454 resultados para disagreement
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A crescente evolução na tecnologia das juntas coladas conferiu um potencial atractivo às ligações adesivas, com aplicações nas mais variadas indústrias. Isto deve-se não só aos aspetos económicos, tais como a melhoria da cadência de produção mas também à resistência mecânica que estas proporcionam. A possibilidade de ligar facilmente materiais distintos, a distribuição mais uniforme das tensões, a melhor resistência à fadiga e a elevada capacidade de amortecimento de vibrações estão entre as principais vantagens da utilização deste tipo de ligação. Estas propriedades transformam as juntas coladas numas das preferidas no momento de seleção de meios de união. O trabalho desenvolvido nesta dissertação enquadra-se no âmbito das ligações adesivas e tem como principais objetivos a produção de uma ferramenta para a produção de provetes de adesivo, assim como a determinação das propriedades mecânicas à tração dos mesmos para testar o desempenho do molde fabricado. Para tal, utilizou-se um adesivo frágil (Araldite® AV 138), um dúctil (Araldite® 2015) e um muito dúctil (SikaForce® 7888). Paralelamente é selecionado o método mais adequado na obtenção destes provetes, designadamente escolhendo entre a moldação em molde aberto e a injeção em molde fechado. Com vista à obtenção dos provetes, foi projetado e construído um molde em aço. Recorrendo à máquina de tração Shimadzu AG – X 100, realizaram-se os respetivos ensaios de tração, para a determinação de todas as propriedades mecânicas dos adesivos. Para efeitos de comparação de resultados foram utilizados dois tipos de extensómetros, um mecânico e um ótico. Os resultados experimentais permitiram observar que a presença de vazios afetou especialmente a deformação de rotura e a tensão de rotura. Detetaram-se pequenas discordâncias, comparativamente com os estudos publicados, de algumas características mecânicas obtidas dos diversos adesivos utilizados. Constatou-se também um ligeiro desfasamento entre os valores adquiridos com os dois tipos de extensómetros utilizados.
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Anxiety disorders are the most common psychiatric disorders observed currently. It is a normal adaptive response to stress that allows coping with adverse situations. Nevertheless, when anxiety becomes excessive or disproportional in relation to the situation that evokes it or when there is not any special object directed at it, such as an irrational dread of routine stimuli, it becomes a disabling disorder and is considered to be pathological. The traditional treatment used is medication and cognitive behavioral psychotherapy, however, last years the practice of physical exercise, specifically aerobic exercise, has been investigated as a new non-pharmacological therapy for anxiety disorders. Thus, the aim of this article was to provide information on research results and key chains related to the therapeutic effects of aerobic exercise compared with other types of interventions to treat anxiety, which may become a useful clinical application in a near future. Researches have shown the effectiveness of alternative treatments, such as physical exercise, minimizing high financial costs and minimizing side effects. The sample analyzed, 66.8% was composed of women and 80% with severity of symptoms anxiety as moderate to severe. The data analyzed in this review allows us to claim that alternative therapies like exercise are effective in controlling and reducing symptoms, as 91% of anxiety disorders surveys have shown effective results in treating. However, there is still disagreement regarding the effect of exercise compared to the use of antidepressant symptoms and cognitive function in anxiety, this suggests that there is no consensus on the correct intensity of aerobic exercise as to achieve the best dose-response, with intensities high to moderate or moderate to mild.
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Depression is a common and disabling disease that affects over 100 million people worldwide and can have a significant impact on physical and mental health, reducing their quality of life. Thus, the aim of this article was to provide information on research results and key chains related to the therapeutic effects of chronic aerobic exercise compared with other types of interventions to treat depression, which may become a useful clinical application in a near future. Researches have shown the effectiveness of alternative treatments, such as physical exercise, minimizing high financial costs and minimizing side effects. In this review, the data analyzed allows us to claim that alternative therapies, such as exercise, are effective on controlling and reducing symptoms. 69.3% of the studies that investigated the antidepressant effects of exercise on depressive were significant, and the other 30.7% of the studies improved only in general physiological aspects, such as increased oxygen uptake, increased use of blood glucose and decreased body fat percentage, with no improvement on symptoms of depression. From the sample analyzed, 71.4% was composed of women, and regarding the severity of symptoms, 85% had mild to moderate depression and only 15% had moderate to severe depression. However, there is still disagreement regarding the effect of exercise compared to the use of antidepressants in symptomatology and cognitive function in depression, this suggests that there is no consensus on the correct intensity of aerobic exercise as to achieve the best dose-response, with intensities high to moderate or moderate to mild.
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Overview and Aims: The investigation of recurrent miscarriage includes the study of uterine morphology. 3D ultrasound allows the evaluation of the morphology (cavity and outer contour), reducing the need for invasive tests such as hystero - salpingography (HSG), hysteroscopy and laparoscopy. We evaluated the diagnostic agreement between HSG and 3D ultrasound in the study of the uterine cavity morphology. Study Design: Prospective study. Population: A total of 34 women referred to our institution with a history of recurrent miscarriage. Methods: To compare the results of 3D ultrasound and HSG, all women underwent both exams. 3D scans were performed by the same operator and HSG were evaluated by the same clinician. The concordance study was performed using the Kappa coefficient. Results: With 3D ultrasound and HSG, uterine anomalies were diagnosed in 52.9% (18/34) and 47% (16/34) of the cases and congenital malformations were the most frequent findings. The agreement between the two techniques was excellent(K = 0.825). The three cases of diagnostic disagreement were analyzed. Conclusion: A high level of diagnostic agreement was observed between HSG and 3D ultrasound. The 3D ultrasound, a low cost and well tolerated technique, when performed by an experienced operator, is the first line exam to study the uterine morphology in women with recurrent miscarriage.
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RESUMO - A frequente insuficiência de informação e até, eventualmente, a presença de elementos cientificamente pouco robustos (ou mesmo hipotéticos) no procedimento de obtenção dos resultados finais (scores) com os diversos métodos de avaliação do risco, julga-se determinar a obtenção de distintos resultados no mesmo posto de trabalho e que interessam analisar. O presente estudo foi efectuado numa empresa da indústria automóvel e pretendeu contribuir para a efectividade do processo de avaliação do risco destas lesões em meio industrial. Utilizaram-se como ponto de partida as classificações de risco em postos de trabalho onde a aplicação do método OCRA — base do projecto de norma Europeu prEN 1005-5 para a estimativa do risco de LMEMSLT (Lesões Musculoesqueléticas do Membro Superior Ligadas ao Trabalho) — identificou níveis de risco moderados e/ou elevados (score OCRA ≥ 16,5). Assim nos postos de trabalho (n = 71) registou-se em vídeo a actividade de trabalho. Analisaram-se os principais factores de risco (postura, força, repetitividade e exposição a vibrações) com uma amostragem de segundo em segundo e aplicaram-se dois métodos: 1) RULA (McAtamney; Corlett, 1993); 2) SI (Moore; Garg, 1995). Dos resultados globais da aplicação dos métodos identificam- se discrepâncias evidentes: o método SI classificou 41 postos de risco elevado e o método RULA classificou apenas 26 postos de risco. Destaque para as divergências entre os postos classificados de risco elevado como, por exemplo: de entre os 41 postos com scores de risco da aplicação do método SI apenas se encontram 12 postos classificados de risco pelo método RULA. Os resultados permitem evidenciar validades preditivas diversas para os factores de risco analisados: 1) situações de aplicação de força (SI = 0,80; RULA = 0,66); 2) presença de posturas extremas (SI = 0,68; RULA = 0,48); 3) repetitividade (SI = 0,35; RULA = 0,43). Conclui-se pela divergência de resultados dos métodos SI e RULA aplicados nos mesmos postos de trabalho que tal situação alerta para a pertinência da utilização de um filtro que permita a identificação dos factores de risco presentes em cada posto de trabalho e que, por consequência, oriente a selecção do método mais indicado ou ainda, em oposição, do método contra-indicado. Este trabalho, como um contributo para uma efectiva identificação e avaliação do risco de LMEMSLT, conduz, no limite, à necessidade de elaboração de uma «grelha» das «grelhas» e de informação mais precisa sobre os métodos e sua aplicação, permitindo, desse modo, uma mais efectiva gestão do risco destas lesões.
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Given the limitations of different types of remote sensing images, automated land-cover classifications of the Amazon várzea may yield poor accuracy indexes. One way to improve accuracy is through the combination of images from different sensors, by either image fusion or multi-sensor classifications. Therefore, the objective of this study was to determine which classification method is more efficient in improving land cover classification accuracies for the Amazon várzea and similar wetland environments - (a) synthetically fused optical and SAR images or (b) multi-sensor classification of paired SAR and optical images. Land cover classifications based on images from a single sensor (Landsat TM or Radarsat-2) are compared with multi-sensor and image fusion classifications. Object-based image analyses (OBIA) and the J.48 data-mining algorithm were used for automated classification, and classification accuracies were assessed using the kappa index of agreement and the recently proposed allocation and quantity disagreement measures. Overall, optical-based classifications had better accuracy than SAR-based classifications. Once both datasets were combined using the multi-sensor approach, there was a 2% decrease in allocation disagreement, as the method was able to overcome part of the limitations present in both images. Accuracy decreased when image fusion methods were used, however. We therefore concluded that the multi-sensor classification method is more appropriate for classifying land cover in the Amazon várzea.
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Dissertação de mestrado em Educação Especial (área de especialização em Dificuldades de Aprendizagem Específicas)
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Atualmente a rede social mais visitada em todo o mundo é o Facebook. Além de nos permitir ter um perfil pessoal podemos partilhar fotos, vídeos, mensagens e outros ficheiros. No Facebook também é permitido criar grupos fechados onde os seus membros podem interagir através de mensagens escritas, de áudio, de vídeo e/ou imagens. Tanto esta rede social quanto os grupos dentro da mesma podem ser usados de forma indevida, mas, por outro lado, também podem ser utilizados para aprender, aprender a fazer, conhecer, desenvolver a linguagem escrita e outras competências. O nosso estudo teve como objetivo conhecer a perceção de educadores de infância e professores de primeiro ciclo do ensino básico relativamente ao uso do Facebook por parte das crianças, bem como às emoções que as crianças manifestam neste uso. Foi um estudo transversal, para o qual construímos e validámos um questionário específico, com questões fechadas sobre o uso da respetiva rede social. O instrumento foi disponibilizado e preenchido online através do Google Forms. A amostra foi de conveniência, tendo sido constituída por 75 indivíduos (69 mulheres, 6 homens) com idades compreendidas entre os 25 e os 56 anos. Os resultados evidenciam que os professores e educadores discordam essencialmente que as crianças aceitem pedidos de amizade e comuniquem pelo chat do Facebook com pessoas que não conhecem, concordando mais que usem para comunicar com familiares e amigos, para aderir a grupos com o objetivo de aprender e que permitem o acesso dos adultos à sua conta. No respeitante as emoções e sentimentos registou-se maior discordância quanto ao facto de as crianças preferirem estar no Facebook do que na presença dos seus amigos e de se sentirem dependentes do uso do mesmo. Porém, observou-se o maior nível de concordância para o facto de ficarem aborrecidas se as obrigarem a sair do Facebook.
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Na gravidez, a mulher experiencia mudanças desenvolvimentais ao nível dos seus relacionamentos significativos. Este estudo compara a qualidade do relacionamento com o companheiro e com outra figura significativa em grávidas adolescentes e adultas, e analisa preditores sócio-demográficos para a qualidade destes relacionamentos. Uma amostra de 130 grávidas (66 adolescentes e 64 adultas) foi avaliada no terceiro trimestre de gestação quanto às características sociais e demográficas e à qualidade do relacionamento com figuras significativas. Os resultados mostram que as adolescentes referem menor confiança (χ2 = 3.365, p = 0,055) e maior discórdia (χ2 = 3.842, p = 0,041) no relacionamento com o companheiro e maior sentimento de ligação (χ2 = 19.126, p = 0,000) e apatia (χ2 = 8.568, p = 0,004) no relacionamento com a outra figura significativa, comparativamente com as adultas. Verifica-se ainda que a gravidez na adolescência associa-se a relacionamentos de menor qualidade, especialmente devido a situações sócio-demográficas mais desfavoráveis e não tanto à condição de ser ou não adolescente.
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OBJECTIVE: To access the incidence of diagnostic errors in the initial evaluation of children with cardiac murmurs. METHODS: We evaluated our 7-years of experience in a public pediatric cardiology outpatient clinic. Of 3692 patients who were sent to the hospital, 2603 presented with a heart murmur and were investigated. Patients for whom a disagreement existed between the initial and final diagnoses were divided into the following 2 groups: G1 (n=17) with an initial diagnosis of an innocent murmur and a final diagnosis of cardiopathy, and G2 (n=161) with an initial diagnosis of cardiopathy and a final diagnosis of a normal heart. RESULTS: In G1, the great majority of patients had cardiac defects with mild hemodynamic repercussions, such as small ventricular septal defect and mild pulmonary stenosis. In G2, the great majority of structural defects were interventricular communication, atrial septal defect and pulmonary valve stenosis. CONCLUSION: A global analysis demonstrated that diagnostic error in the initial evaluation of children with cardiac murmurs is real, reaching approximately 6% of cases. The majority of these misdiagnoses were in patients with an initial diagnosis of cardiopathy, which was not confirmed through later complementary examinations. Clinical cardiovascular examination is an excellent resource in the evaluation of children suspected of having cardiopathy. Immediate outpatient discharge of children with an initial diagnosis of an innocent heart murmur seems to be a suitable approach.
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The experiments reported were started as early as 1933, when indications were found in class material that the factor for small pollen, spl, causes not only differences in the size of pollen grains and in the growth of pollen tubes, but also a competition between megaspores, as first observed by RENNER (1921) in Oenothera. Dr. P. C. MANGELSDORF, who had kindly furnished the original seeds, was informed and the final publication delayed untill his publication in 1940. A further delay was caused by other circunstances. The main reason for the differences of the results obtained by SINGLETON and MANGELSDORF (1940) and those reported here, seems to be the way the material was analysed. I applied methods of a detailed statistical analysis, while MANGELSDORF and SINGLETON analysed pooled data. 1) The data obtained on pollen tube competition indicate .that there is about 3-4% of crossing-over between the su and sp factors in chromosome IV. The elimination is not always complete, but from 0 to 10% of the sp pollen tubes may function, instead of the 50% expected without elimination. These results are, as a whole, in accordance with SINGLETON and MANGELSDORF's data. 2) Female elimination is weaker and transmission determined as between 16 to 49,5%, instead of 50% without competition, the values being calculated by a special formula. 3) The variability of female elimination is partially genotypical, partially phenotypical. The former was shown by the difference in the behavior of the two progenies tested, while the latter was very evident when comparing the upper and lower halves of ears. For some unknown physiological reason, the elimination is generally stronger in the upper than in the lower half of the ear. 4) The female elimination of the sp gene may be caused theoretically, by either of two processes: a simple lethal effect in the female gametophyte or a competition between megaspores. The former would lead not only to the abortion of the individual megaspores, but of the whole uniovulate ovary. In the case of the latter, the abortive megaspore carrying the gene sp will be substituted in each ovule by one of the Sp megaspores and no abortion of ovaries may be observed. My observations are completely in favor of the second explication: a) The ears were as a whole very well filled except for a few incomplete ears which always appear in artificial pollinations. b) Row arrangement was always very regular. c) The number of kernels on ears with elimination is not smaller than in normal ears, but is incidentally higher : with elimnation, in back-crosses 354 kernels and in selfed ears 390 kernels, without elimination 310 kernels per ear. d) There is no correlation between the intensity of elimination and the number of grains in individual ears; the coefficient; of linear correlation, equal to 0,24, is small and insignificant. e) Our results are in complete disagreement whit those reported by SINGLETON and MANGELSDORF (1940). Since these authors present only pooled date, a complete and detailed analysis which may explain the cause of these divergences is impossible.
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Studying the meiosis of two Hemiptera, mamely, Lybindus dichrous (Coreidae) and Euryophthalmus humilis (Pyrrhocoridae), the author has found new proofs in favor of the existence of a centromere at each end of the chromosomes of the insects belonging to that order. Following the behaviour of a pair of large autosomes of Lybindus, he was able to verify that in the first division of the spermatocytes, the tetrad they form divides transversely by the middle, giving rise to two V-shaped anaphase chromosomes that go to the poles with the vertex pointing forwardly. From the end of the first division till the metaphase of the second one, the centromeres occupying the vertex of the V go apart from one another, making the chiasmata existing there slip to the opposite extremities, what changes the V into an X. When the chiasmata reach the acentric ends, the X is again converted into a V. The V of the secondary metaphase, therefore, differs from the V of the primary anaphase, in being inverted that is, in having the centromeres in the extremity of its arms, and no longer in the vertex as in the latter. The opening out of the chromosomes starting at the centric extremities in order to recuperate the dumbbell shape they show in the secondary anaphase, just in the manner postulated by PIZA, is thus demonstrated. In Euryophthalmus humilis it was verified once more, that the heterochromosome, in the secondary spermatocytes, orients parallelly to the spindle axis, accompanying with its ends the anaphase plates as they move to the poles. The author is in disagreement with NORONHA-WAGNER & DUARTE DE CASTRO's interpretation of the behaviour of the chromosomes in meiosis of Luzula nemorosa.
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BACKGROUND/AIMS: For many therapeutic decisions in Crohn's disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel. METHODS: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method. Their assessment was based on the study of a recent literature review of the subject, combined with their own expert clinical judgment. Panelists rated clinical indications and treatment options using a 9-point scale (1 = extremely inappropriate; 9 = extremely appropriate). These scenarios were then discussed in detail at the panel meeting and re-rated. Median ratings and disagreement were used to aggregate ratings into three assessment categories: appropriate (A), uncertain (U) and inappropriate (I). RESULTS: 569 specific indications were rated, dealing with 9 clinical presentations: mild/moderate luminal CD (n = 104), severe CD (n = 126), steroid-dependent CD (n = 25), steroid-refractory CD (n = 37), fistulizing CD (n = 49), fibrostenotic CD (n = 35), maintenance of medical remission of CD (n = 84), maintenance of surgical remission (n = 78), drug safety in pregnancy (n = 24) and use of infliximab (n = 7). Overall, 146 indications (26%) were judged appropriate, 129 (23%) uncertain and 294 (52%) inappropriate. Frank disagreement was low (14% overall) with the greatest disagreement (54% of scenarios) being observed for treatment of steroid-refractory disease. CONCLUSIONS: Detailed explicit appropriateness criteria for the appropriate use of therapy for CD were developed for the first time by a European expert panel. Disease location, severity and previous treatments were the main factors taken into account. User-friendly access to EPACT criteria is available via an Internet site, www.epact.ch, allowing prospective evaluation and improvement of appropriateness of current CD therapy.
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With some 30,000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Major milestones on that path have been the successive "Methadone reports" published by that Office and providing guidance on the care of opiate addiction with substitution treatment. In view of updating the recommendations for the appropriateness of substitution treatment for opiate addiction, in particular for the prescription of methadone, the FOPH commissioned a multi-component project involving the following elements. A survey of current attitudes and practices in Switzerland related to opiate substitution treatment Review of Swiss literature on methadone substitution treatment Review of international literature on methadone substitution treatment National Methadone Substitution Conference Multidisciplinary expert panel to evaluate the appropriateness of substitution treatment. The present report documents the process and summarises the results of the latter element above. The RAND appropriateness method (RAM) was used to distil from literature-based evidence and systematically formulated expert opinion, areas where consensus exist on the appropriateness (or inappropriateness) of methadone maintenance treatment (MMT) and areas where disagreement or uncertainty persist and which should be further pursued. The major areas which were addressed by this report are Initial assessment of candidates for MMT Appropriate settings for initiation of MMT (general and special cases) Appropriateness of methadone supportive therapy Co-treatments and accompanying measures Dosage schedules and pharmacokinetic testing Withdrawal from MMT Miscellaneous questions Appropriateness of other (non-methadone) substitution treatment Summary statements for each of the above categories are derived from the panel meeting and presented in the report. In the "first round", agreement was observed for 31% of the 553 theoretical scenarios evaluated. The "second round" rating, following discussion of divergent ratings, resulted in a much higher agreement among panellists, reaching 53% of the 537 scenarios. Frank disagreement was encountered for 7% of all scenarios. Overall 49% of the clinical situations (scenarios) presented were considered appropriate. The areas where at least 50% of the situations were considered appropriate were "initial assessment of candidates for MMT", the "appropriate settings for initiation of MMT", the "appropriate settings for methadone supportive treatment" and "Appropriateness of other (non-methadone) substitution treatment". The area where there was the least consensus on appropriateness concerned "appropriateness of withdrawal from MMT" (6%). The report discusses the implications and limitations of the panel results and provides recommendations for the dissemination, application, and future use of the criteria for the appropriateness of MMT. The RAND Appropriateness Method proved to be an accepted and appreciated method to assess the appropriateness of methadone maintenance treatment for opiate addicts. In the next step, the results of the expert panel process must now be combined with those of the Swiss and international literature reviews and the survey of current attitudes and practices in Switzerland, to be synthesized into formal practice guidelines. Such guidelines should be disseminated to all concerned, promoted, used and rigorously evaluated for compliance and outcome.
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L’obligació a partir de la LO 1/2004 de realitzar programes formatius en cas de suspensió o substitució d’una pena imposada per un delicte de violència de gènere ha suposat que els operadors jurídics, malgrat el recolzament majoritari a aquesta mesura, es mostrin en desacord amb l’obligatorietat i demanin més discrecionalitat.