Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group

Background: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. Objective: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. Methods: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). Results: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. Conclusion: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.

The VCAM-1 gene that encodes the vascular cell adhesion molecule is a target of the Sry-related high mobility group box gene, Sox18

VCAM-1 (vascular cell adhesion molecule-1) and Sox18 are involved in vascular development. VCAM-1 is an important adhesion molecule that is expressed on endothelial cells and has a critical role in endothelial activation, inflammation, lymphatic pathophysiology, and atherogenesis. The Sry-related high mobility group box factor Sox18 has previously been implicated in endothelial pathologies. Mutations in human and mouse Sox18 leads to hypotrichosis and lymphedema. Furthermore, both Sox18 and VCAM-1 have very similar spatio-temporal patterns of expression, which is suggestive of crosstalk. We use biochemical techniques, cell culture systems, and the ragged opossum (RaOP) mouse model with a naturally occurring mutation in Sox18 to demonstrate that VCAM-1 is an important target of Sox18. Transfection, site-specific mutagenesis, and gel shift analyses demonstrated that Sox18 directly targeted and trans-activated VCAM-1 expression. Importantly, the naturally occurring Sox18 mutant attenuates the expression and activation of VCAM-1 in vitro. Furthermore, in vivo quantitation of VCAM-1 mRNA levels in wild type and RaOP mice demonstrates that RaOP animals show a dramatic and significant reduction in VCAM-1 mRNA expression in lung, skin, and skeletal muscle. Our observation that the VCAM-1 gene is an important target of SOX18 provides the first molecular insights into the vascular abnormalities in the mouse mutant ragged and the human hypotrichosis-lymphedematelangiectasia disorder.

A review of peer support in the context of cancer

Peer support interventions for people with cancer, their families, and friends have been widely used throughout the world. The present study reviewed the research literature on psychosocial oncology over the past decade to assess the prevalence and contribution of articles on peer support. Using CD-Rom databases, 25 articles were retrieved for review. In each article, patients or their family members were the target group for supportive interventions, which were primarily for the delivery of peer support and included either a qualitative or quantitative evaluation of the program. A definitional taxonomy for peer support interventions, which identified eight discrete settings, was derived from three key dimensions: style of supervision, interpersonal context, and mode of delivery. The studies suggested that peer support programs help by providing emotional and informational support from the perspective of shared personal experience. However, a paucity of research-particularly randomized controlled trials-was noted. The reasons may include inherent difficulties in isolating for study what is essentially a naturalistically occurring interpersonal dynamic from the complex social and community contexts from which it emanates. The authors discuss the gap between practice and theory in this area and recommend a broader and more inclusive view of supportive care for people with cancer. (C) 2003 by The Haworth Press, Inc. All rights reserved.

Dynamic stability of laminated FGM plates based on higher-order shear deformation theory

This paper conducts a dynamic stability analysis of symmetrically laminated FGM rectangular plates with general out-of-plane supporting conditions, subjected to a uniaxial periodic in-plane load and undergoing uniform temperature change. Theoretical formulations are based on Reddy's third-order shear deformation plate theory, and account for the temperature dependence of material properties. A semi-analytical Galerkin-differential quadrature approach is employed to convert the governing equations into a linear system of Mathieu-Hill equations from which the boundary points on the unstable regions are determined by Bolotin's method. Free vibration and bifurcation buckling are also discussed as subset problems. Numerical results are presented in both dimensionless tabular and graphical forms for laminated plates with FGM layers made of silicon nitride and stainless steel. The influences of various parameters such as material composition, layer thickness ratio, temperature change, static load level, boundary constraints on the dynamic stability, buckling and vibration frequencies are examined in detail through parametric studies.

Document retrieval for e-mail search and discovery using Formal Concept Analysis

This paper discusses a document discovery tool based on Conceptual Clustering by Formal Concept Analysis. The program allows users to navigate e-mail using a visual lattice metaphor rather than a tree. It implements a virtual. le structure over e-mail where files and entire directories can appear in multiple positions. The content and shape of the lattice formed by the conceptual ontology can assist in e-mail discovery. The system described provides more flexibility in retrieving stored e-mails than what is normally available in e-mail clients. The paper discusses how conceptual ontologies can leverage traditional document retrieval systems and aid knowledge discovery in document collections.

Avaliação assistida informatizada : indicadores do potencial cognitivo de crianças com deficiência

A identificação e a avaliação de crianças com desenvolvimento atípico configuram um processo muito importante para subsidiar as estratégias de ensino voltadas para a promoção do potencial de aprendizagem. O interesse em relação ao prognóstico de crianças com deficiência tem impulsionado o desenvolvimento de novas tecnologias e pesquisas relacionadas à avaliação, prevenção e intervenção. Nesse contexto, torna-se relevante verificar com instrumentos adequados indicadores linguísticos, cognitivos e comportamentais, para assim traçar metas a partir daquilo que as crianças podem aprender. Dessa forma, esta pesquisa teve por objetivo verificar se a avaliação assistida informatizada se apresenta como uma modalidade de diagnóstico mais prescritivo do desenvolvimento cognitivo, quando comparada à avaliação psicométrica, na aplicação em crianças com deficiência. Na modalidade assistida há ajuda do examinador para conduzir a criança a um melhor nível de desempenho cognitivo. Participaram 11 crianças que frequentam uma instituição de atendimento clínico, em saúde, para crianças com deficiência, na Grande Vitória. Na avaliação psicométrica foram utilizados a Escala de Maturidade Mental Colúmbia computadorizada – Colúmbiacomp e o Teste de Vocabulário por Imagens Peabody - TVIPcomp. Na avaliação assistida informatizada foram aplicadas três provas voltadas para as habilidades de classificação e raciocínio analógico: Exclusão de Objetos, Exclusão de Figuras Geométricas e Jogo de Analogia de Figuras, no ambiente informatizado SINDAPSI. Protocolos de registro de fatores afetivo-motivacionais e de operações cognitivas foram utilizados durante as tarefas assistidas. Na avaliação do comportamento, o Child Behavior Checklist – CBCL foi respondido pelas mães. Dados documentais e dos instrumentos foram submetidos à análise estatística descritiva para verificar o desempenho das crianças nas duas formas de avaliação informatizada (psicométrica e assistida). Nos testes psicométricos, 64% das crianças alcançaram índice “abaixo da média” no TVIPcomp, e 55% “médio-inferior” no Colúmbiacomp. Em relação ao perfil de desempenho cognitivo, na Prova de Exclusão de Objetos computadorizada 55% das crianças foram avaliadas como “não-mantenedoras”. Na Prova de Exclusão de Figuras Geométricas computadorizada 55% da amostra foi classificada no perfil “alto-escore”, e no Jogo de Analogias de Figuras computadorizado 45% apresentou o perfil “ganhador”. A amostra demonstrou níveis de dificuldade na realização dos testes,tanto na modalidade psicométrica quanto assistida. Contudo, o desempenho nos testes assistidos foi relativamente melhor, evidenciando que o grupo se beneficiou da mediação,implementada na fase de assistência, para melhorar as habilidades cognitivas. Além disso, a apresentação informatizada dos testes apresentou-se como fator motivador para a realização e persistência nas tarefas.

Versão brasileira do Dynamic Gait Index

O Dynamic Gait Index (DGI) é um teste que avalia o equilíbrio e marcha do corpo humano. OBJETIVOS: Os objetivos deste estudo foram adaptar culturalmente o DGI para o português e avaliar a sua confiabilidade. MATERIAL E MÉTODO: Seguiu-se o método de Guillemin et al. (1993) para a adaptação cultural do instrumento. Trata-se de estudo prospectivo em que 46 pacientes foram avaliados na fase de adaptação cultural e os itens que apresentaram 20% ou mais de incompreensão foram reformulados e reaplicados. A versão final do DGI em português foi aplicada em 35 idosos para examinar a confiabilidade intra e inter-observadores. O coeficiente de Spearman foi utilizado para correlacionar os escores inter e intra-observador e o teste de Wilcoxon para comparar as pontuações. A consistência interna foi analisada pelo coeficiente alfa de Cronbach. RESULTADOS: Houve correlações estatisticamente significantes entre os escores obtidos às avaliações inter e intra-observadores para todos os itens (p<0,001), classificadas como boa a muito forte (com de variação de r=0,655 a r=0,951). O DGI mostrou alta consistência interna entre seus itens nas avaliações inter e intra-observadores (variação de µ ou = 0,820 a a=0,894). CONCLUSÃO: O DGI foi adaptado culturalmente para o português brasileiro, mostrando-se um instrumento confiável.

International thought in the Lula era

In the last fifty years, Brazil began a rapid process of structural transformation, following the first stage of industrial development in the 1930s. Currently the country integrates the small group of countries which evolved from an initial peripheral and subordinate insertion dating back to the nineteenth century, part of the most dynamic segment of the semiperiphery. But this category, intermediate between the "maturity" and "backwardness", according Modernization theorists, or between the "center" and "periphery", as theorists of the Dependence defend, has undergone a process of overcoming considerable positive progress in the direction of the group of states that dominate the current world system. In this way, during the years 2003-2010, foreign policy, along with the formulation of a new regionalism as a strategy of global integration and a new ideal model of State, has been a key factor

On the discovery of business processes orchestration patterns

COORDINSPECTOR is a Software Tool aiming at extracting the coordination layer of a software system. Such a reverse engineering process provides a clear view of the actually invoked services as well as the logic behind such invocations. The analysis process is based on program slicing techniques and the generation of, System Dependence Graphs and Coordination Dependence Graphs. The tool analyzes Common Intermediate Language (CIL), the native language of the Microsoft .Net Framework, thus making suitable for processing systems developed in any .Net Framework compilable language. COORDINSPECTOR generates graphical representations of the coordination layer together with business process orchestrations specified in WSBPEL 2.0

Bananas, Dark Worlds, and AspectH: (Group 5 Discussion)

This report summarises our idea of code clone detection in Haskell code and refactorings based on identified clones as it evolved in our group-of-three discussion

Ensuring dynamic strategic fit of firms that compete globally in alliances and networks: proposing the Global SNA - Strategic Network Analysis - framework

In order to sustain their competitive advantage in the current increasingly globalized and turbulent context, more and more firms are competing globally in alliances and networks that oblige them to adopt new managerial paradigms and tools. However, their strategic analyses rarely take into account the strategic implications of these alliances and networks, considering their global relational characteristics, admittedly because of a lack of adequate tools to do so. This paper contributes to research that seeks to fill this gap by proposing the Global Strategic Network Analysis - SNA - framework. Its purpose is to help firms that compete globally in alliances and networks to carry out their strategic assessments and decision-making with a view to ensuring dynamic strategic fit from both a global and relational perspective.

Ultrapassando as dificuldades da dislexia através da arte

Resumo: A intervenção em crianças disléxicas nem sempre é fácil uma vez que, à partida, serão crianças desmotivadas por insucessos repetidos, complexos de inferioridade, timidez, baixa autoconfiança e auto-estima, com pouca capacidade de atenção e concentração. A família, a escola e a sociedade em geral têm um papel decisivo, não deverão exigir nem impor metas complicadas, adaptando sempre uma postura de compreensão da criança. A criança disléxica aprende num ritmo diferente, como tal, precisa que a escola adeqúe as suas práticas educativas tendo em conta as suas características e especificidades. Pretende-se com este trabalho aprofundar conhecimentos sobre a temática da dislexia e sua aplicação, dentro da sala de aula, na disciplina Educação Visual e Tecnológica, numa turma do 2º Ciclo do Ensino Básico que inclui uma aluna considerada disléxica. Começámos por caracterizar a turma, a aluna e os contextos envolventes em que as mesmas se inserem, seguidamente fez-se uma intervenção estruturada, a longo e curto prazo, numa dinâmica de planificação, acção e reflexão, numa perspectiva de educação inclusiva, com práticas educativas cooperativas e diferenciadas. Ao longo das sessões de trabalho, a turma teve a oportunidade de se manifestar nas assembleias de turma, na negociação das actividades, de trabalhar em pares, em grande e pequeno grupo, criando desta forma um clima de inter-ajuda e de cooperação na sala de aula, funcionando com as duas professoras da disciplina, partilhando momentos de aprendizagem e socialização de saberes. A aluna considerada disléxica passou a interagir na turma com os colegas, de forma positiva, e estes com ela. As suas dificuldades foram superadas com a ajuda dos colegas, partilhando os seus saberes, dúvidas e experiências. Foi uma experiência positiva para o grupo, para a aluna e para as professoras da turma. Abstract: The intervention in dyslexic children is not always easy from the start, a priori, children will be discouraged by repeated failures, inferiority complexes, shyness, low selfconfidence and self- esteem, with little attention span and concentration. The family, school and society in general have a decisive role, should not require or impose complicated goals, always adapting an attitude of understanding of the child. The dyslexic children learn at a different pace, as such, requires the school to adjust its educational practices in view of their characteristics and specificities. The aim of this work to deepen knowledge on the subject of dyslexia and its application in the classroom, Visual and Technological Education as the subject, in a class of the 2nd Cycle of Basic Education that includes a student considered dyslexic. We have began by characterizing the class, the student and the surrounding contexts in which they are involved, then became a structured intervention in the long and short term, in order of creating a dynamic planning, action and reflection, with a inclusive education perspective, with cooperative practical education and differentiated. During the work seasons, the class had the opportunity to express themselves in class meetings, the negotiation activities, working in pairs, in large and small groups, thus creating a climate of mutual help and cooperation in the classroom, working with two teachers of the subject, sharing moments of learning and socialization of knowledge. The student consider as dyslexic has started to interact in the class with the colleagues in a positive way, and they with her. Their difficulties were overcome with the help of colleagues, sharing their knowledge, doubts and experiences. It was a positive experience for the group, to the student and the teachers of the class.