Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience

INTODUCTION: Nephrotic syndrome is one of the most frequent glomerular diseases among children, and steroid therapy remains as the treatment choice. In spite of this, 10 to 15% of the patients are steroidresistant, and the best therapy for such cases has never been defined. Mycophenolate acid (MA) is one of the treatments used in such situations. OBJECTIVE: To describe the clinical behavior of children diagnosed with steroid-resistant nephrotic syndrome (SRNS) and to assess the therapeutic response to MA. METHODS: This was a retrospective and descriptive study. RESULTS: 26 clinical records of patients with SRNS; 70% male and 30% female. All patients underwent kidney biopsies, which showed a predominance of focal segmental glomerulosclerosis (FSGS). The immunosuppresive drugs used were: Mycophenolate mofetil (MMF) 100%, Cyclosporine 69.2%, Cyclophosphamide 23.1%, and Rituximab 23%. One month after treatment initiation with MMF 61.5% achieved remission. The median of relapses per year for the patients was 3 (p25: 2.75 - p75: 4). This median became 1 (p25: 1 - p75: 3.25) after using this medication (p = 0.08). Furthermore, prior to the start of the MMF treatment, the median of the steroid dose was 1 (p25: 0.5- p75: 1.62) mg/k/day. After using MMF, this median became 0.07 (p25: 0 - p75: 0.55) mg/k/day (p < 0.001), in 8 patients prednisolone was stopped. CONCLUSION: In our experience, treatment with MMF showed positive results such as decrease in the frequency of relapses, less proteinuria, and reduction in the dose of steroids administered without deterioration of glomerular filtration rates. However, more studies are needed to assess efficacy, safety, and optimal dosage.

Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients. Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital. Methods: Retrospective and descriptive study. Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%. Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant.

Metrics for Predicting User Behavior and Experience in an Interactive Storytelling System

In much of the previous research into the field of interactive storytelling, the focus has been on the creation of complete systems, then evaluating the performance of those systems based on user experience. Less focus has been placed on finding general solutions to problems that manifest in many different types of interactive storytelling systems. The goal of this thesis was to identify potential candidates for metrics that a system could use to predict player behavior or how players experience the story they are presented with, and to put these metrics to an empirical test. The three metrics that were used were morality, relationships and conflict. The game used for user testing of the metrics, Regicide is an interactive storytelling experience that was created in conjunction with Eero Itkonen. Data, in the forms of internal system data and survey answers, collected through user testing, was used to evaluate hypotheses for each metric. Out of the three chosen metrics, morality performed the best in this study. Though further research and refinement may be required, the results were promising, and point to the conclusion that user responses to questions of morality are a strong predictor for their choices in similar situations later on in the course of an interactive story. A similar examination for user relationships with other characters in the story did not produce promising results, but several problems were recognized in terms of methodology and further research with a better optimized system may yield different results. On the subject of conflict, several aspects, proposed by Ware et al. (2012), were evaluated separately. Results were inconclusive, with the aspect of directness showing the most promise.

Flipped classroom technology from teachers’ perspective: implementation experience, barriers and perspectives

Blended learning approaches rise their popularity, however not all professors apply them and find them useful and appropriate. This research focuses on study of flipped classroom arrangement and effectiveness of this concept implementation. The Master’s Thesis explores impact of flipped classroom implementation on resource savings for proffesors. The research is based on the literature review of different education arrangements and results of their implementation, on the survey conducted among proffesors from different Universities and on two experiments of flipped classroom implementation. The results reveal advantages and disadvantages of the concept, professors’ attitude to it and possibility to future research and practice in this field

The contagion effect of public debt on monetary policy: the Brazilian experience

This paper attempts to explain why the Brazilian inter-bank interest rate is so high compared with rates practiced by other emerging economies. The interplay between the markets for bank reserves and government securities feeds into the inter-bank rate the risk premium of the Brazilian public debt.

Design thinking framework of experience innovation

Innovation remains one of the key drivers of sustainable and successful business. The variety of innovation approaches such as open models, intersectional thinking and co-creation tackles the challenge of viable novel offerings across the world. These approaches have certain similarities and their elements constitute design thinking. Recent market and society trends such as technological advances and globalization have intensify companies’ interaction with customers. Emotional engagement, pleasing communication and delight have gained equal to functionality importance. The complex of these components constitutes consumer experience. Academic research conceptualizes these changes by introducing customer-centered innovation, which replaces product-oriented approaches. However, both methods omit experience concept and provide fragmented explanation of experience innovation. Experience is an essential process of offering perception, which drives customer decisions. Therefore, an agenda of experience innovation development can systemize and explain the mechanisms of experience innovation. The purpose of this study is to create and explain the stage process framework of experience innovation by the means of design thinking approach. The research proceeds in accordance with the following sub-objectives: 1. Conceptualization of consumer experience through customer value. 2. Creation of experience innovation framework by the means of design thinking. This study is conducted by the means of conceptual research methods. The main theoretical contribution of the study is creation of the integrated framework of consumer experience innovation. The elaboration of design thinking agenda and methods applied to experience design builds the guidelines of experience innovation development. This research synthesizes the conceptual elements of the framework that resolves inconsistencies and duplications of theories. This essential clarification simplifies application of the experience innovation agenda, which can be useful for the wide range of specialists, from marketing to strategists, and from managers to entrepreneurs, willing to offer compelling experience to customers. The study highlights the crucial role of consumer experience in maintaining customer loyalty and designs the roadmap of innovating experience through the communication with customers.

Animal Experience in Kant’s Philosophy

The role of animals in the philosophy of mind is primarily to help understand the human mind by serving as practical examples of cognition that differs from ours either in kind or in degree. Kant regarded animals as beings that only have the faculty of sensibility. By examining what Kant writes about animal experience we gain knowledge concerning the role of sensibility in experience, free from the influence of understanding and reason. I look at Kant’s view of animals in the historical context of alternative views presented by Descartes’ and Hume’s views. Kant’s view can be seen as a counterargument against Descartes’ doctrine of animal machines according to which animals do not have minds and they do not think. I suggest that while it can be argued that some kind of elementary experience could be possible in the physiological level, this only makes sense when it is possible to become conscious of the unconscious sensation, and this requires a mind. A further option is to claim that there is only a difference in degree between human and animal cognitive capacities. This is Hume’s view. I argue that even though Kant’s and Hume’s view on the cognitive capacities of animals seems to depart from each other to a considerable extent, the differences between them diminish when the focus is on the experience these capacities enable. I also briefly discuss the relation of the metaphysics of animal minds to animal ethics.

User Experience Patterns for/of Innovation by Design: A Survey on Design Practices in the Software Development and Innovation Lifecycle

The User Experience (UX) designers are undoubtedly aware of how many UX design methods currently exist and that sometimes it becomes a problem to choose an appropriate one. What are all of methods that designers have in their “arsenal”? When can they use them? This thesis presents the research on the design methods in the contemporary context of User Experience (UX) and Innovations by using a survey approach. The study is limited to cover the domain of consumer mobile services development and provider companies around the world. The study follows 2 clear objectives: (1) to understand what design methods are currently used in that context and to what extent they are used (2) to identify at what stage according to the UX design thinking process for creating innovations they are placed. The study contributes to the research in the field of UX design and Innovations and extends the knowledge in that field together with communities’ (UXPA, SIGCHI, SIGSOFT) members’ cooperation. The research is vital due to lack of information on design practices and their application in the chosen context.

The role of motivational systems in community service involvement : initiating and sustaining factors and quality of experience /

Community service participation can have a positive impact on development, especially for youth. Although researchers have found positive outcomes, there has been a notable decline in youth participation over the past few years (Statistics Canada, 2000). Given the positive outcomes and current decline, it has been argued that youth should be encouraged to get involved in service activities. In the present study, quantitative and qualitative data were collected to determine factors that would help youth to initiate and sustain service, along with examining the quality of their experience. Eighty-two university undergraduate students (23 men), ranging in age from 17-20 years completed a 60-minute self-report questionnaire. Initiating and sustaining factors, motivational systems (similar to approach and avoidance dimensions), activity dimensions {Structure, Supportive Social Environment), quality of experience {Positive, Stress-Challenge), and future intention to participate in community service were measured. Eight participants also completed a 20-minute telephone interview to complement and expand on the quantitative data collected. Some initiating and sustaining factors were specific to individuals higher on the avoidance dimension, while others were relevant to those higher on the approach dimension. Several factors also were important to individuals regardless of their motivational system orientation. Positive quality of experience was related positively to experiencing a supportive social environment. In addition, women rated their community service as more positive than did men. A predicted interaction between the avoidance dimension and Structure in predicting positive quality of experience was not supported; however, positive quality of experience was predicted by the interaction of the approach dimension and Structure. A tested interaction between the avoidance dimension and Supportive Social Environment in predicting positive quality of experience was not supported. Similarly, a predicted interaction between the approach dimension and Supportive Social Environment in predicting positive experience quality was not supported. However, Supportive Social Environment was positively related to positive quality of experience. No support was found for a mediational role for positive quality of experience or stress-challenge quality of experience in exploring the relation between motivational orientation and fiiture intention to engage in service activities. The results of this study suggest that participating in a service environment that is supportive and provides the opportunity for social interactions with others would promote positive quality of experience and help youth sustain involvement. Thus, to help youth have positive experiences and to remain active in service, it is important for service agencies to promote these types of environments. In addition, some initiating and sustaining factors were specific to youth higher on the avoidance dimension and some were relevant to youth higher on the approach dimension. Therefore, service agencies may need to consider using different recruitment and retention strategies, depending on the type of youth they wish to recruit.

An exploration of the experience of implementing the second step violence prevention curriculum in one primary general learning disabilities class /

Violence has always been a part of the human experience, and therefore, a popular topic for research. It is a controversial issue, mostly because the possible sources of violent behaviour are so varied, encompassing both biological and environmental factors. However, very little disagreement is found regarding the severity of this societal problem. Most researchers agree that the number and intensity of aggressive acts among adults and children is growing. Not surprisingly, many educational policies, programs, and curricula have been developed to address this concern. The research favours programs which address the root causes of violence and seek to prevent rather than provide consequences for the undesirable behaviour. But what makes a violence prevention program effective? How should educators choose among the many curricula on the market? After reviewing the literature surrounding violence prevention programs and their effectiveness, The Second Step Violence Prevention Curriculum surfaced as unique in many ways. It was designed to address the root causes of violence in an active, student-centred way. Empathy training, anger management, interpersonal cognitive problem solving, and behavioural social skills form the basis of this program. Published in 1992, the program has been the topic of limited research, almost entirely carried out using quantitative methodologies.The purpose of this study was to understand what happens when the Second Step Violence Prevention Curriculum is implemented with a group of students and teachers. I was not seeking a statistical correlation between the frequency of violence and program delivery, as in most prior research. Rather, I wished to gain a deeper understanding of the impact ofthe program through the eyes of the participants. The Second Step Program was taught to a small, primary level, general learning disabilities class by a teacher and student teacher. Data were gathered using interviews with the teachers, personal observations, staff reports, and my own journal. Common themes across the four types of data collection emerged during the study, and these themes were isolated and explored for meaning. Findings indicate that the program does not offer a "quick fix" to this serious problem. However, several important discoveries were made. The teachers feU that the program was effective despite a lack of concrete evidence to support this claim. They used the Second Step strategies outside their actual instructional time and felt it made them better educators and disciplinarians. The students did not display a marked change in their behaviour during or after the program implementation, but they were better able to speak about their actions, the source of their aggression, and the alternatives which were available. Although they were not yet transferring their knowledge into positive action,a heightened awareness was evident. Finally, staff reports and my own journal led me to a deeper understanding ofhow perception frames reality. The perception that the program was working led everyone to feel more empowered when a violent incident occurred, and efforts were made to address the cause rather than merely to offer consequences. A general feeling that we were addressing the problem in a productive way was prevalent among the staff and students involved. The findings from this investigation have many implications for research and practice. Further study into the realm of violence prevention is greatly needed, using a balance of quantitative and qualitative methodologies. Such a serious problem can only be effectively addressed with a greater understanding of its complexities. This study also demonstrates the overall positive impact of the Second Step Violence Prevention Curriculum and, therefore, supports its continued use in our schools.

Exploring the experiences of male spousal caregivers for their wives with alzheimer disease in their homes : the lived experience and the men's perception of support groups /

This research is qualitative in nature and has explored, by means of interviews, the '^^ experiences of 10 men in their roles in caring for their spouses with Alzheimer Disease (see glossary) in their homes. Additional data were collected by attending 3 formal support group meetings and one informal meeting of a group of men who brought their wives to a support group meeting for their wives with AD. The data retrieved supported the assumption that education about the disease, utilization of formal community support services, and attendance at caregiver support groups or programs can assist healthy male caregivers in caring for their wives with AD in their homes.

An investigation into the physical and psychological stress factors that elementary teachers experience : recommendations to boards and personal calming strategies /

The prlmaiy objective of this study was to Identify and describe the physical and psychological stress factors that elementary school teachers experience and how teachers cope with stress. A secondary objective was to offer boards and teachers potential coping strategies counteracting stress and the effects of stress. The sample consisted of 120 elementaiy teachers from southern Ontario. Ten elementaiy schools were randomly chosen. The Teacher Stress Inventory questionnaire (Flmian, 1989) was used. Data were analyzed using a variety of statistics. Test norms and interpretations were performed based on standard results obtained from the author of the questionnaire (Flmian, 1988). Overall, the results indicated that work-related stressors were the main factor for teacher stress. This Included such factors as caseload/class is too big, too much administrative paperwork, and having little time to prepare lessons. Implications for further research and practical suggestions for further reseairch are discussed. Also a variety of recommendations to boards and for individual use are discussed. Some recommendations are having counselling available for teachers, workshops on how to handle stress, and learning how to breathe and using calm visualization.