowned Harvard Business School professor – Benjamin Esty, states2 that Project Finance is a “relatively unexplored territory for both empirical and theoretical research” which means that academic research efforts are lagging the practice of Project Finance. Second, the report presents a practical case regarding the first Road Concession in Portugal in 1998 ending with the lessons learned 10 years after Financial Close. Lastly, the report concludes with the analysis of the current trends and changes to the industry post Financial Crisis of the late 2000’s. To achieve this I’ll reference relevant papers, books on the subject, online articles and my own experience in the Project Finance Department at a major Portuguese Investment Bank. Regarding the latter, with the signing of a confidentiality agreement, I’m duly omitting sensitive and proprietary bank information.

Entre la ejecución y la representación: intersecciones de lo real en la construcción escénica. Between the execution and the representation: intersections of the real thing in the scenic construction.

Esta propuesta de investigación se enmarca en los encuentros y discusiones que se están realizando en la Escuela de Artes de la Facultad de Filosofía y Humanidades (CEPIA, CIFFyH y SeCyT, de la U.N.C), en relación a las problemáticas de la investigación en Artes. Los encuentros llevados a cabo en diversas ocasiones y a lo largo de 2009, demuestran la necesidad de establecer un campo particular de la investigación y su relación con la práctica artística. Este proyecto nace de estas inquietudes y establece ciertos ejes de trabajo que permiten poner en práctica ciertos esbozos imaginados. En este sentido, nuestra propuesta se centra en definir la misma construcción escénica como objeto de estudio, delimitando sobre éste la problemática de lo real en el trabajo de la ficción, proponiendo además un equipo que permita investigar en su propio desarrollo creativo las diversas variables que entran en juego. De este modo, se trabajará en una propuesta de laboratorio escénico donde los planteos de orden teórico atraviesen la práctica y, a su vez, la observación de ésta permita una reelaboración y profundización del pensamiento contemporáneo sobre la problemática ejecución/representación, desde los diversos órdenes en que ésta interviene. La idea de representación teatral que planteaba Aristóteles señala que las acciones devienen necesariamente en la definición del carácter de los personajes. Este concepto es clave en el desarrollo del teatro occidental y por ende en las diferentes concepciones de actor. La definición de acción dada por Aristóteles es problemática para parte del teatro contemporáneo ya que supone que toda acción es mimética. También da por supuesto que en el teatro se conforman personajes, y que la unidad narrativa está dada por una programática, que es definida por la acción.La presente investigación se propone indagar en la relación entre la ejecución de la acción y su representación en el desarrollo de un laboratorio teatral. Esto implica que necesariamente es aplicada al trabajo escénico. Nuestra hipótesis de partida es que la relación conflictiva entre acción, ejecución de la misma y representación, se produce a partir de la operación material sobre lo real . Estas intersecciones podrían ser pensadas como una teoría del montaje donde la corporalidad es el principio necesario e irreductible de la construcción. La intersección de lo real es una problemática que permite ahondar sobre los procedimientos por los cuales se construye la escena. La idea de un teatro material, obliga a pensar con qué procedimientos se construye ficción. Un teatro que intenta recalar en lo “real” como modo de señalar la cosa misma, se propone, desde la perspectiva de la realización, indagar en los mecanismos de su construcción (procedimientos), por lo cual supone que la actividad teatral puede dar cuenta de los procesos por los cuales se realiza. La realización de una acción, puede remitir a sí misma y genera una relación “extraña” y ambigua con el mundo de referencia. La acción en sí misma, pone en cuestión la idea de modelo y da cuenta de una crisis en la representación. La teoría ha intentado dividir y sistematizar de manera binaria la manifestación teatral: Teatro de Representación/ Teatro Performático, para distinguir un teatro vinculado a la creación de personajes o para relacionarlo a un teatro de ejecución. Sin embargo, pensamos que es posible encontrar en la producción escénica, intersecciones de lo real que median el mundo de la representación y el de la performance para la construcción de ficción. Nuestra hipótesis de base es que si intervenimos el plano de la ejecución en el actor, la representación varía sustancialmente sus mecanismos de producción de sentido. Este primer planteo no es conflictivo hasta que se pone de manifiesto lo real. This research’s proposal is framed into the meetings and discussions that have been taking place in the School of Arts of the Faculty of Philosophy and Humanities (CEPIA, CIFFyH y SeCyT, of the National University of Cordoba), concerning the difficulties of research in Arts. The meetings carried out along 2009, demonstrate the need to establish a particular field of research and its relation to the practice of arts. This project is born from these concerns and it establishes central axis for the work, that enables us to put on practice some sketches imagined. In this regard, our proposal focuses on defining the construction of the scene as object of study, in itself, delimiting the issue of “the real” in the work of fiction. Proposing, furthermore, a team for researching the many variables that comes into play, in their own creative development. Consequently, the work will be developed in the method of a scenic laboratory, where the theoretical proposals cross over the practice and, in turn, these observations allow a reworking and deepen of contemporary thinking about the problematic of performance / representation, from the diverse orders in which it intervene. The idea of theatrical performance proposed by Aristotle, indicate that actions necessarily turn into the definition of the nature of the characters. This concept is key to the development of Western theaterand consequently on the different conceptions of actor. The definition of action given by Aristotle is problematic for a part of the contemporary theater, because it assumes that every action is mimetic. Also presumes that in the theatre the characters are formed, and narrative unit is given by a programmatic, which is defined by the action. This research proposes to explore the relationship between implementation of the action and its representation in the development of a theatrical laboratory. This implies that it is applied necessarily to the scenic practice. Our preliminary hypothesis is that the co.

Business research, self-fulfilling prophecy, and the inherent responsibility of scholars.

Business research and teaching institutions play an important role in shaping the way businesses perceive their relations to the broader society and its moral expectations. Hence, as ethical scandals recently arose in the business world, questions related to the civic responsibilities of business scholars and to the role business schools play in society have gained wider interest. In this article, I argue that these ethical shortcomings are at least partly resulting from the mainstream business model with its taken-for granted basic assumptions such as specialization or the value-neutrality of business research. Redefining the roles and civic responsibilities of business scholars for business practice implies therefore a thorough analysis of these assumptions if not their redefinition. The takenforgrantedness of the mainstream business model is questioned by the transformation of the societal context in which business activities are embedded. Its value-neutrality in turn is challenged by self-fulfilling prophecy effects, which highlight the normative influence of business schools. In order to critically discuss some basic assumptions of mainstream business theory, I propose to draw parallels with the corporate citizenship concept and the stakeholder theory. Their integrated approach of the relation between business practice and the broader society provides interesting insights for the social reembedding of business research and teaching.

Traitement pharmacologique de la schizophrénie: évaluation comparative de la qualité des recommandations de pratique clinique [Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia]

INTRODUCTION: Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. AIM OF THE STUDY: The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". RESULTS: The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. DISCUSSION: The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little consideration by the authors regarding the applicability of the recommendations. CONCLUSION: Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".

Comparing the treatment provided by migrant and nonmigrant health professionals: dentists in Scotland

Many OECD countries are increasingly relying on migrants to address shortages of trained health professionals. One key concern is whether migrant health professionals provide equivalent health care. We compare the treatment provided by migrant and non-migrant health professionals using administrative data from the Scottish dental system. A difference-in-differences model is estimated to examine whether migrant dentists respond differently to case mix and individual circumstances as compared with their non-migrant counterparts, and assess the extent to which any differences diminish over time. After controlling for both observed and unobserved differences between individual dentists and the cohort of patients that they treat, we find that migrant dentists have marginally different practice styles, and the variation diminishes over time within two years of practice.